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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.

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!

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!).

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