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A Day in the Life of...

PGY1 PGY2 PGY3 PGY4

Kevin Masterson, M.D., PGY1

MastersonKevin004_copy.JPG  I was assigned to the VA inpatient Psychiatry unit for my first couple months of
  residency.  For the program here at IU, the year is split into half Psychiatry and half
  medicine (3 months inpatient medicine, 2 months Neurology, 1 month ER).   The
  Psychiatry half is divided into 3 different, 2-month long rotations: 2 months inpatient at
  VA, 2 months at Larue D Carter Hospital for long term psychiatric patients, and 2
  months at the newly built Eskenazi Hospital which is Marion County’s safety-net
  community hospital.

  My days at the VA generally start at 7am when I first check to see if there are any important updates on my patients (level of medication compliance, episodes of agitation/disruption on the unit, pertinent labs/consult notes, ect) and then check to see if any new patients have been admitted overnight so I can review their H&P.  Around 7:45 I will meet with the PGY2 overnight call resident who will fill me in on calls they received from the night nurse about my patients or what their impressions are of the newly admitted patients.  The Psychiatry inpatient unit at the VA has 16 beds total.  I am currently working at the VA with another resident so we each have about 8 patients at one time.  The unit stays busy as we typically remain at capacity. 

On Tuesdays-Thursdays we have “morning report” at 7:45, which is an informal 20-30 minute resident-led didactics session led by PGY1s and PGY2s.  Often the morning report revolves around an interesting case study or article that was found.  After finishing didactics I check in with the medical students and PA students rotating with us to see if they have any questions.  After heading to the unit, I pre-round on all my patients which usually takes a bit over an hour.  We meet as a team (residents, students, attending, pharmacist, social workers, nursing staff) at 9:30.  Working at the VA is a very busy time, but my favorite part is all of the people I get to interact with on the treatment team.  There is a very strong sense of comradery as we find time to joke around a bit each morning.  After rounds we conduct interviews with the new patients that came in overnight.  The intern leads the interview while the attending staff observes and adds any follow-up questions at the end.  Thus far this has been my favorite part of the VA experience.  I’m learning a lot about using different styles of interviewing and how useful it can be to change styles, if needed, during the interview.  After interviews are complete, I make sure all orders are placed and begin writing my notes as well as checking in with the medical students and delegating appropriate tasks to them.  The VA is a great rotation for medical students to have a lot of autonomy so I try to encourage them to be as involved as possible.  At about 4:30-5pm I will meet up with the night call resident for changeover and update them on any pertinent upcoming labs or potential issues they may encounter overnight.

Fridays have a different schedule due to protected meeting/didactic time from 11-3 at Goodman Hall.  This time is filled with Grand Rounds (PRITE review in the summer months), a resident business meeting, an educational talk for all the residents, and then a PGY-1 only lecture.  This time is a nice opportunity to catch up with your fellow residents, especially if you are currently in the non-Psychiatry half of intern year since it helps keep you grounded with our program.  Also there is free lunch provided, which is an incredibly important detail if you think of food as much as I do.  It is a very relaxed space so residents from all years in the program openly interact with each other and check-in on each other’s progress as well as sometimes plan some weekend hangout time.

I live in downtown Indianapolis which is wonderful because my morning commute is sometimes 5 minutes if the gods of the green lights are kind to me that day.  Downtown Indy has a lot of great restaurants that I continue to work my way though.  Just yesterday I walked into downtown with a friend and got breakfast and then went to Gen Con, which is a pretty huge board/card game convention that occurs each year.  The cultural trail downtown is right next to my apartment and gives me an easy route to run to one of the local parks.  The Broad Ripple area to the north of the city, and the Fountain Square area to the south, are both bustling and have lots of additional opportunities for food, sightseeing, dancing, comedy clubs, and more.  I was a medical student at Indiana University School of Medicine and have not yet tired of the city and am continually glad I decided to stay in the area to work with this program filled with hardworking, yet relaxed and well-grounded people.

Anne Wessel, M.D., PGY2

WesselAnne003_copy.JPG  Second year in this residency program is a nice mixture of inpatient and outpatient
  settings with a variety of experiences. The six residents are in two groups, with three
  of you working more in the outpatient setting for 6 months, while the other three
  residents 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 spending the first 6 months of my 2nd year on inpatient rotations. July 1st for me started with the Forensics rotation that lasts 1 month. This experience is unlike any other during residency. 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. One thing I really enjoy about this rotation is how each day's schedule is different! Within my first week of the rotation, I had been to three different jails, in addition to Logansport State Hospital, and had already worked with several different amazing forensic psychiatrists.

When this rotation is complete, I will move on to Methodist Hospital to do ECT and work in their psychiatric ER for a month, then head to the VA to work on the consult service for 2 months, followed by 1 month of consult work at Riley Children's Hospital and finally a month at Methodist Hospital of inpatient work on the children's unit.  A great variety.

One thing, however, that is a constant during your 2nd year are the didactics. Each Wednesday afternoon from 1:30-4pm, our PGY-2 class meets at the Neuroscience Center for lectures. Currently, we are doing a block of neuroscience lectures that have involved building brain models and a complete brain dissection! Fridays we meet as an entire residency program from 11-3pm for Grand Rounds, our resident business meeting and 'power hour' at the Neuroscience Center. These meetings are invaluable times where we all come together and share our current experiences from work, learn new things about psychiatry, but also get to catch up on life outside of the program!

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 Riley Children's Hospital, University Hospital and the Neuroscience Center clinic crisis line. Call duties are roughly every 4-6 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.

Overall, living and working in Indianapolis has been great. I had never been to the city prior to my interview, but since moving here, I have had only wonderful experiences. My husband and I bought our first home in the Broad Ripple area and have loved being able to take part in all of what Indianapolis has to offer! From going to the NCAA Final Four and the Indy 500, to eating out at all the great restaurants and talking walks on the Monon trail with our dog, this is a great environment to be in and I am so glad I chose to come here!

Joseph Niezer, M.D., PGY3

Niezer_Joseph_04.JPG  Welcome to the IU Psychiatry Adult Residency page!  My name is Joey Niezer. I
  attended IU for medical school and had the good fortune to remain at IU for my
  residency.  I have been asked to share what “a day in the life” of a PGY3 resident looks
  like and will do my best to paint a picture! In the PGY3 year of our residency we have
  the opportunity to work in several, diverse outpatient clinics that offer exposure to a
  wide range of patient populations and psychopathology.  Each half day of the week,
  with the exception of Wednesday and Thursday afternoons which are set aside for
  didactics, we have the opportunity to work in a different clinic. We are assigned to
  these clinics throughout the year and thus are able to experience continuity of care with the patients we see beginning in July and continuing through the PGY3 year.  My personal schedule is as follows:

On Monday mornings, I work in the Geriatrics clinic at the VA. This clinic is an elective for me and one I am very excited to be a part of. I have the opportunity to not only treat psychiatric disease in the geriatric population but also to gain more clinical experience managing the co-morbid neurologic and medical conditions that may be affecting mood, cognition, perceptual disturbances etc. under the supervision of a geriatrician with an internal medicine background.  On Monday afternoons, I am in my other elective half-day clinic doing tele-psychiatry through one of the Community Mental Health Centers located on the northeast side of Indianapolis. I am able to see patients via a setup analogous to Skype and perform med management for patients who might not otherwise have access to a psychiatrist given the rural setting in which they reside. Given the active and worsening psychiatrist shortage, the opportunity to gain exposure to tele-psychiatry is an invaluable skill for graduating residents to have so that we as a profession can improve access for our patients, particularly in rural communities.

On Tuesday mornings, I work in a heavily research-based clinic that focuses on the treatment and prevention of first-episode psychosis in adolescent and young adults. It’s a fascinating patient population to work with and the ongoing research in this clinic has already helped me to think about the neurobiology of schizophrenia in greater depth as well as appreciate how much more work is needed to further elucidate our understanding of this devastating disease. Tuesday afternoons, I work in a primary care clinic in which the psychiatrists work (literally) right alongside the primary care physicians. This model (known as the medical home model), allows both primary care physicians and psychiatrists to work more closely together to stabilize and improve the functionality of our common patients whose psychiatric and non-psychiatric conditions often worsen each other (i.e. untreated depression leading to poor diabetes management, hypoglycemia/hyperglycemia affecting mood/sleep/appetite).  On Wednesday morning I work in a clinic that primarily treats patients with severe mood d/o’s often with comorbid Borderline Personality Disorder.  This is a particularly challenging clinic given the severity of disease, but as such provides excellent educational opportunities. As noted above, Wednesday afternoons are reserved for didactics, which in the PGY-3 year delve deeper into the diagnosis, epidemiology, neurobiology and treatment options of psychopathology.

My Thursday mornings are spent at the VA in a general adult psychiatric clinic where I see patients with a myriad of conditions ranging from mood disorders, to OCD, PTSD, substance abuse, and personality disorders.  From 1-3 PM on Thursday afternoons the PGY-3 class has psychodynamic psychotherapy didactics in which we discuss our individual therapy patients as well as various readings on the topic of psychodynamic psychotherapy.  On Fridays, myself and two other PGY-3 residents see our psychotherapy patients. The room in which we see patients has a double-sided mirror which allows us to observe each other doing therapy, which while initially terrifying has proven to be an excellent way for us to learn from each other and provide better care for our patients.  As the other residents have noted, from 11-2 on Friday’s we meet as an entire residency program for Grand Rounds, our resident business meeting and 'power hour' at the Neuroscience Center. These meetings allow the entire residency to not only spend time together for educational purposes but also fosters a sense of camaraderie and, I believe, contributes significantly to the collegial, supportive atmosphere that exists in our program.

Monday through Friday I do not start a clinic earlier than 8 AM and am typically done with patient care by 4:30 PM at the latest. This schedule allows for ample time for reading outside of clinic both to prepare for didactics as well as to simply read about topics that interesting cases may have presented. This outpatient schedule also allows for ample opportunity for moonlighting to supplement one’s psychiatric experience (as well as income).  I personally could not be more pleased with the work/life balance that the PGY-3 schedule fosters.

Outside of work, I have recently moved into a house in downtown Indianapolis that gives me an approximately 5 minute commute to work everyday, which is hard to beat! I have now lived in Indianapolis for over 4 years counting my time in medical school at IU and have sincerely enjoyed living in this city. Having just moved downtown from the Broad Ripple area (which in and of itself is a vibrant area), I realize just how much more of the city I have yet to explore!  As an avid sports fan, I particularly appreciate what Indianapolis has to offer given the multiple, professional sports teams as well as it being the host of the NCAA Final Four and Super Bowl in recent years. I am also a huge Notre Dame football fan and am fortunate to be able to drive to South Bend, IN in under two hours for games on Saturdays in the fall!  I hope this summary of my experience as a PGY-3 has been helpful!

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!).

Department of Psychiatry | 355 W. 16th St., Suite 4800 | Indianapolis, IN 46202 | Ph: (317) 963-7316 | Fax: (317) 963-7313