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.
I’m currently a PGY-1 psychiatry resident at the University of North Dakota. For my first rotation, I’m starting with 2 months rotating on Internal Medicine floors. This is what 1 week of this rotation looks like for me:
Monday: I came in for the first day of the work week at around 7:45 AM to chart review with my coffee. It took a bit more time to review their charts because many patients were new to me, since new admissions came in over the weekend. Then, from around 9:30 AM, my attending and I walked around the different floors of Sanford Medical Center Fargo (SMCF) for rounds, seeing patients until around noon. Then I went to the physician’s lounge for lunch and I put in some orders for patients while eating. Next, we drove over to Sanford Broadway Medical Center to round on a few more patients there (my supervising attending was on a “float” service, where he was responsible for patients across the 2 hospitals). After seeing all of our patients, I completed discharge orders, notes, and spoke with family over the phone until around 4 PM. Between the 2 hospitals, I was responsible for 4 patients. Afterwards, I went home to change and before heading to JL Beers, a restaurant and bar in Fargo, for a dinner meeting with my PGY-4 mentor. The fries with their house-made ranch are delicious! A must-have for ranch lovers.
Tuesday: On Tuesday I arrived and started to chart review at 8 AM. By 9 AM we were rounding on patients across the different medicine floors until around 11 AM. We drove to Broadway Center and rounded there until a bit after noon. Afterwards, I was able to eat a lunch from the physician’s lounge consisting of macaroni and cheese and pulled pork. I worked on notes, made phone calls, and finished by 3 PM. This was my last day working with this attending, as their work weeks are scheduled from Wednesday through Tuesday. So, I made sure to message the attending I would be working with next!
Wednesday: I started my day at 8 AM after meeting with, and introducing myself to, my new supervising attending. He assigned 2 patients to me, whose charts I reviewed until 9 AM. I then joined my attending, case manager, and nursing staff on morning rounds. This week my supervising attending was working exclusively on one floor at SMCF. After rounds, I was able to complete my notes by 12:30 PM, grab lunch from the physician’s lounge (a delicious meal of chicken parm!) and make my way over to didactics. Didactics are every Wednesday and our lectures, for the first part of the year, start with us learning about psychiatric interviewing, psychopathology, and psychopharmacology. On this day, our focus in these classes was on mood disorders. It's nice to reconnect with my co-residents each week and switch gears from medicine to psychiatry!
Thursday: On this day, I started reviewing charts on 2 new patients and one patient I was following until rounds at 9 AM. We ended rounds by 11:45 AM and grabbed lunch from the physician’s lounge. I had a cheeseburger and fries. However, I also always get some fruits and vegetables with my lunch. I have found the fruits and vegetables to be fresh and tasty, which I greatly appreciate! After lunch, I completed my notes, checked in on some patients, and had some individual learning time with my attending until around 4 PM.
Friday: To finish off the work week, I came in at 7:45 AM with a coffee and reviewed charts for the 3 patients I was following. There were no new patients on our list. After rounding with the team from 9 AM until 11 AM, I completed my notes and reviewed with my attending, finishing around 2 PM. After work, I got ready to spend the weekend with friends at the Red River Farmer’s market, Brewhalla, and the Plain’s Art Museum!
Overall, in my first few weeks in this rotation (and in residency!), I have been learning a lot about discharge planning, the EMR, and the workflow within the hospital as a new resident here. I have been given time and space to learn and grow as a new intern through the patience of the attendings, the advice of those ahead of me, and the kindness of everyone here so far. I have felt so welcomed and am quickly beginning to feel at home here in
A week in the life of PGY-2 psychiatry resident
Monday: I’m currently rotating with Sanford’s Partial Hospitalization Program (PHP). I like to get there a little before team table rounds at 8:00 am. I listen to the updates about the admitted patients and present the new admission for the day. Today, we have one follow-up that we see as a team. My job is to review the psychiatric medications with the patient. Next, I interview the new patient with the attending. After this, I head back to my office to finish up orders and notes. I’m usually done with this at around noon, which is the perfect time to head across the street (using the tunnel that goes under the road) to Sanford South University Hospital, where lunch is provided in the physicians’ lounge. After lunch, I’ll typically head home, as I’m able to respond to messages and work on things from there. Since Monday is a lighter day, I like to use this time to pre-chart on my clinic patients for tomorrow and get in some exercise.
Tuesday mornings also start at PHP. Some Tuesdays will have two new patients on the schedule for admission, so they can be a little busier. Today, however, we have 3 follow-ups and only one new admission. Similar to Monday, we see the follow-ups as a team, and I see the new admission with the attending. Then I head to my office to work on notes. At around noon, I head across the street to grab a quick lunch. Then, it’s about a 10-minute drive over to the Amber Valley building, where our clinic is located. Today, I have one new patient and one patient that was transferred to me from a former resident who has since graduated. Since we are just starting in the clinic, I have 1 hour and 30 minutes with the new patient and 1 hour with the transferred patient. After I see each patient, I go to my attending’s office to staff. Since I only have two patients today, I finish a little early, and I use that time to complete my notes.
Wednesday: For the first three months of PGY-2, we have psychotherapy didactics on Wednesday mornings. We start at 8:00 am with Motivational Interviewing, followed by CBT Theory and Practice, Psychotherapy Experience, and Group/Family/Couple Therapy. We don’t have Grand Rounds today, so we leave at noon for lunch. We are right across the street from SMCF, another location where lunch is provided, but today I’m going to head home to relax and have lunch there. I’m back to the Amber Valley building at 1:30pm for afternoon didactics: Research Methodology and Design, Intermediate Psychopharmacology, and Substance Use Disorders. Each lecture lasts for an hour with 15-minute breaks in between, so the day ends right at 5:00 pm.
Thursday: I’m back at PHP for 8:00 am team rounds. Today, we have two follow-ups scheduled and one new admission. Much like Monday, I see the patients, then work on my notes before grabbing lunch. On Thursday afternoons I have Scholarly Activity, which is one half-day per week of dedicated time for independent study/work. Today, I am using this time to work on my Grand Rounds presentation, which I will give in about 6 months. This time can also be used for things like working on research, preparing for didactics, or finishing up charting. Since Thursdays are on the lighter side, I like to go to the gym on these days as well.
Friday: There are no admissions scheduled at PHP on Fridays, so the first part of the morning wraps up pretty quickly with just one follow-up today. Because of this, residents rotating here lead a group session from 10:00 am - 11:00 am. I decided to talk about anxiety this week. I like to come prepared with a few learning points as well as some questions for discussion. After the group, I head over the South University for an early lunch, and then I make my way to Amber Valley for my second clinic day this week. Today I have one new patient and two transferred patients. Once again, after seeing each patient, I staff with my attending. This month, I am staffing with a different attending on Fridays and Tuesdays. My last appointment ends at 4:30 pm, leaving 30 minutes for questions or teaching with my attending, if needed. I like to stay to get my notes finished; others prefer to head home to work on notes there.
A Week in the Life PGY-3
A typical week as a PGY-3 focuses on continuing to develop clinical skills while increasing your independence. Third year provides the opportunity to continue to build long-term therapeutic relationships with your clinic patients for both medication management and psychotherapy. Typically the day starts around 8 a.m. and ends around 5 p.m and 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.
During the third year there are ongoing rotations through the consult-Liaison service and inpatient psychiatry, and we continue to cover occasional call shifts on the weekends. We rotate in the family medicine/internal medicine clinic as well, supporting our medicine colleagues with any psychiatry related patient questions on our collaborative care rotation. Third year is also when we begin going to a rural outreach clinic in person once a month at sites such as Bismarck, Minot, or Williston, ND to see psychiatry patients who would otherwise not have access to specialty care. We also build telemedicine skills by seeing our rural outreach clinic patients via telehealth one half day a week throughout the year. 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.
Protected didactic time continues on Wednesday afternoons each week during third year and includes lectures, case conferences, and grand rounds. Third year also 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.
Elective time can include rotations such as sleep medicine clinic, ECT, inpatient psychiatry, emergency psychiatry, a reproductive psychiatry course, becoming board certified in lifestyle medicine, research time, and many more opportunities. If you have a certain area of interest our program works to support you in finding opportunities to pursue it!
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.
A Week in the life for 4th year:
Fourth year of residency has many similarities to third year. You continue your outpatient medication management clinic one half day a week, where you will continue to follow your patients for the third year of this longitudinal experience. You will also continue outreach clinic for a second year, which is one half-day of telehealth per week or, once a month, one full day of in-person clinic where you travel to the outreach site. During travel weeks, you will still get one comp day off that week for travel, and we don’t have to travel in the winter months. Throughout the year, you continue with the split schedule of one rotation in the morning and another in the afternoon the majority of the time. You will also continue to have didactics on Wednesday afternoons.
New experiences in fourth year include one half-day per week of geriatric psychiatry in a nursing home setting for the full year, and child and adolescent psychiatry, which may be one half-day per week in an outpatient clinic for the full year or one full day per week in a residential setting for half the year. Another core rotation of fourth year is clozapine clinic, which is one half day per week for 3 months. These rotations all involve seeing both new patients and transfers from previous residents. You’ll also have the opportunity to help with mentoring some of the other classes, including assisting second year residents with transitioning to clinic or doing site check-ins with first year residents during the first couple of months of residency.
The remainder of fourth year, which is about half of the total time, is available for electives. Some of the most popular fourth year electives include ECT, TMS, sleep medicine, weight loss clinic, and continuing Lifestyle Medicine. Other common options include additional inpatient or outpatient time, substance use treatment, consult-liaison, and continuing psychotherapy clinic. Some elective time can also be used to study for your upcoming board exam. A large variety of other electives are available and can be chosen or created to fit your interests. Another change in fourth year is that you will no longer have call. This can mean having weekends off or can be an opportunity to start or continue moonlighting. Overall, fourth year offers a great combination of ongoing experiences, opportunities to pursue your interests, and balance to prepare for graduation and transition to practice.