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A Day in the Life of...

PGY1 PGY2 PGY3 PGY4

Seth Judd, D.O., PGY1

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My intern year at Indiana University (IU) has been very busy but also very exciting.  Like other programs, the PGY-1 schedule is split up into six months of psychiatry and six months of off-service rotations, which include three months of IM or pediatrics, one month of EM, and two months of Neurology.  Where IU differs from other programs is in the breadth of diversity offered during the psychiatry months.  Each intern is given the opportunity to spend two months at Larue Carter Hospital, two months at Wishard Memorial Hospital, although, this location will soon be changed to the new county Eskanazi Hospital, and two months at the Richard L. Roudebush VAMC. 

I started my PGY-1 at Larue Carter Hospital.  It is an old state hospital that provides services for adults, the majority of which are psychotic, and children who are dealing with severe, chronic psychiatric illness often accompanied by complex psychopharmacology issues.  Larue Carter is also a facility that emphasizes teaching and research, providing advanced training to psychiatric residents and fellows, psychologists, and medical students.  Furthermore, it is home to the Psychotic Disorders Clinic, which oversees ongoing research and clinical trials of new and existing treatments.  Training at this facility has been a great experience.  Most of the patients on my current unit have been here for months, but many have been here for years; several over 10 years!  With only a few admits/discharges per month, this facility offers a chance to establish good rapport with the patients, to hear their stories, and to better see the long term effects of your treatment plan.  In addition, there are a few deaf patients on the unit, which provides a unique opportunity to work with and learn from this amazing, but often misinterpreted, population.  Another aspect of Larue Carter’s diverse offerings is their group meetings, such as the borderline groups, that are open for resident attendance.

A typical day at Larue Carter starts around 8 am.  The medical students and I will check in on patients until 9 am when we start rounds with the treatment team.  The team includes the attending, a psychologist, two social workers, nursing staff and sometimes other professionals, such as a dietician or a drug and alcohol counselor.  After rounds we spend time with the attending discussing patients, their treatments plans, and any necessary changes that need to be made.  During the afternoon, I write notes and see patients with the students.   I typically work with 2-3 students, and Larue Carter allows ample time for teaching, which I really enjoy; it not only helps the students learn during their psychiatry clerkship but helps strengthen my clinical knowledge.  A few days out of the month I assist in filling out a forensic note for patients who are incompetent to stand trial.  Occasionally, I go the City County Building to testify in court commitment hearings; this is available at other hospitals as well.  It’s a wonderful experience to have as an intern to learn about the commitment process, to gain confidence in testifying, and learn about the legal system, specifically its relationship with the field of psychiatry.    The attendings I have worked with here have been very supportive, and they love to teach.  It is a great place to learn from both the staff and the patients.

During my PGY-1 year I also have the opportunity to train at Wishard’s Crisis Intervention Unit (CIU).   The CIU is the location for on-call training during the intern year.  Call is typically once a week, beginning at 4:30pm and going until 10:00pm.  In addition to seeing patients at the CIU, you may be called to see patients in the ER, to provide consults on medicine floor, to evaluate for capacity, and to see patients on the inpatient unit and in the Annex (Midtown Triage).  Both the social workers and the attending with whom you staff are very friendly and helpful.  Each night you are on call you might find yourself staffing with a different attending, which provides a great learning atmosphere as each attending imparts their own unique skills, perspective, and support.

Didactic days are currently being held on Fridays from 11:00am – 3:00pm.  The first hour starts off with PRITE board review overseen by the residents, typically fourth years and attendings who just recently graduated.  This review hour is held during the summer until Grand Rounds begin in the fall.  From noon to one is the Resident Board Meeting (RBM).  During this hour we get fed (free food!) and discuss many topics concerning our program.  These include any upcoming social events and conferences but also any concerns at the various sites at which we train.  RBM offers residents a chance to discuss these issues as a team.  Next, from 1-2pm, is Power Hour.  During this hour faculty teaches the entire program but sometimes residents will lead a discussion on a recent research paper.  The last hour we split into our prospective years and have a faculty-led lecture.  Didactic time is protected time, and so it offers the residents a chance to take a break from the busy clinic work and focus on the lectures at hand.

On a different note, I wanted to comment briefly on the city of Indianapolis, since location can be a decisive factor when mapping out a career.  Having grown up near the west coast and having lived on the east coast for several years, I was initially a little skeptical about living in the Midwest for at least four years.  However, during my short time here, the city has really grown on me, and I’m finding out there is a ton of exciting things to do.  Whether you’re single or married and have a family, Indianapolis has a lot to offer to help relax from the busy work schedule, including sporting events, museums (I love the IMA), tons of great restaurants, outdoor activities, and musical events.  Plus, this is the Midwest; it’s cheaper, which means you’ll have more money to actually do these things.  And there are plenty of great places just a few hours away to visit, like Chicago, Cincinnati and St. Louis. 

In closing, I’d like to thank you for taking the time to check out the psychiatry program at Indiana University.  It is a great program that is very supportive with plenty of opportunities to teach.  You get to work with an amazing group of residents, and there is a plethora of ongoing research – top 25 for NIH funded research.  We have an array of diverse clinical training sites, a new Neuroscience Center with emphasis on collaboration of neurological services, and a city that has something for everyone.  I hope you will take into consideration all of these factors as you apply during this upcoming application cycle, and I look forward to meeting you soon.

Caitlin Adams, M.D., PGY2

caitadam.jpgIt is hard to believe that intern year is behind us, but this year is off to a great start!  Second year has been split roughly into two blocks: six months inpatient, six months outpatient psychiatry.  The first six months I rotate through two months of child and adolescent, two months of adult consultation-liaison, 1 month of emergency psychiatry, and 1 month of forensics.  The second six months will be outpatient clinics in addiction, geriatrics and cognitive-behavioral therapy.  I am currently on the child and adolescent psychiatry consult service at Riley Hospital.   I arrive around 8:30am and read about my patients, and then the team meets to table round on the patients.  The team is interdisciplinary and includes an attending psychiatrist, psychologist, psychiatry resident (me!), psychology intern, two social workers and two medical students.    Then we go see new consults, meet with primary teams, etc.  The day ends around 4:30 pm.  There is plenty of time to teach medical students, write notes, revisit patients, and talk to the primary teams. 

On Wednesdays, I ride the people mover for about five minutes to Goodman Hall for didactics with my fellow second year residents from 1:30 to 4:30 pm.  On Fridays, from 11:00 am-2:00 pm, I return to Goodman Hall for grand rounds, resident business meeting and “power hour,” which is an hour lecture on an interesting topic in psychiatry.   Past lectures have brought neurologists to talk about impact of psychiatric diagnoses on movement disorders, a toxicologist, who spoke about serotonin syndrome and neuroleptic malignant syndrome and once a month we have “This Month in Psychiatry” where we talk about new research/articles. 

I think another important point to mention about residency here at IU is the incredibly faculty.   We have an amazing new chairman, Dr. McAllister who is approachable and very interested in the residency and residents.  Dr. Chambers, our program director, and Jeanette Souder, our program coordinator, are both incredible and always available for any reason.  I have also had the chance to get to know several attending physicians through the Indianapolis Psychiatric Society that meets on a monthly basis and talk with my faculty mentor frequently to discuss patients, psychiatry and to exchange movies and restaurant suggestions.

Now onto what everyone wants to know about, overnight call! As first years, we took call from 4:30-10:00 pm at Wishard Hospital with staff in house for questions. This year, we are given much more autonomy now that we have a year behind us. No need to be nervous, there is always an attending physician that is available by pager/phone to staff cases and answer any questions. In addition, there is also an upper level resident that is on back-up call and is also available by pager/phone to answer any questions or help out in any way. We are based at the VA, and cover the VA, Riley Hospital (pediatric hospital), and University Hospital. This may sound overwhelming, however a typical night will be around two VA ER consults, and you may have to drive to either Riley or University once during a call.  One of my favorite parts of this campus is that there are so many training sites with every diverse patient populations at each facility.  And, all of the training sites are in such close proximity to one another.  Each of the hospitals that we cover are within walking distance, or are also are easy to drive from one parking lot to another.  Weekends are home call and you are given a full post-call day after a night on call.

I can’t finish talking about a day in the life of a resident without mentioning life outside of work.  It is not just the program that makes me excited to be here, but the city itself as well.  I LOVE Indianapolis.  Dr. Levy and I are currently the social chairs, and have no problem coming up with fun and exciting things to do around the city.  For the sports fans, we have the Indianapolis Indians (minor league baseball), Indianapolis Pacers (NBA), Indianapolis Colts (NFL), Indy 11 (soccer), not to mention a professional ultimate Frisbee league!   For the arts fans, the Indianapolis Symphony is fantastic and has “Symphony on the Prairie” outside during the summers.  The Indianapolis Museum of Art always has incredible exhibits, recently they had an Ai Weiwei exhibit that traveled only to a handful of cities across the US!  They also show movies on the lawn outside in the summers, and play classics in their indoor theatre throughout the winter.  For the food fans, Indianapolis has incredible restaurants that are not your typical run-of-the-mill chain restaurants.  Napolese has incredible wood-oven pizzas, Yats has delicious Cajun-creole food, and I could eat one of everything on the menu at Mesh on Mass.  If you enjoy the outdoors, there is a cultural trail downtown that is great for running or biking, and the Monon trail connects downtown to the northern neighborhoods.  There is a beautiful canal downtown that is nice to walk along during the summer and sometimes you will be able to hear a concert outside at White River Park.   And, Indianapolis has the largest half-marathon in the country to celebrate the Indy 500, and we will soon have the largest orangutan exhibit in the world at the beautiful Indianapolis zoo.  Anything you like to do, we have it here in Indianapolis!  Please don’t hesitate to contact me or any of the residents with questions about psychiatry in Indianapolis!

Greta Krause, D.O., PGY3

gkrause.jpgMy name is Greta Krause and I am a current PGY III at IUSM Psychiatry Residency. The third year of residency is primarily focused on outpatient therapy which includes learning to provide medication management as well as psychotherapy.  There are many opportunities that provide diverse patient populations as well as specific psychiatric disorders.  A unique aspect of third year is the ability to begin defining an area of particular interest within the field of psychiatry. 

I am primarily working at Neuroscience Goodman Hall in a variety of clinics, each unique in the experience they offer in terms of patient population, pathologies and working environment.  I have clinics working with primarily bipolar patients, a mood disorder clinic, anxiety disorders, and traumatic brain injury patients.  These clinics all provide very diverse experiences that would be difficult to find in many other residencies.  The attending’s all have a passion for teaching as well as the psychiatric disorders they specialize in working making this an exciting and rewarding learning experience.   I also have a psychotherapy clinic that allows my therapy session to be viewed by fellow residents as well as a supervisor.  This is not as nerve racking as it sounds- it’s actually fun!  Receiving their feedback as well as being able to watch other’s interview style has been a really great experience. 

Didactics continue in the third year continue to be very informative and more interactive/case-based.  We also attend a weekly psychodynamic psychotherapy lecture that involves learning the history of psychoanalysis as well as how to apply it to our specific patients.  This is a wonderful opportunity to share in learning from multiple people and their different styles and viewpoints on treatment. 

Lastly, Indianapolis is a great place to live and work.  Living downtown has not only provided convenience for me in a short commute, but has allowed me the chance to see all that the city has to offer.  Something is going on all the time!  It is definitely not a boring Midwest city but rather one that is lively and full of activities that are sure to fit your interests!

Niclaire Neely, M.D., PGY4

NeelyN003_copy.JPG  It’s hard to believe this is my last year of Psychiatry Residency!  The PGY-4 year is 12
  months of electives. I decided to do outpatient clinics for the first six months followed by
  6 months of (mostly) inpatient rotations. I’ve continued some of my clinics from 3rd
  year, like the OEF/OIF clinic at the VA (patients have been out of the military less than 5
  years).  I’m also continuing in the integrated care clinic which uses the medical home
  model. In addition, I added some new clinics and faculty have been enthusiastic with
  creative ideas to further my education. For example, I’m continuing with my early
  psychosis clinic, but in a different way. It’s the same clinic, but I now see a
  predominantly Spanish speaking patient panel.  I’m also helping to teach a bilingual group of first year medical students in the Introduction to Clinical Medicine class. It’s a clinical skills class that has a component which emphasizes medical Spanish.  Since I was a Spanish teacher before I went to medical school, I love it!

I’m at the state hospital  one half day per week doing a psychopharmacology elective working with some patients with refractory illness. It gives me a chance to really dig through the records of  these patients, talk to them and think through what could be the next steps in their treatment plans (with the help of
very knowledgeable faculty).  

I would be remiss if I didn’t mention that a very generous faculty member is helping me start a telepsychiatry clinic at the VA. We’re very fortunate to get exposure to the medical home model and telepsychiatry, which are becoming more common as time goes on.

During the second six months, I’ll follow a more traditional model with month long rotations. I’ll be doing two months on the inpatient unit at the county hospital. It was where I started on psychiatry as an intern and I want to go back to get a sense of how much I’ve learned over residency. I also plan to spend some time on consults and am currently developing an elective that allows me to focus on the business aspects of medicine.  There are many options for electives and the flexibility to create your own, if you desire.

I should mention I see therapy patients too! For me, it was important to incorporate therapy throughout training. We focus on Cognitive Behavioral Therapy in PGY-2 and Psychodynamic Psychotherapy in PGY-3. I’m continuing into PGY-4 with electives. I have an individual therapy supervisor and I’m in a clinic that is directly supervised. In that clinic, the supervisor and other residents watch you do therapy from another room and you’re able to get direct feedback after the session. It’s really helpful and not intimidating at all.

Like many people, my interests have changed during residency. IU is a program that is big enough to allow for growth in different areas, but has approachable faculty who, in my opinion, have been helpful in developing those interests and finding new opportunities in the fourth year to develop them even
further.

As for life outside of work (and yes, there is a life outside of work here!), we live by a large park and there’s plenty of opportunity for sailing, bike riding, running and anything outdoors. Indianapolis has plenty of stuff to do like the Indianapolis Museum of Art, the Indianapolis Zoo, and some cool neighborhoods with lots of great shops and restaurants.  I’ve also been about to cross some items off my “Bucket List” like seeing Wrigley Field (only 3 hours away!).