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A Day in the Life of...

PGY1 PGY2 PGY3 PGY4

Tim Cantwell, M.D., PGY1

CantwellTimothy003_copy.JPG  Like most other Psychiatry residency programs, IU divides intern year into two blocks.
  For six months, you will rotate off service (three months of medicine, two months of
  neuro, and one month of EM).  The other six months are spent on service rotating
  through three different hospitals which offers a very diverse patient population and
  exposure to a variety of pathologies.  You spend two months at the Indianapolis VA as
  the resident for a busy inpatient unit.  For another two months, you work at Larue
  Carter State Hospital which is for long term mentally ill individuals.  The final months are
  spent on the inpatient psychiatric unit at Eskenazi Hospital, which is the safety net
  hospital for Marion County.

I am currently working at the VA medical center on 5 East, which is the adult psychiatric inpatient unit.  Typically, my day begins at 7:15 when I arrive in my office.  I start by checking to see if there were any new admissions overnight.  If so, I read the H&P performed by the second year psychiatry resident who was there overnight.  I then look at labs and nursing notes on my patients.  Around 7:45 I get changeover from the night resident who lets me know if they received any calls on my patients and gives me a brief synopsis of the patients they admitted overnight. 

There are medical students and a PA student who rotate through this unit each month.  After changeover, I check on them to make sure they don’t have any questions and to see if they noticed any problems from overnight on the patients they are covering.  This psychiatric unit has 16 beds and is usually pretty busy.  We typically run in the 14-16 range.  Logistically, I typically carry about eight patients (between 7 and 9).  My patients, as well as the rest of the unit, are split up between the medical students.  If there is a sub-intern (4th year medical student) then they will have primary responsibility for 4-5 of the other patients on the unit and will report directly to the attending physician (Dr. Mathewson).

On Tuesday-Thursday, we have morning report from 7:45-8:15, at which time, an upper level psychiatry resident will go over an interesting case or give a short lecture on a particular topic.  I then begin seeing patients.  It typically takes me 1-1 ½ hours to see all my patients.  At 9:30 we meet as a treatment team (social work, students, charge nurse, etc.) and discuss all the patients, their medications, concerns they might have, and their overall plan.  After we run the list, the students leave and get to work and the attending sees the new admissions with myself (if I pick them up) and whichever student will be covering them.  After the interviews, I then start entering orders and calling any consults (or instruct the students on calling consults) that our patients need.

I typically spend the rest of the day writing progress notes, following up on any issues that arise in the morning, and seeing any new patients that are admitted to the unit.  I also field calls from the nursing staff and try and give an educational mini lecture to the students at least a few times a week.  I stop taking calls or new admissions at 4:30and start to wrap up anything that is incomplete.  Usually, I am finished by 5-5:30 and will then text the on call resident (the residents made this really easy on me and provided everyone’s cell phone numbers so I could just text them).  We meet in the 2nd year call room and I give changeover on the patients on the unit.  I let them know of any problems that we had, any potentially aggressive patients, or anything they need to follow up on overnight.

On Fridays, we have protected time from 11-3.  This is really nice because most of the residents meet during this time so you get to see everyone on a regular basis.  It is also really helpful because this is time set aside to learn about different topics and an opportunity to ask the upper levels about any questions that have come up.  Everyone here is very approachable, and I have no hesitations in asking for their opinions or help on any patients or issues.

Finally, I figure that I should speak on the living situation in Indianapolis.  I live in Fishers, which is on the northeast side of Indianapolis.  It is a really nice city and has been voted one of the best places to live in the US and its school system (Hamilton Southeastern) was voted one of the best in the country a few years back.  The homes here are extremely affordable and there are many very nice neighborhoods close to the interstate to choose from.  As for the commute, I live about as far northeast as you can get (I live by cows and fields), and it takes me about 1 venti coffee frappuccino to get parked downtown at the medical center.

Jayme Ahmed, M.D., PGY2

Ahmed_Jayme_04.JPG  Second year is a transitional period in our residency program, as you have just finished
  a year of inpatient psychiatry and medicine as an intern, and will now spend half of the
  year supplementing the inpatient experience you gained, and the other half building a
  foundation in the outpatient realm.

  I am currently rotating on 6 months of outpatient psychiatry. Mondays through
  Wednesdays I report to the Addictions clinic at the VA at 8am and see patients in
  30-minute appointments until 4pm. Typically I see an average of 4-5 patients daily.  These veterans are enrolled in the clinic for various substance abuse treatments; some are in remission, while others are still grappling with active addiction, and come to the clinic in withdrawal and needing Buprenorphine induction. One of two attending physicians is always available to staff the cases, and I share a work room with my fellow classmates who are also rotating through this clinic. This is a great time to learn from your colleagues!

Wednesday afternoons I report to the Neuroscience Center for didactics with the rest of the second years. Right now, IU faculty is lecturing to us about the physiological and behavioral mechanisms of addiction, as well as neuroscience as a whole- everything from anatomy to the complexities of neurotransmitter effects.

On Thursdays I have Geriatrics clinic at the VA starting at 8am. Similar to Addictions clinic, there are scheduled patients throughout the day seen in 30 to 60-minute blocks. Staffing is typically reserved for the end of the day, so that all the cases may be discussed together to foster the best learning opportunity for all the residents. For one month out of the six, you accompany another attending physician to do house calls for those veterans who are better served by going to their homes. There certainly is a lot to be learned from this aspect of the rotation, as it is difficult to truly understand the biopsychosocial model without directly seeing the circumstances under which a patient lives.

Friday mornings and late afternoons are dedicated to Cognitive Behavioral Therapy, where I am scheduled to see therapy patients in the mornings, and staff the cases in the afternoon. These patients are scheduled for 60-minute slots, and much of the experience is centered around establishing a rapport with patients and becoming comfortable with the very different, and yet essential art of therapy. Between the hours of 11am and 2pm, all residents attend psychiatry grand rounds, resident business meeting, and “power hour” at the Neuroscience Center.

The other aspect of second year is overnight call. Although the thought of taking call can be anxiety-provoking, I can safely say that it is fun and absolutely educational! There are at least 2 levels of pre-determined back-up- namely an upper level resident who is designated as back-up for the week, and an attending on call at each institution- but really you have so much more available support if you want it. You will take overnight call approximately every 4 to 6 days for the entirety of your second year. Weekends and Fridays are considered “home call,” as you are not expected to be on-site unless you are called in. Weekend calls last from 8am to 8am the following day. Weekday calls start at 4:30pm after your usual day of work, and end at 8am the following morning. You cover the VA (and this is where our call room is located), Riley Children’s Hospital, University Hospital, and any Neuroscience Center clinic phone calls. Although this may sound like a lot, it is a rare occasion to be called by all the sites in one night.

As far as our available inpatient units, you are only responsible for covering the needs of the unit at the VA while you are on call. Your responsibilities range from formal consults on patients admitted to medicine, giving advice regarding managing or initiating psychotropics for inpatients, and admitting patients to the VA inpatient unit from the ER. The day after your call is considered a post-call day, and you are not expected to go to work or lectures. That being said, it is not unusual to feel well-rested enough to attend the lectures anyway!

Ben McAllister, D.O., PGY3

McAllister_Benjamin05.jpg  One month into the PGY3 year and so far it has taken me on an amazing journey to a 
  variety of clinics!  During this year residents are exposed to the world of outpatient
  psychiatry and psychodynamic psychotherapy.  The great thing about this year is that
  we get to experience continuity of care throughout the year.  As residents we work
  alongside our patients during the hills and valleys they experience over the year.  I
  would also add that we are a lucky bunch of residents because we have a wide selection of clinics that we can work in during the PGY3 year.  My year consists of a number of unique clinics; I will share with you my daily/weekly schedule.

My clinic days typically start around 8 or 9 AM.  Clinic days tend to be split between morning and afternoon locations; this is what adds to the variety.  On Monday my schedule is split between the OEF/OIF clinic at the VA Medical Center and the 38th Street Ezkenazi primary care clinic.  While working in the OEF/OIF clinic I provide psychiatric care to veterans returning from service, in this clinic we see a variety of conditions from mood disorders to anxiety disorders.  In the afternoon while working in the primary care clinic I am integrated into a unique practice model where we work as a consult team to assist the primary care clinicians with behavioral healthcare needs.  My Tuesday clinic schedule is my elective rotation day.  Our program allows PGY3 residents one full day of elective time per week.  This continues to demonstrate the unique flexibility we have at Indiana University.  I chose to continue working in a geriatric psychiatry clinic at the VA Medical Center, but worked with two of my mentors to create a new portion of this rotation to include home visits.  If you have an idea, our faculty will support you in making it become reality!   Once a month I am seeing geriatric patients in their home and I am being provided a number of resources from the VA.  After a fun and busy Tuesday, I spend my Wednesdays at the Neuroscience Center (Goodman Hall).  In the morning I see patients in a mood disorder clinic.  We see a number of patients with Bipolar Disorder and many are very complicated cases which provide excellent learning opportunities.  Afternoons consist of chief meetings with Dr. Chambers and then off to didactics.  Didactic time is protected time for residents so we do not have to worry about clinic responsibilities and can focus on learning from our faculty with diverse interests.  Equipped with new knowledge, I start my Thursday morning in a Midtown mental health clinic which is a part of the community mental health system in Indianapolis.  This clinic is predominately a mood disorders clinic and has provided a number of very good learning cases thus far.  Thursday afternoons are set aside for psychodynamic didactics, psychodynamic supervision and time to see our psychodynamic psychotherapy patients that we will be seeing throughout the year.  I wrap up a busy week on Friday by working in the Adult Psychotherapy Clinic (APC).  In this clinic we observe other residents conducting therapy and I am also observed conducting psychotherapy.  This clinic allows for immediate feedback from my co-residents and my supervisor and also helps me develop skills that will be useful as I continue working with my patient.  As Friday wraps up I attend the weekly resident business and Power Hour meetings which are a great time to come together and check in after a busy week to address any thing going on within the program.  Did I mention lunch is provided?   We sure are a lucky group!   Wow, what a week!  I would also add that there are a number of other clinic sites available that include:  clinics that focus on psychotic disorders, addictions, and child and adolescent psychiatry just to name a few.

Lastly, time spent outside of clinic includes exploring great locations to get outdoors with our dog.  Indianapolis has some wonderful places to go such as the 100 acres at the Indiana Museum of Art, the Monon Trail and Holliday Park just to name a few.  We also enjoy going to new restaurants in the city, there is a wide selection to choose from.  Also, if you like sports you can go see the Colts, Pacers or any of your favorite Big Ten teams play when the various tournaments come to town.  You can also check out an Indy 500 race at the Speedway.  Indianapolis has been a great place to live-you can enjoy big city living with small city convenience.  Thank you for checking out our website, feel free to email me should you have questions. Good luck on the residency search!

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!).