A week in the life of a 4th year

Monday:

VA outpatient clinic with IM resident rotation: TI usually arrive about 30 minutes before the start of clinic at 9:00AM to review patients for the day. I typically will see two 60-minute intakes, and the rest are 30-minute follow-ups for a total of 5 hours of patient care. Most appointments are for medication management, but often we also use the time for psychoeducation and even short psychotherapy interventions. I get one hour of supervision from 3:00-4:00PM, and I usually stay another half hour to finish documentation after supervision finishes. In addition, about once a month, an Internal Medicine resident will spend the afternoon in clinic with me. When they are present, they observe my clinic and we spend an additional half hour after patient care finishes for teaching.

Tuesday:

Psychotherapy elective: I start seeing patients around 9 am and usually have three 60-minute therapy appointments. Documentation is brief, so typically I spend a half hour wrapping up documentation and preparing any materials needed for the following week’s session after patient care is complete. I primarily see patients for trauma focused work, including CPT and DBT. I also do an hour of supervision with a psychologist trained in these modalities.

2P medical student/resident teaching: Around 1pm, I head up to the psychiatric ward at the VA. The unit is relatively small, but usually there are two medical students and one PGY-1 resident rotating. My role is to provide a short didactic on a topic presentation, such as Catatonia or ECT. After the teaching, I usually am available on the unit for the next 1-2 hours to help answer questions, give feedback about notes, let students practice presentations or support whatever the learners need that day. I usually take some time before heading home to prep didactic materials for the following week while the learners finish their documentation and join sign out.

Wednesday:

St Lukes Outpatient clinic: I see patients for up to 5 hours, starting at 8:00 am. It’s often my earliest morning as I like to have at least a half hour of pre-charting time before I see my first patient for the day. I have 90 minute intake appointments and 45 minute follow ups, so I usually see fewer patients than my VA clinic and have more time in the appointment to manage complex cases, do psychotherapy, help with care coordination, or to work on documentation as I go. Typically, I will have one psychotherapy patient, but mostly I do medication management. I do group supervision with the PGY-3 resident on the site, which typically goes from 1-3pm. I might spend up to a half hour finishing up documentation and orders after supervision before heading home.

Thursday:

Didactic days: This is one of the best days, because I get to see all of my co-residents! The PGY-3’s and 4’s do most of our didactics together, with topics rotating every 2 years. However, during the noon hour, residents from all years gather for lunch, which the residency provides. The day is a mix of lectures, therapy seminar, journal club, case conference, grand rounds, business meeting, and T-group, a process group for residents led by group therapists. The day usually runs from 9:30-4pm, which leaves some extra flexibility in the morning for scheduling supervision or attending other meetings.

Friday:

Chief Day: Our program offers the option to be a chief resident to fourth year residents that have interest. We split up duties (I am the chief of recruitment and inpatient rotations) but share some global duties such as mentorship, teaching or program planning. This day is usually a “build your own adventure”. I might spend time supporting residents in off site rotations by doing a site visit or may have prescheduled meetings to work on specific projects or issues that have arisen. Each chief day we have at least an hour of supervision to discuss ongoing projects or how to build leadership skills and increase our effectiveness in administrative roles. The rest of the day is a chance for me to work on tasks, such as keeping rotation information up to date, prepping for an upcoming lecture, helping younger residents transition to a new rotation, or planning for recruitment season.

Evenings/weekends:

About once a month, I’m on call at the VA from Friday PM to Saturday AM or from Saturday PM to Sunday PM (which includes rounding). And for 3 weeks per year, I’m on night float, which includes a Sunday PM to Monday AM shift. While I never make plans that can’t be cancelled or interrupted while on call, I often will still try to do my normal activities as much as possible just with my call phone within reach.
If I’m not on call, I often have plans with friends to play DND, grab dinner or discuss this month’s book club book in the evenings after work. Depending on the season, I often spend weekends running on the greenbelt, playing a pickup game of volleyball, hiking in the foothills, floating on my kayak, or snowshoeing near Idaho City. My favorite weekends are when we hop from event to event, which can range from the farmer’s market to Tuba Christmas at the capital to the spirit of Boise balloon festival.