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A Day in the Life of...

PGY1 PGY2 PGY3 PGY4

Carla Arellano, M.D., PGY1

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  Fourth year, amiright??! I was in your exact position around this time last year; quadruple
  checking my ERAS application to make sure I hadn’t thrown away the last 4 years
  because of one ‘psyciatry’ blooper. I promise it’ll all be okay and I can assure you that
  you’re already in a great spot since you’re reading this! Kind of like nobody can actually
  verbalize how hard med school is before you start, I don’t think anyone could have
  prepared me for how awesome my experience as a PGY-1 in the IU Psychiatry
  Residency program would be, so I’ll just tell you a bit about my experience and leave it to you to decide!

One thing I like about the program is that there’s no complacency when it comes to improving the residency experience. Starting with my incoming class, all PGY-1 residents begin on psychiatry rotations and we won’t be off-service for more than 2 months at a time (hope I’m not breaking any hearts by telling you that we won’t be on 3 consecutive months of internal medicine). In addition to 3 months of IM, the PGY-1 curriculum also includes 2 months of neurology, 1 month of emergency medicine, and inpatient psychiatry at 4 different hospitals.

I just finished a month of adult inpatient psychiatry at IU Health Methodist Hospital and am now one week into another adult inpatient rotation at Eskenazi Hospital’s Mental Health Recovery Center. As Marion County’s safety-net hospital serving the community’s underserved and often most gravely disabled patients, Eskenazi offers residents the opportunity to gain experience in caring for individuals with psychotic disorders who are quite symptomatic. My day usually begins around 8am when I arrive on the unit to preround and pick up new patients. I’ll then briefly visit with each patient to say hello and assess for clinical changes. After that, I prepare plans for each patient and meet with the 3rd year medical students rotating through the unit to go over care plans for the patients they’re following. At about 10:30, our team of physicians, medical students, a social worker, a nurse, and an occupational therapist review the patient census, offer updates from the previous 24 hours, and discuss treatment and discharge plans. The rest of the day typically consists of placing orders, completing interviews with newly admitted patients, obtaining collateral information, checking back in with patients, and writing notes. Even though there’s a general structure of events, no day is like the other and there is never a dull moment!

Eskenazi also has a psychiatric emergency department called the Crisis Intervention Unit where all PGY-1 residents take call approximately every 1-2 weeks from 4:30pm-10pm (not bad when you consider that we have weekends off during all psychiatry rotations!). The CIU offers walk-in appointments but you’ll often be consulting for the emergency department and will assess patients in either the ED or secure holding if they’re under police custody. It’s a great way to practice assessing patients in an acute setting and to learn how to determine if a patient needs to be admitted or if outpatient follow up is more appropriate. The CIU social workers are also incredible at their jobs and hilarious people in general, so it’s really an all-around great place to work!

One last thing and I’ll stop bragging. The IU Psychiatry Residency program really values resident education, which is why we have 4 hours of protected time every Friday from 11am to 3pm, regardless of whether we’re on a psychiatry rotation or off service. Resident wellness is also important, so the noon-1pm hour consists of free lunch and socializing. It’s a great time to catch up with co-residents, learn some stuff about psychiatry, and diversify your week!

Thanks so much for stopping by the website and learning a bit about our program. I hope we’ve adequately painted a picture of just how awesome it is and we wish you all the best this year!

David Pollock, M.D., PGY2

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  Second year of our residency program is a bit different from many programs in that we
  are exposed to pretty even amounts of outpatient and inpatient work. The residents are
  in two groups, with half of you working more in the outpatient setting for 6 months, while
  the other half are doing more inpatient work for 6 months. Everybody switches in
  January. I personally am biased towards this additional exposure to outpatient as that’s
  where my interests lie, but I also believe that there is value in getting exposure to
  outpatient psychiatry earlier on. It also sets you up with the opportunity to begin your transition to third year which is exclusively outpatient. 

Right now I am on the inpatient side of the year. Rotations are one month long except for our VA consult-liaison rotation which is two of the six months. My first month of second year was spent at University Hospital doing consults. It was definitely one of my favorite rotations as you get to see how psych is interwoven with medically complex patients (University Hospital has many transplant patients). Further, you have an opportunity to learn from the team, including Dr. Diaz, Chad Baughman (an experienced and exceptional PA), and PGY-4’s who also rotate through. We have a one month rural geriatrics rotation in Crawfordsville where we are exposed to a different population and pace of practice and have the opportunity to work with Dr. Rao who has a reputation for being a wonderful teacher and very patient-centered. Two months are spent at Riley’s Children Hospital which recently opened a new Behavioral Health unit. We also have a weekly half-day of clinic at a substance use disorder clinic at the VA and have protected time for didactics on Wednesday afternoons as well as protected time on Fridays for Grand Rounds, Resident’s Business Meeting and the all-resident didactics called Power Hour.

The other half of the year is spent in the outpatient setting with certain days set aside for different clinics. We have 1.5 days of substance use, 1 day of geriatrics, 1 day of forensics, and 1 day of emergency psych. Our substance use clinic is at the VA and it is a great opportunity to learn about substance use disorders while also treating mental health issues.  Our attending is passionate about teaching and in addition to learning about how to start suboxone, methadone and naltrexone, she teaches us about how to manage an outpatient healthcare team.  In our geriatric clinics we have an opportunity to learn about the intersection between geriatric medicine, neurology and geriatric psychiatry.  This clinic is a great place to practice some independence as Dr. Wang likes us to take ownership of our patients. During the Forensics rotation you spend your time with forensic psychiatrists learning about how this sub-specialty of psychiatry intertwines with the legal world.  Each day, you are challenged with applying your medical psychiatric knowledge to legal situations. We also have the opportunity to work with inmates and learn about some of the difficulties our correctional system faces in mental health. Emergency psych is a good place to do safety assessment while also see patients who may be intoxicated, psychotic, or in some other crisis state.

Perhaps the biggest change from intern year to second year is call. Second year will be the first time you are spending the night at the hospital, and while this can seem daunting at first, you have a tremendous amount of support. There will always be an upper level resident who has been designated as the back-up call person who you can reach out to at any time, with any questions, no exceptions. There will also be an attending on call who can provide additional means of support and serve as a great resource. While there is plenty of support, it is also an important time to develop our skills as we have a large degree of autonomy. Your responsibilities are centered around the VA hospital, where the call room is, and this is more or less your home base. You will also cover University Hospital, the Neuroscience Center clinic crisis line and Riley Children's Hospital as back-up for the Child Fellow. Call duties are roughly once weekly. During the week, call runs from 4:30pm - 8am the following morning while on Saturdays and Sundays, call is 24hrs, 8am-8am. Weekends and Fridays are 'home call' meaning you can receive calls from home and do not need to report to a site until a patient needs to be seen. The day following your call day is a 'post-call' day where you are not expected to work or attend lectures. 

Work-life balance is pretty easy to find here. Our call schedule is reasonable and it is easy to access the hospitals as they are clustered together in town. There is plenty of time to read up about cases at the end of the day, but there is also time to spend on other pursuits, including playing on intramural teams with other residents. I live near Massachusetts Avenue which is one of the cultural hotspots in town. I enjoy having quick access to restaurants and nightlife while also being about 10 minutes from the hospitals.  

You Na Kheir, M.D. PGY3

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  Hello, my name is You Na Kheir (first name: You Na) and I am a current PGY3 at the IU
  Psychiatry residency program. Third year clinical training is mostly outpatient and our
  rotations were selected based on our interests and availability of clinics among residents.
  There are ample opportunities to work with many excellent faculty members at IU. I think
  one of the strengths of our program is its diversity of opportunities and excellence in
  education. Everyone's schedule varies daily, and clinics are divided up by half days to maximize our exposure to a variety of psychopathologies and patient populations. It is fun to hear from my PGY3 colleagues about their experiences in other clinics and what they are learning concurrently.

 On Monday mornings, I am at the outpatient mental health clinic at the VA Hospital with Dr. Niculescu. He is interested in personalized medicine in psychiatry and genomics and phenomics of neuropsychiatric disorders, so we discuss one or two topics after the clinic, updating each other on recent evidence-based data on treating psychiatric illnesses. In the afternoon, I work with Dr. Overley at PARC (Prevention and Recovery Center for Early Psychosis) which focuses on treating, educating, and research on individuals experiencing the early stages of psychotic illnesses. Patients with various kinds of psychotic illnesses do very well in this recovery model of mental health treatment and interdisciplinary setting.

On Tuesday mornings, I am at IU Health Neuroscience Center with Dr. Nurnberger seeing patients with various mood disorders, primarily bipolar I or bipolar II disorders. Patients are psychiatrically quite complex, with some patients on 3-4 different kinds of psychotropics and requiring great attention to manage their symptoms and improve their functionality. So far, I've been learning a lot of new medications being used for FDA-approved as well as off-label purposes, but I am hoping that my clinic experience helps refine my psychopharmacology skills as well as brief/acute psychotherapy skills. On Tuesday afternoons, I am at the Riley Hospital for Children’s outpatient clinic with Dr. Dunn, who is a board-certified neurologist and a child and adolescent psychiatrist. I see a lot of children/adolescents with ADHD, behavioral disturbances, oppositional defiant disorders, and mood disorders. We learn how to navigate difficult psychosocial environments and detect/treat these disorders.

On Wednesday mornings, I work with Dr. Fretwell at the Midtown mood clinic, which is also informally known as a “borderline clinic” due to the nature of patient population. Patients are psychosocially and psychiatrically challenging and I learn how to be comfortable with symptom management via medication and effective therapy treatment. On Wednesday afternoons, PGY3s have didactics, covering various topics in a systematic fashion, including mood disorders, psychotic disorders, and addictions.

On Thursday mornings, I work with Dr. Bateman at the Healthy Aging Brain Center (HABC). A neat thing about the HABC is that the group developed their own psychometric instrument called the HABC monitor which has been validated through research. In some ways, the clinic is run more like an internal medicine or geriatrics clinic and has a much higher patient volume with a faster pace. Thursday afternoons are dedicated Psychodynamic Psychotherapy lectures by Dr. Butler who is trained in psychoanalysis and still practices psychoanalytically oriented therapy.

On Fridays, I am in the Academic Psychotherapy clinic.  We use a one-way mirror to interview our patients and we get to see colleagues sessions this way as well. It is quite unnerving knowing that my colleagues and a therapist are watching everything during the session, but it is also tremendously helpful to continue to develop my strengths and work on my weaknesses during therapy. On Fridays, we also have departmental grand rounds, resident business meetings with lunches, and power hours/journal clubs led by residents and/or faculty members.

A word about research - I did not have any research experience prior to residency, but I became involved during my PGY2 year through mentorship and had the privilege of publishing a few papers. A wonderful thing about this program is that there are so many opportunities and great faculty members who are willing to mentor you that if you are motivated and interested, you’ll learn a lot and grow tremendously as a clinician, educator, and/or researcher – you choose! I am a current chief of research and education committee organizing monthly power hours for residents, recruiting guest speakers within and outside of our residency program, and presenting papers on various topics for discussions.

I am still relatively new to Indiana/Midwest in general, having moved for residency from the East Coast, but I love this program so much and appreciate what this program has done for me both academically and in my personal life. I have grown as a psychiatrist-physician because my program focuses on its excellence in education, dedicated mentorship, and opportunities for research and career development. I respect and enjoy working with our faculty members, including our program director, Dr. DeMotte, and our wonderful program coordinator Jeanette, who makes the program run smoothly and supports everything we want to accomplish during our residency years. My residents are kind-hearted and smart and it helps working and learning with great people all the time during four years of residency. I hope you check out our program and consider being part of this wonderful residency!

Steve Moberly, M.D., PGY4

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  Life as a 4th year psychiatry resident has been an extension of the ongoing process of
  personal  and professional growth as it pertains to the role of a psychiatrist. I entered the
  program with a desire to better identify and serve the mental health needs of our society.
  The support and flexibility of the residency program has been unwavering in allowing me
  to strive in the fulfillment of these goals.

  With a background in research and a supportive program, I have established collaborations to better characterize public mental health and the psychiatric workforce in Indiana. The aim of this work is to establish a framework from which psychiatry as a profession may better address populations that are underrepresented and in greatest need of services.

While I have been enabled to pursue this research with vigor, I have also been afforded the opportunity to continually refine my skills with patient interactions and treatment modalities for mental illness. There is ample opportunity to further my understanding of the underpinnings of mental illnesses. This training has guided my development in how assist in patient recovery by addressing biological, social and systems levels of pathophysiology and mental wellness.

My day-to-day clinical time is reflective of the diverse training opportunities. I currently work in a variety of settings including a homeless outreach team, consulting inpatient and outpatient medical teams, general adult psychiatry clinic, VA clinic, and a psychotherapy clinic. In addition, I have ample time built into my schedule to pursue research and further education.

A significant component of this training are the things I have learned from the supportive relationships established with other members of the medical profession. The quality of leadership, mentoring, and peer relations has far exceeded any expectation I may have had. I have also thoroughly enjoyed the opportunities to interact with newer residents, clinical staff, and medical students. I am certain that these interactions have guided my own development as much as they have for others involved.

Our residency program provides an excellent framework for the progression of autonomy. The support and guidance available through every step has neither been lacking nor overbearing.  In the 4th year of residency we are allowed to develop our schedules since all required clinical experiences have previously been met. In looking back on my experiences through the years, I could not have elected a better residency training experience. Taken as a whole, I am very satisfied with the ways this experience has contributed to my development as both a person and a professional.

Department of Psychiatry | 355 W. 16th St., Suite 4800 | Indianapolis, IN 46202 | Ph: (317) 963-7288 | Fax: (317) 963-7313