A Day in the Life of a 2nd Year

PGY-2 is split among various rotation sites with three months spent on the Behavioral Health Unit at Saint Alphonsus Regional Medical Center, two months at St. Luke’s Regional Medical Center working on the Consult Liaison Service, and three months at the Boise VA rotating with the Addiction Medicine program. In the second year, residents also complete a two month emergency psychiatry rotation at the VA, and have a two week selective rotation and six weeks of night float duty at the VA.

“A Day in the Life of A 2nd Year on St. Luke’s Consult-Liaison”

Makayla Bolls, DO

St. Luke’s Consult-Liaison Rotation

The St. Luke’s consult service provides residents with broad experience managing psychiatric consults in a large hospital system. The psychiatry team evaluates patients admitted to medical or surgical services when psychiatric concerns arise.

The Boise service covers ~430 beds in the main hospital, the inpatient rehab hospital across the street, rural hospitals virtually, and will soon expand with a new tower adding nearly 100 more beds. The census usually ranges from 5–10 patients, including both new consults (1–3 per day) and follow-ups. Cases are highly variable, spanning acute psychosis, delirium, suicidality or violence risk, peripartum assessments, agitation management, capacity evaluations, and more. The unpredictability keeps it exciting.

Daily Workflow
Morning: Residents chart review overnight consults and follow-ups. We present the patients when the attending and social worker arrive to formulate a plan for the day. New consults or more acute patients are prioritized.

Midday: Patients are seen either individually or with the team depending on the day and attending. Once patients are seen and plans finalized, we coordinate with families, social workers, case managers, and the primary team attendings. Once all in agreement, orders are placed, and we can work on notes.

Lunch: Resident can use the physician lounge where they have salads, sandwiches, soups, and snacks or their badge stipend at the cafeteria or Starbucks.

Afternoon: The team continues seeing patients that weren’t seen in the morning and address new consults as they come in. Some cases are straightforward; others require more coordination. New consults can come in late and if they aren’t urgent, we typically see them the following day. The day usually ends with finishing notes, final team communication, and—on calmer days—even a walk around downtown Boise.

“A Day in the Life of A 2nd Year on BHAC”

Austin Coleman, DO

VA Behavioral Health Acute Care (BHAC) Rotation

BHAC or, Behavioral Health Acute Care, is our “Emergency Psychiatry” rotation here at the Boise VA. While we are unfortunately not co-located in the emergency department itself, we are in an adjacent building where most of our outpatient psychiatrists have their offices and routinely see patients. This rotation is extremely variable and really characterized as a mixed bag. We see patients for inpatient psychiatric hospital follow-ups, scheduled higher-acuity patients who need to be seen regularly prior to establishing with a regular psychiatrist, patients that walk-in with various requests, as well as any patient presenting to the emergency department that needs psychiatric evaluation.

In the morning, I usually arrive by 08:30 which gives me 30 minutes to chart review prior to our morning huddle at 09:00. Typically we will have 2-3 scheduled patients each day as well as a varied number of walk-in patients and patients presenting to the emergency department. Morning huddle is with our BHAC nurse who has also chart-reviewed the patients and will give me and the attending for that day a run-down of our schedule. Attending coverage varies by the day at BHAC, so you get to see many different styles of practicing Psychiatry!

By noon I will either be casually eating lunch after having seen only one patient, or I will be in the emergency department evaluating my third potential patient for admission. Depending on the day, this rotation is truly feast or famine. Some days I am able to study psychopharmacology all afternoon, other days I am seeing back-to-back patients until the end of the day.

End of day is variable, but typically ends around 1600 as this is when BHAC officially closes. After this point, any new patients presenting to the emergency department who need psychiatric evaluation will be seen by the night float resident.

Overall, BHAC is an excellent learning experience for a variety of reasons. As an introduction into outpatient care, it equips you to evaluate whether patients are appropriate to maintain outpatient care, or require further stabilization either voluntarily or involuntary. This rotation forces you to think on your feet, making quick, calculated decisions. Additionally, this aids in teaching time management and efficiency in workflow.