A Typical Week for a Fourth-Year Med-Psych Resident
Monday
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Morning: Fourth year is outpatient year! This means trading in the exhilarating and long hours of inpatient services for 10 months of dedicated study to both the psychopharmacology and psychotherapy of outpatient psychiatry. We get to dive into four different types of therapy: supportive, CBT, psychodynamic, and family systems. On Monday mornings, I am at the VA, providing therapy for both my supportive and CBT patients. We are assigned supervisors who help us navigate the realm of therapy. I always come away from supervision with a better understanding of the therapeutic process and game plan for my next session.
I personally love this model of learning therapy as it allows autonomy to try different techniques and interventions in real time while still having the support of an attending. I also will frequently come away from supervision with a podcast or book recommendation! I start my day at 7:30 to prep notes and respond to emails prior to meeting with one of my mentors and therapy supervisors at 8:15. I then spend the next 45 minutes sipping loose leaf tea, discussing my therapy case, learning about the history of therapy, discussing my own learning goals, and occasionally coming up with new education projects with my mentor. I will then see my CBT patient for an hour, followed by an hour of dynamic/supportive supervision, before seeing my supportive patient for an hour. -
Afternoon: I start my afternoon with our med-psych noon conference, during which we learn from different physicians, both locally and at other institutions, about specific pathologies relevant to med-psych or case presentations from our combined medicine and psychiatry inpatient team. We also have the opportunity to present yearly as residents on a topic of our choice at this conference.
I then head to my VA primary care clinic, a seven-minute drive from the main hospital, where I spent the afternoon. After two years in this clinic, I have come to know some of the veterans very well and have been humbled by their gratitude for the care we are able to provide. I generally will see four to five patients, each within 30-minute time slots, and staff with an attending during the visit to verify the plan before wrapping up with the patient. -
Evening: I head home around 4:30/5pm and take my pup on a walk or jog while the sun is still out. There is an awesome trail about a two-minute walk from my house that we enjoy. I then will eat dinner and spend an hour or so finishing up notes. I spend the rest of the evening meal-prepping dinners for the week if I haven’t already done so on Sunday.
Tuesday
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Morning: I wake up around 6:30, make myself a cup of coffee and smoothie, before heading to the Duke outpatient Behavioral Health (BHOP) clinic to see patients for medication management. I prep my notes and start seeing patients around 8am. I usually will have one to two new patients and two to four follow-up patients, depending on the day. We see a broad array of pathology from depression and anxiety to post hospital discharge autoimmune encephalitis patients, which allows for so much learning in the outpatient setting. From 11 to noon, all the residents working at the clinic that morning gather in the attending work room to discuss interesting or difficult cases, and help each other trouble shoot or provide alternative perspectives. The attendings will typically mix in some informal teaching on a topic of our choice.
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Afternoon: After morning clinic, I drive about five minutes to in-person Academic Half-Day. Yes, that is right, an entire half day dedicated to teaching! Lunch is provided and we generally have some down time to catch up with our co-residents. Next up is either a residency-wide or class meeting. About once a month, I attend an hour and a half long workshop as part of either the Clinician Educator Track (CET) or Psychotherapy Track. I joined CET as a PGY1 and have loved the experienced and presented at conferences because of my work in this track!
I joined the Psychotherapy Track this year as I have more time to be able to attend sessions with 10 months dedicated to outpatient psychiatry. We then have three one-hour teaching sessions usually as a part of lecture series, building off the content we learned the week prior. This week I have a lecture on the basics of psychodynamic psychotherapy, ethics in psychiatry and the neuroscience of reward in substance use disorders. -
Evening: Academic Half-Day ends at 5pm, I head home to grab my pup and take the trail to downtown Durham where I meet up with a friend at a local brewery for dinner and a craft beer. The past couple of weeks, I have headed to Raleigh right after clinic for local concerts. We have amazing artists that perform in the Triangle area!
Wednesday
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Morning: I wake up at 6:30 and head to my acceptance and commitment therapy (ACT) elective. The morning consists of seeing patients with a one hour break for didactics. The class is made up of residents, PhD students, and post-doctorate psychologists which allows for incredibly rich conversations on the principles behind ACT and how we are formulating our own patients. The instructors are very supportive and always available to meet and talk through cases or concepts as needed.
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Afternoon: I drive home to whip up a healthy lunch and take a moment to bask in the sun with my pup on my patio during the lunch hour. This moment of gratitude for being able to sit amongst my flower garden, eat fresh vegetables from the farmers market, and allow my dog to run around the yard chasing squirrels is something unique to fourth year and brings me so much joy. During this time, I tune into the psychiatry Sharing Struggles Zoom series in which attendings model vulnerability by sharing difficult things they have experienced as part of their training or as a physician. This unites the psychiatry community and gives us a platform to get to know one another on a deeper level while also providing support and validation. I then head to BHOP clinic for a similar experience as my Tuesday afternoons.
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Evening: I get home around 5pm, load up my mountain bike, and drive about 15 minutes to a local single-track trail. I then allow some time to read about one of the psychotherapies I am currently studying before heading to bed.
Thursday
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Morning: I wake up at 6:30 and head to the VA for a morning of CBT lectures, VA clinic specific teaching, team meetings, and I see my psychodynamic therapy patient.
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Afternoon: I again head home for lunch on my patio while I listen to Grand Rounds. This week’s speakers blew us all away with his conceptualization of narcissistic personality disorder, peppered with countless examples he had collected over decades of practice. I then head to Family Studies, my favorite therapy experience. The afternoon consists of an initial lecture on understanding dynamics within family systems, followed by two therapy sessions, one that you lead as the therapist, and the other that you observe as a team member through one-way mirrors. This way, the supervising therapist can message you tips in real time to assist with the therapy process. I have loved cheering on my co-residents as they do incredible work walking with couples and families through difficult situations.
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Evening: I get home around 6pm and go on a quick jog with my pup prior to eating dinner and prepping notes for clinic tomorrow am.
Friday
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Morning: I wake up at 6:30am and head to the VA for my medication management clinic. I see one new patient and a handful of follow up patients. I have found it so helpful to have clinic both at the VA and at Duke as both serve different patient populations and associated pathology. I end the morning with supervision.
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Afternoon: I am chief of the psychiatry consult-liaison service at Duke University Hospital and have a half day of chief time to coordinate details related to the rotation, check in on the residents, and do some chalk talks for medical students and residents rotating on the service.
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Evening: I head to Raleigh for date night consisting of trying a new restaurant and walking around downtown Raleigh to see local artists and musicians showcase their talent as part of First Fridays.
Weekend
During the 10 months of outpatient, we have almost all weekends off! I have celebrated this with many weekend trips to the beach two hours away, a friend’s wedding in Vermont, and attending conferences. On weekends that I stay in Durham, I love going to farmer’s market in either downtown Durham or Raleigh to buy fresh produce, plants, and maybe some native flowers! There is so much access to the outdoors and I typically will explore new trails or lakes in the area.
Estimated average number of work hours per week: 50
I chose Duke because ...
… So many reasons but I will attempt a succinct response! I was and continue to be impressed by the rigor of the program, allowing for incredible training and a wide diversity of patient cases, combined with the down-to-earth genuine leadership who clearly are invested in each of us individual trainees.
My favorite thing about Durham is ...
… Durham is such an easy place to live! You can rent a cute old house full of character and still be walking distance to downtown. There are frequent free events that the community always shows up for including monthly art walks in the summer, weekly farmers market (out of this world flowers, tomatoes, cheeses), food truck rodeos, beer fests, to name a few. Notably, the food scene is pretty incredible!
My favorite thing about Duke is ...
… Duke has provided me countless opportunities including incredible mentorship, opportunity to co-create and co-facilitate a medical student elective on a topic I am passionate about, enrich my skills as a lifelong learner/educator through the clinician educator track, and global health rotations in the future. Most importantly, I am surrounded by genuine, kind, and driven co-residents creating a supportive environment during residency training.
My advice to prospective residents is ...
… Spend time reflecting on your values and what you want in a residency program and for the next five or more years of life! If things like access to outdoors, having a home for family, supportive residency environment, preparedness for being an attending, and great mentors make your list than I strongly encourage you to consider Duke!
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