A Week in the Life (PGY4, Med-Psych)

A Typical Week for Jeffrey Lee, MD


  • Jeffrey Lee with with test tube

    Morning: My Monday mornings are spent at the VA mental health clinic, where I am seeing patients for psychopharmacology. The days usually start around 8:30am. The VA mental health clinic gives you a taste of more independently managing your own panel, as you are responsible for scheduling your own patients and administrative time. I typically see two to three patients in the morning, which is followed by supervision. The VA is unique in that you do not necessarily staff patients immediately after each case but rather at the end of the half-day.

  • Afternoon: The med-psych conference occurs every week at noon, which consists of a range of med-psych related topics each year, from conferences reflecting on difficult patient experiences to clinically focused sessions on topics such as autoimmune encephalitis and alcohol use disorder. I listen to this on the way to my afternoon clinic at the Duke Outpatient Clinic (DOC) for my medicine clinic. I have been at the DOC for the last several years, and one of the big strengths of the program has been building a longitudinal outpatient medicine clinic experience throughout all five years. At this point in my training, I have picked up a solid panel of primary care patients who I see on a regular basis. One of the other bonuses is seeing familiar faces of all the staff members and co-residents each week. It feels like a home to me at this point! 

  • Evening: I get off from the DOC at around 4pm and stop by the local Costco on the way home for some groceries. There are several convenient grocery stores around Duke, including Whole Foods and Harris Teeter. I decompress the rest of the night, heating up some weekend-prepped meals and working out.


  • A morning view of the helicopter pad and sunrise taken from the 8th floor of Duke Hospital.
    A morning view of the helicopter pad and sunrise taken from the 8th floor of Duke Hospital, before Jeffrey headed to the Gen Med 12 work room.

    Morning: Tuesday mornings are spent in therapy clinic. Fourth year is the first time that med-psych residents have therapy patients, consisting of one psychodynamic case, one CBT case, and one supportive psychotherapy case. These are typically combined with supervision hours with a CBT and psychodynamic therapist, during which you can talk about your cases and theoretical concepts in each modality. It is a totally different set of skills that is exciting to learn about and extremely helpful to help conceptualize patients in a more holistic manner. For example, I have found that I have been able to start applying therapy skills during my psychopharmacology appointments with good effect. 

  • Afternoon: Before academic half-day formally begins, I attend the monthly lecture for participants in the clinician educator track. During these monthly meetings, we focus on specific educator skills that I can utilize while teaching students on service. Examples include how to give a chalk talk and effective feedback. These sessions are extremely interactive and practical; I utilize many of the skills I have learned from this track. This week, we are doing peer-teaching by practicing a chalk talk we have created and receiving effective feedback immediately afterwards. Afterwards, I attend academic half-day. Every Tuesday while on psychiatry services, the afternoon is filled with informative lectures across a range of different topics. It is sometimes virtual and sometimes in-person. As a med-psych upper-level resident, we receive an a la carte selection of lectures we may attend. This is because during our medicine months, we do not go to academic half-day. As a result, if there are lectures that we missed from prior years, we can choose to attend those. This week, I attend lectures on psychodynamic psychotherapy, cognitive behavioral therapy, and the biology of sleep. 

  • Evening: Academic half-day ends at around 5pm each week. A group of us (nerdy) psychiatry residents like to play D&D (Dungeons and Dragons), so I head over and get into character for a fun night of questing. I’m currently playing an innocent young lad who is seeking to reunite with his father, only to find that the reality is filled with betrayal and lies. It’s all filled with laughter and fun times, which is important after a long day at work.


  • Morning and afternoon: I spend Wednesdays with an assertive community treatment (ACT) team, which consists of a community-based group of psychiatrists, social workers, therapists, and other mental health professionals. They are associated with UNC. It is a great experience being able to step outside of the office, drive into the community, and meet people in their own homes to get a glimpse into their daily lives. I have been learning a lot about using long-acting injectables, community resources (e.g., different group homes, different types of supplemental income), and helping people navigate the healthcare system.
  • Evening: The current med-psych chiefs host monthly “office hours,” which is essentially just a fun opportunity to get together outside of the hospital and meet at a local spot to grab some food/drinks and hang out. Since the med- psych residents are often on different rotations and rarely see each other in the hospital, it is great to have a consistent time to see each other and catch up.


  • Morning: I go to my outpatient psychopharmacology clinic at Duke, called the Behavioral Health Outpatient Clinic (BHOP), on Thursday mornings, where I typically see two to three patients. This is the same clinic that I have been attending since third year of residency, which is nice because I now have a panel of continuity patients that I regularly see. Patients are typically suffering from a variety of commonly seen outpatient diagnoses, such as depression, anxiety, and PTSD. All the residents typically meet after we see our patients, and the attending typically gives a brief presentation on a relevant outpatient topic. For example, this week, our attending discusses how to diagnose and treat ADHD.

  • Afternoon and evening: Thursday afternoons and evenings are filled with family studies, which is a unique therapy experience during our outpatient year. The afternoon typically consists of an initial introductory lecture on a topic in family studies (e.g., creating genograms), followed by a series of therapy sessions, one that you conduct and the other two that you observe. Although these typically used to be held in-person, they have been transferred to Zoom since the pandemic. The interesting part about family therapy is that you are doing therapy accompanied by a supervisor and several residents that observe you in the background with their cameras off. Your supervisor provides live feedback on the session via direct messages through Zoom. This has been an invaluable source of information, both through observing how other people conduct therapy and from the direct feedback that I receive. I am currently working with a couple, but many other people work with entire families.


  • Morning: Friday mornings are like Monday mornings, where I am at the VA mental health clinic for psychopharmacology management. I have one new patient appointment slot on Friday mornings, but otherwise primarily see follow-ups. I again have supervision after I see my patients in the morning.

  • Afternoon: Friday afternoons are like Thursday mornings, where I have my outpatient psychopharmacology clinic at BHOP. I even get to work with our very own interim program director, Dr. Helmke! There are different attendings who staff different days at BHOP, but you typically stick with them throughout the entire year, which is nice because you get to know each other and staffing styles.

  • Evening: I have been teaching myself Spanish since the beginning of the year, so I head over to a local Meetup group for fellow Spanish language enthusiasts! We meet at a local bar, and I do my best to keep up with the native speakers who show up at the event. I have much to learn, but I have slowly picked up bits and pieces and can at least make myself (somewhat) understood by those around me!

Weekend (Saturday/Sunday)

  • Morning: The beautiful thing about weekends during PGY4 year is that they are entire weekends off, instead of only one day (or no days ...) as is common during previous years of residency. I leisurely wake up whenever my brain tells me to, without a clanging alarm. I have felt the most well rested this year compared to any of the other years of residency. I meet up with one of my psychiatry co-residents, Will, to do some deliberate practice for psychodynamic psychotherapy. It’s a fun learning method we discovered this year where you role play different patient scenarios and respond to various statements that a patient might say. It’s been a lot of fun and a great learning experience. As you might be able to tell, I’m kind of a nerd about learning.

  • Afternoon: I relax in the afternoon by jamming out on the piano (I’ve been using Musescore to pick random fun songs to play), tidying up the house, and catching up with friends and family over the phone. I might catch up with some more co-residents or read up on some topics from the week. Some weekends, I choose to moonlight at the local hospital (either Duke Regional Hospital or Central Regional Hospital), which is a nice way to keep up my inpatient skills during my outpatient year. 

  • Evening: Evenings on the weekends are typically spent preparing meals for the week. I am a big fan of my Instant Pot, which I use to cook basically everything. I specialize in vegetable stir fry dishes, which I have perfected (to my tastes, at least!) over the years.

Estimated average number of work hours per week: 45

I chose Duke because ...

… I knew I would be training in an open-minded, collaborative environment that could nurture my intellectual curiosity while maintaining my compassion for patients. 

My favorite thing about Durham is ...

… how kind people are to one another, from strangers on the street to the staff in the hospital. The southern hospitality is very real!

My favorite thing about Duke is ...

… witnessing the combination of passion and humility of my colleagues. In addition, everyone is tremendously thoughtful and willing to help each other out at a moment’s notice.

My advice to prospective residents is ...

… to pick a program where you can see yourself thriving both intellectually and emotionally. Five years is a long journey, and you want to traverse it with people who you care about and who care about you. 

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