Resident Life

2019-2020 Chiefs | Sarah Bommarito, Andrew LeBlanc, Alexandra Audu, Jenny Baumhauer

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 of 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 U of M family!

Sincerely,
Alexandra Audu, MD
Jenny Baumhauer, MD
Sarah Bommarito, MD
Andrew LeBlanc, MD

 

A Day in the Life of a Psychiatry Resident

PGY-1

Myra Sullivan

Hello everyone! My name is Myra Sullivan, and I am one of eleven interns who 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 will alternate between two months of psychiatry and two month of off-service rotations. Off-service rotations consist of the following: internal medicine, neurology, pediatrics, family medicine, and a month in the ED at the Ann Arbor VA Hospital. I am currently on the Acute Inpatient Mental Health unit (AIMH), which is the inpatient psychiatry unit at the 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 heard.

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 8:00 PM to take late admissions.

Typically, each week you will have one weekend day to explore Ann Arbor! I like to go on adventures with Midnite, my retired racing greyhound. (She’s a little faster than I am though…)

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

Alex Scott

Hi everyone! I’m Alex and I’ve really enjoyed the start of my PGY-2 year here at the University of Michigan. The second-year rotations include adult inpatient, consult-liaison, and child and adolescent services, as well as work in Psychiatric Emergency Services (PES). You’ll do two months in PES (one of days and one of nights), which allows you to develop understanding of how to best triage and treat psychiatric emergencies in adults and children. The pathology is very diverse, and you’ll work closely with the pediatric and adult medical emergency departments.

A typical night on this rotation looks like this:

10:00 PM to 11:45 PM

I show up at PES and obtain sign-out on any patients from the day resident. Soon, new patients start showing up on our workroom display known simply as “the board.” Each patient’s history is first gathered by the social workers who then present the cases to me. This saves a lot of time and allows me to finely discuss key aspects of the presentation and perform thorough a safety risk assessment with the patient. In turn, I make a briefer presentation to the attending, who is on site until 2 AM, and we all come to a disposition decision together. The social workers make all the collateral phone calls and handle all transfers and admissions to outside hospitals, which is super helpful.

11:45 PM to 1:00 AM

I see about seven new patients total on any given “busy” night. One of my first patients is a young girl who’s appropriate for discharge, so I talk with her parents while our social workers arrange a safe discharge plan with appropriate outpatient resources. Another patient is elderly, psychotic, and a danger to himself, so I complete the legal documentation required for psychiatric admission in Michigan. He will be admitted to our inpatient unit. I take a medical history and perform a physical exam before writing admission orders and finishing documentation in our EMR (Epic). One of the nurses brews a fresh pot of good coffee! I brought a homemade BLT for midnight lunch.

1:00 AM to 2:15 AM

The pager is chirping—there is an urgent consult from the medical floor about a patient on the cardiac floor who is demanding to leave AMA. As the only psychiatric resident in house, I also take care of any consult issues overnight. These can generally be managed over the phone with the primary team (e.g. agitation recommendations), but this patient needs an urgent assessment as to whether she has capacity to leave AMA. I see her, call down to my attending and staff over the phone, and convey our recommendations to the primary team. When I return to PES, the attending has left for the night, but they have seen and made dispositions for all remaining patients. The board is calm…

2:30 AM to 3:30 AM

…but not for long. A child with autism, a college student with mania, and a man with alcohol use disorder all trickle in. The social worker intake system staggers the cases so that we are not overwhelmed. The college student requires some antipsychotic medication and eventually restraints. He is escorted to the back of PES (the “secure core”) where acutely ill patients have close nurse monitoring and seclusion if necessary. The patient with alcohol use disorder hasn’t had a drink in 12 hours, and he appears sweaty, anxious, and angry. I worry about seizures and call over to the medical ED to send this patient there, given a history of complicated withdrawals noted in his chart. We often send patients to each other as needed.

3:30 AM to 5:30 AM

I staff these patients over the phone with another attending who is on 24-hour call. The overnight attendings are always helpful and thoughtful, sounding remarkably alert and oriented on the phone despite the hour. Indeed, if the patient list swells beyond my capacity, this same overnight attending will come to PES to help; however, the workload is generally manageable. Being the only psychiatric resident in the hospital overnight was an intimidating prospect at first, but with the training I received during intern year, the experience becomes quickly satisfying. There is a lull around 5 AM, and I make headway on my notes. I reassess the patient in the secure core, who appears much calmer.

6:00 AM to 8:00 AM

During this time, I finish my notes and answer some phone calls regarding medical patients on whom psychiatry is consulted. I also prepare my sign-out for the day resident. It’s been a busy night but a good one. The social workers are bed-searching for many patients, and one by one they are transferred out to their respective accepting hospitals. I have some time to check my email and text my friends.

8:00 AM

The attending arrives for the start of the new shift. I sign out, wrap up my notes, and go home. I walk my black lab, Gus. I usually sleep from 10:00 AM until 5:00 PM, so I have plenty of free time until my next shift begins.

PGY-3

Stephen Leung

My name is Stephen Leung, 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. 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 Tuesday schedule.

8:00 AM to 8:15 AM

In our UMATS clinic (U-M Addiction Treatment Services), I start the day by meeting with my attending to discuss a plan for the day. We run through our list of patients and discuss treatment goals. We discuss with nursing staff if we need their assistance in drawing labs or administering medications such as naltrexone injections.

8:15 AM to 11:30 AM

I typically spend 60 minutes seeing a new patient, with an additional 30 minutes to staff the case and coordinate treatment. I usually see two additional return visits in UMATS for the rest of the morning and can typically find time between patients to catch up on documentation.

11:30 AM to 12:00 PM

I meet with my attending to debrief each case from the morning. We spend time discussing anything from articles of interest to interviewing techniques.

12:00 PM 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. At a minimum, the program provides us with a free lunch with educational material two days out of the week.

1:00 PM to 4:00 PM

The afternoon is dedicated to bipolar clinic. Patients are often referred to our bipolar clinic either for diagnostic clarity or for a higher level of care for known bipolar disorder. We see one new patient every other week in bipolar clinic, and we have two hours for the initial intake. This allows us to review pertinent records, conduct a comprehensive interview, and discuss treatment within a multidisciplinary team. The clinic is staffed by some of the leading researchers within the field. By utilizing their knowledge and resources, we are often able to provide treatment that patients may not otherwise receive in the community, such as IV ketamine or ECT. On the days that I don’t have a new intake, I see patients in our bipolar medication group where I work with an attending to see multiple return visits at the same time.

4:00 PM to 5:00 PM

The day wraps up with a bipolar team meeting. If I saw a new patient in the afternoon, then I will discuss the case with the team and elicit their feedback. We have care managers and social workers present in the meeting, and they are extremely helpful in coordinating follow-up and providing referrals. The meeting usually concludes with a teaching exercise conducted by a faculty member.

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

Shami Entenman

My name is Shami and I’m one of the fourth-year psychiatry residents at the University of Michigan. Our fourth and final year of residency is exciting for many reasons, one of which is that we have eight months of elective time. This flexibility allows us to pursue clinical, research, educational, and administrative interests as we also start to make career plans. A typical week for me looks like this: 

Monday all day

Psychiatric Emergency Services (PES): While we all rotate through our dedicated Psychiatric Emergency Room earlier in residency, I chose to spend Mondays in PES to gain more experience in this busy, high-acuity setting. This elective helps me better understand how to triage patients, manage agitated patients, and be part of a multidisciplinary team. On Monday afternoons I also meet with my global supervisor to talk about patient and career questions as well as any other topic in psychiatry that comes to mind. After work I head to water polo practice.

Tuesday mornings

Assertive Community Treatment: On these mornings, I spend time at Washtenaw County Community Mental Health, specifically with the Assertive Community Treatment team (or “A-C-T”). I join one of the social workers, and together we go on home visits in Washtenaw County. This helps to provide community support and medications for adults with severe mental illness. This rotation has allowed me to gain experience seeing patients in different settings rather than just in the office or the hospital.

Tuesday and Wednesday afternoons

VA Emergency Room: On these two afternoons, I join the mental health staff in the Ann Arbor VA Emergency Room, helping to see patients who present to the ER with psychiatric concerns. We work with the inpatient team and outpatient clinics to help coordinate care for these patients, depending on their concerns. Similar to being in PES, this rotation helps me learn how to more effectively manage acute and unique situations. Tuesday and Wednesday evenings are often filled with trivia or recreational sports leagues.

Wednesday mornings

Therapy Mentorships: Throughout third and fourth year we all participate in several therapy mentorships that are taught by our social work and psychology colleagues. These mentorships focus on specific therapies such as Interpersonal Therapy, Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Psychodynamic Therapy, Motivational Interviewing, and Couples and Family Therapy. After the morning session, I head to our grand rounds and then to our weekly resident lunch.

Thursday and Friday mornings

Outpatient Clinic: On these two half-days, I see patients in our outpatient clinic at the Rachel Upjohn Building. I have been seeing many of these patients since the beginning of third year. These appointments are for medications, therapy, or a combination of both.

Thursday afternoons

Didactic Lectures: On Thursday afternoons, I join the rest of the fourth-year class for our weekly lectures. We typically have two lectures each afternoon with topics ranging from psychiatric symptoms of strokes, to applying for jobs after residency, to insomnia, and many more. These afternoons are also a great chance to catch up with classmates! My Thursday evenings are typically filled with water polo.

Friday afternoons

Research: On Friday afternoons I have dedicated research time. I recently started working on a project with the transplant team with members of both Psychiatry and Surgery departments, and I use this time to focus on the project.

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, our program is incredibly open to helping and accommodating your interests. Other possible electives in fourth year include the high-risk OB service, consult-liaison services, tele-psychiatry, PTSD clinics, substance use clinics, and many, many more. Go Blue!

 

After Work