It’s important to define your priorities for PGY-4 to stay balanced and efficient. But also be sure to appreciate the flexibility!"
-Class of 2020 member

The final year of residency (PGY-4) concludes training in the General Psychiatry Residency Program and allows the resident to hone skills and pursue further educational endeavors.


Crisis Bridging and STAR

This year includes an ongoing commitment to outpatient work with psychotherapy and psychopharmacology patients. Residents spend one hour each week on the Crisis Bridging Service (follow-up of patients recently discharged from the Emergency Department and Inpatient Services), staffing with an attending physician. PGY-4s are also assigned to a half-day Substance Treatment and Recovery (STAR) clinic to manage substance abuse patients and perform new patient evaluations.


An average of one day per week is dedicated to an elective choice of an advanced community psychiatry assignment through the North Carolina Area Health Education Center (AHEC) program. This may include clinical work with special populations (substance abuse, adolescents, criminal justice, rural services, mobile crisis, assertive community treatment teams, etc.) or it may focus on administrative issues within the community or research interests.

Collaborative Care

Residents have opportunities in both integrated care and collaborative care models in a variety of primary care and specialty care settings.  In collaborative care, residents provide consultation services through weekly case review with the care manager, as well as support to providers and make treatment recommendations when questions arise. Overall, the rotation will provide experience in consultation and case review with a care manager, development of liaison skills through provider consultation, working within a population health framework, and opportunities to be involved with quality improvement and/or educational projects in the primary care setting.

Acting Attending

As a senior resident in the training program, the PGY-4 will also spend two blocks as an Acting Attending. During these segments, the resident will act as the attending physician for the:

  • inpatient units,
  • outpatient clinic,
  • Emergency Department, or
  • consult-liaison service.

In this capacity, the PGY-4 will lead treatment team, provide guidance to younger residents, teach medical students, and make final medical decision for patients. There will always be an attending physician available for advice and recommendations, but this experience allows the PGY-4 to fully utilize the training, knowledge, and leadership skills that have been cultivated throughout residency.


The remainder of the fourth-year is an elective of the resident’s choice with a myriad of opportunities available. Faculty mentors are available as advisors to assist residents in pursuing their educational goals. Some residents elect to pursue senior administrative responsibilities as Chief Residents, while others continue to develop their skills in clinical or research arenas.

Sample PGY-4 Electives
Mental Health Policy Palliative Care
Memory Disorders Global Psychiatry
Campus Health Clinical or Basic Science Research
Psychotherapy / Supervision ECT Certification
Geriatric Psychiatry Neuropsychiatry

Call Schedules

Senior residents continue to take 6 – 7 weekend rounding calls annually. PGY-4s see patients in the outpatient clinic, inpatient units, and spend 1:1 supervision time with an attending physician.


PGY-4 residents may elect to supplement their clinical training with moonlighting shifts at the UNC Emergency Department, WakeBrook, or the Alcohol and Drug Abuse Treatment Center (ADATC). While the General Residency clinical experience is very robust, senior moonlighters enjoy the ability to practice attending-level autonomy.


Residents who matched with the Child and Adolescent Psychiatry fellowship begin that specialization as a PGY-4. Residents who are interested in applying for the Consultation-Liaison Psychiatry fellowship, Forensic Psychiatry fellowship, or other fellowship opportunities are encouraged to submit applications during the fall of PGY-4.