Resident Life

2018-2019 Chiefs | Chelsea Alberding, Matt Weinlander, Shami Entenman, Tom Chaffee

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 in our treatment, learn how to manage crises, and understand the implications of mental health and mental illness within our society. We are so glad we chose U of M for residency during this critical period of learning at the beginning of our careers. There are so many people and resources available here 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 that prospective candidates will consider joining our U of M family!

Sincerely,

Chelsea Alberding, MD

Tom Chaffee, MD

Shami Entenman, MD

Matthew Weinlander, MD

 

A Day in the Life of a Psychiatry Resident

PGY-1

Stephanie Linscheid

Hello everyone! This is Stephanie Linscheid, one of twelve interns who just recently began their first year in the University of Michigan's General Psychiatry Residency Program. Being on the interview trail, one of the questions I most wanted to know is what a typical day looks like at each program. Hopefully this will help to answer that question for you as you consider U of M!

As an intern you rotate through six two-month blocks of either psychiatry or medicine and neurology. I started my intern year on the Acute Inpatient Mental Health unit (AIMH), which is the inpatient psychiatry unit at the Ann Arbor VA Hospital, along with two other co-interns. We spend a total of three months on this unit our first year. Here is a general overview of a typical day on this service:

8:00 AM to 10:00 AM

Arrival and Pre-rounds: We arrive at the inpatient psychiatry unit and receive sign-out on our patients from the overnight second-year resident. After talking with the overnight resident, we use the VA's EMR to review nursing reports, lab results, and vitals, and any other pertinent information before heading into the unit to do our daily interviews with our patients. Each day we ask our patients about the previous night, assess their mood, and perform a mental status exam to help us determine or update the treatment plan for each patient.

10:00 AM to 10:30 AM

Treatment Team Meeting: We enter a room in the unit where a multidisciplinary meeting takes place every weekday. This meeting is attended by social workers, residents, attendings, medical students, nurses, occupational therapists, and pharmacists who are involved in our patients' care. At this meeting, each patient's progress is discussed and the treatment plan is reviewed. Patients are often invited into the meeting to discuss the goals of their hospitalization, their strengths, and any obstacles they feel they need to overcome to meet their goals. This meeting offers the possibility to coordinate care among the many integral parts of the team, and the patients appreciate the opportunity to have their voices hear.

10:30 AM to 4:30 PM

Patient Care: After the morning activities, we head back to the resident room to present our plan for each patient to one of two attending psychiatrists for final approval and feedback. We then complete the daily orders, titrate medications, call patients' family members or friends for collateral information, and see our patients again to provide updates and answer questions about their treatment plans. Some days we attend grand rounds or mentor lunches during this time, which gives us the opportunity to learn more about psychiatry and spend time with our co-interns. In addition, during this period we begin to accept new admissions and complete H&Ps. We always have medical students on the service, so there are plenty of teaching opportunities too. Beginning at 4:30 PM, if we have completed our work for the day, we can start signing-out our patients to a senior resident and then head home. One or two times per week we each stay for short call, remaining on the unit until 8 or 10pm to take late admissions.

Each week we have at least one weekend day off to explore Ann Arbor and hang out!

On your interview day, I hope you can get a feel for how this program provides a wonderful learning experience--with approachable and knowledgeable attendings, excellent support staff, a great deal of autonomy, and the ability to encourage and bounce ideas off each other as co-interns.

PGY-2

Priyanka Reddy

My name is Priyanka Reddy and I'm excited to have started my second year of residency training at the University of Michigan! During our second year, we work in a myriad of settings including Adult and Child Inpatient Psychiatry, Consultation-Liaison Psychiatry, and Psychiatric Emergency Services [PES]. During our rotations at PES, we complete both day and night month - long shifts, which allows us to develop understanding of how to best triage psychiatric emergencies and how to efficiently assess and treat numerous patients with varying psychiatric disorders. It is a wonderful experience and we are so fortunate to have such a great free-standing Psych ER here at U of M.

Here is an example of a "typical night" on this rotation.

10:00 PM to 10:20 PM

Arrive to our Psych ER and obtain sign-out on any patients from the day PES resident. 10:20 PM to 11:45 PM During this time, I see approximately two patients in the psychiatric ER. A majority of the history has been gathered by our excellent social work clinician support staff, so my primary task is to go back to discuss key aspects of the HPI and perform thorough safety risk assessments, which will influence our clinical decision making. Subsequently, I staff with my attending, who is on site until 2 a.m. and as an interdisciplinary team, we make a clinical decision and plan.

11:45 PM to 12:30 AM

One of my patients is appropriate for discharge, and I work with our social workers to arrange a safe discharge plan with appropriate outpatient resources. My other patient is suicidal, psychotic, and a danger to himself, so I complete the legal documentation required for psychiatric admission here in Michigan. Afterward, I write admission orders and finish my documentation in U of M's EMR called MiChart, based on the EPIC platform.

12:30 AM to 1:15 AM

My pager goes off—there is an urgent consult from the medical floor about a patient who wants to leave AMA. As the Psych ER night resident, I also take care of any consult issues overnight. The patient in question has been seen by the psychiatric consult team during the day, and the team has left very specific instructions. I go and see the consult, then discuss the case with my attending, and finally convey our recommendations to the primary team.

1:15 AM to 2:00 AM

I continue to see patients in the ED and staff with my attending. An autistic child, a patient for whom English is a second language, a college student, a homeless man in alcohol withdrawal, and a despondent geriatric patient all come in and are seen by our staff. I call over to the medical ED [just around the corner from PES] and send the patient in alcohol withdrawal there, given a history of complicated withdrawal—it's nice to have excellent support from our medical colleagues, and we will often send patients to each other as needed. Our ER board is still very busy, and my attending helps by seeing some patients.

2:00 AM to 6:00 AM

My attending leaves at 2 a.m., and I continue seeing patients independently in the E.D. and staff with an attending over the phone as needed. Of course, if the work flow becomes extremely busy, my overnight attending will come to the ER to help; however everything is generally manageable. Being the primary psychiatrist in the hospital overnight felt scary at first, but with the training I received during my intern year, the experience of being by oneself overnight gradually becomes empowering as you realize that you're able to handle quite a lot.

6:00 AM to 8:00 AM

During this time, I continue to work in the ER and manage any consults from the medical floor as well as requests to see patients on our inpatient psychiatric units. I will also prepare my sign-out for the day team.

8:00 AM

The day resident returns for their next shift. I sign out to them, wrap up my notes, and go home. There is time to fit in a dance work out session and catch up with family before I go to sleep.

PGY-3

Matt Weinlander

My name is Matt Weinlander, currently a PGY-3 in the general psychiatry residency program at the University of Michigan. The past two years have been mostly inpatient, so the 100% outpatient PGY3 year is pretty exciting. While the hour-by-hour experience of a typical day during 3rd year varies depending on what clinic and psychotherapy mentorship we're in, PGY3 year is mostly a regular 8am-5pm schedule M-F, with the exception of the occasional call shift on a weekend night. Best of all, each resident gets their own office at the beautiful Rachel Upjohn Building! Below I've outlined a typical day during 3rd year. Hopefully, this will succeed in giving you a pretty good idea what to expect when you match here.

8:00 AM to 9:00 AM
Return Visits. I will generally see one or two return visits (RVs), which are patients I am following long-term over the course of a year. We can choose whether we want to schedule our return visits for 30min or 60min, depending on individual needs, complexity of medications, or if we're providing psychotherapy. Most of our RV patients come from new evaluations we complete during the course of third year. Some days, instead of new evaluations (described below), we have the whole day blocked off for RVs.

9:00 AM to 11:00 AM
New Eval. We have a multitude of sub-specialty clinics to rotate through where we will see new patients, including Perinatal and Women's Health, Anxiety, Depression, Child/Adolescent, Geriatric, Substance Use, or Bipolar Clinic to name just a few. In the adult clinics, we have two hours to see a new evaluation, staff with an attending (usually right down the hall), formulate a plan and provide some patient education, then document. It's usually plenty of time. During our Child Psychiatry days, we get three hours per new eval.

11:00 AM to Noon
Weekly supervision with an attending. An hour each week, I meet with my supervisor to discuss any issues that come up with return-visit patients, talk about how psychotherapy is going, or discuss my future career goals.

Noon to 1:00 PM

Lunch! Depending on the day of the week, lunch may be provided by the department (for Grand Rounds, Psychodynamic Seminar, etc).

1:00 PM to 3:00 PM
Another new evaluation (max will be two in a day, up to four per week), or more time for return visits.

3:00 PM to 5:00 PM
This time varies, and could be taken up by psychotherapy mentorship, team meetings, or didactics. Psychotherapy mentorship consists of didactics and case presentations on all the major psychotherapy modalities including CBT, DBT, Psychodynamic, and Motivational Interviewing. Our psychodynamic patients provide an invaluable teaching experience, since we have direct supervision by a community therapist/psychiatrist, many of whom have an affiliation with the Michigan Psychoanalytic Institute. If it is a team meeting day, we get together as a multidisciplinary group and discuss patient cases, have lectures prepared by experts in the field, or have case presentations by the residents. Our didactics run throughout the year and cover a wide range of pertinent topics.

5:00 PM

Done for the day! Time to head to the gym, hike one of the many trails around Ann Arbor, get some drinks at the various brewpubs, or have dinner at one of the several fine restaurants in the areas.

PGY-4

A Week in the life of a 4th Year Psychiatry Resident

Lisa Anacker, MD

My name is Lisa Anacker, and I’m one of the chief residents in my final year of residency at the University of Michigan. The 4th year really allows our clinical, research, and career plans to solidify. One of the strengths of our program is the flexibility in scheduling the 4th year, which allows for up to 8 months of electives. Your elective time can include clinical rotations, scholarly pursuits, administrative time, or really anything you can think of that enhances your learning. A typical week for me would look like the following:

Monday all day
Forensic Electives: I will be doing a Forensic Psychiatry Fellowship upon completion of my general residency, so I have a significant interest in this field.  The 4th year of our program allows me to not only do a full month of Forensic Psychiatry at the nearby Center for Forensic Psychiatry in Saline, MI, but also allows me to design my own electives in subjects such as this that interest me. During this day, I may be working with Dr. Debra Pinals, a prominent and nationally renowned Forensic Psychiatrist that is on the faculty here at UofM, or may be doing forensic electives seeing severely mentally ill patients in the county jails with Community Mental Health.  For my classmates who are interested in other fellowships or specialties, they too could be spending entire days or months focusing on topics of interest in Psychosomatic Medicine, Addiction Psychiatry, Geriatric Psychiatry, or others.

Tuesday all day
Supervision and Outpatient Psychiatry: I receive weekly global supervision to discuss my outpatient case load, career goals, or any concerns that come up. I also have an hour of psychotherapy mentorship to discuss my ongoing psychodynamic and therapy cases. The rest of the day, I see a roster of outpatients that I have seen over the past 2 years for a combination of therapy and medication management.

Wednesday morning
Therapy Mentorships: Throughout the year I participate in several therapy mentorships run by our social work and psychology colleagues. These mentorships help us develop our skills in Interpersonal Therapy, Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Psychodynamic Therapy, Motivational Interviewing, and Couples/Family Therapy. After our session, I head to our department grand rounds and then to our weekly resident lunch.

Wednesday afternoon
Psychiatric Emergency Room: While we all rotate through our dedicated Psychiatric Emergency Room as a PGY1, 2, and 3, I am doing an extra elective in our ER to gain more experience in this busy and fast-paced setting. This elective helps me better understand how to triage patients based on acuity, manage agitated patients when they arise, and learn how to be a part of a multidisciplinary team of social workers, nurses, techs, and physicians.

Thursday morning
ECT: I work with our amazing ECT team (made up of attending psychiatrists, ECT nursing staff, anesthesiologists, certified nurse anesthetists, and more) on delivering this therapy for patients for whom it is indicated, for example, in the treatment of severe depression and other psychiatric disorders.  The attending psychiatrists teach me the medications and specifics necessary to deliver safe and effective ECT.  This will give me an extra skill set upon my graduation, as doing this elective will allow me to feel confident in my ability to use and deliver ECT as a future provider.

Thursday afternoon
Resident Didactics: Weekly lecture with our PGY4 class. Topics range from a review of neurology, psychopharmacology, and basic science, to career advice (how to read a contract, working in different treatment settings), to forensic discussions, to board preparation, and more.

Friday morning.
Medical Student Elective: I am in the Clinical Scholars Track here in our residency program—a track that prepares psychiatry residents for careers as clinical track faculty members through development of medical education skills, academic productivity, and professional identity—and so have a special interest in academic psychiatry and teaching.  I am currently working on developing lectures and presentations for residents to teach to medical students when they rotate through our program.  I work closely with representatives from the medical school and residency program to work on this project.

Friday afternoon
Administrative and Chief Time: I am currently our VA Chief working with our PGY1 class at the Ann Arbor VA Medical Center. This time on Friday afternoons allows for administrative time, educational time to further teach medical students and residents, and to help problem-solve any issues that have come up for our PGY1s.

The above rotations are only a small sample of what a resident can do here as a PGY4—if you have an interest in an area of psychiatry, the program here is incredibly open to helping and accommodating your interest in the PGY4 year.  Other possibilities in 4th year include the high risk OB service, consult-liaison services, tele-psychiatry, PTSD clinics, international travel should you desire, and many, many more electives. As you can image, the opportunities are endless!

 

After Work