Essential Guide for DO Graduates Researching Peds-Psych Residency Programs

Understanding the Landscape: Pediatrics-Psychiatry & the Triple Board Pathway

For a DO graduate interested in Pediatrics-Psychiatry, you’re looking at a uniquely structured training path that sits at the intersection of two (sometimes three) specialties. Most commonly, this means considering:

• Pediatrics–Psychiatry–Child & Adolescent Psychiatry (the “Triple Board” pathway)
• Less commonly, combined Pediatrics–Psychiatry tracks or separate categorical pediatrics and psychiatry programs with a plan to do Child & Adolescent Psychiatry fellowship later.

Before you dive into how to research residency programs, it helps to understand:

What is Triple Board?

Triple Board is a 5-year integrated program leading to board eligibility in:

1. Pediatrics
2. General Psychiatry
3. Child & Adolescent Psychiatry

You rotate through all three disciplines in a carefully planned curriculum, usually with:

• 24 months pediatrics
• 18 months general psychiatry
• 18 months child & adolescent psychiatry
  (Exact distribution varies by program.)

Triple Board is highly structured and exists only at a limited number of institutions, which makes program research strategy and careful evaluating residency programs especially important for DO graduates.

Unique Considerations for DO Graduates

As a DO graduate targeting an osteopathic residency match (now part of the single accreditation system), keep in mind:

• Some Triple Board or combined programs have a long history with MD graduates; others are openly DO-friendly.
• Programs may differ in:
  • How they view COMLEX alone vs. requiring USMLE.
  • Their prior experience with DO trainees in peds, psych, or Triple Board.
  • Their openness to osteopathic principles, OMM, and holistic care.

When you research programs, you’re not just assessing fit with Triple Board; you’re also assessing fit as a DO graduate in a dual-discipline environment.

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Step 1: Clarify Your Training Goals Before You Start Researching

Before you start clicking through websites or spreadsheets, you need clarity on what you want from your peds psych residency experience. This will focus your search and prevent information overload.

Define Your Long-Term Career Vision

Ask yourself:

• Do you want to work primarily with:
  • Medically complex children with psychiatric comorbidities?
  • Integrated care (e.g., peds clinics with on-site mental health)?
  • Inpatient child psychiatry? Consultation-liaison? Developmental-behavioral pediatrics?
• Do you picture your future practice as:
  • Academic vs. community-based?
  • Clinical-heavy vs. balanced with research, education, or advocacy?
• Do you want to be board-eligible in all three (peds, psych, child psych), or are you open to:
  • Categorical pediatrics + Child & Adolescent Psychiatry fellowship later?
  • Categorical psychiatry + Child & Adolescent Psychiatry with pediatric consultation focus?

Your answers determine whether Triple Board is the best fit, or if a more traditional sequential path could meet your goals.

Identify Non-Negotiables vs. Preferences

Write two lists:

1. Non-negotiables (must-haves)

   • Will accept DO graduates / DO-friendly culture
   • Robust training in both pediatrics and child psychiatry
   • Support for integrated care, developmental-behavioral issues, etc.
   • Geographic constraints (family, spouse/partner, visa issues)

2. Preferences (nice-to-haves)

   • Strong research focus in child mental health, neurodevelopment, or trauma
   • Opportunities in advocacy, policy, or public health
   • Specific patient populations (e.g., autism, foster care, rural kids)
   • Program size and culture (tight-knit vs. larger, more diffuse)

Having this hierarchy will drive all further program research strategy, because you’ll know what matters most when evaluating residency programs.

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Step 2: Build a Target List Using Public Data Sources

Now that you know what you want, start building a comprehensive list of potential programs. Because Triple Board and combined peds psych residency tracks are relatively few, your first task is simply to identify where they are.

A. Use Official Databases and Directories

1. NRMP & ERAS Listings

   • Search for:
     • “Pediatrics-Psychiatry-Child and Adolescent Psychiatry” or “Triple Board”
     • “Combined Pediatrics-Psychiatry” (if applicable)
   • Note the program codes, application tracks, and number of positions.

2. Residency Explorer (if available to you)

   • Filter by:
     • Specialty: Pediatrics and Psychiatry
     • Consider also searching by institution and seeing if both specialties are present, then checking if they offer Triple Board.
   • Look at:
     • Program size
     • Board pass rates (for peds and psych)
     • Resident demographics

3. FREIDA (AMA)

   • Search under Pediatrics and Psychiatry and filter by:
     • “Combined” or “Special track”
   • Review program descriptions to identify Triple Board offerings.

4. ACGME & ABPN/ABP Resources

   • Sometimes list combined training pathways and accredited programs.

Create a spreadsheet with columns like:

• Program name & institution
• City/state
• Type (Triple Board, combined, or alternative approach)
• Number of positions/year
• DO-friendly notes (from website, current residents, etc.)
• COMLEX/USMLE requirements
• Research strengths
• Clinical strengths (peds, psych, child psych)
• Geography/lifestyle notes
• “Red flags” column

B. Supplement with Targeted Google Searching

Because Triple Board is relatively niche, some programs are easier to confirm via simple web search:

• Search terms:
  • “Triple Board residency [state]”
  • “Pediatrics-Psychiatry-Child and Adolescent Psychiatry program”
  • “Combined pediatrics psychiatry residency”
• Open each program’s website and verify:
  • If the Triple Board track is current and actively recruiting.
  • How many residents per year.
  • Training structure.

If you see out-of-date info (“Last updated 2018”), mark the program for follow-up via email later.

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Step 3: Deep-Dive into Each Program’s Website – With a DO Lens

Once you have your long list, the next phase of how to research residency programs is a structured deep dive into each website. You’re not just reading casually; you’re deliberately evaluating residency programs for both Triple Board fit and DO-friendliness.

A. Curriculum and Rotation Structure

Look for:

• How the five years are divided

  • Is there a clear breakdown of pediatric, psychiatry, and child psychiatry rotations?
  • Are there integrated rotations (e.g., pediatric consult-liaison psychiatry, developmental clinics)?

• Clinical exposure

  • NICU/PICU exposure?
  • Community pediatrics vs. tertiary care?
  • Child psychiatry inpatient vs. outpatient balance?
  • Exposure to developmental-behavioral peds, autism clinics, foster care, trauma?

• Call structure

  • How often are you on peds call vs. psych call?
  • Night float systems?
  • How do they manage duty hours across three specialties?

Red flags or caution signals:

• Very vague or missing rotation schedules.
• Outdated sample schedules with no clear Triple Board details.
• No mention of child & adolescent psychiatry specifics.

B. Culture and Support for Combined Trainees

Triple Board residents often straddle multiple departments:

• Does the site explicitly address:

  • How Triple Board residents are supported?
  • How they are integrated into each department’s resident group?
  • Mentorship – are there designated Triple Board or combined-training faculty?

• Is there evidence of:

  • Graduation of prior Triple Board cohorts?
  • Alumni spotlight stories?
  • Leadership roles for combined trainees?

Search for keywords like “Triple Board”, “combined training”, “integrated”, “pediatrics and psychiatry”.

C. DO-Friendliness and Board Exam Requirements

As a DO graduate residency applicant, important website clues include:

• Resident Lists and Photos

  • Do you see DOs among:
    • Triple Board residents?
    • Categorical peds or psych residents at the same institution?
  • If yes, this is a strong sign of DO-friendliness.

• Application Requirements

  • Do they accept COMLEX alone?
  • Do they “prefer” or “require” USMLE?
  • If USMLE is required and you didn’t take it, consider:
    • Emailing to clarify: “We accept COMLEX only” vs. “We really mean USMLE.”

• Osteopathic Recognition or History

  • Some programs have official Osteopathic Recognition; others simply show a history of welcoming DOs.
  • Any explicit statement like “We welcome applications from DO graduates” is reassuring.

D. Academic, Research, and Advocacy Opportunities

Look for evidence of:

• Child mental health research in:
  • ADHD, autism, trauma, mood/anxiety, eating disorders.
  • Integrated care models, school-based mental health.
• Public health and advocacy opportunities, such as:
  • Child welfare advocacy.
  • Behavioral health integration in primary care.
  • Policy rotations or legislative advocacy.

As a DO, your holistic mindset often aligns well with integrated and preventive approaches. Programs emphasizing biopsychosocial care may be especially synergistic.

E. Practical Example: Website Deep Dive

Imagine two Triple Board programs:

• Program A

  • Detailed rotation schedule with clear year-by-year breakdown.
  • Dedicated Triple Board director.
  • Resident page shows 2–3 DOs in pediatrics and psychiatry programs.
  • Explicit statement: “We welcome COMLEX or USMLE; DO graduates are strongly encouraged to apply.”
  • Several faculty doing research on integrated pediatric primary care and child trauma.

• Program B

  • Only a one-paragraph generic description: “We offer integrated training in pediatrics and psychiatry.”
  • No rotation schedule, no mention of Triple Board faculty.
  • Resident roster lists no DOs.
  • Applications page says “USMLE Step 1 and 2 required; COMLEX not accepted.”
  • No mention of research.

From a program research strategy perspective, Program A moves to your high-priority list; Program B may be removed or placed as a low-priority “reach” if there’s some compelling factor (e.g., dream city, unique clinical site).

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Step 4: Go Beyond Websites – Talk to Real People

The most powerful way to understand a peds psych residency or Triple Board program is to talk to people inside it. This is where you validate or refute what the website suggests.

A. Connecting with Current Residents

Priority contacts:

• Current Triple Board residents
• Pediatric and psychiatry categorical residents at the same institution
• DO graduates in any track at that program

How to reach them:

• Program website often lists current residents with email addresses (especially for combined programs).
• Ask the program coordinator:
  “I’m a DO applicant interested in Triple Board. Would it be possible to connect with a current Triple Board resident or DO graduate to hear about their experience?”

Questions to ask:

• “How integrated is the training really, day-to-day?”
• “Do you feel supported by both pediatrics and psychiatry departments?”
• “What has your experience been as a DO (if they are DO) or with DO co-residents?”
• “How flexible is the program if you want to do more research/advocacy/unique electives?”
• “What are the biggest challenges of Triple Board here?”
• “How well do grads do in the boards and in job/fellowship placement?”

B. Talking with Program Leadership

You don’t need to email every program director pre-application, but targeted outreach can be helpful, especially to clarify questions specific to DO graduates or Triple Board tracks.

Sample questions for leadership:

• “Do you accept applicants who have taken COMLEX only?”
• “Do you have a history of matching DO graduates into Triple Board or categorical pediatrics/psychiatry?”
• “How are Triple Board residents mentored, and how do they navigate three departments?”
• “What are common career paths of your Triple Board alumni?”

Keep emails concise and professional. You’re collecting data, but you’re also making an impression.

C. Use Your Medical School Network

• Ask advisors and faculty:
  • “Have any of our graduates matched into Triple Board or peds psych at X institution?”
  • “Do we have alumni in pediatrics or psychiatry at [program] who might share insights?”
• Tap into:
  • Pediatric and psychiatry interest groups.
  • Osteopathic specialty societies (e.g., ACOI, AOA sections with child psych or pediatrics focus).
  • Online communities for DO graduates and applicants.

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Step 5: Systematically Compare and Rank Programs

By now, you’ll have a mix of objective and subjective data. The next step is to systematically evaluate residency programs and compare them in a way that reflects your values as a DO applicant interested in pediatrics-psychiatry.

A. Create a Weighted Scoring System

Consider categories such as:

1. DO-Friendliness (weight: high for you as a DO graduate)

   • Presence of DO residents
   • COMLEX acceptance
   • Program culture toward osteopathic training

2. Triple Board / Combined Training Strength

   • Curriculum clarity and integration
   • Faculty expertise and mentorship
   • Reputation and longevity of the Triple Board program

3. Clinical Breadth in Peds & Psych

   • Diversity of pediatric patient populations
   • Strength of child & adolescent psychiatry experiences
   • Exposure to integrated and consult-liaison care

4. Career Development & Outcomes

   • Board pass rates
   • Alumni careers (academic, clinical, advocacy)
   • Opportunities for research, QI, education, leadership

5. Location & Lifestyle

   • Geography, cost of living, commuting
   • Support systems (family, partner, childcare if needed)
   • Wellness, call schedule, and program culture

Score each category (e.g., 1–5) and apply weights based on importance. This transforms “gut feelings” into a structured program research strategy.

B. Identify Your Tiers

From this scoring:

• Tier 1 (Top Choice / Strong Fit)
  • DO-friendly, strong Triple Board track, aligned with your goals.
• Tier 2 (Good Fit / Moderately Competitive)
  • Some minor downsides (e.g., location or less research), but overall strong.
• Tier 3 (Safety / Geography-Focused)
  • Maybe fewer resources or less ideal but acceptable training and DO-friendly.
• Exclude List
  • Programs that are clearly not DO-accepting or lack real Triple Board support.

This tiering will guide not only where you apply, but also how you prioritize effort for away rotations, supplemental applications, and interview prep.

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Step 6: Tailor Your Application Strategy as a DO Triple Board Applicant

Researching programs and evaluating residency programs is only half the battle; the other half is aligning your application with what these programs are looking for.

A. Understand What Triple Board Programs Seek

Common characteristics Triple Board leadership values:

• Demonstrated interest in both pediatrics and psychiatry:

  • Clerkship honors, sub-I’s, electives in child psychiatry or developmental peds.
  • Longitudinal volunteer or research experience with children and families.

• Comfort with complexity and ambiguity:

  • Experience managing medically and psychiatrically complex cases.
  • Reflections on integrated care, biopsychosocial approaches.

• Emotional maturity and resilience:

  • Ability to balance competing expectations across departments.
  • Insight into personal coping and wellness strategies.

Your status as a DO can be an asset if you highlight:

• Training in holistic, patient-centered care.
• OMM/OMT experience when appropriate (e.g., chronic pain, somatic symptoms, functional disorders).
• Strong communication and primary care orientation.

B. Address COMLEX vs. USMLE Proactively

From your program research, sort programs by test preferences:

• Category 1: COMLEX-only accepted

  • No action needed beyond listing your scores.

• Category 2: COMLEX accepted but USMLE strongly preferred

  • If you have USMLE, highlight it.
  • If you don’t, consider reaching out once to ask whether COMLEX-only applicants are realistically considered.

• Category 3: USMLE required, COMLEX not accepted

  • Generally avoid if you don’t have USMLE, unless the program explicitly tells you they’ll make an exception.

If your COMLEX scores are strong, emphasize them as evidence of readiness for both pediatrics and psychiatry.

C. Use Your Personal Statement and Experiences Strategically

Based on your program research:

• Tailor your narrative to Triple Board themes:

  • A specific moment that captured the intersection of pediatrics and mental health.
  • How your DO training informs your approach to the mind–body connection in children.
  • Long-term goals, such as integrated pediatric behavioral health or advocacy for youth mental health.

• Showcase experiences that align with what top-fit programs emphasize:

  • If they have a strong autism center, highlight your work with neurodiverse children.
  • If they emphasize trauma-informed care, discuss your advocacy or research in that area.

This targeted approach shows programs that you didn’t just send a mass application—you did thoughtful program research and see a genuine fit.

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Step 7: Re-Evaluate Programs After Interviews

Your pre-interview research creates a preliminary impression, but interviews give you fresh data. Use this chance to refine your ranking with updated evaluating residency programs criteria.

A. During Interview Day

Observe:

• How do faculty talk about Triple Board trainees?
• Do they speak positively about DO graduates?
• Are residents candid about challenges, or is everything “perfect” (which can be a red flag)?
• How do pediatrics and psychiatry residents relate to each other—siloed or collaborative?

Ask:

• “How do Triple Board residents maintain a sense of community with peers across three specialties?”
• “What have been the biggest program changes in the last 3–5 years?”
• “How are DO residents supported and integrated here?”

B. After Interview Season

Update your spreadsheet:

• Add columns for:
  • Interview impression (1–5)
  • Cultural fit comments
  • Strengths and weaknesses noted during visit

Then ask yourself:

• “Would I be comfortable spending 5 years here as a DO working across three departments?”
• “Do I feel that I could become the kind of pediatric-psychiatry physician I want to be at this program?”

Align these reflections with your initial priorities to construct a final rank list.

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FAQs: Researching Pediatrics-Psychiatry and Triple Board Programs as a DO Graduate

1. As a DO, do I need to take USMLE to be competitive for Triple Board or peds psych residency?
Not always. Many osteopathic residency match pathways now operate under a single accreditation system, and numerous programs accept COMLEX alone. However:

• Some Triple Board programs still require or strongly prefer USMLE.
• Through your program research, categorize each program by exam requirement.
  If you’re early enough in training and highly committed to very competitive academic programs, USMLE can broaden your options; if you’re later in the process, focus on programs explicitly open to COMLEX-only applicants.

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2. How can I tell if a program is genuinely DO-friendly or just “neutral”?
Look for:

• Presence of DO graduates among current residents in pediatrics, psychiatry, or Triple Board.
• Explicit website statements welcoming DOs or accepting COMLEX.
• Feedback from current or former DO residents regarding culture and support. If a program has never had a DO resident and is vague about COMLEX, consider it more of a reach unless you receive reassuring clarification from leadership.

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3. Should I only apply to Triple Board programs if I want a pediatrics-psychiatry career?
Not necessarily. Triple Board is an excellent but niche pathway. You can achieve a strong peds psych career by:

• Categorical pediatrics → Child & Adolescent Psychiatry fellowship.
• Categorical psychiatry → Child & Adolescent Psychiatry with heavy pediatric consultation. When you research programs, include both Triple Board and strong categorical pediatrics/psychiatry programs with robust child mental health and integrated care opportunities. This diversified approach can improve your match chances and still lead to your long-term goals.

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4. How many Triple Board or combined peds psych programs should I apply to as a DO graduate?
Given that Triple Board spots are few and competitive, DO applicants often:

• Apply broadly to all Triple Board programs that are reasonably DO-friendly and align with their goals.
• Add a balanced mix of:
  • Categorical pediatrics programs with strong child mental health exposure.
  • Categorical psychiatry programs with robust child & adolescent and pediatric consult services. Use your program research strategy to build a list that reflects both ambition and realism, shaped by your exam scores, clinical record, and geographic needs.

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By approaching your search with a structured, data-driven method—grounded in your values as a DO and your vision for a pediatrics-psychiatry career—you can navigate the unique Triple Board and combined training landscape with clarity and confidence.