Mission

The NCC Combined Internal Medicine and Psychiatry Residency Program provides world class, integrated, training in both specialties for active-duty physicians.

Vision

To develop and nurture clinically excellent military physician leaders prepared to address the complex interplay of medical and psychiatric conditions in the service of our armed forces, our nation, and humanity. 

Aims

Resident and Faculty Wellness

• Promote diversity and create a professional, equitable, respectful, and civil environment that is free from discrimination.
• Enable a work climate informed by the Job Characteristics Model (JCM) that emphasizes autonomy and timely feedback.
• Support one another in accomplishing goals and performing and living at our highest potential.

Leadership

• Integrate mentorship, sponsorship and coaching starting in intern year.
• Apply leadership and management skills via Leading Change curriculum.
• Provide Military unique curriculum including Combat and Operational Stress Course, Traumatic Event Management, and Supervisor Courses, etc. that prepares future Military medical leaders.

Clinical Care

• Provide access to diverse patient population across the greater DC area.
• Enable autonomy and provide choices in self-directed experiential learning.

Scholarship

• Create learning climate to encourage curiosity and critical thinking.
• Advance knowledge to reduce military mental health burden and improve military readiness.

Education

• Organize and create curriculum based on Self-Directed Learning and Adult Learning Theories and Principles to improve -knowledge and skill retention.
• Develop faculty in order to support organizational and residency mission and aims.

• Tuesday and Thursday Noon Conference
• Weekly Grand Rounds
• Weekly PGY Specific Didactics from 1 - 4 p.m.
• Monthly Morbidity and Mortality Conference

Internal Medicine (IM) - Psychiatry (Psych) Residency Rotations

Walter Reed National Military Medical Center

• Adult Partial Hospitalization (PGY-2, selective)
• Consult-Liaison Psychiatry (PGY-1, PGY-4, selective)
• Forensic Psychiatry (PGY-4, selective)
• Geriatric Psychiatry (PGY-1, selective)
• Inpatient Neuropsychiatry (PGY-4, selective)
• Inpatient Psychiatry (PGY-1, PGY-2, PGY-4, selective)
• Outpatient Addiction (selective)
• Outpatient Child and Adolescent Psychiatry (selective)
• Pain Management (selective)
• Procedural Psychiatry (ECT, rTMS) (selective)
• Sleep Disorders (selective)
• Internal Medicine subspecialties

A.T. Augusta Military Medical Center

• Addiction Residential Treatment Facility (PGY-1, selective)
• Child/Adolescent Partial Hospitalization (selective)
• Inpatient Psychiatry (PGY-4, selective)
• Inpatient Child and Adolescent Psychiatry (selective)
• Outpatient CAPS (PGY-3, selective)
• Other electives

INOVA Fairfax Hospital

• Consult-Liaison Psychiatry (PGY-2, selective)
• Northern Virginia Mental Health Institute (NVMHI)
• Inpatient Psychiatry (PGY-2, selective)

Children’s National Medical Center

• Inpatient Child Psychiatry (PGY-2, selective)

Washington D.C. VA Hospital

• Consult Neurology (PGY-1, selective)
• Neurology Clinic (PGY-2, selective)
• Internal Medicine (PGY-1, selective)
• Inpatient Psychiatry (Selective)

Washington D.C. Department of Behavioral Health

• Emergency Psychiatry (PGY-4, selective)

Almost all inpatient IM and Psychiatry rotations are organized into day/night shifts, with the exception of the 24-hour Saturday Psychiatrist on Duty role during PGY2; week-long home call for ATAMMC Inpatient Psychiatry during PGY3 and PGY4; and 28-hour call at WHC MICU during PGY2, PGY4, and/or PGY5 (if rotating at that site). While on inpatient IM and Psychiatry rotations at WRNMMC, teams take short call every two to three days and four days, respectively, completing admissions and consults until the night team takes over. PGY1s and PGY2s take half the amount of IM and Psychiatry call and back-up coverage per year as compared to their categorical counterparts. PGY3s and PGY4s take two to three weeks and one to two weeks, respectively, of home call for the ATAMMC Inpatient Adult and Adolescent Psychiatry Units. PGY4s and PGY5s take about half the amount of IM back-up coverage as compared to their categorical counterparts.

Required IM rotations (e.g. ward medicine, MICU, inpatient cardiology, night float, etc.) consist of six days of duty and one scheduled day off per week. All Psychiatry rotations, clinic weeks, IM electives, and research consist of five days of duty and two days off per week, unless the resident is on Psychiatry weekend call or activated Internal Medicine back-up coverage.

The IM/Psychiatry Residency offers several educational opportunities to develop competent dual-hatted physicians and military officers. By the end of residency, residents develop the knowledge to care for patients in any environment—from the austere to community clinics to major military treatment facilities—through a variety of rotations and trainings.

Examples of military-specific curricular elements include:

• Faculty coaches for final-year medical and nurse practitioner students at Operation Bushmaster
• Regular completion of Profiles, LIMDUs, and MEB referrals for clinically indicated Active Duty Service Members (ADSMs)
• Frequent interface with ADSMs’ Commands to communicate and collaborate on medical and military disposition
• Specialty evaluations, including Command-Directed (CDEs), Presidential Support Duty, Temporary Disability Retirement List (TDRL), and many others
• Operational psychiatry rotation at BACH at Fort Campbell
• Electives including Military Tropical Medicine course, Sick Call rotation in the Active Duty Medical Home, and Integrative Disability Evaluation System (IDES) familiarization
• Point of Care Ultrasound (POCUS) certification available for PGY2 through PGY5
• Didactics including topics such as sports medicine, special warfare, military finance, military profiling for medical officers, and medical retention standards
• Opportunity to attend military schools, including Air Assault and Airborne
• Simulation sessions on trauma care and procedural skills
• Combat Casualty Care Course (C4)
• Advanced Trauma Life Support (ATLS)

The IM/Psych Residency understands the importance of scholarly work in order to develop physicians who value curiosity, critical thinking, creativity, innovation, and teaching. Scholarship requirements for graduation include completing one capstone presentation to present at departmental Grand Rounds, presenting an annual case conference for IM and Psychiatry didactics, and participating in or leading one of the residency’s Quality Improvement initiatives. Additionally, the program prioritizes fostering ongoing and new scholarly activities, with recent examples from current residents including curriculum development, case reports, book chapters, quality improvement projects, and clinical research. Residents also have the opportunity to work on projects at well-known research institutions, including Walter Reed Army Institute of Research (WRAIR), the Uniformed Services University of the Health Sciences (USUHS), and the National Intrepid Center of Excellence (NICoE).

As part of our military specific curriculum, we engage in one practical Objective Structured Clinical Exam (OSCE) related to military decision-making process, command decision breathing, combat operational stress control, and traumatic event management. This takes place in our simulation center at WRNMMC each year. Additionally, as a PGY-3 you will have the opportunity to act as a subject matter expert and observer controller for USUHS students in their practical simulation and capstone exercise Operation Bushmaster.

The program integrates mentorship, sponsorship and coaching beginning in the first year of training, including:

• Applying leadership and management skills via Leading Change curriculum
• Providing military unique curriculum including:
  • Combat and Operational Stress Course
  • Traumatic Event Management
  • Military Supervisor Courses  (course that prepares future military medical leaders)

Opportunities are available at the following sites:

• National Intrepid Center of Excellence
• Walter Reed Army Institute of Research (WRAIR)
• USUHS

Additionally, we are the home of Army Study to Assess Risk and Resilience in Service Members. Additionally we have robust faculty led research projects and a National Institutes of Health Collaboration.

Residents participate annually in a PGY 4-led quality improvement project.

Didactics dedicated to military professional competence.

Dedicated course during 4th year didactics to prepare graduates for clinical leadership positions.

Simulations designed to prepare residents to respond to requests from military leadership for courses of action related to the behavioral health readiness of service members.

• WRNMMC
• Veterans Affairs Medical Center (Washington, D.C.)
• Children's National Hospital, D.C.
• D.C. Dept of Public Health
• Alexander T. Augusta Military Medical Center
• Northern Virginia Mental Health Institute
• Inova Fairfax Medical Campus
• Washington Hospital Center
• Virginia Hospital Center-Arlington
• Blanchfield Army Community Hospital

If you choose to rotate here, you will typically spend four weeks with us: two weeks on one service and two weeks on another service. During your time here, we have goals for you as a rotator and goals for ourselves as the recruitment chairs also. We hope these goals help explain what priorities to our program are as you decide if we are the program for you.

Our Goals for You

• Experience what the day-to-day life of a Walter Reed psychiatry resident is like.
• Participate in patient care to develop the skills and attitudes of a military psychiatrist.
• Create meaningful relationships with other sub-interns, residents, and faculty.
• Have fun!

Our Goals for Ourselves

• Welcome and support a diverse cohort of military medical students to the Walter Reed Psychiatry training program who embrace the values of diversity, equity, and inclusion.
• Continue to grow in our capacity to incorporate principles of diversity, equity, and inclusion into recruitment, interviewing, and the selections process.
• Expose applicants to the opportunities our program has to offer to thrive as a trainee and develop into a military psychiatrist through clinical experiences, didactics, and interactions with current residents and faculty.
• Help students envision themselves as part of the Walter Reed Psychiatry community by facilitating opportunities to further explore their interests and become familiar with the national capital region.

All interviews will be held virtually (in-person interview upon request) and will be approximately 30 minutes in length. Applicants will be emailed information about their specific interview date and time with a link. Applicants will be asked structured questions. In the interview, there will typically be three people present – a program director or associate program director, a faculty member, and an intern/resident physician.

The American Board of Internal Medicine and the American Board of Psychiatry and Neurology offer dual certification in internal medicine and psychiatry. A combined residency must include at least five years of coherent education integral to residencies in the two disciplines. Participating residencies must be in the same institution.

To meet eligibility requirements for dual certification, the resident must satisfactorily complete 60 months of combined education, which must be verified by the directors of both programs. The written certifying examinations cannot be taken until all required years in both specialties are satisfactorily completed.

Residents engage each year in our Residents as Teachers curriculum. They are given foundational knowledge in teaching and coaching medical students and future residents. They are provided the opportunity during PGY 3 to perform as subject matter experts and observer/controllers for the USUHS students in their practical simulation and capstone exercise Operation Bushmaster. During PGY 3 residents are provided direct opportunities to teach medical students at the uniform services University health sciences in the area As a PGY-4 a required rotation includes senior teaching resident where residents develop implement and teach a medical curriculum and are responsible for noon conferences and morbidity and mortality conference for that month.

Given our co-location with the USUHS there are multiple additional opportunities for residents to perform and engage as teachers with medical students we routinely have medical students rotating at our sites as well as teaching opportunities to as described above, such as a unique opportunity to assist or teach at the USUHS as a resident.

We have faculty with board certification or training in the following specialties and subspecialties:

• All Internal Medicine subspecialties
• General psychiatry
• Physical medicine and rehabilitation
• Sleep medicine
• Forensic psychiatry
• Consultation-liaison psychiatry
• Child and adolescent psychiatry
• Addiction psychiatry
• Geriatric psychiatry

Residents will select global supervisors and therapy supervisors during their PGY-3 year that provide guidance on clinical patient encounters. They can also select mentors to guide them on research, PGY-4 Grand Rounds presentations, quality improvement projects, on selectives or other required rotations (ex: the Senior Teaching Resident rotation).

We should be proud of directly supporting our country and those that are ready to fight for our freedom, but their well-being is made possible by our own health. More explicitly, our mission accomplishment is made possible by residents and faculty who themselves strive to maintain their own psychological and physical health, even in the face of significant challenges. In doing so, we build healthy habits for ourselves, model for our patients and those around us how we should handle life’s challenges and may help others gain confidence to seek help when it’s needed. Difficulties arise for us all, and it is more in how we handle them that we are defined than their occurrence. There are several resources and programs to support resident wellbeing.