A Day in the Life for Psychiatry Residents

7:30 a.m. — Chart review
I begin the day by arriving at the unit and reviewing patient charts for morning rounds.

8:30 a.m. — See patients, start notes
I see my patients and open my notes for the day. If time allows, I get started with a couple of notes before the treatment team meeting to make the rest of the day go smoother.

10:45 a.m. — Multidisciplinary treatment team meeting
This meeting includes representatives from nursing, pharmacy, occupational therapy, social work, patient care coordination and other support staff. Interns are expected to lead the discussion for each patient, present a preliminary assessment and treatment plan, and incorporate feedback from the team and the attending psychiatrist. Treatment orders are finalized by the end of the meeting and are ready to be implemented to guide patient care.

11:45 a.m. — Place orders, continue notes
I put in orders based on finalized treatment plans immediately following the team meeting to get things started without a delay. Then, I continue working on notes until lunch.

12:30 p.m. — Lunch
At the clinical site where I’m currently rotating, there is a cafeteria with a salad bar, a hot food bar, a station for sandwiches and wraps, and more. Residents receive a 40% discount on all items from the cafeteria at this location!

1:00 p.m. — Finish notes
After lunch, I finish patient notes. Depending on the day’s workflow, I am sometimes able to leave early, provided that all notes and orders are complete and I remain available to address any additional patient care needs remotely.

4:30 p.m. — End of day
Most work days conclude by 4:30 p.m., except when I am scheduled for a call shift in the Crisis Intervention Unit (CIU), about once every two weeks on average.

4:30 to 10:30 p.m. — Crisis Intervention Unit (CIU) call shift
About once every two weeks, interns are assigned an evening call shift in the CIU. These shifts involve evaluating patients who are in a mental or emotional crisis and deciding whether or not an admission to the inpatient floor is needed. There is no weekend call for psychiatry rotations during the PGY-1 year, so all of these shifts fall on weekdays.

Other considerations for the PGY 1 year
Half of the PGY 1 year is spent on inpatient psychiatry rotations, while the other half of the year is divided between off-service rotations such as emergency medicine, family medicine, internal medicine and neurology. Daily schedules and call responsibilities while on non-psych rotations would be different from those described above and would vary from service to service.

The schedule described above reflects the busiest inpatient psychiatry rotation of the PGY 1 year. Other psychiatry rotations typically involve an even lighter workload, allowing for a great work-life balance during intern year.

My experience as an intern so far
As a medical student, I was told that the intern year of residency would be the most difficult and least enjoyable part of my training. My experience as a PGY 1 psychiatry resident at IU has been the opposite! The faculty are supportive, my co-residents are amazing and the environment has been great for learning. It has been a fascinating and inspiring experience working with the patients. There is seldom a dull moment. I feel so lucky to be here, and this is without a doubt my favorite job I’ve ever had.

The start of my second year has been very exciting for me. Now that required rotations (medicine, emergency medicine and neurology) are out of the way, I just have psychiatry rotations to look forward to. My current schedule is a three-month-long block that allows me free time to explore my areas of interest and have a better work-life balance. My current schedule has me at different sites throughout the week with two other co-residents. Each day I am scheduled with a different provider.

Monday
My week starts with a research day. At the start of the rotation, we discussed our area of interest and focused on research relating to that topic. I am currently interested in perinatal psychiatry, giving me a chance to data mine different research papers regarding postpartum psychiatry care. I will concede data mining is a little out of my comfort zone, but this has been an excellent opportunity to develop my research skills and broaden my knowledge regarding a future career interest.

Tuesday
Forensic psychiatry day. This has been the most eye-opening rotation for me so far. We explore the different aspects of the legal system, capacity, the ability to stand trial and the nuance behind an insanity plea, which involves understanding the mental state of the defendant at the time of the crime and how it may affect their culpability. Our day usually consists of interviews with current patients in the Marion County Jail or spending the day at the state hospital. As the second year has offered me more time to explore my areas of interest, I often find myself watching court cases on YouTube with a better understanding of  the intersection between psychiatry and the law.

Wednesdays and Thursdays
Palliative care cognitive behavioral therapy (CBT), where we get a chance to develop therapy skills. With CBT training on Friday, this has been an excellent way to practice what we've learned. So far, my therapy sessions have been one of the most rewarding aspects of my second year, as therapy was an essential element that drew me to psychiatry. After seeing our patients, we debrief with our attending and discuss ways to improve our interview skills, challenge and help patients, and note what therapy techniques were helpful for each patient.

Friday
Friday starts with CBT training in the morning, followed by didactics for the rest of the day. We once again get the chance to go over our palliative care patient's therapy session. Having Danielle Henderson, PhD, and two other co-residents to bounce ideas off and learn from has softened a steep learning curve. The rest of the day often feels like hanging out with the rest of the psychiatry program. Lunch is provided to give us the much-needed boost to get through the next few hours of lecture.

We must not forget to add the start of being on call. These shifts, while they may sound daunting, are a crucial part of our training. They provide a great way to highlight (and remind myself) how much learning has happened so far! During these shifts, I am responsible for responding to urgent psychiatric issues that may arise in the hospital. Luckily, I can reach out to my co-residents and attending for support when needed.

Third year is an excellent time to build confidence in the outpatient setting. With a full year of outpatient clinics, you'll enjoy continuity in your work, allowing you to really see the progress your patients make. The best part is that you get to choose clinics that align with your interests, which makes the experience even more rewarding. You'll also deepen your understanding of psychopharmacology, rounding out the strong foundation you've built during the first two years. By the end of third year, you'll feel ready to step into a junior attending role in your fourth year. A typical day in my life as a third-year psychiatric resident at Indiana University School of Medicine is both demanding and rewarding. 

Monday 
My week kicks off on Mondays at Goodman Hall, where I work in the adult psychiatric outpatient clinic. Here, I encounter a wide variety of complex psychiatric cases, often complicated by significant medical comorbidities. The diversity of these cases challenges me to integrate my knowledge of both psychiatric and medical principles, pushing me to think critically and apply my training in real-time.

In the afternoon, I shift my focus to psychoanalytic psychotherapy. These sessions are a crucial part of our training, as each resident is assigned to one patient for the whole year, allowing us to connect with patients on a deeper level and address the psychological aspects of their conditions. After each session, I staff with my attending, discussing the patient's progress and refining our approach. This collaboration is invaluable, providing me with insights and guidance that help me grow as a psychiatrist. By the end of the day, I feel a sense of accomplishment, knowing I've made meaningful strides in my patients' care.

Tuesday 
I am on the research track, so I have protected research time on Tuesdays. As a research fellow in radiology imaging sciences, I work at the neuroimaging core of the Indiana Alzheimer’s Disease Research Center, one of the largest and most renowned centers for Alzheimer’s research internationally. My work involves studying the brain microstructural changes in patients with Alzheimer’s through analyzing MRI images. Our residency program provides robust support for research initiatives, offering ample opportunities to contribute to cutting-edge projects, which enhances my clinical training and deepens my understanding of neuropsychiatric care.

Wednesday 
Wednesdays bring me back to Goodman Hall, where I spend the morning working in the addiction clinic. Here, I treat a variety of addiction psychiatry cases, working with patients navigating substance use disorders and related challenges. This experience is vital for keeping my knowledge of addiction medicine up to date, and it gives me the confidence to manage these challenging cases effectively. The hands-on experience I gain in the addiction clinic is something I truly value, as it allows me to apply evidence-based practices in real-world scenarios. In the afternoon, I transition back to the general adult clinic, where I oversee a broad spectrum of psychiatric cases, addressing various mental health conditions ranging from mood and anxiety disorders to more complex, co-occurring psychiatric and medical issues.

Thursday 
I start my day once again at Goodman Hall, this time in the ECT/TMS clinic. My work here involves evaluating patients with treatment-resistant depression, determining their suitability for treatments like transcranial magnetic stimulation (TMS) or electroconvulsive therapy (ECT). This aspect of my residency is particularly fulfilling, as it allows me to work with cutting-edge treatments that can significantly improve the lives of patients who have not responded to traditional therapies.

In the afternoon, I continue my clinical responsibilities at the VA, delivering psychiatric care to veterans and addressing the distinct mental health challenges they face.

Friday 
By the time Friday rolls around, it's a bit of a breather since the day is fully dedicated to didactics with protected time for learning. We start the morning with PGY-3 psychotherapy didactics, diving into different therapeutic approaches. Around noon, we gather for our weekly resident business meeting, where lunch is provided, and we catch up on updates from committees and sites. The meeting usually wraps up early, giving us a chance to chat and unwind with our co-residents. In the afternoon, we join the other residency classes for didactics, where we cover a variety of topics that change throughout the year.

Saturday and Sunday 
Our weekend is mostly free, with just three or four weekends a year where we're on call at Riley Hospital for Children. Other than that, we have those days completely off, which gives us a great work-life balance — something our program really values. Many residents use those weekends to moonlight, while others take the time to relax, unwind and enjoy their hobbies. Personally, I love cycling, so I often hit the trails around Indianapolis and the suburbs. 

Fourth year is all elective time, and I chose a variety of educational opportunities. I want to do addictions and general adult outpatient psychiatry when I’m all done with graduate medical education, and about half my clinical time this year is in the outpatient setting. I have a longitudinal-style schedule, so I do something different every day of the week. I’ll take you guys through a typical Wednesday.
 
6:45 a.m. — Rise and shine
Hello, alarm clock. My husband usually departs before me due to his work schedule. I enjoy the light roast coffee he made; feed, walk and water our Labrador retriever; devise a stylish outfit because fashion is a hobby of mine; and head to work. 
 
8:00 a.m. — Pre-charting
Before clinic starts, I preview my patients for the morning. For new patients, this includes a review of their mental health referral, past engagements with psychiatry, etc. For follow-ups, I’m usually looking for any pertinent medical updates, medication fills, controlled substances reporting, etc. I like to make a skeleton of my notes beforehand. 
 
8:30 a.m. — See clinic patients
I have a mix of intakes and follow-ups, for which the appointments are 60 and 30 minutes, respectively, either virtual or in-person. We discuss their concerns, and they leave with prescriptions and various non-pharmacological recommendations. I spend a good chunk of each visit on lifestyle counseling because the data show that diet and exercise make a difference in improving mental health. 
 
11:00 a.m. — Staffing
The VA Medical Center is a bit unique in that we staff all our patients at the end of the half-day, rather than during each visit. Some attendings work remotely, but I think most are on-site, as mine is. I learn a lot from this attending, which is a main reason I kept the clinic as an elective. 
 
11:45 a.m. — Write notes
I aim to finish all my clinic notes before the end of lunch hour. It’s much better with the on-site computer vs. remote access on my laptop. I appreciate the didactics we’ve had about the importance of notes for billing and medicolegal purposes; such lessons helped me to be more efficient and thoughtful about what I write. 
 
12:15 p.m. — Chiefs meeting
I’m our Eskenazi Hospital site chief this academic year. Every Wednesday, the program director, assistant program directors, program coordinator, chief, assistant chief and site chiefs meet via zoom to discuss pertinent news and goals of the residency program, raise resident concerns and talk through some decisions as a leadership team. Earlier in my career, a mentor from med school and residency told me that direct involvement in how one’s workplace is run tends to increase workplace satisfaction. Anecdotally, I’ve found that advice to be true. Regardless of leadership involvement, our program takes resident feedback very seriously, and there have been several positive changes in the last few years that were driven largely by resident feedback.
 
12:45 p.m. — Lunch
Always make time for lunch. The VA Medical Center has shockingly good sushi available, which is my usual pick. Otherwise, I may bring a protein shake or other light meal. 
 
1:00 p.m. — Eskenazi Hospital CIU
As my required senior subattending elective for the year, I work in the Crisis Intervention Unit at Eskenazi Hospital, which is our county safety net hospital. There’s a PGY1 present during the day on Wednesdays, so I get to do psychiatry in an emergency setting and teach some of my junior colleagues. We also work with an excellent team of social workers and some cool attending psychiatrists. 
 
4:30 p.m. — Go home
Another pleasant workday on the books. My house is about 15 minutes away at baseline and 20 minutes during traffic. Add music or an audiobook, and the drive goes quickly. 
 
6:00 p.m. — Pilates
I’m obsessed with Pilates — hyperbole, not a self-diagnosis. Really though, I started going three times a week during PGY2, and I still love it. There are a lot of Pilates, barre, and yoga studios in Indy and its surrounding communities. 
 
Concluding thoughts
Thanks for reading about a typical day-in-the-life! I am so happy to be at IU, and I’m grateful for the education gained and friendships built since starting residency. Most of my weekends are free, and there is a lot of fun to be had. I’ve sincerely enjoyed our residency’s social and wellness events over the years, such as yoga at the art museum, hikes at Eagle Creek, book club, brunches, game nights, volleyball, post-didactics local brewery visits, boating at Monroe Lake, conferences and dinners with the state psychiatric society, pumpkin patches, a sledding and hot chocolate gathering, chili cooking competitions, Friendsgivings, winter holiday and Halloween parties, occasional filmmaking and, of course, our annual retreat. Overall, residency is a beautiful life chapter, and I’m happy it’s at IU.