A Day in the Life of a Psychiatry Resident

Reflections from a Day in the Life of a PGY-1

I like to arrive at work around 7:30 a.m. and by 7:35 a.m. all the good morning greetings have been exchanged with our friendly staff, and it is time to fire up the computer. First, I look at my new patients and get to know them. Then I take a look at the follow-up patients’ nursing notes, vitals and any other labs/imaging that I may have ordered. At 8 a.m., it is time for morning sign-out where we either have educational presentations. We always enjoy a good discussion revolving around the assessment/plan. Around 8:30 a.m., I am out on the floor, rounding with the treatment team (attending, nurses, social worker and students). We talk briefly about the patient, conduct the interview, and then discuss the plan. After rounds, I work on discharges, orders, getting collateral and writing notes – and wait for new patients to arrive. We see a wide range of disorders on our unit and use many types of treatments including behavioral, pharmacological and electroconvulsive therapy (ECT).

At 5:30 p.m., the night shift resident is back on the unit and we sign out. I still can remember my first overnight shift. I was worried going in, but our buddy call system prepared me well, so I was able to have smooth calls. I learned to enjoy my overnight shifts. I felt I often learned the most then, by having a sense of independence yet always being very supported with seniors and attendings who are also on call via phone.

My time on inpatient psychiatry has been rewarding and educational. I feel that I am well prepared to move forward in my career and training. This year has definitely validated my choice in psychiatry.

Reflections from a Day in the Life of a PGY-2

The second year of residency has been busy – but super educational. My favorite block was my elective time with forensic psychiatry, the sub-specialty I plan to pursue, where I spent time at the state hospital and court clinic. In terms of core psychiatric knowledge, I feel like I learned the most on the consult service and while on-call at the VA.

When I’m on the consult service, I typically wake up at 5:30 a.m., so that I have time for a leisurely breakfast with my son, before dropping him off at school and heading into the hospital. I like to arrive at the hospital by 7:45 a.m., to review the medical record for the patients I’m following. At 8 a.m., we have table rounds, where our attending runs the list with us, reviewing plans for each of the patients on our list (typically 15-25 patients on the consult service and each resident tends to follow 4-5). Rounds last about an hour. After rounds, everyone splits up, and we see our patients, then circle back to staff them with the attending. Meanwhile, new consults start coming in – this occupies the rest of the afternoon. We get a lot of consults from our neurology colleagues, which tend to be super interesting – as it is often hard to tease out the neurological and psychiatric components.

If I’m not on call, I leave the hospital at 5 p.m., so I can make it to my son’s school in time to pick him up. When I’m on call, I leave at 4 p.m., to head over to the VA, to get sign-out from the attendings covering the psychiatric emergency room and consult service. Nights at the VA tend to be very educational – as there is always such diversity. There is always an attending on call to help staff cases and answer questions.

Reflections from a Day in the Life of a PGY-3

The third year of residency was unique as the first time in training that the majority of my time was spent in the outpatient setting. Each day, I had the opportunity to work in a different setting in the community, at the VA and even in a subspecialty clinic. The diversity of these experiences was made possible by the impressive range of clinical sites available to our third-year residents. Moreover, the program allowed me to tailor my year, in part, to accommodate my unique interests and fulfill the program’s academic requirements. In my case, this flexibility was especially relevant. Prior to beginning my PGY-2 year in Psychiatry, I completed two years of Internal Medicine training. I have subsequently decided to fast track into Child and Adolescent Psychiatry. The PGY-3 year afforded me the opportunity to maximize the adult patients that I was able to see while exploring my extracurricular and career interests. Additionally, the year supported another dramatic change in my life – a growing family. In February of this year, I was able to take a three-month maternity leave with my beautiful baby boy.

Overall, it was a very busy but exciting year. On Monday mornings, I worked at the Louis Stokes Cleveland VA Medical Center where I saw my own panel of over 65 patients. On Tuesdays, I worked at the Centers for Families and Children, a busy integrated health center in downtown Cleveland. On Wednesday and Friday mornings, I attended a wide variety of applicable didactics. On Wednesday afternoon, I worked at University Hospitals in a clinic for patients with intellectual and developmental disabilities. On Thursdays, I had time to see one of my psychotherapy patients and work on my responsibilities as assistant editor for the American Journal of Psychiatry Residents’ Journal and assistant editor of Research Watch – our resident-lead academic journal review. On Thursday afternoons, I worked at the Case Western Reserve University Health and Counseling Services Center. During the week, I remained engaged in the Leadership in Medical Education clinician-educator track and the program QI project requirement.

Throughout the year, I had the opportunity to establish and maintain therapeutic relationships with a rich and diverse range of patients. I was also grateful to learn from a host of exceptional mentors, supervisors and field leaders. Given a circuitous path through training (and a few unexpected life turns), I could not have asked for a more supportive training program.

Reflections from a Day in the Life of a PGY-4

A day in the life of a PGY-4 is amazing. Your schedule is your own to pursue interests more deeply or explore a whole new area of psychiatry. For myself, I chose to continue some of my community outpatient clinics and it was really rewarding to see how relationships with patients evolve over the course of two years.

The fourth year is also an opportunity to practice being an attending and develop your personal style of interaction with patients, the interdisciplinary team and office staff. For example, what do you say to the patient whose OARRS [Ohio’s controlled substances report] looks suspicious? How do you respond to office staff that checks in a patient who is 15 minutes late to their 20-minute appointment?

Overall, my last year of residency has been busy - but only because I didn’t want to waste the learning opportunity our department provides with its numerous electives (it was almost too hard to narrow it down given that there are only so many days in the week).

Additional Reflections from a Day in the Life of a PGY-4

The great thing about the fourth year of residency in our program is that it's highly customizable, consisting mostly of elective time, allowing each resident to pursue clinical and research experiences they prefer. I served as chief resident for education and research during my fourth year and consistent with my ambitions for a future research career in academia, I utilized most of my time for research, scholarly work, teaching and administrative work. My clinical responsibilities consisted of Resident Psychotherapy Clinic, in which I followed weekly with my two long-term psychodynamic psychotherapy patients, and the FIRST clinic, devoted to patients with first-episode and early psychosis. The elective rotation at FIRST clinic did not exist previously, and I had created that elective given my clinical interest in that patient population. This is another instance of how the program is willing to create new experiences for the residents if they do not already exist.

I utilized my research time by collaborating with researchers in the department. I became the principal investigator of a patient survey study in the psychiatry inpatient and community outpatient setting investigating how the experience of psychiatric hospitalization impacts subsequent trust in the outpatient psychiatric provider, and forthcomingness about psychiatric symptoms such as suicidal thoughts. I became involved in a clinical trial of pioglitazone use in bipolar depression and conducted secondary analysis of research data from clinical trials in the department. I used further scholarly time to work on a manuscript on the subject of philosophy and psychiatry.

I was enrolled in the Leadership in Medical Education (clinician educator) track of the residency, and my educational project consisted of a didactic course on the philosophy of psychiatry, which I had developed and taught to the psychiatry residents in the program. I also utilized my educational time to develop a didactic series for PGY4s: neuroscience for psychiatrists.

I found this mix of clinical, research, scholarly and administrative work highly rewarding and plan to seek this in my future career. I am very glad that the flexibility of the program allowed me to be so productive.