Aneesh Hehr, M.D.
Hello and welcome everyone! My name is Aneesh and I’m one of interns in the Psychiatry Program at the University of Michigan. We’re thrilled that you’re interested in our program! I’ll be sharing my perspective as someone new to the University, walking you through a day in the life of a PGY1.
So far, I’m four rotations into my intern year: Internal Medicine, Inpatient Family Medicine, Consult Liaison Psychiatry and AIMH (acute Inpatient Mental Health) at the Veteran Affairs. We alternate between 2 months on-service and 2 months off-service, which provides a good balance throughout the year. Other rotations during intern year include Neurology, 9C (inpatient psychiatry at the University Hospital), Substance Use Disorder Intensive Outpatient Treatment, Emergency Department, and optionally Inpatient Pediatrics (if you are interested in switching a month of Internal Medicine).
Day in the life:
6:00 AM – 8:00 AM
The workday doesn’t officially start till 8:00 AM. However, if you’re a morning person, Ann Arbor offers a ton of green spaces and walkable areas to explore. Some of my favorites are Bird Hills Trail, Nichols Arboretum Loop trail, and the Pinckney Recreation Area. This is also a great time to grab some local coffee (I highly recommend 19 drips).
8:00 AM – 10:00 AM
I head to the resident work-room around 8:00 AM where I meet my amazing co-residents and medical students for sign out. I take some time to chart review and then start seeing my patients. As interns, we typically manage 4-5 patients which has been a good balance. It allows for exposure to a variety of psychiatric presentations without feeling overwhelmed. Plus, there are several opportunities to teach, including supervising medical students during patient interviews.
Every Thursday morning, we have protected time for lectures. These alternate between formal didactics and Proskills sessions. In our formal didactics we cover a range of topics from suicide risk assessments to psychopharmacology. Proskills is a process group where we also get early exposure to therapeutic techniques.
10:00 AM - 10:45 AM
Next, we log into our daily interdisciplinary team meeting. During these sessions we review every patient and discuss the plan for the day. The team includes attending psychiatrists, residents, pharmacists, nurses, and social workers, creating a collaborative environment where each person contributes their unique perspective to further our patient’s care.
10:45 AM – 12:00 PM
After the meeting, we round with attendings to see patients and staff our cases. This is a fantastic opportunity to learn from experienced and approachable clinicians, gain insight into interviewing techniques, and develop treatment plans. It’s also a good time to grab some snacks from the resident room!
12:00 PM – 1:00 PM
Lunchtime! I usually head to the VA cafeteria and use meal stipends provided by the VA. This is also a great time to catch up with co-residents do some teaching with our medical students. Today we covered the mental status exam and antipsychotic medications.
1:00 PM – 3:30 PM
In the afternoon, we see patients in the emergency department and admit new ones. There’s a good balance between supervision and independence. We work closely with nursing staff to ensure both physical and psychiatric needs of our patients are met. Around 3:30 we prepare for sign out after which we complete our handoffs and head home. I find there’s plenty of time for activities to promote a healthy work-life balance, whether it’s book clubs, running clubs, or intense pickleball sessions. We’re also in the process of starting a psychiatry-themed movie club, so stay tuned! If nothing else is going on, I’ll grab dinner with my co-interns at one of the great local restaurants in Ann Arbor or Ypsilanti (shout out to La Torre Taqueria).
3:30 PM – 8:30 PM
One day a week I am on call in the evening, where I see patients in the Emergency Department presenting with psychiatric concerns. Over the past few weeks, I’ve become more comfortable triaging patients with a variety of presentations. Thankfully, I never feel alone when I need help – I’m always joined by a PGY-2 during these shifts. After call, I head home with a very short commute of 10 minutes. If it’s the last Friday of the month, I’ll join other residents for “final Fridays” where we meet up for happy hour.
Kennedy Werner, M.D.
Hey Everyone! I'm Kennedy, one of the current PGY-2s. The PGY-2 year is comprised of rotations on inpatient child, consult-liaison, adult inpatient (at both U-M and the VA), and Psychiatric Emergency Services (PES). Below is a typical day on my recent month on Consult-Liaison Psychiatry at the Main Hospital.
6:30 AM: I wake up and go work out. I pack a bag with my scrubs to change into after.
8AM: I get to work and start chart reviewing my patients from the previous night. I also await an email from my attending with any new consults. I generally prep my notes for the day in the morning so that other teams can see the psychiatry first contact in case they need to reach out. This also saves time later in the day. During this time, I also touch base with my attendings to discuss which patients are pertinent to see that day. Sometimes, your attending might want to see certain patients together, depending on their workload and schedule.
9:30 AM: I start rounding on my patients, which includes communicating with nursing staff, primary teams, as well as any additional consulting teams.
11AM: I touch base with my attendings again, letting them know any significant updates regarding the patient. During this time, I also touch base with primary teams and communicate any recommendations regarding safety, medication, diagnostic testing/labs for forgive patients.
12PM: lunch! I usually bring lunch from home, however, when in a pinch, I will get lunch from the cafeteria. Sometimes, we have lectures or meetings during this time and lunch tends to be provided! This is always an exciting part of the day.
1PM: we round in a large conference room as a team with our colleagues in social work, pharmacy, and Psychology. These are always very productive meetings where we can all touch base collectively to ensure we are all on the same page regarding patient care.
2PM: I might still need to staff a few patients or communicate some more recommendations to primary teams. It is around this time that I start to write my notes. I always try to throw in a mini lecture or teaching point for medical students rotating on service during this time.
5PM: we are required to stay until this time for any potential consult that might trickle in in the late afternoon.
After work, I'll either pick up carry out or make food. Wake up and repeat :)
Mike Franklin, M.D.
Hi my name is Mike, and I’m currently a PGY-3 in the general psychiatry residency program at the University of Michigan. PGY-3 is entirely outpatient and takes place mostly at the beautiful Rachel Upjohn Building in east Ann Arbor, as well as a few community sites in the local areas. I have my own patients that I see in different clinics on different days. One holdover from the pandemic is that most of our patients are seen virtually, which allows for some flexiblity of in person vs. working from home.
For the first 6 months I have rotations in child, geriatrics, depression, and general adult clinic. In the second half of the year I will have rotations in perinatal, depression, and community mental health. Mixed in are mentoships for therapy (CBT, DBT, IPT, MI). Here is what a typical Thursday looks like for me.
8-9am.
One hour of supervision with my psychodynamic mentor. This is one of the highlights of my week, getting to discuss not only my psychodynamic patient, but also other patients I am struggling with.
9-3pm. Thursday is my Depression clinic day. Typically I will have 1 or 2 new patient blocks (2 hours each), where I will see a new patient in a 2 hour slot. At the end, I will discuss with my supervisor about next steps in treatment. As this is primarily a consultation clinic, we decide if we will keep them on as patients for group therapy and individual psychiatric care, or refer them to the community for care of therapy services. Mixed into this window are 30 minute return visit slots for patients on my personal panel. I have a 1 hour time block with my global supervisor to discuss all of my personal RV patients on Friday. Mixed into this blcok is also a 1 hour blocked time for lunch!
3:30-5pm: Depression Team meeting occurs. This is an interdisciplinary group of psychiatrists, care managers, therapists, and psychologists, as well as trainees. Here I will present my new cases to the group to discuss, to see if other team members have other ideas.
5pm: My day wraps up, and I touch base with my supervising doctors in depression clinic if we want to consider any other changes for my new patients based on the discussion.
The above summary is just a snapshot of the PGY-3 experience. In addition to all the various clinics, we also have weekly grand rounds, weekly didactics on Friday afternoons, and two hours of weekly supervision, one each with an individual faculty supervisor and individual psychodynamic supervisor.
Andrea Brelje, M.D.
Sometime between 545am and 715am – “Mom! Momma. Ma. Mommy!... Dad. Daddy!” The day begins. Mornings with my family have become one of my favorite part of PGY4 year as my work day doesn’t start quite as early as it did in previous years. Snuggles, books, breakfast, an occasional dance party—morning time flies when you’re having fun.
825am – I ‘commute’ 1 minute to my home office while my husband take the kids to daycare. On Wednesday mornings we have 90 minute therapy mentorship for 6 months at a time. Some groups meet in person, some hybrid, some virtual. I’m currently in CBT for anxiety and today we’re discussing the research and practical implementation of exposure therapy for social anxiety. This is really helpful as I plan treatment for a patient I’m currently seeing weekly for CBT. Previous mentorships that I’ve completed / all residents get during their time here include DBT, CBT for Depression, Psychodynamic, Interpersonal Therapy, Parent Management Training (through the child clinic), and Motivational Interviewing. I recently bought a walk pad to use at my standing desk as there are a handful of weekly zoom meetings / lectures that are great opportunities to walk and listen/talk. By the end of mentorship I almost have about 7,000 steps in.
10am – Mentorship finishes and I have 30 minutes until Grand Rounds starts. I usually use this time to catch up on admin tasks. If I attend Grand Rounds in person, I commute 11 minutes (faster at this time of day, not terrible in the mornings) to the Rachel Upjohn Building where outpatient psychiatry is located at University of Michigan. The fall color, especially on Green Rd, is no-joke-spectacular. Parking is painless—it’s a flat lot right next to the entrance for Grand Rounds.
1030am – Grand Rounds. Check out the list of upcoming lectures to get an idea of the breadth and depth of what these cover. This one (Ouida Lecture from 2023) stands out as being particularly powerful. You won’t regret the time you take to watch this recording or come to future Grand Rounds.
Noon – I meet my Global Supervisor for my weekly check-in. I typically send an agenda before these meetings with questions I’ve gathered throughout the week. If I have urgent patient concerns that arise outside my supervision meetings, my supervisor is available by text / phone. As I’ve grown in confidence and competency throughout residency, supervision has mirrored that growth. As a PGY4, supervision topics still include the science (“Can we review the management of hyperprolactinemia in patients who can’t tolerate Abilify?) and art (“I had this tough encounter and wanted to hear your opinion about the way I handled it.”) of medicine. But I’m also receiving more career advising / mentorship which has been helpful as I sketch what my life may look like after residency.
1pm – Quick lunch. As part of the Lifestyle Psychiatry elective I’m doing, I have dedicated time on my schedule on Wednesday afternoons to read about the evidence behind different behavioral interventions (e.g., strength training) and supplements that can be used in mental health. My goal is to create MiChart dot phrases so my colleagues can have referenced information (evidence base, dosing, contraindications, etc.) at their fingertips when questions come up in clinic.
2pm – Psychodynamic therapy patient followed by psychodynamic therapy supervision with a community analyst. As part of our training, each resident sees a patient weekly for psychodynamic therapy. For those interested, there are a couple other options for gaining more training in this area including the fellowship with the Michigan Psychoanalytic Institute (funding available through our residency program) and the PGY4 elective. I’ve did the Fellowship last year with a couple of my co-residents and am currently enrolled in the elective which meets for lecture on Monday nights.
4pm – I continue my Integrative Psychiatry work from earlier today and wrap up no later than 5pm. I get the kids from daycare, which feels like a win for everyone in the family since my husband did basically 100% of the daycare logistics for the first two years of residency. Work is out of sight during these family hours. One of our favorite activities this time of year is picking raspberries from the plants we started at the beginning of residency. They are delicious living proof that there can be a LOT of growth in 3.5 years!
730pm – Kids are in bed and Magic Treehouse audio books begin. I use the evening time to wrap up any lingering notes (on days when I see more patients), pre-chart for tomorrow, or continue some of the research that I’m working on this year. Depending on how long that takes, my husband and I enjoy some laundry / Netflix time or I take a sunset (headlamp this time of year) walk with my sister before going to bed around 11pm.
