Dr. Candi Wolf (left) and co-fellow Dr. Adam Howard participate in a scavenger hunt during CAP fellowship orientation.
A little about me: I am a mom to almost (currently 35 weeks pregnant) two tiny humans; my oldest recently turned two years old. I am passionate about preventive medicine, and for me that translates into a passion for caring for patients from preconception to about six or seven years old. I figure it doesn’t get much more preventive than prior to conception.
Saturday
I am on call this weekend, which means I got a sign-out email Friday night listing the current consult-liaison (CL) patients that would need to be seen over the weekend. Some patients are seen daily (like patients who are catatonic, patients under involuntary commitment, and patients here in the setting of an eating disorder). Other patients are seen once over the weekend (say if a medication was recently started or changed), and some are chart review and see if needed.
Our current CL list is a total of 12 patients and, per the email, I will need to see four patients both days and any new consults that come in. The attending and I agree to rounding around 8:30/8:45am. My toddler won’t allow me to chart check in his presence, so I get in at 8am to review all the patients.
We didn’t get any new consults, so we wrap up rounding and I finish my notes by around 11:30am. I hang out in the hospital until about 12:30pm to give teams time to place any new consults. On call, we cover the CL pager and our community pager from Friday 5pm until the following Friday 8am. This week I didn’t receive any calls on either pager. This is a pretty typical call shift. I grabbed lunch and took my toddler to the park when he woke up from his nap.
Sunday
Since we didn’t get any new consults overnight and I am familiar with the list, we agree to round at 9:30am. I head out at noon and spend the rest of the day with my family.
Monday
Morning: All second-year fellows participate in a school-based clinic. It is still the summer time so that rotation will start in a few weeks. One morning per month I will go to The Little School (a pre-school affiliated with Duke) and observe children in the three- or four-year-old classrooms. All second-year fellows get this opportunity to observe pre-school children with more normative development. In particular, we are paying attention to speech, motor, and social-emotional development. Observing these kids helps us get a clearer sense of typical developmental stages.
Each second-year fellow is assigned to a public elementary, middle, or high school. We see patients as part of the COPE program (a school based mental health program) in the EC classroom. We provide medication management for some of these students. Until school starts, this is when I schedule my countless doctor’s appointments and try to get some studying for boards in.
Afternoon: In the afternoon I have one of my therapy electives. I am doing Parent Child Interaction Therapy (PCIT)/ Parent Management Training (PMT) under the supervision one of the psychologists in the department, Dr. Alexis French. My co-fellow Dr. Bhumika Shah is also completing this elective, which takes place at Lakeview.
It is a requirement to have at least one psychotherapy half day clinic. It’s a fun afternoon. For the first hour we observe, from behind the mirror, as Dr. French conducts PCIT. As child psychiatrists, it is unlikely we will ever implement full model PCIT, so this is more of a learning opportunity and not a space for us to become certified in this modality. That is followed by a one-hour processing session for our cases/seminar depending on how we chose to spend the time. Lastly, we each have two cases that we see independently. I typically wrap up around 5pm.
Tuesday
Morning: After reading Bessel van der Kolk’s “The Body Keeps the Score” in medical school, I have been drawn to how trauma impacts development. Since learning about the Childhood Trauma Track at Duke, I knew I had to pursue it. It is sponsored by the National Childhood Traumatic Stress Network (NCTSN) and involves completing a series of asynchronous online modules, learning and implementing an evidence based trauma-informed psychotherapy, and (optionally) attending an in-person workshop series in Utah. Upon completion of the program, I will be awarded a certificate in childhood trauma, which demonstrates expertise in this field.
With my passion for early childhood development and this burgeoning interest in trauma, I chose to complete my trauma-based psychotherapy in Child Parent Psychotherapy (CPP). This therapy focuses on the dyad. It is grounded in attachment theory, developmental psychopathology, psychodynamic, and object-relations perspectives, cognitive-behavioral methods, and an ecological systems framework.
I love that I get to learn and implement play therapy. This could totally count as my psychotherapy requirement for second year and as the therapy requirement for the trauma track. I spend Tuesday mornings at Lakeview with my CPP patients and their families. One of my co-fellows who is also completing the trauma track is doing trauma-focused CBT as his therapy requirement.
Afternoon: We are required to complete two half-day psychopharmacology clinics. All second-year CAP fellows have Lakeview Child and Family psychopharmacology clinic Tuesday afternoons. It’s a nice chance to catch up with my co-fellows since second year can take us in so many different directions.
We have one hour for new patients and 45 mins for returns. There is a staffing ratio of one attending to two fellows, and we have awesome support staff by way of our nurses and MA. This has been a really great learning opportunity for bread and butter outpatient child psychiatry. In this clinic, we see patients ages five to twenty years old with a variety of diagnoses. I typically wrap up around 5pm.
Wednesday
CAP fellows spend their days hard at work, but they also take time to have some fun. In this photo, Dr. Candi Wolf (second from left) and a few of her co-fellows show off their Halloween headbands in 2024.Morning: I have perinatal clinic at Lakeview. I love this clinic. I staff with two child psychiatrist who have a passion for this population. I see patients in the morning, then the entire team comes together for seminar at 11am. This includes our social workers, PhDs, residents from other specialties such as breastfeeding medicine, and psychology interns. This is a unique opportunity for me to stay up to date with my adult psychiatry skills, while learning to appreciate the nuances of caring for pregnant and lactating individuals.
Afternoon: This is my second of two required half-day psychopharmacology clinics. I was so excited that Dr. Silai Mirzoy joined us at Duke just prior to my second year. She is triple board-trained with an additional fellowship in Infant/preschool psychiatry. I get to spend the afternoon at Lakeview diagnosing and treating kids that are typically three to eight years old. It’s been helpful to understand pathology vs. typical early childhood development vs. trauma-induced symptoms and when it's best to treat vs. support with wraparound services. I typically wrap up around 5:30pm.
Thursday
Morning: Thursdays are Academic Half Day (AHD). We meet at the Lakeview office from 9am until noon, and we usually have three interactive lectures. This week’s lectures are on psychosocial elements of chronic illness and medical trauma, fundamentals of gender affirming care, and play as a diagnostic and therapeutic tool. Fellows are responsible for one journal club, one case conference, and one diversity case conference per year as part of our AHD. Oh, and we get catered lunch!
Afternoon: I see a few more CPP patients at Lakeview and wrap up by 4:30pm.
Friday
Morning: All second-year fellows have Autism Clinic at Lakeview. Cases begin at 8am and we typically see four patients for 45 minutes each. We have about 30 minutes for group supervision before noon. We see kids with a range of autism severity, co-occurring psychiatric disorders, and medical conditions. Dr. Chandrasekhar, Dr. Copeland, Dr. Horrigan, and Dr. Sikich are our supervisors, and they are all experts in the field of autism spectrum disorder. We are also fortunate to have help from Mary Beth Hooks for complex social work needs.
Afternoon: This is my dedicated research time, so I typically work from home. I am conducting a literature review on multidisciplinary early childhood clinics from around the country. My goal is to assess the commonalities, unique factors, and barriers to implementing these holistic clinics.
For the most part, every half-day I am in a different clinic, and it can seem like a whirlwind on paper, but for me it feels very seamless and complimentary. These were my efforts at creating a pseudo infant/perinatal fellowship.
