From their first year through the fourth, psychiatry residents learn to balance full work days and educational training with busy home routines. Learn more about how a typical day looks for each of our resident classes.
Joseph McCann, MD, PGY4
Fourth year of residency is great! This is the year you get to choose what you want to do, outside of two months of time doing rotations in a junior attending role. The junior attending role basically requires a fourth-year resident to be in an active teaching and supervisory position with lower-level psychiatry residents, namely first years. I started off my fourth year by completing my junior attending rotations, both of which I did at the inpatient psychiatry unit at IU Health Methodist Hospital with Dr. Aimee Patel and Dr. Jonathan Withers. July and August are great months to act as a junior attending as you can be very helpful, as this is when the first-year residents start residency. I wanted to come back to the Methodist inpatient unit since this is one of my favorite places to rotate at; it is where interns rotate for two months of their first year.
After I finished inpatient psychiatry at Methodist, I went to a one-month block of outpatient sleep medicine in September. Sleep disorders and sleep issues are very prevalent in psychiatric patients, so I wanted to get a better handle on sleep disorders and their treatment. Prior residents have rotated with sleep medicine during their fourth year, so I reached out to the faculty they have contacted in the past to set up this rotation. Other rotations people have done in the past outside of the department of psychiatry include toxicology (through the emergency medicine department) and global health rotations; while I was an intern on neurology, one of the then fourth years spent one day a week in one of the neurology outpatient clinics. It’s flexible, so if you have an interest in something and want to spend more time getting clinical exposure to it, ask and see if you can do it, you’ll likely be able to.
Starting in October and continuing through the end of the academic year, I will focus primarily on outpatient psychiatry (with some exceptions), with the same schedule each Monday through Friday. I should mention, despite having been on inpatient and off-service rotations for the first three months of fourth year, you can still take up to one day off per week working in other areas. For me, I continued my third year, Monday afternoon, general adult outpatient psychiatry clinic at IU Health Goodman Hall with Dr. Susan Conroy; on Wednesday afternoons, I continued following with my psychodynamic psychotherapy patient from third year along with working on projects related to the education track (see more below). Below I highlight my schedule from October through the end of the academic year:
Monday: In the mornings I will work with Dr. Anup Deshpande in the Goodman Hall psychiatry clinic, working primarily with geriatric psychiatry patients. Then, in the afternoon, I will stay at Goodman Hall and continue in my third-year residency clinic with Dr. Conroy. This is one of my favorite clinics I have worked in, and the way it is set up allows for a significant amount of autonomy and independence to allow for you to become more comfortable making decisions with treating outpatients. I also have a significant amount of continuity with patients, especially since I have been in this clinic now for over one year.
Tuesday: On Tuesdays, I veer away from outpatient to an inpatient setting, as I am going to work at the Logansport State Hospital to see patients. One of the things I really want to have before graduating is having some experience in a state hospital environment. We do not have much exposure to state hospital in our regular residency curriculum, besides a couple days in the second year of residency on a forensics rotation.
Wednesday: In the morning I will be working with Dr. Conroy again, but this time doing outpatient electroconvulsive therapy treatments. Then, in the afternoon, I continue working with my psychodynamic psychotherapy patient from third year. I want to continue getting more experience in therapy, so I am continuing to work with my therapy patient this year.
Thursday: In the mornings I will be working with Dr. Matthew Miles at the VA SUDRP clinic (SUDRP is the VA’s dual diagnosis psychiatry-substance use disorder clinic). I worked with Dr. Miles as a second year resident at the VA in SUDRP, and want more experience with treating substance use disorders prior to graduating. In the afternoons, I continue at the VA, but will work with Dr. Corey Trobaugh in the same VA general adult outpatient psychiatry clinic I worked in as a third year resident. Similar to my Monday afternoon resident clinic with Dr. Conroy, this clinic has a great deal of autonomy and patient continuity.
Friday: In the mornings I take my education half day, during which time I am free from clinical duties to work on various projects related to the education track our residency offers. I have been a part of the education track since being a second-year resident. I help the team that runs the first-year medical student psychiatry course. It’s something I’ve enjoyed being a part of, helping edit and fine-tune presentations for lectures for the course, and running small group sessions when the course is in session in May of each academic year. We have also worked on a research project related to how our course affects bias and outlook towards the field of psychiatry and psychiatric patients. In mid-2023, we had a paper published in Academic Psychiatry regarding this research. For the second half of Friday, I go to didactics, grand rounds, and resident business meeting. This is a great time to visit with and catch up with fellow residents!
Hopefully all the above drives home that fourth year is flexible, and it is really up to you to decide what you want to do during it. Besides being flexible, there is no call in fourth year, which is a really nice change! And I feel like I have plenty of free time in the evenings and on weekends to spend it with my wife, visit with family, and work on hobbies of interest. I’m looking forward to the next stage in my career!
Joseph P. McCann, MD
Psychiatry, PGY 4 Indiana University School of Medicine
For PGY-3 year, our residency has 12 months of outpatient clinics. A highlight of our program is that we can choose clinics based on our interests and have a wide variety patient populations and hospital settings to choose from. These include but are not limited to: general psychiatry, addiction psychiatry, gender health, child and adolescent psychiatry, woman's mental health, and geriatric psychiatry. In these clinics, you will follow the same patients for an entire year and will learn from the different experiences, approaches, and styles of different attendings and clinic settings.
Here is a peek at my weekly schedule:
Monday: I am on the education track and have protected time on Monday mornings to work on lectures that will be used to teach our medical students. In the afternoons, I have a general adult psychiatry clinic at Goodman Hall.
Tuesday: In the morning, I see my psychoanalytical psychotherapy patient and I staff this with an attending after the session. In the afternoons, I have a general adult psychiatry clinic at Eskenazi Health Center on West 38th street. I really enjoy this clinic as I am able to serve a very diverse patient population and feel like I make a difference.
Wednesday: In the morning, I work at the VA Medical Center in an adult psychiatry clinic. In the afternoon, I work in a Goodman Hall clinic that has a mix of general psychiatry and addiction psychiatry. I am interested in addiction psychiatry and look forward to this clinic every week.
Thursday: In the mornings, I have clinic at Goodman Hall where I see patients with a large assortment of complex psychiatric and medical comorbidities. In the afternoons, I have clinic at Riley Children's Hospital on the maternal fetal medicine side in a clinic that specializes in woman's mental health before, during, and after pregnancy. This is also one of my favorite sites as I find serving this patient population very rewarding.
Friday: At this point in my week I can take a breath because Fridays are always devoted to didactics, and we have protected time the entire day. In the mornings, we have our PGY-3 psychotherapy didactics. At noon, lunch is provided and we have our weekly resident business meeting. In this meeting, we give updates on committees, groups, and different projects going on within our residency. I am currently the Goodman Hall site chief so I will make announcements related to that if I have any. This meeting usually ends early, and we have time to catch up with our co residents. In the afternoon we have didactics with all residency classes and rotate through a variety of topics throughout the year.
Saturday and Sunday: You can find me exploring downtown Indianapolis where I currently live. I love being able to walk to most places nearby within 20 minutes. For me, Indianapolis is large enough to always have something new and exciting going on but not so large that it feels overwhelming.
Amanda R. Kaminski, MD
Psychiatry, PGY 3 University of Mississippi School of Medicine
The second year of residency is the year where the real fun begins. All rotations are under the psychiatry umbrella, the profession that we have chosen as ours. Overall, we continue with our Monday to Friday rotations, understanding that Fridays are the days we have our precious Didactics: from 11:00 to 16:00, time to gather with residents and fellows, have lunch together, talk about how life is going, have journal clubs, paper discussions, lectures, Ground Rounds, and more! It is really a fantastic learning time.
In second year, we have several rotations, and we typically share those rotations with one or two classmates. For example, I started with the substance use disorders clinic in the VA Hospital, while other classmates are doing Geriatrics Psychiatry in Crawfordsville, and others a mix of Research, Forensics, and Palliative care in the different tertiary hospitals we have available in Indianapolis: Methodist Hospital, University Hospital, and the modern county hospital, Eskenazi Hospital. This year, we are more exposed to psychiatrists who have led specific tracks within psychiatry, such as addictions, psychotherapy (CBT), consult liaison, and emergency psychiatry, among others. If you have a particular interest in Child and Adolescent Psychiatry, you can start rotations at the leading pediatric hospital of the state, Riley Hospital.
As PGY2s, we also begin to have leadership positions in different subgroups within our program, for example, a representative for the Indiana Psychiatric Society, the Multicultural Physicians Alliance, and multiple committees like Diversity, Safety, and Wellness.
Second year is synonymous with shifts, or as people say here, “being on call.” Now, being on call is the first time you’ll find yourself dealing with clinical situations, just as if you were alone dealing with real-life medical decisions. The truth is that we always have attending psychiatrists and multiple group support chats to ask and to back up our clinical decisions, making it a sine-qua-non opportunity to learn and test ourselves.
Finally, the second year is when you settle more into the beautiful city of Indianapolis, a “right-size city” with all the amenities of big cities like an international airport, professional sports, museums, tons of parks, bicycle paths, and cosmopolitan cuisine available, and at the same time, all the warm midwestern hospitality and commute friendly distances. In just one line, IUSM and the entire experience here in Indianapolis have vastly exceeded my expectations.
Ricardo A. Serrano, MD
Psychiatry, PGY 2 Universidad de Chile Facultad de Medicina
PGY-1 has six months on service and six months off service. The bulk of your on-service months are inpatient psychiatry at our various inpatient wards. For me, this has been a great opportunity to learn my role as an intern and how to make the magic of patient care happen. During my on-service months, I'm learning to communicate and aid the patient care team between nursing, social workers, attendings, seniors, and medical students. From learning the basics, such as putting in orders, to reading literature and developing a new treatment plan for complex cases, I've been amazed by the variety of cases and seeing my own skills as a physician grow. During off-service months, we understand our colleagues' perspectives from a neurological, emergency, and internal medicine standpoint. Even when I see patients during my on-service months, I recall questions and patient cases from my neurology and emergency medicine month. I can't wait to see how I grow throughout the rest of my intern year!
Every person and every rotation will have a different schedule, but my general day during an on-service month goes as follows:
6:00 a.m.: First alarm goes off. It's an ECT day at Methodist! I'm so happy to be on a service where I can be with my patients the morning of ECT and even give the treatment (under the wonderful guidance of Dr. Patel). It's a life saving intervention and I'm so thankful to be at a program where I can observe, learn, and offer it.
6:45 a.m.: Arrive at the hospital and go to the ECT area. I chat with my patients and ask how they are feeling before ECT. Sometimes our inpatient ECT service is busier than other times, but we are usually able to finish up around 8:00 a.m.
8:00 a.m.: Arrive in the team room with attendings, seniors, medical students, and other interns. I chat with nursing and begin chart reviewing my patients. At IU-Indy, we get to learn a variety of EMRs and how hospital systems operate. I believe a large part of the intern year is learning how a hospital works during the day, night, and on weekends! It's important to understand these logistics to set everyone up for success. After I chart review, I go see my patients before our 9 a.m. treatment team meeting. I prioritize my patients who are discharging first so that I can make sure they are safe and ready to leave.
9:00 a.m.: Morning report! This is one of my favorite parts of the day because I love interdisciplinary care. Our room is packed with doctors, nurses, social workers, pharmacists, therapists, (sometimes) chaplains, and students from all these disciplines. We run through each list and talk about how patients are doing, what concerns we have, and how each of us can contribute and coordinate care. I make notes of any orders I have to put in, families I have to call, or other issues to address with my patients.
9:30 a.m.: I put in any critical orders for patients, call any consults needed, get patients' discharge orders in, and begin working on notes. I also file any legal paperwork (e.g., commitment paperwork or emergency detention paperwork.). On Fridays, we have didactics until 4 p.m., so I head over to Goodman Hall as soon as I have wrapped up orders and notes on my patients.
9:45 a.m.: New patient interviews! If we have any new patients coming onto the unit, this is the time we chart review and get ready to interview new patients. At first I was very nervous to do interviews in front of my senior and attending, but I'm very grateful to be at a program that allows autonomy, gives feedback, and is rooted in patience and kindness. My senior and attending will chime in after the end of my interview with any additional questions, and we will all debrief afterwards. They give me tips on how to advance my interview skills and work through a differential and plan with me. They understand I am a learner and help guide me as much as I need!
11:00 a.m.: Treatment team meeting! This is a time for attendings, seniors, interns, and medical students to formally present new patients and run through the list. It's not all business, though! We laugh, connect, share personal stories, and enjoy each other's company. Many times, the C-L team at Methodist will join us.
12:00 p.m.: Lunch time! At IU, we are given meal stipends during our inpatient months at Methodist and for our call shifts at Eskenazi. On tougher days, I try to get myself a treat at Sonny's Deli in the basement of Methodist. On a daily basis, I get my noon bolus of coffee before I head back to my computer and finish up orders, consults, calling families, and notes. On Thursdays, we have CL didactics at noon and will listen together.
2:30–3:00 p.m.: Most of my responsibilities are completed around this time. I usually check in with nursing to make sure they have everything (especially orders) before I head out. I check in with my co-intern and attendings as well.
After work: On the days that I don't have call, I get home around this time. I pet my cat for about 15 minutes and then get ready to go to the gym and start thinking about dinner. Later in the night (if I have the strength), I do some UWorld as I'm getting ready for Step 3. I try to keep up with my emails as best as possible, and if I have any reading to do, I try to set aside some time to research treatments or read up on a topic in psychiatry. Dr. Patel will send relevant articles based on the unit's case, and those are usually my go-to reading material! I'm lucky to be in a program with a personally, professionally, and academically supportive program director.
If I don't have the strength to do Uworld or read articles, I spend time with my partner. We like to watch comedy TV shows like The Office, Parks and Rec, and Brooklyn 99. We are both big football and basketball fans, so we usually have a game going on in the background. We bought our first home in Carmel and usually plan what the next gathering we will host for our friends (aka my co-interns!). During the week, my co-interns and I will make plans for the weekend. Indianapolis is a great city that is growing and always has something to do. My co-interns are THE BEST, and I always look forward to hanging out with them.
Call nights: On the days that I have call at the CIU from 4:30 to 10 p.m., I head over to Eskenazi. I check in with the social workers to see if they need anything right away. I wait until I'm told to see a patient in the ED or when a patient arrives at the CIU. While I wait, I try to study or catch up on emails. When I do see a patient, I chart review, go see the patient, put in any urgent orders, staff with my attending, and then complete the rest of my orders based on our assessment and plan. The CIU is an amazing opportunity to practice independently and have an attending who checks your work! It's also great practice to write H&Ps.
Overall, my intern year has been amazing. I've always heard how difficult intern year can be, and I'm thankful to be at a program that supports their interns every step of the way. Deciding which program will be the best fit can be a difficult decision. As you continue to consider IU School of Medicine, I hope you'll appreciate how the entire program is built to make each resident a strong, independent, culturally competent psychiatrist. The rotations during the first year are designed to give you a full perspective of patient care. The attendings are kind, patient and allow you to grow in your own style and treatment. Your seniors and upperclassmen are supportive and always eager to help (even before Match). They know intern year can be a difficult transition, so they make sure you don't feel alone or unheard. The variety of sites allows you to see patients of all backgrounds and pathologies. Indianapolis is perfect for an intern year with a variety of things to do within a short distance (and, of course, it helps to have the best class of co-interns to enjoy it with). I've grown leaps and bounds, both personally and professionally, within 2.5 months as an intern at IU School of Medicine, and I can't wait to see the psychiatrist, individual, and Hoosier I grow into.
Anisha Sharma, MD
Psychiatry, PGY 1 Loyola University Of Chicago Stritch School Of Medicine