A Typical Week for a First-Year Fellow
Monday
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Dr. Kothari and his wife hiking in Hanging Rock State Park. Morning: It is the second week on the child psychiatry emergency department rotation (5100). I get into work at 8am after a short commute with no traffic! We have two patients to follow up on. I log into Epic and do a quick chart check, check in with nursing and then talk to my attending about the tentative plan. At 8:30am, Zoom rounds start with case management and the whole team (nursing, case management, psychology, psychiatry). We see our patients and I work on notes for the rest of the morning.
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Lunch: It is a short drive to the child and adolescent psychotherapy clinic from the hospital but the good news is there is abundant lunch options in the plaza! Today I choose Chipotle but I plan on trying the new Indian restaurant at some point in the future.
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Afternoon Supervision: Psychotherapy group supervision starts with the 4 first year fellows. What is nice about supervision is the fellows and supervisor discuss all of our therapy cases so there is a big component of group learning. Dr. Mauro, our supervisor, goes over the different types of schools (charter, public, private, home) and how it plays itself out in North Carolina. We also continue our discussion of our two therapy patients with OCD and how exposure-response therapy is going. I also talk about my two cases, including my new therapy case, and formulate a rough plan with the team.
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Afternoon Therapy Patients: It is therapy time! Although we all don’t have cases for all 3 slots, we can observe each other to learn about cases that we may not be the primary therapist on. Today, I observe a patient with a diagnosis of OCD and watch as my co-fellow does a great job of externalizing the disorder with the patient. I have two therapy patients today including a new patient. Dr. Mauro observes my new patient and talks to the patient about the “Coping Cat” booklet, which is helpful for children who are dealing with anxiety.
Tuesday
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Morning and Afternoon: Another day on 5100 but today we have four patients to see for evaluation this morning. I split up the duties with the attending and psychiatry resident to see the four patients. It is a day to learn about the different outpatient resources in North Carolina as we are able to discharge three of the four with quick outpatient follow up. Today, I learn that we have a Spanish speaking outpatient therapy clinic in the state and multiple in home therapy services as well. At 11:30am, we have our treatment team meeting with nursing, case management, behavioral health team, psychology and the psychiatry team for the patients on the unit. At 12 noon, since it is nice out, I eat lunch with the child psychiatry fellow on consults and medical student outside. The afternoon is lighter clinically so our attending invites us to go outside and we do some impromptu teaching on a topic of our choice. I want to learn more about anger and children and get a great overview about the subject!
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Durham Bulls Athletic Park Evening: As Duke residents and fellows, we get free tickets to the Durham Bulls Athletic Park so I take my wife to go to the baseball game. Durham Bulls win on a walk-off hit in the 9th! The weather cools off nicely and we have a nice evening!
Wednesday
- Morning and Afternoon: Another day on service in the ED but it is a half day for me as in the afternoon I work with child sleep expert Dr. Sujay Kansagra. I wrap up my patients before 12 noon and head home as I have 4 patients I see via telehealth in the afternoon. As Dr. Kansagra is child neurology trained, I get exposure into the sleep and child neurology world, learning about the different behavioral and medication interventions for sleep in complex patients. Dr. Kansagra is nice enough to teach me after patient encounters have ended and I learn about CBT-insomnia, sleep hygiene and child sleep medications.
- Evening: Since I worked from home in the afternoon, I have some flexible time after to work on a case report that I am writing up for publication on a patient I saw on child psychiatry consults earlier in the month. I send some emails out and do a brief literature review on the case.
Thursday
- Morning: Today is a day where we have an extra hour to sleep in as academic half day starts at 9am! We have three hours of in-person lectures, but Dr. Chandrasekhar and the academic team do a great job of getting pertinent lectures from experts in their area. Today, at 9am, it is ADHD from Dr. Joe Horrigan. We end lecture at 9:50am to get a good 10 minute break before our next two hours, which include an Introduction to the Trauma Track, as well as, the first case of our Diversity Case Conference series presented by a second year child psychiatry fellow.
- Afternoon: I eat lunch with my first-year fellows and we have until 1:30pm before Family Studies starts. In family studies, 1:30 to 2:30pm, is our weekly lecture, and today’s topic is structural family therapy. I then observe my co-fellow do family therapy for the first block and prepare for my family therapy case in the second block. It is a great training environment as each case has a direct one-to-one supervision as well as one to two other team members (combination of residents, fellows and psychology interns) who help discuss the case before and after. I feel like I’m making good progress with my family studies therapy case and leave at 5:35pm to head home!
Friday
- Morning, Afternoon and Evening: It is the last day of the week on 5100 and that means wrapping up the unit for the weekend. The morning is typical but afternoon yields some great teaching on ECT from our medicine-psychiatry attending. It is a great interdisciplinary discussion about best ways to treat catatonia & autoimmune encephalitis. We run the list for the weekend team via Zoom sign-outs shortly after and then I spend the remaining part of the Friday afternoon updating handoffs and completing the sign out email. All in all, a great week with a good balance of clinical responsibility, supervision and teaching! To commemorate the end of the week, my wife and I go into downtown Durham for axe throwing!
Saturday
It’s time to do some of my favorite activities over the weekend as we get a majority of weekends off as fellows. This particular Saturday is going to a nearby state park (Hanging Rock) to hike, look at waterfalls and the nature that North Carolina has to offer.
Sunday
On my other weekend day off, I get to explore downtown Durham a bit more with church and then going out to eat at Bull City Burger and Brewery. The rest of the day is spent relaxing, tending to my outdoor garden and cooking dinner.
Read about a second-year fellow's Week in the Life.