Rikin (right) and co-fellow Huseyin Bayazit, MD, spend some time together on the weekend.Morning: I am in the perinatal psychiatry clinic at the Lakeview building. Here, I see pregnant and post-partum patients struggling with psychiatric illnesses. I enjoy the supervision we get from Drs. Stransky and Kimberg, and the team of psychologists, general psychiatry residents, psychology interns, and case management. We discuss cases and have one-hour didactic session specific to perinatal psychiatry at the end of clinic hours. We work in collaboration with ob-gyns at high-risk perinatal clinics and pediatricians to address complex care needs.
Afternoon: This is the time for a Psychosocial Treatment Clinic (PTC), i.e. continuity psychotherapy clinic. We either have a didactic or team-based learning session at 1pm and then I join our attending psychologist for group supervision. I then see my therapy patients for the remainder of the afternoon. We are trained in different approaches under cognitive behavioral therapy to help our patients with anxiety disorders, OCD, behavioral problems, and depression.
Tuesday
Morning: I start my day with a hot breakfast and a cup of coffee and will be engaged with my team to get updates on ongoing research projects. This is my research half-day, when I spend my time on research and scholarly projects.
Afternoon: All second-year fellows have the Child Development and Behavioral Health Clinic (i.e., medication management clinic) on Tuesday afternoons. We start with a 30-minute one-on-one session with the supervisor (Drs. Kimberg and McMickens split between a total of four fellows), discussing cases with pre-chart details and management plans. I see my patients and often will have another learner in the clinic with me, usually a pediatric intern. We have a 1.5-hour slot for intake, and the rest are 30-minute follow-ups. We see the patients and then check-out with our attending and together discuss a treatment plan with the patient and family. I finish seeing patients at 5pm, and I am able to finish my notes by then and leave for home.
Wednesday
A few CAP fellows enjoy lunch together during a fellowship Research Day event (Rikin is second from left).Morning: All fellows attend the COPE clinic (school-based mental health program) to get exposure to children and adolescents struggling with mental health needs. We meet them where they are and work with the COPE administration and teachers at school to better address their needs. We participate in meetings to help those with behavioral demands and provide extra support to enhance their academic performance. Each fellow is assigned elementary to high school and attends them twice a month. The COPE program is an educational experience under the mentorship of Dr. Stransky.
Afternoon: I have chosen the TMS and Spravato clinic as my elective at the Durham VA Medical Center. I was trained in evaluating the motor threshold and designing the treatment plan from rTMS to Theta-burst TMS to manage treatment-resistant depression (TRD). There are one to two TMS sessions during the first half, where I work with my attending, Dr. Jonathan Young, and RN Sarah. At 2pm, I have a consult intake session, and the initial hour is spent interviewing the patient; thereafter, we configure treatment options to cater to the needs of TRD. The director of the clinic is very involved in educational sessions by sharing RCTs and articles related to clinical guidelines on utilization of TMS.
Thursday
Morning: We have our Academic Half-Day (AHD), which is a 50:50 split between in-person and virtual. Being the education chief, I worked with my program director, Dr. Chandrasekhar, on developing the didactics and creating an enriching educational experience. We started with “bootstrap” sessions to build the foundation in child psychiatry and then dive into specific disorders (ranging from epidemiology, neurobiology, recent research, clinical guidelines, and psychopharmacology) dedicated for each month. At times we also invite faculty/alumni to share some career-related guidance and offer one-on-one mentorship to the fellows based on their needs.
Afternoon: We have one-hour Grand Rounds at noon, with both in-person and virtual attendance options. Then, the rest of my time is spent attending to administrative needs.
Friday
Morning: All second-year fellows attend the autism clinic at the Lakeview building. I have clinical and research interests in neurodevelopmental disorders and this was one of the reasons for considering Duke as my top choice program. We have one-on-one supervision with attendings (Drs. Sikich, Horrigan, Chandrasekhar, and Copeland) who are pioneers in this area at the national level. Due to complex clinical and case management needs, we are fortunate to have one-on-one supervision for each patient encounter. And we love having Mary Beth in our interdisciplinary team to address social care needs, and she goes the extra mile for our patients and their families.
Afternoon: After clinic, I have lunch with my wife and then re-collaborate with my team to continue working on our research projects. This is my second research half-day, which gives me enough protected time to support my research career. There are many clinical research projects fellows can get involved in based on their area of interest.
Saturday/Sunday
When I am on call, I arrive at the hospital around 8:30am to chart check on the CL and ED patients on our list. Then I run the list with our weekend on-call attending. We start seeing patients on the floor and ED, and after completing patient rounds, we team up with the behavioral health case manager (BHCM) to help assist the patients with referral processes and/or disposition planning. I finish my notes before 3pm and head home. We get one new non-urgent consult that I discuss with the team and plan to see the next morning. I respond to pages from the hospital and community pager.
Co-fellow Huseyin Bayazit, MD, at the grill.
On the days when I am not on-call, I spend time with my wife and family. We love exploring different cuisines, from Ethiopian and Mediterranean to Mexican and Italian, and Durham serves them all. We both are huge movie buffs and enjoy both Bollywood and Hollywood at our favorite AMC Southpoint theatre, which showcases formats in Dolby Atmos and IMAX. Some weekends we hike out with other fellows and a few friends, and there are tons of places to explore if you like mountains, lakes, and waterfalls. Summertime evenings are our tradition to cook outdoors and invite family and fellow friends for dinner. We are immigrants and feel fortunate to have found family in our friends and co-fellows.
