A Day in the Life for Psychiatry Residents

That’s right, folks! Home stretch. My PGY4 year started on July 1 at 8:00 a.m., with my acting-attending role at Eskenazi Hospital, the local safety net hospital in Indianapolis. This has been one of my favorite places to rotate in, and the first rotation I did during intern year. I decided to come full circle and end my last year the same place I started (poetic, I know).

At IU, our PGY4 year is fairly flexible. Some of my co-residents chose to structure their week with various clinics and allocate some time to research and educational pursuits. I allotted for a monthly option because of my interest in inpatient psychiatry. I plan to start with Eskenazi, and then rotate through other inpatient hospitals at IU, such as Methodist Hospital, and the Roudebush VA Medical Center (VAMC). I also plan to sprinkle in a few other of my interest areas, such as pharmacology and toxicology, and also complete a month abroad with IU’s global health track.

A little bit about the global track (because I love it): It is an interdisciplinary track where residents participate in a variety of learning activities about global health. We attend conferences, do global health projects and work with mentors. Many of us choose to complete a rotation abroad. IU is affiliated with AMPATH and many residents choose to go to Kenya, Africa but our program is pretty flexible so Working in other countries is an option.

Back to the day-to-day: I arrive to the inpatient unit around 8 a.m. I start by picking up a census sheet and reading over my patients for the day. Usually, each PGY4 caps at 15 patients, and we work with interns who carry 10 patients each. I complete my pre-rounding on my established patients. If there are new patients, I save those for the afternoon so the intern and third-year medical students can learn how to interview patients, complete mental status exams and come up with a plan. After my pre-rounds, it’s time for team meeting. In my role, I am now running the team meeting, which feels daunting to say, but at this point I feel confident in my ability to do so. It’s actually fun. After the team meeting, we work together to place orders for medications, and start any discharges for the day. Then, I grab lunch. Never skip lunch. In the afternoon, we see new patients and come up with plans together. I like to sprinkle in a little bit of medical student teaching when I have time in the afternoon. I usually finish my day around 4 p.m.

Every Monday, I do a clinic through the VAMC and we have didactics every Friday afternoon. Besides the obvious learning opportunities, I like being able to socialize with my co-residents during didactics…and eat free food. Every Thursday, I moonlight in an outpatient clinic for a few hours. But on other days after work,I complete errands and do a workout class or grab dinner with a friend. I end my evenings with some tea and Netflix (trying to level up to HBO…).

I’m loving 4th year so far, but especially love the fact that I have no scheduled call shifts. After 3 years of call, I’m grateful for the free weekends. Overall, I am looking forward to this year and the opportunity to consolidate all my learning thus far in my career. It feels like the end and the beginning at the same time.

Our third year of residency is 12 months of outpatient clinics. PGY-3s choose a variety of clinics across different hospital settings. The clinic populations encompass, but are not limited to: general psychiatry, child and adolescent, addictions, gender health, woman’s mental health and geriatric psychiatry. A specialty of this program is the variability in which we can build our third-year schedule and the variety of clinic exposure.

While the variety at IU is one of our biggest strengths, it does take a bit to get comfortable with transitioning to different sites throughout the week. The attendings and other residents are very helpful with this transition. I realize now that I prefer this schedule versus being at one location for 12 months. With this type of scheduling, you learn from the experiences and approaches of various attendings and clinics, you follow the same patients for an entire year and time flies because every day is so different.

Due to COVID, patients still have the option to be seen virtually, but our sites are transitioning back to in-person appointments or a hybrid model (mix of virtual and in-person).

Here’s a peak at my weekly schedule:

Mondays: In the mornings, I work at the VA Medical Center doing general adult psychiatry. In the afternoon, I work at LifeCare as a psychiatric provider. This clinic specializes in comprehensive care for individuals living with HIV and any needs they may encounter due to their illness.

Tuesdays: I am on the research track and spend my entire day working on projects I am affiliated with. My current research looks at young adults who have experienced first episode psychosis and their involvement in the criminal justice system and legal issues they face compared to the general population.

Wednesdays: In the morning, I work at the gender wellness/health clinic at Eskenazi Hospital. This clinic specializes in comprehensive care to individuals who identify as transgender and my role encompasses providing mental health care to those looking for services. In the afternoon, I am at the IU Neuroscience Center/Goodman Hall for a general psychiatry clinic. During this time, I also have one therapy patient weekly where I administer and practice CBT.

Thursdays: In the morning, I have another Goodman Hall clinic with a variety of general psychiatry patients with a myriad of medical and psychiatric comorbidities. In the afternoon I have my psychoanalytical psychotherapy patient and following this session I staff with an attending.

Friday: Didactics! We have therapy didactics in the morning and general psychiatry didactics in the afternoon. Every week we get free lunch and all of the residents get to see each other and catch up during our protected time! I am also on various committees and am currently the Associate Chief Resident transitioning to Chief in January. As a result, this requires I attend a variety of meetings not only for program development but also for resident wellness. Examples of the committees include on-call and didactic development. Being on these committees and having an interest in forensic psychiatry (with a desire to do a followship upon graduation), I was able to help establish a three-week didactic series that covers criminal and civil forensic psychiatry. The topics covered will provide a better understanding of forensic psychiatry and they will also provide information that general psychiatrists may encounter at the intersection of medicine and the law.

During second year, we have a mix of inpatient and outpatient psychiatry. Right now, I am on my part of the year that is mostly outpatient. Monday through Wednesday I see patients in SUDRP clinic, which is an addiction-focused clinic through the VA Medical Center. On Thursday, I spend my time working emergency psychiatry and helping out on consults at Methodist hospital. On Friday, I have protected time in the morning that I use for education projects and diversity committee work. In the afternoon, I attend weekly didactics.

As a second year, you have a chance to be more involved with leadership roles. I elected to take on the role of co-chair for diversity committee. While continuing my first-year duties as one of the representatives on the call committee.

Here's an outline of my day in SUDRP clinic:

5:30–5:45 am: My alarms goes off. If it’s Tuesday or Thursday, then I am usually at cycling class by 6:00 am. After cycling, I run home and get ready for work, leaving my house around 7:10 am.

7:30 am: I start my day at the VA SUDRP clinic by catching up with my fellow residents, drinking my coffee and chart review my patients.

8:00 am–12:00 pm: I see patients and spend about an hour with each, which is usually enough time to interview the patient, staff, place orders and write notes.

12:00 pm: LUNCH TIME! If I do not bring my lunch, I head to the VA cafeteria. My two favorite options are the sushi or made to order sandwiches.

12:30–4 pm: I am back to seeing patients. After I finish with my last patient around 2:30, my fellow residents and I usually have a didactics session with our attending until about 3:15-3:30. * If do not have call, then I will head home around 3:30 pm. I usually walk my dogs and spend time with my husband. We often grab dinner with my fellow residents. 4:30 pm: CALL TIME! If I am on call, after clinic I make my way over to the call room in the VA. I turn on my page and turn up my phone to make sure I receive notifications. I look at the sign-out to make sure I am updated about the patients on the unit. Then I wait for pages. While I wait, I will work on unfinished notes, work on lecture for the first-year medical student course or relax and read a book.

Throughout the night, I assess patients in the emergency room for the need for inpatient psychiatric care. I also return pages from the unit. If the hospital is not busy, I try to get some sleep between patients. Around 7:45 am, I send sign out to the day team.

8:00 am: Time to rest! I head home and climb into bed to get much needed rest on my post-call day.

PGY-1 is a great mix of solidifying knowledge and skills about general medicine, as well as learning more about the practice of psychiatry. Because of the variety of services in which we practice as interns (emergency medicine, internal medicine, neurology, inpatient psychiatry and emergency psychiatry call), I have been able to follow patients in several settings. It is fun to see how my skills grow, as I broaden my interviewing skills, differentials and treatment options for patients.

My daily schedule is rotation dependent, but generally, my day goes as follows:

6:45 am: First alarm goes off. I strategically am renting a house immediately across the White River, so for the majority of my rotations, I have a 3-minute drive to the Eskenazi hospital parking lot (which is ideal to park for both rotations at Eskenazi Hospital and the VA Hospital). 

7:45 am:  Arrive at the hospital and begin chart-reviewing on patients. At first, getting used to the different EMRs and figuring out which information was important to review took a while for me (and I would try to arrive at the hospital earlier). After some time, I've gotten faster, and usually review the patient's vitals, new labs/imaging, which medications (scheduled versus as needed medications) they received, and nursing notes. 

 After chart reviewing, I go see my patients alone before rounding with staff and the team. This is one of the favorite parts of my day. As I get to know a patient over time, I've been able to learn how treatments really improve the patient's well-being. It's also fun just chatting with people.

9:30 am: Rounds begin! Most of my rotations have had table rounds, where we discuss how patients are doing and treatment plans for each patient with the attendings, pharmacists, social workers and therapists to coordinate our care. The medical students usually present first, and then I'll add pertinent information or plan updates if necessary. The social workers and pharmacists will chime in about any concerns they have. Finally, depending on the attending, we will have pertinent group discussions about how to best care for the patients. This part was terrifying at first because I felt more responsible for the assessment and plans for each patient than I ever did in medical school, but it has gotten easier over time. All of my attendings have been very supportive with my plans for patients—and will reign me in when I get too ambitious too fast for a patient!

10:45 am: I put in orders for patients, get patient's discharge orders in and begin working on notes, if I haven't already. I also file necessary paperwork (e.g., commitment paperwork or report filing after emergency detentions at the VA.)  On Fridays, we have didactics until 4 pm, so I head over to Goodman Hall as soon as I have wrapped up orders and notes on my patients.

12:00 noon: I grab lunch. I tried to tell myself that I would only order salads from hospital cafeterias during residency, and I lasted about a month. I discovered the sushi at the VA (mildly pricey, but surprisingly alright), quesadillas at Eskenazi hospital and Au Bon Pain everything at Methodist Hospital. I usually head back to my workstation and keep working on my notes.

1:00 pm: Sometimes, we see new patients together as a team. My attending, the medical students, and I will group interview a select few patients. Usually, the medical student will begin the line of questioning, followed by me, followed by the attending. It's still uncomfortable discussing a plan with a patient in front of everyone and answering the patient's questions in front of everyone. Again, as I've gotten more comfortable with the different medications and treatment options we offer patients, I've gotten better at answering their questions. 

If things are wrapping up, I will spend some time working through various psychiatry topics with medical students. I love this time because I always feel I learn information better when I am asked to teach it and I inevitably learn more from the really good questions the medical students ask.

2:30 pm: I try to have the majority of my work done by this point. I call patient families to update them or for more collateral information, if needed. I will sometimes do some more chart digging for certain patients, as well. 

3:30-4:30 pm: My days usually ends. When I get home, I plop on my couch for about half an hour, scroll through emails, and read up a little about a patient question I had during the day (e.g., how lithium toxicity can present). Dr. Davis recommended a great website, simpleandpractical.com, that sends out a daily newsletter about a daily psychiatry topic (for a subscription fee that can be reimbursed with our education fund). 

5:00 pm and beyond: About once a week on my psychiatry rotations, I will work at the Crisis Intervention Unit (CIU) at Eskenazi Hospital for emergency psychiatry call through the evening. There, the licensed clinical social workers are so great at talking through patients before I go see him. After my assessment, I staff with the attending, write admission orders and write H&Ps on patients. I average about three patients per evening call shift. There are some very acutely psychotic patients that come through the CIU, so I always make sure I stay safe and I often learn a lot from them.

 

Most other evenings, I do some light housework before my husband comes home from work. We either cook together or walk to a place downtown for dinner. There are a ton of different food options within a mile or two of the downtown area. I'm forever discovering new places. Our walk is always down the White River State Park area, which is beautiful. I try to go to a Zumba classed at the local YMCA or squeeze in a home workout a several times a week. As I wrap my evening up, I'll watch Netflix with my husband while knitting a bit, postcard with friends on Postcrossing, work on my bedtime routine and then try to limit my phone browsing before bed. I'm asleep by 11 pm!