A Typical Week for a Fifth-Year Med-Psych Resident
Monday
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Morning: I am currently in the first six months of my final year in psychiatry. My second half will be spent on medicine. On Monday mornings, I arrive at the ECT suite around 7:30am, where I spend the morning performing ECT for patients in the inpatient and outpatient setting. I have learned the details of the process over the last couple of months (e.g., checking in with patients in the waiting area, coordinating with the anesthesia team to verify medications, timing out, and delivering the actual procedure).
One of the most fulfilling parts of this rotation so far is the amount of autonomy that I have been given as the rotation has progressed. For example, attendings now encourage me to run the procedure from beginning to end at this point and only step in if I need help. At times, I am asked to perform consults on inpatients, both on Monday mornings and Wednesday afternoons. Oftentimes, I perform ECT on patients who I originally saw as a consult and get to see the real-time progress in their mental health, which is extremely gratifying. -
Afternoon: Afternoons are med-psych chief time. The med-psych conference occurs every week at noon, which consists of a range of med-psych related topics each year, from morning report type conferences full of active engagement to more clinically oriented talks on topics ranging from ECT to substance use disorder.
As chief for the first half of the year, I have been curating a set of speakers and topics that best represent the spectrum of entities one might see in the med-psych world. My goal this year is to create a standardized curriculum that may be continued in future years. The rest of the afternoon, I check in with the GM12 (med-psych) inpatient team to address any needs and work on chief-related administrative duties. -
Evening: I have been teaching myself Spanish for the last year and a half, and I practice for a little bit before my next day in clinic. Most nights, I chat with language partners or watch videos in Spanish. In addition, I spend some time exercising each night – as we all know, the mind and body are interconnected!
Tuesday
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Morning: Tuesday mornings are spent at El Futuro, which is a local community-based nonprofit organization providing mental health services to Latinx individuals in the Durham area. I see patients in a community psychiatry setting, meeting people where they are. Working at El Futuro has taught me about providing cross-cultural care in a way that is respectful, humanistic, and considers the larger context (e.g., family systems and culture) in treating an individual. I sometimes feel out of my comfort zone given that I am still learning Spanish, but I have approached this endeavor with curiosity and humility and have grown tremendously as a clinician because of it.
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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, I 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. Thus, if there are lectures that we missed from prior years, we can choose to attend those. This week, I attend lectures on career series (still cannot believe I am graduating in less than a year!), advanced topics in psychiatry (this week, it’s on sleep psychiatry), and psychodynamic psychotherapy. -
Evening: Academic Half-Day ends at around 5pm each week. Several years ago, a group of my (nerdy) psychiatry co-residents started a D&D (Dungeons and Dragons) group. Although they have sadly since graduated and are scattered around the country, we have maintained our group virtually. I have bravely taken up the mantle of Dungeon Master for the first time, and I spend the evening leading them on an adventure to solve the mystery of a tainted drink that has plagued the local town. It’s all filled with laughter and fun times, which is important after a long day at work.
Wednesday
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Morning: I spend the morning in Acceptance and Commitment Therapy (ACT), where I see two patients and attend the consultation team. Last year, I enjoyed therapy tremendously during my outpatient psychiatry year, which led to me joining both ACT and Dialectical Behavioral Therapy (DBT) this year. The skills I have learned in ACT have expanded my repertoire of therapy skills and ways of conceptualizing the patients that I see not only in the therapy setting but also in my own pharmacotherapy cases. There is a cognitive flexibility that comes with practicing ACT that I appreciate and apply readily in all areas of my life, both at work and beyond.
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Afternoon: I switch gears and attend ECT seminar in the afternoon. This is the second part of the ECT elective. While Monday was focused on the procedural aspects of ECT, Wednesday afternoons are more didactic-focused, discussing the theoretical and practical aspects of ECT. The lectures are excellent and give me a frame for understanding the procedural days on Mondays. Didactics include both a formal lecture followed by ECT rounds, where inpatient teams discuss their patients receiving ECT in a collaborative environment with the ECT physicians.
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Evening: Each month, the med-psych chief hosts "office hours," which is a fun opportunity to get together outside of the hospital and meet at a local spot to grab some food/drinks and hang out. It is a nice way to socialize with attendings outside the hospital, since one attending hosts the office hours each month. This year, I’ve been promoting more activities, so we head to the local bowling alley in search of some strikes. Since the med psych residents are often on very 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.
Thursday
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Morning: I spend Thursday mornings at the Duke Outpatient Clinic (DOC) for my medicine clinic. I have been at the DOC for all five of my years in residency, 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 that I see on a regular basis. One of the other bonuses is seeing familiar faces each week. It feels like a second home to me at this point! Working at this clinic has been one of the most meaningful parts of residency, as I have come to see my own growth in integrating medicine and psychiatry concepts in the way that I approach the care of patients who I have many times over the years.
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Afternoon/evening: I spend Thursday afternoons doing Dialectical Behavioral Therapy (DBT) co-leading brief skills group. Each week, I take turns with my co-leader to teach a new set of DBT skills. This is a unique environment because it is a primarily teaching role where I review specific skills from the manual (e.g., this week, I taught opposite action) and teach to a group of patients who are not part of my own panel. I get live supervision as well, which is a bonus. DBT has taught me many practical skills that I can translate into other clinical environments. After the skills group is DBT consultation team, where other psychology students and clinicians come together and process difficult cases, learn new DBT skills, and prevent therapist burnout. It’s a fantastic environment, as it’s rare in residency to have such close cross-disciplinary contact and learn from experts coming from a different background.
Friday
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Morning: I have Friday mornings off, dedicated to research time. I spend time working on my Untold Stories project, which investigates the impact of a transdisciplinary visual art and narrative-based intervention that I started at the Duke Outpatient Clinic a few years ago. Before heading to clinic in the afternoon, I prepare some lattes and drop them off for the med-psych (GM12) inpatient team. I’ve been learning how to make lattes and perfecting latte art for the last year or so, and I started this initiative to help boost energy and morale for residents on the service.
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Afternoon: Friday afternoons are spent at my outpatient psychopharmacology clinic at Duke, called the behavioral health outpatient clinic (BHOP). I have been at this clinic since my 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. I get to work with our very own current 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.
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Evening: I usually spend my Friday evenings relaxing and catching up with friends and family. This week, I head over to my co-resident Lynnette’s house, where we enjoy a home-made meal together with her family. Since my own family is all in Seattle, it’s been important to form a community here in Durham with co-residents during the journey of residency.
Weekend (Saturday/Sunday)
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Morning: The beautiful thing about weekends during PGY4 year and PGY5 year (during psychiatry months) is that most weekends are entirely off unless you’re on call (rarely). I leisurely wake up whenever my brain tells me to, without a clanging alarm. I catch up on some reading for the upcoming week for ACT and DBT and make some lattes for my roommates (I’ve been trying to perfect my latte art) while listening to my relaxing coffee playlist.
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Afternoon: I relax in the afternoon by playing some music. I’ve played piano for most of my life, but I decided to learn how to sing last year. I head over to the Duke Music Building and spend a couple of hours belting out notes to my heart’s desire. It’s quite a cathartic experience and needed during residency at times! 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 primarily outpatient PGY4-5 years.
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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 (on six months of psychiatry)
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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