From the chiefs:
The University of Michigan Psychiatry Residency program is a solid training program that prepares residents for independent practice in a variety of treatment settings: inpatient, outpatient, emergency, veterans’ care, pediatric, substance use, and forensics, to name a few!
Residents have an incredible amount of faculty support over four years as we hone our medication management skills, apply a wide spectrum of therapy modalities, learn how to manage crises, and gain understanding of the implications of mental health and mental illness within our society. We are so glad we chose U-M for residency during this critical period of learning at the beginning of our careers. At our program, we believe you will find many people and resources to help you achieve your goals, whether you are considering a career in academics or private practice or have specific interests in patient care, education, or research. We hope prospective candidates will consider joining our University of Michigan family!
Sincerely,
A Day in the Life of a Psychiatry Resident
PGY-1
Welcome to Michigan Medicine Psychiatry!
I’m Jessica, one of the new psychiatry interns. I’ve been loving intern year so far, and I’m excited to share a typical day on inpatient psychiatry! I’m currently on our University of Michigan Adult Psychiatric Service. This is where we complete one of our four month-long inpatient psychiatry rotations during intern year. The other three months are spent at the VA-Ann Arbor Adult Inpatient Mental Health (AIMH) unit, which has a similar workflow, though unique patient population and payor system. We also have first-year psychiatry rotations on the VA Consult-Liaison and Intensive Outpatient Substance Use Disorders services. The other half of the year is spent on off-service rotations in Internal Medicine, Family Medicine, Emergency Medicine, Neurology, and Inpatient Pediatrics, if interested, to round out our general medical experience.
8:00 – 9:45 a.m.
Days on the Adult Psychiatric Service start around 8:00 a.m. This is similar on VA AIMH. I head to the ninth-floor resident workroom overlooking beautiful Ann Arbor and start the day with chart review on my patients. As an intern, my patient assignments are limited to five. This has made the transition from medical student to new resident very manageable, and I still feel as though I’m seeing patients with a variety of presenting psychiatric concerns. After reviewing overnight events, I meet with some or all of my patients independently before our daily interdisciplinary team meeting.
9:45 – 10:30 a.m.
At 9:45 a.m., I sign into our virtual interdisciplinary team meeting, where each patient’s case is briefly presented and discussed with the attending psychiatrist, nursing, social work, and the team’s therapists. A similar daily meeting occurs on VA AIMH. Collaborative care is a priority on both units and certainly improves collegiality and the quality of treatment we provide. I’ve learned so much from my interprofessional colleagues. They’ve been very supportive, making a world of difference in my new role as an intern!
10:45 – 12:00 pm
After the team meeting, I round to meet with patients that I didn’t see earlier in the morning and any newly admitted patients with an attending psychiatrist. During rounds, I appreciate being able to watch our psychiatrists at both institutions model expert approaches to patient care, provide feedback on our interview techniques and treatment planning, and give valuable teaching on the fly!
12:00 – 5:00 p.m.
After rounds, I’ll grab some lunch. Time for lunch breaks is encouraged as a vital part of resident wellness! This is often from the cafeteria at the University Hospital, which hosts local Ann Arbor restaurants on a rotating basis with more cuisines than I would’ve ever dreamt possible for a hospital setting. After lunch, I use the rest of the afternoon to wrap up any work I didn’t get to in the morning and finish my notes. I leave work around 5:00 p.m. most days and am home within 20 minutes or so. My short commute is just one of many perks of living in a small, yet vibrant and wonderfully diverse city. This leaves plenty of time to cultivate a healthy work-life balance, making time for those things that are important to me – walking my dogs, exercising, and cooking dinner with my partner before calling in for the night with a good book.
5:30 – 9:30 p.m.
One day a week, I have a short Psychiatric Emergency Services (PES) shift. I’ll have dinner at the hospital and head to PES. This is a unique service not offered by all institutions and was one of the many aspects that drew me to our program. PES is a purely psychiatric emergency room, staffed by attending psychiatrists, residents, social workers, and nurses. It’s been a great setting to get exposure to risk assessment and treatment planning in psychiatric crises, as well as our community resources, while still feeling well-supported by an interprofessional team.
On this rotation, as well as our VA AIMH rotation, we have one or both weekend days off. I’ve been using these days off hang out with my amazing co-interns and explore what Ann Arbor and southeastern Michigan has to offer!
PGY-2
Hey Everyone! I'm Britt, 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 PES (Psychiatric Emergency Services). Below is a typical day on my recent month on Consult Liaison Psychiatry at the Main Hospital.
8am - I get settled at my desk in the CL workroom on the 9th floor, with a view out over Ann Arbor, and sip the free cup of coffee I grabbed from the House Officers' lounge on my walk in. I skim the list of new consults and review the morning email from the attending who fields new consult pages to find out who I'll be assigned today. I quickly catch up on vitals, lab values, and notes for my old patients to figure out who I need to see today before starting to review the chart of the new patient in depth.
9am - I decide to see my new patient first as nothing urgent has come up with any of my other patients. It turns out to be a really interesting case and I get to practice my exam for catatonia. The sub-I and I review facets of the Bush Francis Catatonia Rating Scale on our way to the next patient. We follow up with one patient who is recovering from delirium, and another patient who has been struggling to wean off a ventilator in the ICU due to significant anxiety.
11:45am - I jot a few quick notes down so I don't forget anything important but I'm starving, so I go around the corner to check if my friends on the inpatient unit next door are free for lunch. One of the best things about PGY2 is that 2-3 of us work on the CL team and 2-3 residents work next door, so we get to see each other frequently. Today folks are pretty busy, so I grab food from the cafeteria and take it outside to spend some time in the sun. On Tuesdays, we have didactics from 11-2 so we reliably catch up over lunch those days.
12:15 pm- I staff my patients from the morning and then my attending lets me know we've got a new consult - lithium overdose. I page recommendations to the patients' primary teams and then take some time to remind myself about the medical consequences of taking too much lithium and review with the sub-I how we will determine when the patient is medically ready for transfer to a psychiatric unit.
1:00pm - We have our daily team meeting with the attendings, the social work team, and the nurses who offer behavioral advice to the floor nurses caring for particularly difficult patients. It's a quick meeting but really helps to get us all on the same page. I am thankful for all the support we get from this team - the social workers often provide info to patients about outpatient resources and complete all the bed searches for patients who need transfer to a psychiatric unit.
1:15pm - The sub-I and I run down to see the new patient. Fortunately, the patient is alert enough to talk today so we spend a good amount of time getting to know her.
2:15 pm - I see my last follow-up patient and then settle in to finish my notes. I really want the neurology service to consult on one of the patients I saw earlier in the day and am happy to see that the senior on service is one I worked with as an intern; I don't have to call the consults but I know she'll do a great job.
5:00pm - Today the flow of new consults and staffing went really well. I finish my notes, give some feedback to my student, and then head out for the day around 5 pm. I get to drive home along the Huron River, one of my favorite spots to stop for a walk after work. While it doesn't always happen, today I beat my husband home and my cats are eager to see me.
PGY-3
My name is Saad Shamshair, 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, with the exception of some community clinics. We each have our own individual offices in which we see patients on a regular 8 AM to 5 PM schedule Monday through Friday. Since the start of the pandemic, much of the experience can be virtual and we have the option of whether we want to work from home or go into the office (unless you have a face to face evaluation scheduled). The academic year is divided into two 6-month blocks. Between the two 6-month blocks, we rotate through various clinics (depression, anxiety, perinatal, bipolar, geriatric, substance use) and psychotherapy mentorships (CBT for depression and anxiety, DBT, IPT, couples therapy, and motivational interviewing). The day-to-day schedule varies depending on the day of the week. Here’s an example of my typical Monday schedule.
8:00 - 10:30 am
On Mondays, I am in Anxiety Clinc. The first part of the morning is time for me to see follow up patients that have previously been evaluated. I can typically find time between patients to catch up on documentation.
10:30 am - 12:00 pm
I will have my first new evaluation of the day. I typically spend 60 minutes seeing a new patient, with an additional 30 minutes to staff the case and coordinate treatment. About an hour in, my attending joins me and I present the case to them in front of the patient. We discuss a plan together and I complete my note afterwards.
12:00 to 1:00 pm
Lunch! This is free time to either have a quiet lunch in my office or have lunch outside with my co-residents.
1:00 - 3:30 pm
The afternoon is another new patient slot for me in Anxiety Clinic. I will have two hours to complete the evaluation. The clinic is staffed by some of the leading experts within the field.
3:30 - 5:00 pm
The day wraps up with an anxiety team meeting. I will discuss the new cases with the team and elicit their feedback. We also discuss other referrals and other evaluations completed by the team members.
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 Fridays afternoons, and two hours of weekly supervision, one each with an individual faculty supervisor and individual psychodynamic supervisor. On your interview day, I hope you get a chance to see the breadth of outpatient experiences as you tour the Rachel Upjohn Building!
PGY-4
My name is Amy Beauchamp, and I am a PGY-4 at the general psychiatry residency program at the University of Michigan. This last year of residency is very flexible with 8 months of electives, allowing you to choose rotations based on your professional interests, whether it is to solidify specific knowledge or to explore subspecialties in psychiatry. I decided to do more hospital-based rotations, as my interest lies in the hospital-based realm. I did the addiction consult team elective and the ECT (electroconvulsive therapy) elective as both areas are important to further understand for any psychiatrist, but particularly in the inpatient setting.
7:00 AM-8:00 AM
I arrived at Mott Children’s Hospital and head up to the ECT treatment room. We have a few patients to treat who are too young to be treated at the adult hospital. Due to this we get to the hospital a little earlier than the usual 7:30AM start time with our adult patients. On arrival the ECT team is just meeting in the room, which consists of a CRNA, ECT technologist, attending anesthesiologist and attending psychiatrist. The first patient arrives, and the team quickly pulls up Frozen on an ipad to help calm the patient down as we get an IV going. Prior to each patient’s treatment, I review the medications for the procedures, including sedative and muscle relaxants, with the CRNAs. Once the medications are verified, the ECT technician will bring the patient into the procedure room, where the treatment will start. As the physician of the team, I am responsible for making important clinical decisions, such as checking to see if the patient is relaxed enough for stimulation, monitoring the EEG to determine if it is necessary to terminate a seizure, and deciding if any additional medications are needed to control the patient’s blood pressure or agitation.
8:15 AM- 11:00 AM
Following the treatments at the children’s hospital, the team heads back to the adult side to treat the remaining patients. On a typical day there are 15-20 patients scheduled for treatment, with each treatment taking around 15 minutes. In between treatments I will often discuss cases, medical choices, and brainstorm plans for any new patients who are starting for the first time with the attending. Throughout this time, I am documenting the treatments, including length of seizures, and any additional medications that were needed pre, peri, or post procedure. Even though there can be around 20 patients a day, by the time the last patient’s treatment is done I am just signing the last note for the morning.
11:00AM- 1:00 PM
I grab a quick lunch from the cafeteria and discuss any other topics I have questions about the with attending psychiatrist.
1:00 PM- 5:00 PM
I arrive at the addiction consult service team room, where I meet up with the attending physician, social worker, nurse, and peer recovery coach who make up our team. Sometimes there are other residents from internal medicine or family medicine who are part of the team, which is always fun since I have not worked on the same service with another specialty since intern year. We quickly discuss patients who still need to be seen for rounds in the afternoon—usually these are patients who were gone to a procedure during normal morning rounds. We have a couple patient’s who we started on suboxone. One for ongoing pain for pancreatitis, and another for opioid use disorder. After checking in briefly with them to see how they are doing, we are off to see a new consult. The new consult is a young woman with a history of IV drug use who presented with neurological symptoms that were found to be related to endocarditis likely caused by IVDU. The social worker takes the lead, as many patients who have struggled with substance use are distrusting of physicians, and this helps build better rapport. We discuss options for any ongoing cravings, but she doesn’t wish to take any opioid replacements. The peer recovery coach will meet with her later, and we discuss with the primary team the importance of treating pain appropriately to ensure that she has adequate pain control.
We return to the team room (which is always stocked with candy), and I quickly write the new patient note. I finish everything up around 4:30PM and then make my way home to play with my dog and start cooking dinner.
