A Typical Week for a Third-Year Med-Psych Resident
Monday
Michael and his wife, Finola
Morning and afternoon: Monday mornings are early, especially if it’s a new rotation on a medicine service, both because I’ll need time to make coffee, read some of whatever novel I’m working my way through at the moment, but also because third year, which is predominantly internal medicine rotations, includes learning lots of new patient lists (often two interns’ worth) when switching between rotations and taking the leadership role to identify gaps and opportunities in their care. So I’m pre-charting, reviewing signout from the previous JAR or SAR (depending on whether you’re in the first half of the year, med-psych PGY3s are treated as either a JAR or SAR for IM purposes), and getting to the hospital for signout at 7. Noon conference for med-psych is on Mondays, so if things are going well with my patients on medicine, I’ll listen in; if not, the program is working on ways to have some of the highest yield material available for later review.
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 her doggy arthritis isn’t too bad, and consider indulging in one of Durham’s many excellent ice cream options. Yes, my wife and I have a problem, but with two-plus years in Durham under our belts, the upshot is: we’ve tried a lot of great ice cream. Historically, I would have said that 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.
But now I’ll add an entirely separate plug for Pistachio Durham, a Persian ice cream and coffee shop serving a mix of classics like chocolate chip or strawberry alongside Turkish coffee, date, cucumber, and more, alongside homemade baklava and other Persian treats. This is one of my favorite spots in Durham, and not only because it’s so accessible from where I live!
Tuesday
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 during the first one to two years, our frequent switches to psychiatry and American Board of Internal Medicine 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 some consult services.
Third year adds a new wrinkle, since we also begin outpatient psychiatry work (while on IM ambulatory rotations and some psychiatry rotations) at the Behavioral Health Outpatient Clinic. When possible, we are given a full day in psychiatry clinic, typically on Thursdays, which allows us to participate in as much as possible of the outpatient didactic curriculum with our current psychiatry class (a designator that changes over the course of the year as your psychiatry classmates move into the outpatient world full-time). So occasionally a note or a medication refill from a psychiatry outpatient will get done here before I’m off to the hospital for signout.
While on psychiatry, Tuesday afternoons are Academic Half-Day (AHD), which for PGY-3s offer a mix of courses, some of which will be opportunities to catch PGY-2 lectures that you missed while joining your PGY-3 classmates for others more tailored to the outpatient setting. This is a great time to start getting to know the psychiatry class below you, with whom you’ll be spending lots of time next year while on outpatient.
Marley reads MurakamiEvening: 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 or Fullsteam or a cocktail at the Velvet Hippo, my new favorite Durham rooftop bar), spend a few extra hours at home with my wife and dog, or catch a movie at the AMC (Twisters? Longlegs? My wife is on a horror kick but I’m a sucker for a classic remake).
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. Shout outs also to Loco Pops and the neighborhood surrounding it, Durham’s Old West End, which is great for an evening stroll.
Wednesday
Morning and afternoon: On ambulatory, 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).
When not on ambulatory, as a third year you probably get the highest diversity of practice locations within one year, as you may be IM day floating at Duke Regional Hospital, learning a new general medicine list every day and working to teach and lead a team of residents from departments like anesthesiology, radiology, or psychiatry, or at the Durham VA Hospital, which is itself located right across the street from Duke’s main hospital.
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, on ambulatory it’s up the street instead to the VA’s primary care clinics 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.
Thursday
Morning and afternoon: My wife and I have trouble saying no to joining book clubs with our friends or family members, so I might be furiously trying to finish this month’s book (Elsa Morante’s History and Magda Szabo’s The Door are two for this month; others include revisiting Dostoevsky’s Crime and Punishment in a new translation) before work. I’ll also be looking to plan something for this evening with friends in Raleigh or here in Durham, which might include a hike at one of the area’s numerous state parks, a trip into Raleigh to explore a new restaurant scene, or some genuine Neapolitan pizza in downtown Durham. Academically, Thursdays on ambulatory might include a full day in the Behavioral Health Outpatient Clinic—a nice change of pace from IM clinic and an introduction to the tempo of PGY-4 for next year—with Psychiatry Grand Rounds, or a SAR talk by one of my IM colleagues on a topic important for developing into an independently practicing internist.
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 and their new baby, 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. Perhaps I’ve wandered out to Cary (Cary:Raleigh::Fort Worth:Dallas) for the best NYC style pizza in the area (and some of the best in NYC when they were located up there) at Di Fara.
Friday
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. Depending on the time of year, I may be back to doing a familiar IM rotation in a new way (for instance, a JAR rotation on VA GM or senioring the med-psych service), or working as an IM PGY-3 on Duke Gen Med or in one of the VA ICUs, where you are responsible for taking care of the ICU patients, evaluating floor patients for transfer to the ICU, and running codes throughout the hospital with the assistance of the intensivist on duty.
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. If the book club novel hasn’t been finished by this point and the meeting is on Saturday, I may be staying up late playing catch up in time for the meeting Saturday evening.
Weekend
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, 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).
For those with family and friends in far-flung places, I’ll also plug the ease and accessibility of travel from RDU, which has taken me on numerous short weekend trips to NYC to visit my brother and his new wife, to Portland, OR, to visit my father-in-law, back home to St. Louis, and (on longer breaks) to Japan, Turkey, France, and elsewhere (reach out if you want to know more about doing lots of traveling without having any money via credit card miles—I can hook you up!). It’s a surprisingly connected hub that makes it easy to get where you want to go to see the people you love.
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, Di Fara Pizza (again!), Convivio, Littler, and Killer Queen Wine Bar as a random list of favorites.
Estimated average number of work hours per week: 55-60 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 in a diversity of practice locations.
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. North Carolina is also super accessible to/from other places on the East Coast and Midwest where my wife and I have lots of family and friends.
My favorite thing about Duke is ...
… the med-psych family, which includes established and newly minted faculty, my co-residents, and the community of combined trainees (in Med-Peds, Neuro-Psych, and Triple Boards) here at Duke.
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, someone to whom your patients can more easily relate, as well as someone who maintains a good grasp of the reasons that you entered medicine in the first place. If you don’t know why you’re doing what you’re doing, your patients won’t know either!
