A Typical Week for a First-Year Fellow
Monday
I’m on consults this block and live about 15 minutes from the hospital, so I drive to the hospital and park in the staff lot by 7:55 a.m. After a short walk, I’m in the workroom by 8:00 a.m. I check for overnight admissions, pre-chart existing patients, and help divide the list with the resident and medical student on our team.
Zoom rounds start at 8:15 a.m., where we review case management needs and triage which patients to prioritize. By 8:45 a.m., we’re at the bedside seeing patients together as a team. We usually staff each case right after the interview and aim to communicate our recommendations in person to the primary team—or follow up via message if needed. Today, we wrap up bedside rounds by 11:00 a.m. I spend the rest of the morning closing the loop with teams, writing notes, reviewing the student’s documentation, and debriefing some of the interesting cases we saw.
Mondays are a half-day for me on consults because I do outpatient therapy in the afternoon. After checking out with the attending and transferring the pager (we use an app), I grab a sandwich at the cafeteria and drive five minutes to our outpatient clinic. I get there a little early and catch up over lunch with my co-fellows.
Therapy supervision begins at 1:00 p.m. and is structured as a group. Today we focus on strategies for early sessions and walk through contextual functional analyses for two established patients. Supervision wraps up by 2:40 p.m., and I use the next 20 minutes to review notes and prep for the afternoon.
We are allotted three hours for therapy patients. Today, I see two new therapy patients and observe a co-fellow’s case. After finishing my notes, I head out around 6:00 p.m. I spend a relaxed evening at home with my wife and our dog, Moose, catching up on a few articles that relate to patients I’m following on service.
Tuesday
Another full day on consults. The morning flows similarly to Monday, and by noon, most of the initial work is wrapped up. It’s a nice day, so I take my lunch outside. My co-fellow on the 5100 unit is out there too, and we catch up before heading back in.
At 1:00 p.m., I join a multidisciplinary meeting over Zoom to discuss a complex disposition for one of our patients. The primary team, hematology/oncology, hepatology, neurology, palliative care, psychology, and case management are all present. It’s a productive meeting—30 minutes of discussion that saves a whole day of back-and-forth messaging.
In the slower part of the afternoon, one of the medical students asks about involuntary commitment in North Carolina. We take some time to walk through the history, current procedures, and pediatric-specific considerations.
A new consult comes in around 3:30 p.m. After a brief chart review, we see the patient together. Even with the late addition, I finish my notes and head home by 6:00 p.m. That evening, we cook dinner and then head to a dog-friendly local brewery with an open mic night we enjoy.
Wednesday
It’s another full day on consults, with an interesting start—bedside ECT for a patient in the ICU. Our team meets with the hospital’s ECT team and performs a pre-treatment assessment, then stays to observe the procedure. It’s a rare and valuable experience, especially ahead of our 11:00 a.m. lecture on pediatric catatonia and ECT. The attending gives an overview of catatonia pathophysiology and emerging treatment strategies.
Later in the day, at 2:30 p.m., we join ECT rounds, a department-wide meeting to discuss all active ECT cases across Duke’s hospital system. As the fellow, I present the case and pose clinical questions for discussion.
Around 4:00 p.m., I get a page for a behavioral response on one of our patients. I connect with the nursing staff, social workers, and security to create a plan, and the situation de-escalates quickly.
I wrap up a few final tasks and then head out. Tonight is our program’s first movie night of the year—one of our attendings hosts us to watch “Eighth Grade” by Bo Burnham. I grab some pizza and snacks and enjoy the film with co-fellows and faculty.
Thursday
Thursday begins with some extra time in the morning, thanks to academic half-day. I take Moose on a walk to the neighborhood coffee shop and bring home a latte before heading in.
Academic sessions start at 9:00 a.m. and include three 50-minute lectures with 10-minute breaks. After lectures, lunch is catered from a local Mediterranean restaurant. It’s a great time to reconnect with co-fellows before heading to family studies clinic in the afternoon.
Family Studies begins with a one-hour lecture on family and couples therapy, joined by fellows, residents, and psychology interns. Then, we break off into teams for casework. I observe the first case and provide feedback as part of the team. For the second case, I’m the primary therapist. After the session and team discussion, I finish my note and leave around 5:30 p.m.
It’s still summer in North Carolina, so after work, my wife and I head to a friend’s pool with some other psychiatry trainees for dinner and a casual evening swim.
Friday
The last full day on consults this week brings three new patients. One of the medical students uses a consult for their observed assessment, and we spend the morning reviewing clinical strategies before they present to the attending. I independently follow up with my panel and circle back with the attending for the remaining new consults.
It’s sunny again today, so I mobile order my Starbucks from the hospital lobby and sit outside to catch up on messages and update the primary teams.
At 2:00 p.m., we have a lecture and group discussion focused on safety planning—particularly challenging clinical scenarios and how to approach them. By 3:00 p.m., we sign out to the weekend team, going over anticipated changes or concerns. After the brief check-in, I stop by a few patient rooms and then return to the workroom for final updates before heading home.
That evening, I finally return to write a paper I’ve been meaning to work on since fellowship started. I squeeze in a few hours of writing, make dinner, and tackle a few chores before easing into the weekend.
Weekend
One of the best parts of fellowship is having most weekends free. Whether hiking in the mountains, exploring new breweries, or catching a local concert, we’re usually out doing something. This weekend, we rented a beach house on Emerald Isle with friends. Between swimming and relaxing in the shade, it’s a great way to beat the summer heat.
Read about a second-year fellow's Week in the Life.