Life as a Child and Adolescent Psychiatry Fellow

Samantha L. Wagner, MD, PGY 6, 2nd Year

I’m a second year Child and Adolescent fellow. The first 6 months of second year is primarily outpatient clinics while during the second 6 months there is a little more freedom for electives. One of my absolute favorite things about my CAP training through IUSM has been the variety of different clinic options available through the department. I have been able to see and work with patients with a variety of different disorders and complexities. But also having a lot of different clinic options comes with the opportunity to work with a lot of different fantastic attendings in those clinics. I value the personal and professional investment and mentorship I have received from attendings in my different outpatient clinics just as much as I have valued the breadth of my experiences with patient.

On any given morning during second year of fellowship, I drag myself out of bed and start to get jazzed for the day of outpatient appointments ahead! I first have to make sure my four-legged best pupper friend, Cricket, has been fed and outside and given enough cuddles to last her the entire day. And then I’m off! The Child and Adolescent outpatient clinics are located primarily in the Pediatric Care Center, which is a beautiful new building on the same campus as Riley Children’s Hospital. There are other pediatric clinics in the building, but the child and adolescent psychiatry department is housed on the entire 4th floor. I live in a neighborhood in downtown Indianapolis called Fountain Square and love it for many reasons, but I especially love how close it is to the medical campus. Indianapolis is a very affordable city with a low cost of living and a variety of safe, affordable neighborhoods within a 15-20 min drive to work.

I spend the morning seeing patients. I start with the patient after they have been roomed and will get the interval history prior to staffing with my attending. We will then go back to the patient room together and discuss the plan and answer any further questions or concerns. Our clinic schedule is broken up into half days and we will spend a specific half day each week with a particular attending in their clinic. Some of the patients I see have been seeing the attending for a few years and have seen a few different fellows along the way, while other patients I have been able to complete the intake appointment and see them from the beginning of their time with the clinic!

I am doing a variety of both telemedicine appointments and in person visits. In between appointments if there is spare time I am working on orders and my documentation, also will be preparing for upcoming appointments. Each CAP fellow has their own cubicle on the 4th floor of the PCC that gives me a quiet, private space to work. We have access to our cubicle at all hours, which is very nice.

I see patients from different socioeconomic, cultural and ethnic backgrounds and all with a wide variety of psychopathology. On Tuesday afternoons, I work with an attending who specializes in neurodevelopmental disabilities so I am primarily seeing patients with Autism. I also spend an afternoon in the Tics, Anxiety and Compulsions (TAC) clinic where I work with an attending who specializes in anxiety disorders, Tourette’s and OCD. There are also general clinics available as well. I plan to go into outpatient adolescent psychiatry, so I love to work with adolescent mood disorders, substance use treatment, etc. I am also in a dual diagnosis clinic for adolescents, ENCOMPASS, which I absolutely love.

I usually finish my clinical day by wrapping up outstanding notes and orders prior to leaving clinic. I get home with plenty of time to make dinner, relax and snuggle with Cricket!

David Scofield, MD, PGY4, 1st Year Fellow

I am one of the first-year Child and Adolescent Psychiatry fellows. For the month of August, I am on the consultation liaison psychiatry team at Riley Hospital for Children. On a given day, I wake up, make coffee, walk around the house, and don my outfit for the day. Then I drive into the hospital!

My first task is to open the medical record, look through all the patients on our list, and see what may have happened overnight. I check to see if we have any new requests to see patients, and then call the teams to learn about these new patients. We meet as a big team in the morning with medical students, residents our staff physicians, and our clinicians and therapists and talk about all the patients we’re going to see. Then we’re off to the races!

The rest of the day is pretty dynamic: talking with patients, talking to families and other care teams, maybe doing some teaching with the students. We have to think critically about a lot of different issues. Energy level is high. It feels like we are going through the circulatory system of the whole hospital because we see kids with all different concerns.

Some days I am “on call.” On these days we answer calls from the emergency department about kids who have come into the hospital. We make decisions about whether they discharge home, if they are admitted for further care or if other medical teams need to be involved.

These situations can be complicated but we have wonderful staff to work with. Some days I also see our kids who have been admitted to the hospital for psychiatric care. We work with a multidisciplinary team who do activities, therapy, and medication management. There are wide variety of interesting responsibilities and opportunities to problem solve throughout the hospital in child and adolescent psychiatry. I love what I do!