A Day in the Life of a PGY-1 Resident

Hello! My name is Margaret Haglund. I graduated from the Mount Sinai School of Medicine this past May and am currently in my fifth week of internship here at Columbia. Before earning my MD, I was an undergraduate at Wesleyan University, where I majored in government and political theory. I am not a native New Yorker: I grew up in Kingston, Ontario, Canada.

The PGY-1 year at Columbia contains ten rotations. Interns spend 1 month in the Medical ER, 2 weeks in the Psych ER, 3 months on medicine floors, 1 month in the ICU, 1 month on the Geriatrics service, 2 months on the Neurology service, and 2 weeks on a Substance Abuse rotation. We also have a three-month elective block during the year, which can be used for a variety of clinical and/or research experiences within psychiatry--or for additional medicine months, should you so desire. Each of the 11 interns has a different schedule of rotations, with medicine and psychiatry months interspersed throughout the year. My schedule had me begin with a month of Geriatrics; I am currently in the midst of my second rotation, Substance Abuse. Next week, I will begin my first 2 weeks as day-float on a general medicine floor.

So far, I have been pleasantly surprised by my experience as an intern. I had braced myself for the worst, expecting a full year of grueling work and exhaustion. Instead, my first two rotations have been enjoyable and primarily educational in nature. I've spent time at several clinical sites, research divisions, and community programs, and am getting a taste of the wide variety of opportunities available at Columbia. I've had plenty of time to read and ask questions, and have found that my co-residents, fellows, and attendings have been eager to engage in discussion with me. I've also been able to attend Department of Psychiatry events, including Grand Rounds, resident lunches, and coffee hours. Believe it or not, I've even had ample time to sleep, adapt to my new environment, and enjoy the summer in New York City.

Like the majority of my co-interns, I live on the Upper West Side. Highlights of my new neighborhood include its proximity to Central and Riverside Parks, its many restaurants and shops, and its reasonable rents (relatively speaking, of course). The commute to Columbia is also easy and quick. My apartment is only a half-block away from an A/C subway stop, and it takes me about 30 minutes to get to Columbia's main medical center campus.

My first rotation, Geriatrics, was a Department of Medicine rotation. During our time on the medical service, we psychiatry interns have the same duties and participate in the same educational activities as do the medicine interns. It is nice to feel a part of both programs, and I have enjoyed getting to know some of the medicine residents during my first month here.

On a typical day on Geriatrics, I woke up at about 7:30AM and arrived at work at about 9AM. The Geriatrics service is housed at the Allen Pavilion, which is an affiliate community hospital located at the northern tip of Manhattan. Psychiatry interns usually spend two to three months there throughout the year while on medicine rotations. Getting to the Allen from the main medical campus takes about 15 minutes by subway or shuttle bus.

Mornings on Geriatrics usually consisted of time spent seeing patients in clinic, teaching sessions with my co-interns, and intern report. We attended noon conference every day at lunch. Afternoons were spent seeing patients in clinic, doing consults, and sometimes visiting patients at their home. Over the course of the month, we also visited nearby nursing homes and a hospice, and gave a community talk at a senior citizens' center. My day typically ended between 4 and 5PM.

This week, on the Substance Abuse rotation, a typical day begins around 9:30AM. I wake up at about 8AM, eat breakfast, and hop on the subway to the STARS program, located just a few blocks away from PI on 166th Street. The STARS program is a substance abuse research clinic, where psychiatrists run a number of studies investigating new treatments for heroin, cocaine, and marijuana dependence. On a typical morning, I might sit in on a new patient evaluation to assess eligibility for enrollment in a study. I might also attend a research meeting, where the progress of studies is discussed. Around noon, there is often a resident or other psychiatry lunch. In the afternoon, I might head over to the buprenorphine clinic, an outpatient treatment program for individuals recovering from heroin dependence. All manner of patients are seen at this clinic; in one afternoon, I saw a 28 year old musician, a 70 year old philanthropist, a 55 year old adolescent counselor, and a 30 year old hair stylist, all at different phases of recovery. When not at STARS or at the buprenorphine clinic, I might be found at a methadone clinic in midtown, on an inpatient addiction unit on the Upper West Side, or at Columbia's cocaine lab, where the effects of the drug are tested in vivo! My typical day ends at about 5PM.

I hope that I've given you a sense of some of the many experiences you might have as an intern at Columbia. It's hard to believe I've done all this in only 5 weeks! I know that some of the hardest months of the year are still to come; however, my first two rotations have shown me how highly resident education is prized here, and how welcoming and supportive the community is. I look forward to what is to come!

A Day in the Life of a PGY-2 Resident

My name is Tresha Ann Gibbs, and I am a second-year psychiatry resident at Columbia.

Currently, I work on the inpatient unit located on 9-Garden-North in the main Milstein Hospital building. It is a twenty-four bed unit that is distinct among our second year inpatient rotations in that it is primarily insurance-driven. As such, there is a rapid turn around in patients, and I am exposed in a very short time to a large variety of psychiatric disorders and their management. Generally, I arrive at approximately 7AM to get an early start on my day. After settling in and greeting the nurses, I begin to see my patients. At any one time, I carry four to five patients on this unit. During each patient encounter, I assess the patient's symptoms, sleep habits, and safety, and I provide brief supportive psychotherapy as needed. I then meet with my attending, and we discuss our treatment and disposition plan for each patient. Outside of time spent doing clinical work, there is a host of formal didactics, which occur daily and cover topics that include psychotherapy, pharmacology, neuroscience, and many others. The most difficult aspect of second year is learning to manage my very busy schedule.

On certain days of the week, I admit a new patient to the unit. This is one of my most exciting experiences because I enjoy meeting new patients and "working them up." Also, I perform the admission interview which gives me an opportunity to practice my interviewing skills, which at this point in my career still need improvement. While I know how to get information from patients having performed many admissions on medicine, there is certainly an art to the psychiatric interview. Each time that I admit a patient, I practice. I usually request feedback from my attending supervisors on the unit with the hope that I will learn a new skill or clinical pearl from each interview.

Usually, if all goes well at work and there are no last minute emergencies, I am home in time to eat dinner with my husband. It is important for us to spend time together as a means of decompressing from the busy day, and also to cultivate a family life. Some evenings, when I am on call, I don't return home but stay overnight at the hospital as the doctor on-call or "DOC." As the DOC, I respond to calls from all the inpatient units regarding a variety of issues, including any emergencies that occur overnight. These on-call shifts occur approximately two to three times per month and are reasonable--nothing like the overnight calls I did while in the ICU.

I am extremely satisfied in my work so far as a new second-year psychiatry resident. I feel excited as I gain a new skill set over the next three years of adult psychiatry training. In the future, I hope to pursue a fellowship in child psychiatry.

A Day in the Life of a PGY-3 Resident

Hi, my name is Jonathan Horey, and I'm going to give you a whirlwind tour of my typical week as a PGY-3 resident. My day starts at 6:30AM with my 2-year-old son waking up and singing his ABCs, a Thomas the Train song, or a variation thereof. I live in hospital-owned housing, which essentially means low rent, good maintenance, and living 3 blocks from work. All residents are eligible for this benefit (the hospital owns 26 apartment buildings in the immediate area), which is especially useful during your intern year when free time is, well, more limited.

I make it to my office by 8AM, check voicemail, email, and look at my calendar for the day. As PGY-3s (and -4s) we each have our own office, which is a very nice feature of this year. One morning a week, I work in our psychotherapy clinic performing new patient evaluations and presenting them to an on-site attending, as well as seeing my established patients for follow-up appointments. Another morning, I see patients in our psychopharmacology clinic, again seeing new patients, presenting them to an on-site attending, and seeing follow-ups. The other mornings are a combination of seeing my long-term therapy cases (which are patients we see twice-weekly for anywhere from 2-3 years) and supervision from nine different supervisors of varying specialties (including supportive psychotherapy, CBT, child psychiatry, substance abuse, and more). The amount and intensity of supervision is one of the unique features of the residency and reflects the department's dedication to teaching. This "open door" policy is one of the main reasons I chose Columbia, and I have taken advantage of it many times to call not only my formal supervisors, but other faculty with expertise in areas I may have questions about. This has resulted in a range of assistance, including informal suggestions over the phone, formal supervision on a given case, and meeting in person with the patient and the supervisor.

The middle of each day is dedicated to classes with subjects ranging from psychodynamic psychotherapy, emergency psychiatry, dialectical behavioral therapy, neuroscience and psychopharmacology, to name but a few. I like having class every day, as it is a chance to see my fellow residents and provides a daily opportunity to focus on learning. Two of my afternoons per week are dedicated to working in our psychiatric ER, affectionately known as the CPEP, which stands for Comprehensive Psychiatric Evaluation Program. In the CPEP, we can observe patients over the course of up to 72 hours to start treatment, gather parallel, and make an informed decision about an appropriate disposition. As PGY-3s, we also staff the ER overnight and end up doing this in week-long blocks of 12-hour shifts for a total of about 4 weeks each. Thankfully, this represents the whole of our "call" for this year, and we schedule this as a class which allows more flexibility for all of our personal lives. My other three afternoons in the week are split between seeing follow-up psychotherapy cases (including one long-term child case), supervision, and one afternoon per week that I dedicate to my own research. While carving out this time for research is a challenge, those of us who have chosen the research "track" offered by the residency are strongly encouraged to do so and our clinical responsibilities are reduced to make it possible. In fact, this research time is given priority over our supervisors, and supervisor changes are made if there are conflicts with the research half-day. I have been working since medical school with a research group in the substance use research division and have found it to be a very rewarding experience that has given me another perspective on potential career paths in psychiatry. Another important part of my week is co-leading a group with one of my fellow residents at two of the local psychiatric community clinics, focusing on patients who have recently been discharged from the hospital. This was an idea we came up with as residents, and the clinic directors, as well as our residency directors, have been supportive in making this possible.

Writing this has left me wondering how all these responsibilities fit into one week, but I also do have a personal life and, most of the time, I feel my time is well balanced between my family and work. I can honestly say that, for the large majority of my days, I wake up looking forward to going to work and find it to be challenging, rewarding, and fulfilling, which is due in no small part to the unique combination of intensity and flexibility that this program provides.

A Day in the Life of a PGY-4 Resident

My name is Sander Markx, and I am one of the fourth-year residents. The joy of fourth year is that many of the requirements of our psychiatric training have been fulfilled in the first three years, leaving the fourth year open to pursuing individual interests. There is essentially only one requirement for the year, a four-month rotation in Consultation-Liaison Psychiatry, allowing for eight months to pursue a variety of experiences.

During the first two days of the week, I arrive around nine o'clock and begin the day seeing patients or my supervisors. We each have our own office and the freedom to schedule our days as we deem appropriate. I am continuing to treat about twenty-five patients from my third year caseload in a number of modalities: psychopharmacological management, as well as cognitive-behavioral-, supportive- and psychoanalytic psychotherapies. The patients I treat suffer from a variety of psychiatric disorders, including personality disorders, eating disorders, obsessive-compulsive disorder, and chronic psychotic illness. Appointments with some patients are on a twice-weekly basis while others come in every three months. By the time I graduate, I will have been treating several patients for two years and some for almost three. The experience of treating patients over time with an understanding of the longitudinal course of illness has been extremely rewarding during the residency.

While a number of my fourth-year peers have chosen to do several electives, I chose to devote almost all my elective time to research. So during the remaining three days of the week, I work on my research projects full-time. I usually start around eight thirty, depending on the project that I'm working on. I'm currently involved in evaluating a large number of patients with known cytogenetic abnormalities who suffer from a psychotic illness. This involves travelling across the state of New York to visit the patients and their families in their local hospitals or clinics where I do clinical interviews and facilitate advanced genetic testing. I am also involved in an imaging study where we are doing FDG-PET scans of patients with schizophrenia with a known genetic defect. These patients presented with extensive neuro-anatomical abnormalities on MRI, and this PET study will shed light on functional abnormalities of specific neural circuitry in these patients. Most of the time, however, I'm working in the lab of Dr. Joseph Gogos, where we are looking at several knock-out mice that involve several candidate genes that are thought to play a role in the development of schizophrenia. Dr. Gogos has been a great mentor who has been extremely available to teach the principles of creating a mouse model for schizophrenia. It has been exciting to be able to do several research projects at the same time that are all focusing on schizophrenia using such diverse research modalities.

Monday through Thursday, between eleven and one, I am in class with my peers. This year's classes mostly focus on advanced issues that build on topics taught in previous classes (i.e. specialized psychopharmacology or specific issues in therapy), career development (i.e. setting up private practice, how to plan workshops), and topics relevant for the Consultation-Liaison Psychiatry rotation. On Fridays, we all attend Grand Rounds. The residency director and the rest of the administration all make great efforts to protect the educational experiences of the residents.

Over the fall and winter, I will be doing Consultation-Liaison (CL) Psychiatry. This is a four-month rotation during which I will follow several patients in the Milstein Hospital. During this time, there will be twice-weekly CL case conferences, in addition to the regular daily classes throughout the week. While on this rotation, I will have the opportunity to integrate all the clinical knowledge I have built up during the previous three years of training. In addition to CL psychiatry, I will also be teaching psychiatry to second-year medical students as part of their medical school curriculum. This involves attending their lectures and then subsequently running a two-hour small group on patient interviewing, psychopathology, and treatment. For many of the medical students, these sessions are their first exposure to formal patient interviewing.

I usually end my days in the early evening between five and seven, depending on whether I'm seeing patients or doing research that day. During my fourth year, I have been able to get excellent training in how to set up a wide range of research projects while also continuing my clinical education. I have found Columbia to be an inspiring environment to learn in - with an excellent curriculum, many opportunities, and amazing faculty who are motivated to teach and are extremely available.