A Day in the Life of...
Shariff Tanious, M.D., PGY1
Hello, my name is Shariff Tanious and thanks for checking out IU Psychiatry Residency! In our program here at IU, the first year is split in half between psychiatry and non-psychiatry rotations. I began the year on the non-psychiatry rotations, which include Internal Medicine, Emergency Medicine, and Neurology. On Psychiatry, you will get the opportunity to rotate in adult inpatient units at the VA Hospital, IU Health Methodist Hospital, and Eskenazi Hospital, which serves as Marion County’s safety-net hospital.
Currently, I’m rotating at the VA Hospital on Internal Medicine. My day begins around 6:30-7AM when I get to the hospital and read up on my patients and get ready for the day. At 7:30, I get sign out from the night team and they fill me in on anything that may have happened to my patients overnight. We then round together as a team, which includes the attending, a senior resident, another intern, and several medical students. This is a great opportunity to learn more, not only about your patients, but about other patients as well! We use a mixture of table rounds and discovery rounds depending on the day in our call rotation and how many patients we have on our service.
After rounds are over, I spend the rest of the day going back and seeing patients again, putting in orders, and working with medical students. It’s a great environment at the VA hospital, taking care of veterans and working with the staff there that is committed to that cause. There are also many opportunities while on medicine to perform or observe procedures and get totally involved in the care of your patients. Even though I’m a psychiatry resident, I’m treated like any other resident and really feel like a part of the team. Additionally, on Wednesdays are intern Internal Medicine didactics. This is a nice chance to get to learn about some other topics that you may not have encountered yet while on the wards, and is a great refresher for when you have to take Step 3.
I take call at the VA on a 4-day rotating schedule. While on call, your team is responsible for admitting patients from the emergency room until 7:00. There is a night float team that covers any overnight admissions for the team. On the other days you may still get admissions, but never past 4:00. On pre-call day, as soon as I’m finished with my work, I can sign out to the call team and get some rest before call the next day! It’s a busy, but rewarding rotation that has made for a nice transition from medical student to resident.
One of the great things about the residency program at IU is the commitment to resident education. On Fridays we have protected didactics from 11am – 3pm at the Neuroscience Center. This is also a great chance to catch up with the other residents on different services as well as have a great lunch that is provided by the department! We have intern specific didactics as well as ones for all the residents. I look forward to Fridays as a chance to catch up with everyone and enjoy the friendships I have made so far.
During my time off, I like to spend time with my wife and daughter getting to know Indianapolis better! We live west of the city, near Eagle Creek Park, which has many wonderful trails for hiking and water activities (which is great to have, having moved to Indianapolis from the beach in Virginia!). We also love taking our daughter to the Children’s Museum of Indianapolis which is an amazing museum with wonderful programming and exhibits for kids and adults! We also like spending time at the zoo, which is also not far from downtown. Indianapolis has shown itself to be a friendly city with all the amenities of a big city, but with all the charm of a small town. There are many wonderful restaurants and activities that are going on throughout the city and I’m so glad that I chose the program here!
Danielle Patterson, M.D., PGY2
Second year in this residency program is a nice mixture of inpatient and outpatient settings with a variety of experiences. The residents are in two groups, with half of you working more in the outpatient setting for 6 months, while the other half are doing more inpatient work for 6 months. Everybody will then switch in January. This is a fantastic balance as it gives you the chance to solidify the knowledge and experience you gained during intern year with inpatient experience, but it also sets you up with the opportunity to begin your transition to outpatient work, which you will do your entire third year of residency.
Right now I am in the outpatient setting working in the substance use and geriatric clinics. Those of us in the outpatient clinics have slightly different schedules but we they all average out to 2.5 days in substance use, 1.5 days of geriatrics, ½ day of didactics and a full day of CBT. Our substance use clinic is at the VA so it has been a great opportunity to learn about substance use disorders while also treating mental health issues. Our attending is passionate about teaching and in addition to learning about how to start suboxone, methadone and naltrexone she teaches us about how to manage an outpatient healthcare team. In our geriatric clinics we have an opportunity to learn about the intersection between geriatric medicine, neurology and geriatric psychiatry. This clinic has been a great opportunity to learn how to work on time management and proper documentation. We have a whole half a day dedicated to didactics. Currently, we are doing a block of neuroscience lectures that have involved building brain models and a complete brain dissection! Friday is my favorite day of the week because we get to see our entire residency and learn about CBT. In the mornings we have lectures about CBT and then we put our skills to use with patients in the afternoons. Mid-day we have grand-rounds or PRITE review, residency business meeting including free lunch, and power hour.
The second half of the year my rotations will be one to two months in length. During the Forensics rotation you spend your time with forensic psychiatrists learning about how this sub-specialty of psychiatry intertwines with the legal world. Each day, you are challenged with applying your medical psychiatric knowledge to legal situations. To do this, you will visit various jails in and around Indianapolis and work with patients who are currently inmates. You also get to work at Logansport State Hospital, which is the only forensics hospital in the state. For the most part, the patients you will see are being assessed for their competency to stand trial and to evaluate what their mental status was at the time of their legal offense. I will also have a rotation at Methodist Hospital where I will administer ECT and work in the psychiatric ER for a month. For two months I will get to head back to the VA to work on the consult team. The nice thing about second year is that we also get to start working with children. We have one month of consult work at Riley Children’s Hospital and a month at Methodist’s inpatient Child and Adolescent Psychiatric unit.
Perhaps the biggest change from intern year to second year is call. Second year will be the first time you are spending the night at the hospital, and while this can seem daunting at first, you have a tremendous amount of support. There will always be an upper level resident who has been designated as the back-up call person who you can reach out to at any time, with any questions, no exceptions. There will also be an attending on call who can provide additional means of support and serve as a great resource. Your responsibilities are centered around the VA hospital, where the call room is, and this is more or less your home base. You will also cover University Hospital, the Neuroscience Center clinic crisis line and Riley Children's Hospital (as back-up for the Child Fellow). Call duties are roughly every 6-7 days and during the week run from 4:30pm - 8am the following morning. On Saturdays and Sundays, call is 24hrs, 8am-8am. Weekends and Fridays are 'home call' meaning you can receive calls from home and do not need to report to a site until a patient needs to be seen. The day following your call day is a 'post-call' day where you are not expected to work or attend lectures.
I was born in Indianapolis and have lived here most of my life so I feel somewhat obligated to enlighten my fellow residents about all that the city has to offer. This year I was elected Social Chair so I send out a weekly email detailing all of the exciting events going on in the city over the weekend. One of the great things about our residency is that the residents get along really well both inside and outside of the hospital. At the request of some of my colleagues I am working on getting a supper club, a resident happy hour, and a trivia team going!
Susan Conroy, M.D., Ph.D., PGY3
Hi, my name is Susan and I’m a PGY-3 resident in the general psychiatry program here at IU. Third year clinical training is mostly outpatient, so the schedule varies daily. One of the great things about our program is the wide variety of patients we see, and this is reflected in my weekly clinical schedule. Our schedules are divided up by half days, with 3-5 patients generally seen each half day in each clinic. Monday afternoons I work at the VA, seeing veterans with various psychiatric disorders including PTSD and depression. Tuesday mornings, I work at the Prevention and Recovery Center for Early Psychosis (PARC), a clinic that is part of Midtown Mental Health-Eskenazi hospital. There I see young adults who have developed a psychotic illness in the past several years. This is a unique clinical experience and it particularly interesting to see how physicians, nurses, case managers, pharmacists, and others can all work together to improve the lives of these young people. Wednesday mornings I am at Goodman Hall, the home base of our psychiatry department, seeing primarily adults with difficult-to-treat mood disorders, as well as some patients with psychotic illnesses and developmental disabilities. Thursday mornings I have Adult Psychotherapy Clinic, also at Goodman Hall, where I do weekly psychodynamic psychotherapy sessions with a patient, and watch other residents during sessions with their patients. In this clinic, residents learn from our faculty preceptors, our patients, and each other. Friday mornings I work in the Crisis Intervention Unit at Eskenazi, a psychiatric emergency and urgent care center, so these patients are often more acutely ill than in my clinics. We also have time set aside for formal didactics, Wednesday afternoons for general psychiatry and Thursday afternoons for psychodynamic psychotherapy. During all four years, Friday mid-day is reserved for Grand Rounds, Resident Business Meeting (lunch provided!) and Power Hour, a lecture/discussion series. It’s great to see everybody all together on Fridays after being at different locations during the week.
I’m on the Research Track, which provides protected time and mentoring for residents who are interested in becoming physician-scientists. Monday mornings, Tuesday afternoons, and Friday afternoons I have set aside for research. I am involved in several research projects in our department, so I spend this time brainstorming projects, meeting with faculty mentors and research groups, analyzing data, reading the literature, and working on abstracts and manuscripts. Sometimes during these times I also help out with research studies, by doing mental status and physical exams for research participants. So far my main work has been on brain function in patients with early psychosis. I presented some of this work at a national meeting last May and plan to present at another one this December (in Florida—hooray!). Our program does provide time off for educational meetings. Additionally, we have monthly research track meetings where research faculty and interested residents get together and take turns presenting research studies to the group.
I did both my MD and PhD in neuroscience at IU, and I am fortunate to continue my training into residency here at IUSM. Some of the major strengths of our program include: collegiality (Hoosier Hospitality is real!), flexibility in tailoring education to each resident’s interest, a wide variety of training sites, and the never-empty candy jar at our program coordinator Jeanette’s desk.
Rusty Stennett, M.D., PGY4
Our curriculum is currently structured such that PGY-4 residents get to make up their own schedules, and it has been quite interesting for me to see how my classmates have handled that differently. Some chose to be junior attending on an inpatient unit for a few months and then do a lot of outpatient clinics or vice versa. Some residents chose to do 8-12 different blocks of inpatient or consultation based activities. Some chose more research activities. I have elected to do outpatient continuity clinics for the duration of the year, keeping some clinics from the previous year and adding some new ones to ensure I get a great variety!
On Mondays I go to the VA and work in the PRRC, which stands for Psychosocial Rehabilitation and Recovery Center. This is a multidisciplinary clinic geared towards veterans suffering from severe and persistent mental illness; it’s common to see schizophrenia and bipolar disorder here. Because many of the patients come to the clinic multiple times during the week, it has the feel of a close community.
Tuesday is a day I use to gain more experience in outpatient child psychiatry. One of the attending physicians who works on the child psych inpatient unit also works in a private practice outpatient setting, and allowed me to join him in his outpatient clinic. It has been a great learning experience so far. I’ve seen ADHD, mood disorders, psychosis, and some developmental disorders during this broad experience. The attending is a pleasure to work with and we have great discussions about the patients we see together.
Wednesdays are pretty unique. One of our outpatient sites has a therapy room with a one sided glass window so residents and staff can observe anonymously. This is really great for learning; we discuss psychotherapy and receive feedback from both peers and instructors on the same day. My classmates and I chose to do this clinic together in order to improve upon our psychotherapy training. Typically each of us will see one or two patients, and then view the other residents doing therapy with their patients.
I spend Thursdays at the Midtown Adult Addictions clinic providing psychiatric and substance dependence care for dual diagnosis patients. I staff with thoughtful and supportive attending physicians. Each day we have a team meeting, during which psychiatrists, nurses, therapists, and case managers all come together to discuss how we can best serve the most challenging patients.
Fridays are for didactics and quality improvement projects at one of our outpatient sites, as well as the regularly scheduled grand rounds, business meeting, and resident led power hour.
I’ve enjoyed my time here in Indianapolis immensely. This program affords a good balance of work and personal time. I have found the residents to be a close bunch and will particularly cherish the time many of us have spent together playing in kickball, soccer, and basketball leagues. I’m so impressed with what Indianapolis has to offer both personally and professionally that I’ve chosen to stay here to pursue a career in general adult psychiatry at the conclusion of residency.