A Week in the Life (PGY2, Med-Psych)

A Typical Week for Michael Rauschenbach, MD, PhD


  • Selfie of Michael Rauschenbach (right) and his wife
    Michael and his wife, Finola

    Morning and afternoon: I tend to get up an hour or more before I need to be at the hospital, to give myself time to make coffee, read a novel, catch up on news, or to exercise if I’m feeling ambitious. Second year is split evenly between internal medicine and psychiatry, with psychiatry rotations often but not always starting a bit later than internal medicine ones, so the sleep I tend to get and my morning routine vary slightly based on the service, but in general I feel strongly that wellness in residency requires not just time to socialize with friends outside of the hospital and with your family if applicable, but also plenty of time spent recharging. I tend to block out a bit of each morning for this. The remainder of the morning is spent pre-charting (hopefully more efficiently than intern year), getting 7am signout from the overnight team on most rotations, followed by prepping for rounds and then rounding. Most internal medicine rotations include noon conference with free lunch, and afternoons are spent working to finish tasks while admitting new patients and working on discharges. Signout is 6:30 to 7pm depending on the rotation, and I head home with a quick stop by the cafeteria to stock up on protein bars or grab dinner.

  • Evening: At home, I eat dinner with my wife (or leftovers if she’s gotten hungry before 7:30 or so), walk the dog if it’s still light out, and consider indulging in one of Durham’s many ice cream options. Yes, my wife and I have a problem, but after just over 15 months in Durham, the upshot is: we’ve tried a lot of great ice cream. Two Roosters is probably the best for straight ice cream, Rose’s Noodles, Dumplings, and Sweets is terrific for dinner, but far more importantly has transcendently good fancy ice cream sandwiches, perhaps my favorite dessert in town and actually unforgettable once you’ve had one.


  • Morning and afternoon: Coffee and a few pages of a novel, pre-charting on my inpatient list, and occasionally prepping clinic patients is the order of business. While Duke’s internal medicine program maintains a 4+2 program for Med-Psych residents while on medicine, our frequent switches to psychiatry and ABIM primary care clinic requirements mean that med-psych residents also experience a bit of the “traditional” model, with clinic half-days on some inpatient rotations, including the GM12 Med-Psych service, several inpatient psychiatry rotations, and while at the Central Regional state psychiatric hospital. I might prep a clinic note or two before getting signout at 7am, the usual program of pre-charting and rounding, followed by psychiatry academic half-day (AHD) on Tuesday afternoons during psychiatry and med-psych rotations. This provides dedicated learning time, offers the opportunity to recharge a bit outside of the hospital during the week, and gives us a chance to see colleagues in categorical psychiatry, hopefully in person after several years of hybrid Zoom/in-person academic half-day due to Covid. 
  • Michael Rauschenbach's dog with front paws on a book
    Marley reads Murakami
    Evening: Signout is at 6:30 to 7pm for most internal medicine rotations, but lectures end at 5pm on psychiatry AHD. This offers the opportunity to attend departmental events (like watching the sunset over Lake Crabtree or grabbing a beer at Hi-Wire, Fullsteam, or The Honeysuckle at Lakewood), spend a few extra hours at home with my wife and dog, or catch a movie at the AMC (Oppenarbie? Barbenheimer? Something else…). Additional ice cream options include the Parlour, a local favorite that is very tasty but no better than Jeni’s, a national chain which somehow manages to feel “local” wherever it is and which is also excellent.


  • Morning and afternoon: If I haven’t prepped clinic for Wednesday afternoon, I do this furiously while mainlining 1.5x the usual number of cups of coffee in the morning; otherwise, just the usual morning of pre-charting, rounding at the hospital, and progress notes, followed by a dash across town to my primary care clinic at the VA (on some psychiatry and med-psych inpatient blocks, as well as outpatient clinic blocks). The Durham VA Hospital itself is located right across the street from Duke’s main hospital, and med-psych residents do several rotations there, which offers valuable exposure to a very high-need patient population at a busy tertiary care center that takes care of veterans referred from all across North Carolina, South Carolina, Virginia, and elsewhere. However, its primary care clinics are located up the road, so I’ll head over there for an afternoon spent seeing four to six patients from my team’s panel. One of the benefits of the length of med-psych training is that by the later years in clinic, you often know your patients quite well, and the dedicated time we spend in the outpatient setting during fourth and fifth year offers valuable opportunities to really hone primary care skills. 
  • Evening: Depending on how efficient my clinic day was, I’ll hopefully finish up clinic notes before heading home for dinner, a call to one of my brothers or a friend, and a walk with the dog. In the summertime, I might consider a late evening run to escape the heat. My dog likes to walk around Durham’s Old West End, near Loco Pops, which serves specialty ice cream pops as well as numerous delicious flavors available in traditional scoops.


  • Morning and afternoon: My wife and I have trouble saying no to joining book clubs with our friends, so I might be furiously trying to finish this month’s book (Zadie Smith’s The Fraud and Dostoevsky’s The Adolescent are the two upcoming tasks for this month) before work. I’m also trying to reclaim the undergraduate’s insistence that weekends start on Thursday night by beginning to plan for the weekend, with options that include The Monti for live storytelling, a hike with the dog at one of the numerous state parks in the area, a Durham Bulls game, or a trip to Raleigh to visit friends for dinner. Thursday includes Psychiatry Grand Rounds or, on internal medicine rotations, a Cohen conference by one of my PGY2 peers in medicine, which is an approximately 30 minute-long case presentation discussing a diagnostic or therapeutic dilemma you encountered while preparing teaching points under the guidance of an expert faculty discussant.

  • Evening: If my early weekend ambitions were successful, I’m at dinner at Irregardless Café, one of the oldest vegan and vegetarian friendly restaurants in Raleigh, with my vegetarian wife and some of our friends from graduate school, or enjoying Pincho Loco, a truly excellent, traditional scoop style ice cream place near Ninth Street whose only virtue/downside (depending on your perspective) is that it serves ice cream scoops that actually approximate amounts of ice cream that a healthy adult might want to consume. I am ambivalent about whether this is a good thing.


  • Morning and afternoon: Coffee and pre-charting, perhaps a bit of reading about some of the complexities of a patient presentation on my current inpatient service, and then off to the hospital for rounds. PGY2 internal medicine rotations, while only occupying six to seven months of the year compared to eight to nine in PGY1, include some of the most formative parts of training, including rotating in the Duke Medical Intensive Care Unit and on VA Gen Med (both as senior), in the Duke ED, and your first experience as the upper-level resident on the GM12 med-psych service, the interdisciplinary inpatient service that all med-psych residents (and nearly all faculty) rotate on at least once yearly. The service offers a fascinating mix of cases, a weekly conference for discussion (on Mondays), and a chance to spend quality time with med-psych faculty who will hopefully become mentors and friends throughout your time at Duke.
    Evening: Depending on the service, it’s either time to start the weekend, or time for another quiet evening spent relaxing, catching up on Netflix or watching some basketball, or exploring another Durham ice cream spot, such as (wildcards!) Tutti Frutti, a froyo spot located near my house, or Pelican’s shaved ice.


  • Morning and afternoon: I will certainly be getting an additional hour or so of sleep in the morning on my day off, and then it’s time to give my dog Marley her longest walk of the week while my wife does her long-run as part of her seemingly never-ending marathon training, followed by a variety of exciting options to explore. The Durham farmer’s market, Coco Cinnamon (for churros and excellent coffee), Epilogue Books in Chapel Hill (for the unparalleled combination of drinking chocolate and excellent niche fiction recommendations), The Regulator Bookshop in Durham (with a healthcare provider’s discount) or The Golden Fig (a used bookstore next to Guglhupf Café, one of the most popular brunch spots in Durham) are all possibilities, as are a hike at Eno River State Park, a trip to Asheville or Wilmington for mountains or beach, respectively (though each is several hours away and thus better attempted on a golden weekend).

  • Evening: Dinner with friends, hosting a wine tasting for folks who are interested or attending a tasting event at Rocks and Acid Wine Shop in Chapel Hill, or hanging out downtown on a beautiful summer night are all potential options. The list of great places to eat is overwhelming, but I’ll specifically mention Viceroy, La Vaquita, Littler, and Killer Queen Wine Bar as a random list of favorites.

Estimated average number of work hours per week: 55 hours for outpatient blocks, 65-80 hours for inpatient blocks

I chose Duke because ...

… of its longstanding commitment to rigorous combined training in internal medicine and psychiatry, the charisma and dedication of program leadership, faculty, and residents with whom I met during the interview process, and the chance to serve patients from an incredible variety of backgrounds.

My favorite thing about Durham is ...

… its natural beauty, as well as the way that it manages to attract so many different types of people; my wife and I have found it easier than expected to spend time with people from inside and outside medicine, with a ton of different interests and in many different contexts.

My favorite thing about Duke is ...

… the med-psych family and the patients I get to meet.

My advice to prospective residents is ...

… to spend time with your loved ones and on things you are passionate about outside of work as well as within it; it all contributes to your being both a better clinician, and someone to whom your patients can more easily relate.

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