I have really enjoyed all of my years at IU and am happy to share what you can expect from a fourth-year experience. Most of the fourth year is elective time to pursue your own interests and hone your individual techniques with various populations. This is a very fun point to reach in your training. One notable requirement is a junior attending role during fourth year, which is what I am currently doing in July and August, as a junior attending at one of our inpatient psychiatric units, C8 at IU Health Methodist. Here’s my typical day:
7:30-8:00 am: Arrive to the unit and look at the list of patients and assign myself a selection of interesting patients.
9:00 am: Participate in discussions among the interns, nurses, therapists, pharmacists and social workers regarding diagnosis, formulations, medication/therapy interventions and discharges of our shared patients.
12 noon: I eat lunch and always grab my Americano from the Copper Moon Coffee Bar (they start making mine when they see me in line). The rest of the day I help see new patients, document occasional H&Ps, call families, coordinate with outpatient providers, or anything else I can do to be helpful to the interns. I also provide some informal education as opportunities arise to the student and interns. I loved being part of a team like this as a junior resident, but it is even more fun as a senior resident as I return with a greater body of clinical knowledge and savvy, coupled with a proportional increase in confidence in my conceptualizations of patients and selections of management strategies. My first rotation here also happened to be on this unit, and it has been very rewarding to come back as a senior resident and help impart knowledge and confidence to the students and interns as I know I benefitted greatly from my past seniors, and it also has helped me realize just how much I've grown during this residency!
4:00 pm: I end my workday and go home and see my super awesome 5-month-old son, Desmond, and his super mom, my wife Dana! After some family time, I often go play soccer with one of four different pick-up groups. Otherwise, once Desmond is counting sheep, I usually spend my evening playing a combination of piano, board games, and video games. A nice perk of fourth year is that there is no call, so my evenings and weekends are totally free. Many of my co-residents use some of this available time for moonlighting, but alas, that's not my style.
Starting in September, my schedule will switch significantly, as I will be entering a more longitudinal schedule for the rest of the year. Some highlights include working in the college mental health clinic in IU Bloomington on Mondays and working with Dr. Lysaker utilizing metacognitive therapy in patients at the VA Hospital on Thursdays.
I think every year of our psychiatry residency has been very manageable and rewarding in their own ways, and far this year is set up to continue this excellent trend. I feel empowered every day to come to work and learn while being a helpful team member, and then to leave work at work and go home to be a good husband and father, and some days, a decent soccer player, and perhaps one day, with the help of Chris Hyppolite, a semblance of a pianist.
Stephen J. Brandt, MD
Psychiatry, PGY 4 Southern Illinois University School of Medicine
Third year is all outpatient for us. PGY-3s can choose from many clinics in which to work in different hospital settings. Some are general psychiatry clinics, while others are more specialized such as addiction, gender and geriatrics. While the variety at IU is one of the biggest strengths of this program, it does take a few weeks to initially to get comfortable with being at so many different sites each week.
The attendings and other residents are very helpful with this transition. I realize now that I prefer this schedule rather than being at the same place for months at a time. This way, you get to learn from the experiences and approaches of different attendings and clinics, can follow the same patients for the entire year, and time flies because every day is so different. The wonderful program coordinator and director also do their best to have us in the clinics we want.
Due to COVID, some clinics are still virtual, while others are in person. I’ve enjoyed both settings. There is a special connection with in-person appointments that is difficult to replicate virtually, but the convenience of working from home on certain half days is nice, too. My weekly schedule looks like this:
Mondays: VA Medical Center working with two different attendings.
Tuesdays: Goodman Hall (GH) clinic at the IU Neuroscience Center in the morning and Psychotic Disorder Clinic at Eskenazi Health in the afternoon.
Wednesdays and Thursdays: I have more GH clinics, including ones that focus on functional neurological disorders, and a separate therapy block for all PGY-3s.
Friday: Didactics! We have therapy didactics in the morning and general psychiatry didactics in the afternoon.
For call responsibilities, PGY-3s cover Riley Children’s Hospital for one week at a time, until 11:00 p.m. On weekdays, call is 4:30 p.m.–11:00 p.m., and on weekends from 8 a.m.–11:00 p.m. The workload for normal workdays and call is very manageable.
I'm thankful for being able to train in such an excellent program and fun city. From the variety of training sites, I'm learning a lot and feel prepared for the future by working with different patient populations, health systems, psychiatric conditions and attendings. I've felt supported the entire time, from everyone including my coresidents, program director, program coordinator, attendings, and other hospital staff. Outside of work, there are lots of things to explore in Indianapolis and the time to do so.
Olga Lykhytska, MD
Psychiatry, PGY 3 Wayne State University School of Medicine
7:00 am: Alarm rings and I am feeling lucky that I can get at least 7 hours of sleep, sometimes 8. After packing myself some breakfast I grab all my necessities for the upcoming call day at the Richard L. Roudebush VA Medical Center: pager, call book, remote access cable, change of clothes and toiletries--check. Except for a hectic first call day, I have settled into the long 24-hour days of call as well as I could, sometimes dreading those late-night calls. I walk out the door and hop into some national public broadcasting on my 15-minute commute. Last month, I heard our Program Director, Dr. DeMotte, and our CL attending, Dr. Reis, locally interviewed, and gleamed at the thought of good representation for Psychiatry in the news.
I arrive at Riley Hospital just in time to walk to the Red Wagon Café, where I grab a small coffee. As I walk by security, the same security guard wishes me a great day. The sense of familiarity and routine have become surprisingly comforting to me, as I walk into the child psychiatry consult room. I pull up the EMR, and review details from my patient consult list. I have been following about five patients. I chart review and get ready for table rounds. Our medical students, clinicians, psychology interns, and attendings gather to systematically go over the patient list and determine our daily goals for each patient.
After we break, we discuss our sickest of patients. Our patient with NMDA encephalitis is agitated, and we calculate Ativan equivalents. This is one of many patients on consults with interesting presentations and etiologies ranging from catatonia secondary to encephalitis to functional neurological disorders. For several of our patients possibly presenting with catatonia, we quickly review our plan to perform the Busch-Francis scale. One might possibly receive an Ativan challenge today. My fellow, Dr. Powell, directs me to some very useful articles on catatonia, and the team reads and discusses possibilities.
After my daily note writing I walk across the green and past Eskenazi Hospital’s courtyard to arrive at the Veteran Affair’s building. I turn on that pesky pager and get ready for some admissions. Suicide risk assessments happen most often during this time, and I get in the flow of those admissions, trying my best to manage my time. I order some take out and wait for 11 pm, expecting some Riley assessments.
12 midnight: No calls present, so I use the extra time to call the family and hit the sack.
5:00 am: I am called again from the inpatient unit at VA to help with some medication for anxiety. I finish my tasks and get ready for morning sign out and briefing with Dr. Poor. In the morning bustle, I walk out of the VA looking more disheveled and tired than colleagues coming in, but with a sense of pride and completion. Likely I will tend to my plants today, enjoy some housework, and visit the Fountain Square district for a meal after some sleep.
Krystal Salazar, MD
Psychiatry, PGY 2 Indiana University School of Medicine
I usually wake up at 5:30-6:00 am depending on how industrious I am feeling. I do my morning routine including a headspace meditation and leave my apartment around 7:15-7:30 and my day usually goes as follows:
8:00 am: Action time. Last month I was on inpatient at Methodist Hospital. When I was there, I started by printing out the list, writing out vitals, labs, the MAR and any notable events that happened overnight. Then I try to stop by to see as many patients as I can before our 9 am staff rounds.
9 am: We meet with nursing, pharmacists, and therapists to coordinate our care. Afterwards, we meet with Drs. Michael DeMotte and Aimee Patel to talk shop. After that I see the patients that I haven't had a chance to see yet.
11 am: This is when we formally table round with the consults and emergency holding psychiatrists joining. We let the medical students present our patients and we then discuss the fine points of our plan. We will also discuss expected arrivals or more complex management. If time allows, we have teaching at this time.
LUNCH BREAK!!! The most refreshing time of the day. If you didn't bring your lunch, I personally recommend Sonny's Pizza in the basement. It’s a pretty great NYC style pizza joint. My go-to order is a slice of margherita with two breadsticks and a mountain pepper. It really hits the spot.
12:30-ish onwards: I put in any orders that weren't placed earlier and take on my to-do list. This is the time to get my patients up to date on their plans, make calls for collateral, and anything else that I had earmarked before I write my notes and head out.
3:30-4 pm: My days usually ends.
On some days I like to drop by a local coffee shop after work. Quills Coffee is nearby and pretty good. I’ll grab myself a tall glass of Yerba Mate and read on something that popped up during the workday. For example, if I am prescribing a patient lithium, I might read up on how to interpret lithium levels and lithium toxicity. After I'm done, I head home, catch up with family and friends, and either read a book or watch a show.
What I like about Indianapolis thus far is that it is very cheap here, the people are friendly and there is a lot to do in this town. As a long-time Chicagoan, I am honestly impressed by how robust and diverse food options and the arts are here in Indianapolis. There are also nearby towns and hiking options that I try to explore on weekends. I really recommend checking out Brown County State Park and the little-known Jackson-Washington State Forest.
David Schargorodsky, MD
Psychiatry, PGY 1 Un of Illinois Col of Med (chi/Peor/Rock/Chm-urb)