I am on call this weekend! I arrive at Duke University Hospital at about 8:30am to review patient charts and meet with my attending. Although there are currently 15 patients being seen by the Consult-Liaison (CL) team, there are only a few more complex patients who need to be seen over the weekend (for example, patients with eating disorders, catatonia, psychosis, or suicide attempt). We round on the patients, write notes, answer a couple of pages from the pediatrics team with questions about our shared patients, and then wrap up.
I left the hospital at about 1pm. I did not receive any pages outside of working hours and we did not receive any new consults over the weekend, so this was a light call weekend. We are on call about six weekends per year. This still leaves plenty of free time, and some weekends I moonlight at Central Regional Hospital or our ED Boarding Unit at Duke Hospital.
Monday
Morning: This is my dedicated research time, so I typically work from home. I am developing my research proposal, but I will be analyzing survey data from Duke’s gender care clinic. I am interested in assessing suicidality in this vulnerable patient population of adolescents and young adults seeking gender-affirming care.
Afternoon: I commute to Lakeview Clinic for my psychotherapy elective, which is a combination of Parent Child Interactive Therapy (PCIT) and Parent Management Training (PMT). In a typical afternoon, I observe one PCIT case conducted by my supervisor, Dr. Alexis French, have an hour for supervision, and see one to two of my own PMT cases by telehealth. I chose the PCIT/PMT psychotherapy elective to learn effective strategies to help parents manage common challenging behaviors. I think these skills will be highly transferable to practicing in any setting.
Tuesday
Dr. Bolon in the CAPS office.
Morning: I am at Duke CAPS (Counseling And Psychological Services), where I see Duke undergraduate and graduate students for medication management. It is the end of August so students have just returned to campus, and I’m still getting settled. We have a process group Tuesday morning with other learners and clinicians, and my supervisor, Dr. Jason Cho. The CAPS office is in a beautiful new building on campus, about a 20-minute walk from the Lakeview office. I chose this elective because I enjoy working with transitional age young adults.
Afternoon: All second-year fellows have Duke Child Development and Behavioral Health (CDBH) clinic. I briefly meet at 1pm with my supervisor, Dr. Courtney McMickens, to go over my cases, then see a mix of new and returning patients. New visits are one hour long and follow ups are typically 30 minutes. In this clinic we typically see patients ages 5-20 years old with a variety of diagnoses. I typically wrap up seeing patients by 5:30pm.
Wednesday
Morning: Wednesday mornings vary! One morning per month I 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. You have to see a wide variety of neurotypical kids to be able to suss out signs of developmental delays or underlying pathology.
This Wednesday, I am going to my school-based rotation at a Durham County high school. Each second-year fellow is assigned to a public elementary, middle, or high school. We see patients as part of the COPE program in the EC classroom. We provide medication management for some of these students.
Afternoon: I go to Lakeview for the Duke Center for Eating Disorders (DCED) multidisciplinary group supervision/case discussion, followed by a one-hour didactic session related to psychotherapy for eating disorders. This week we had an introduction to CBT for Eating Disorders. Though I am not seeing eating disorder therapy cases, I wanted to attend these lectures to gain better understanding of eating disorders and various therapeutic modalities. The rest of the afternoon I have administrative time, during which I perform duties related to my chief role, have meetings, study for the upcoming general psychiatry boards, and catch up on notes and emails.
Thursday
Dr. Bolon in the Student Wellness Center, the building that houses CAPS.Morning: Academic Half Day (AHD). We meet at the Lakeview office from 9am until noon, and usually have three interactive lectures. This week the lectures topics are treatment of ADHD, school-based consultation, and introduction to childhood trauma. Fellows are responsible for one journal club, one case conference, and one diversity case conference per year as part of our AHD.
Afternoon: Grand Rounds are during the lunch hour and typically I join by Zoom, though some are available in person. I return to CAPS for my second half-day during the week, which includes time for staffing cases with Dr. Cho.
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 ASD. We are also fortunate to have help from Mary Beth Hooks for complex social work needs.
Afternoon: I have a combination of two remote consultation rotations. I cover the NC-PAL phone line and participate in Collaborative Care Model (CoCM) with Dr. Copeland. NCPAL is a great resource for North Carolina primary care providers who need a pediatric or perinatal mental health consultation. The PCP’s typically present a case with some questions, and we (myself and the attending) make recommendations for further assessment and treatment. CoCM is another way to support primary care providers. Dr. Copeland, the care manager, and I meet over Zoom to review a panel of pediatrics patients and make recommendations to treat depression and anxiety.
Phew, that was a full week! It may seem dizzying to have different clinics every half day and it definitely takes some getting used to, but I appreciate that we have a lot of options for electives. I am fortunate to have such a rich variety of clinical experiences and settings that will make me a well-rounded clinician.
