School of Medicine & Health Sciences

A Week in the Life of a Resident

To get a sense of what life is like in UND's Psychiatry Residency Training Program, from first- through fourth-year, check out our residents' descriptions of their typical week.

As a new resident, I can safely say that UND is truly a program that emphasizes work life balance, and autonomy. Most rotations start at 8AM and you can expect to generally work a normal 40 hour work week.  
I started my intern year rotating on the inpatient psychiatry at Prairie St. John’s. A typical day on this rotation starts at 8AM.  I usually round on follow up patients, chart review new patients, see my new patients, and then staff with the attending psychiatrist around 10:30. There is a PGY-3 rotating at this site and I consult them with quick questions if my attending isn’t available at the moment. At other times we also have a medical student. Following this I grab lunch (which is free at all our training sites besides the state hospital!) and then finish off notes and self-study until I am dismissed. This rotation exposes you to many interesting acute pathologies, due to PSJ’s large catchment area which includes patients from rural MN & ND, and even Minneapolis. Starting the rotation as a PGY-1, you can expect to manage between 4 patients, but you will increase your patient load as the year & your rotation progresses. As a first year, I’m at my rotation all day M-F except Wednesday afternoon didactics. You will have the opportunity to rotate at Sanford, and the State Hospital for additional inpatient psychiatry experiences. I've heard from my co-residents that off service rotations (IM and Neuro) are excellent learning experiences, due to the wonderful attendings that run those rotations – they opt to work on services that teach our psychiatry residents and are invested in our learning. On Wednesdays, we have didactics from 12:30-5:00, which generally consists of focused and relevant learning experiences in psychotherapy and psychopharmacology.  
UND also works hard to foster an excellent community, my coresidents and I have spent a lot of time together on the weekends and after work, going hiking, boating and enjoying the many amazing restaurants and attractions that Fargo and the surrounding areas have to offer. UND Psychiatry is truly a “hidden gem”, and any prospective applicant should strongly consider UND for a robust training in Psychiatry.  

A Week in the Life of a PGY-2 Psychiatry Resident at the University of North Dakota 
I am currently a PGY-2 Psychiatry Resident at the University of North Dakota. My current rotation is CL Psychiatry, so you can find me on this service for 2.5 days a week. This is what my week currently looks like: 
Monday: 
This is one of my two full days of Consultation-Liaison Psychiatry. I am the only psychiatry resident on Monday, so I show up to the hospital at around 7:45 to look over the list and read handoffs for our patients over the weekend. The list is split up into new consults and follow-ups. We take new consults until 3:30pm. I start my morning by looking over the new consults we have to see, reviewing history, labs, reason for consult, etc. Dr. Brady (my attending) shows up around 8 am and we discuss which of the follow-up patients will be seen today. Our follow up list can vary between 13 and 25 patients, but not all patients need to be seen daily. We will often see individuals for continued medication management, follow up for agitation, assessments for safety, and withdrawal monitoring. Last Monday I saw 3 new consults and 4 follow-ups. After seeing my patients, I staff with Dr. Brady and we discuss a preliminary plan for each of these individuals, and she sees my patients to finalize the plan. I reach out to the primary team to discuss our recommendations, then place the orders. I have usually seen my follow-ups and the initial new consults and have them all staffed by noon. Hopefully, I will have had a good start on my notes at this point J. After lunch, I finish up my notes and keep my eyes on the consult list for any new ones that may continue to come in until 3:30. At this point, I head home to see my golden doodle. On most Mondays, I go to the gym at about 5:30 and start to check over any last things I need to prepare for didactics on Wednesday. 
Tuesday: 
Much like Monday, this is my other full day of CL Psychiatry. On this day, there are two Psychiatry residents on service all day. Just as we do on Monday, we will check the consult list and split new consults. We also split the follow-ups, then begin to chart review and prepare to see these patients. The rest of the day goes much the same as Monday, except that the other resident and I alternate seeing new consults. Additionally, family medicine residents spend 3 weeks of their first year on CL service so there has been a very helpful resident joining us for this past week! Other learners come through the service at various times, including medical students & podiatry residents. With more learners, the afternoon gives us some free time, and Dr. Brady gathers us in a conference room for a chalk talk on urine drug screening. On Tuesday evening, I will once again make sure I have everything ready to go for didactics tomorrow and sometimes throw in some supplemental reading about an interesting topic. Carlat podcasts & articles are favorites among my colleagues!  
Wednesday:  
For the first three months of the year, the PGY-2 didactics are from 8-5 every Wednesday. Mornings consist of our psychotherapy bootcamp. Motivational interviewing to start at 8 am, then on to CBT Theory and Practice, Psychotherapy Experience, and Group/Family/Couples therapy takes us to lunch. These classes prepare us for our psychotherapy rotation which will start in October of PGY-2. Grand Rounds happens during lunch every 1st and 3rd Wednesday, so many of us bring food from home those weeks. If there is no grand rounds presentation, we usually make our way to the Sanford Broadway campus to get free lunch from the physician’s lounge. If we have any extra time, some of us like to go on a walk at the park near the VA. Just last week, I played tennis with one of my fellow PGY-2s for about a half hour! At 1:30pm, didactics continue with our Research Methodology course. We then have our Intermediate Psychopharmacology course where we take turns presenting a different medication to our peers. Finally, we close out the day with our course on Substance Use. Most Wednesdays, the day does not end here. A prior resident got us hooked on trivia, so we make our way to local brewery on this night from 7-9 for a mediocre trivia performance. Miracles do happen though, and we did take 1st once last year! 
Thursday: 
For July, this is a full day of clinic for me. I usually begin to pre-chart on my patients for clinic in the days leading up to my clinic day (downtime on CL works great for this!), and I will show up to the clinic around 7:20am to prepare for the day. First patient is usually a new referral at 8 am, so I make sure that I have my note prepared and have a general understanding of why they are coming to our clinic. Since we have just started clinic, we have been allotted an hour and a half to meet with new referrals. I spend about an hour to meet with the patient and then staff the patient with the attending psychiatrist. We then go back into the room together to confirm the plan with the patient and determine the timeliness of follow-up. My next couple of appointments are usually follow-ups. While these patients are new to me at this point, they are likely transfers from residents who have just graduated. We discuss how they have been tolerating recent changes and what we can be doing to better manage their mental health. I often go to get lunch at about 11:45 and have time before my next patient at 1 to do more chart review if I need. This also seems like a good time to go over my top 3 lunches from the physician’s lounge: 
  1. Gyro day, so underrated but not everyone’s favorite 
  2. Taco Tuesday, build your own tacos or taco salad with chips 
  3. Burger day, a classic of course 
Honorable mention for chicken skewers J 
The afternoon goes about the same as morning with a new referral in the first time slot followed by a couple of follow-ups. As a new PGY-2, our clinic half-days usually consist of 1 new referral and 2 follow-ups. As we start to get in the groove with clinic, we may start getting more patients added on to our schedule, working up to 7 follow ups in a half day (30 min appts).  
Friday: 
This is my half-day on the CL service. This month, the resident I am with has a full day on Friday, so if there is only one consult, I would generally try to see them since I am only there until about noon. Otherwise, the day goes about the same as Monday and Tuesday in which we split up the patients and consults and staff with Dr. Brady. My current Friday afternoons consist of scholarly activity (dedicated independent work/study time). This is when we are given an opportunity to work on Grand Rounds or research projects. I present for Grand Rounds in about 7 months, so I have thoughts of some potential topics, but I occasionally use this time to make sure I have responded to emails and complete things that need to be done around the house. Other times I meet with my faculty mentor or read and prepare for next week’s didactics. I also try to go to the gym on Fridays!

Our typical day in the third year starts at 8 a.m. and ends around 5 p.m. We continue to primarily have a split schedule, which means we are at one rotation site from 8 a.m. to 12 p.m. and then move to a different rotation site from 1 p.m. to 5 p.m. The third year allows you to incorporate your specific interests into the curriculum through elective time. There may be some differences in how your schedule looks depending on if you decide to fast-track for a child and adolescent psychiatry fellowship. In the case of fast-tracking, elective time is slightly reduced but still available.

We continue to follow up with our outpatient psychiatry clinic and psychotherapy clinic. At this point in training, it’s rewarding to have some continuity with those patients from the year prior. There are ongoing rotations through the Consult-Liaison service and inpatient psychiatry, and we continue to cover occasional call shifts on the weekends. We also dive more into working with children and adolescents in the partial hospitalization setting. Didactics remain on Wednesday afternoons and provide a nice change of pace mid-week. While many rotations are similar to those in the second year, the third year also brings new opportunities and exposure. One of these new opportunities is our telemedicine clinic with a rural outreach focus. This rotation involves seeing patients in rural areas via telemedicine once per week and traveling to see patients in person at the rural clinic once per month. Additional new exposures in our third year include working in forensic and community mental health settings. This occurs through our work at the jail and the local human service center.

All in all, the third year is an excellent balance of continuity from the year prior and new experiences. Elective time allows some flexibility and time to explore your interests. The split schedule continues to keep the work-life dynamic, and reasonable work hours continue to support a healthy work-life balance.

Welcome to fourth year and say hello to elective time! Almost half your schedule is dedicated to electives this year, which is a great opportunity to focus on areas of interest or curiosity. Some popular experiences have been ECT, TMS, weight management clinic, sleep medicine clinic and medication assisted treatment to name a few. In addition to elective time, you will also continue with your longitudinal medication clinic. This is where it starts to get really rewarding as you have been seeing many of these patients for 3 years now. Additionally, you’ll work closely alongside pharmacists in clozapine clinic for a few months. You’ll get to care for our elderly population during our nursing home rotation and will continue meaningful rural outreach clinic once per month. Fourth year, like second and third, is still a split schedule with mostly half days at each site. We continue to have Wednesday afternoon didactics, which is a nice way to get all the residents in the same place for an afternoon. One additional major perk…no call! However, some do decide to add in some weekend moonlighting shifts. Overall, fourth year has a great pace and allows you ample time and opportunities to prepare for the upcoming transition from residency to independent practice.

 

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