I applied to a weird residency. It is not so much that I am going to be performing strange medical procedures; it’s just that I generally have to take a few moments to explain what my residency program plans mean. I applied to something called the ‘Triple Board,’ as well as combined adult-child psychiatry residency programs. I entered medical school passionate about working with kids who have autism. I had met several wonderful children on the autism spectrum while working in Los Angeles as an educational therapist (remediating children with learning disabilities with programs which address their weaknesses and emphasize their strengths), and then while working around Vermont doing research about how well parents perceive their children’s autistic deficits. As medical school began and I had to memorize biochemical equations and microscopic anatomy, I stayed grounded by searching for what I could contribute to better these kids’ lives. Ultimately I concluded that addressing their mental health needs would greatly improve their overall well-being, which is something the healthcare system is not doing very well. I wanted to find a residency program which would allow me to learn about the medical care these children already receive, as well as train to treat their mental health problems with medicines and other therapies.
To become a child psychiatrist, one needs to complete an adult psychiatry residency (which typically lasts four years) and then apply again and complete a child psychiatry fellowship which lasts two years. Pediatrics residencies last three years. As I tried to focus on what would best fit my needs my residency search quickly zeroed in on the Triple Board after I met some faculty members at a child psychiatry mentoring event called the Klingenstein Games during the spring of my first year. There I met two associate training directors who explained that the Triple Board consists of being trained in Pediatrics, Adult Psychiatry and Child Psychiatry and taking all three of those board exams – the training would finish in five years – effectively cutting three years off of doing each program separately. This resonated strongly with my desire to understand the pediatric medicinal problems that affect these kids with autism and other neurodevelopmental disabilities. I also found out that there are only nine of these Triple Board programs in existence accepting about 16 to18 students per year, which meant that they would probably be pretty competitive.
I would later learn that other residency programs like UVM offered combined Adult and Child Psychiatry training (lasting a total of five years too) which would allow one to substitute pediatric medical experiences in lieu of adult medicine ones. And on top of that, I learned that one could even complete three years of an adult psychiatry program and then ‘fast track’ or apply to begin a child psychiatry fellowship (at the same institution or a different one) after that third year and complete the two-year child fellowship at the same or a different institution – sometimes being able to still make those substitutions of adult medicine with pediatric medicine rotations.
I applied to both types of programs, because I was pretty sure they could provide what I needed out of residency training – which is to say, at least asking yourself what you might want to do after residency is very important. I was able to spend time during my fourth year rotating through institutions which had both the Triple Board and adult and child psychiatry programs to figure out what was possible in these training programs. I refined my ideas about what I needed to get out of training and met a lot of trainees who had many different plans for what they would do with their combined program experience. Some wanted to work in the area of child abuse, others private child psychiatry practice, some in consult-liaison child psychiatry – working in a children’s hospital checking out children’s mental health needs there, others wanted to land in primary care offices to work with pediatricians and children to address mental health needs, some wanted to work with kids with eating disorders (which require a lot of medical and psychiatric know-how), and others who also wanted to work with kids with neurodevelopmental disabilities.
I was able to attend the American Academy of Child and Adolescent Psychiatry (AACAP) Annual Meeting this past October at Walt Disney World in Orlando. I got to meet a lot of child psychiatrists and hear what they thought about training possibilities – including combined programs and the Triple Board. Some mentioned that they wish they could have done more pediatrics like the Triple Board, and others did a lot of pediatrics without a Triple Board program as that is allowed at some institutions. And I also got to meet the clan of Triple Boarders who will meet for a dinner at each AACAP annual meeting.
Actually applying for residency was a little complicated, as the Triple Board and some combined programs require you to interview for two days with the Pediatrics, Adult Psychiatry and Child Psychiatry programs. Thankfully many of the programs would help you get discounts on hotels or else pay for your hotel during your stay, and I saved some money by stringing interviews together geographically and staying overnight with friends. This sometimes led to long days in the car such as the drive from Vermont to Lexington or a trip from Baltimore to Indianapolis, but more often than not I was able to figure in sufficient driving time. Each program had a slightly different cadence to interviews in terms of numbers of interviews, which disciplines were predominantly represented, how much time you spent with the different varieties of residents as well as how much time you spent with the Triple Board or other combined residents.
But having now finished the application process, I can say that it was remarkably enjoyable though somewhat exhausting. It was exciting to see all of the hope and promise of each of the programs – how they worked to combine the disciplines and improve the training experience as well as where and how their residents planned on practicing. The programs also exemplified a focus on integration of mental health and physical health which seems to be a growing trend around the country in an effort to improve overall health. And while I’ll eagerly await Match Day, I feel like each program I visited was exciting in its own ways and ultimately has contributed ideas to what I would like to do in my own practice someday.
To learn more about the Triple Board, visit: http://tripleboard.org/