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A Day in the Life of a Resident - 2009

A Day in the Life of a PGY-1 Resident

HsuAt 6:00am, my alarm jumps onto my bed and licks my face. I wake up, get out of bed, and clip a leash behind his head. Within 5 minutes Toby and I are strolling through Central Park, enjoying the bright summer morning with other dogs and owners, runners and bikers. As a newcomer to the city, I’ve been pleasantly surprised by how green it is between the concrete and metal of my preconceived notions. By 7:00am, I am sipping coffee in my Upper West Side apartment and logging into Eclipsys – the electronic medical record system that can be accessed through your home computer – to check if any of my patients had any extraordinary events overnight. After a 25-minute commute via the uptown C train, I walk up the stairs from the 168th Street station and have arrived at New York-Presbyterian Hospital, Columbia campus. At 8:15am, I unlock the doors to 9Garden North, the inpatient psychiatric unit where I have just begun my third rotation of the year.

The intern year is divided into 13 four-week blocks. Four blocks are dedicated to psychiatry, two to neurology, one to geriatrics, one to emergency medicine, and four to internal medicine (and of course a month of vacation!). You will spend two months on the 9Garden North inpatient psychiatry service located in the Milstein Pavilion, which is connected to the New York State Psychiatric Institute by two overhead bridges.

As 8:45am rolls around, I join the flow of physicians, activity therapists, social workers, nurses, and students gathering for morning rounds. On 9GN, there are 5 Attending psychiatrists who oversee the care of up to a total of twenty-four patients. Each Attending directly and indirectly supervises us as we care for 3-4 patients. In some cases, a PGY-4 resident will provide additional supervision. This arrangement is a major highlight of the rotation, as the Attendings here truly enjoy teaching and are an incredible resource of knowledge to which you have direct access continually throughout the day.

I provide supportive psychotherapy to each of my patients, make decisions regarding their medications, speak with family members and outpatient providers, arrange and facilitate family meetings, and work with the social worker to plan discharge. We also attend didactic sessions covering topics such as psychopharmacology, ECT, psychotherapy, and substance abuse. Often I find myself wishing that the end of the day would not come so fast!

But the day does always end, and I arrive home sometime between 6:00 and 7:00pm. As interns, we do not take call and have no weekend responsibilities during our psychiatry months, which gives us the opportunity to read, to prepare for didactic sessions, to catch up with friends and family, and to enjoy the many perks of living in New York City.

I hope this has given you a glimpse of what it’s like to be an intern at Columbia. I’ve truly enjoyed my time here so far, and look forward to the rest of my career!

A Day in the Life of a PGY-2 Resident

Judith JosephHi, my name is Judith Joseph, and I am a PGY-2 psychiatry resident at Columbia. I live in Times Square and my morning is fueled by the enormous amount of energy that I encounter on the streets of NYC as I walk to the subway station. I chose to live downtown because I had lived on the Upper West Side for the past 7 years as both a Columbia MD/MBA graduate student and a Columbia anesthesiology resident before I switched to psychiatry. My commute to campus is 25 minutes, door-to-door, on the A-express train.

The PGY-2 year is comprised of two 2-month hospital rotations (Consult Liaison and CPEP), one 2-month outpatient rotation (Intensive Outpatient Program or IOP), one 2-month inpatient rotation on a unit that primarily treats patients enrolled in research protocols (General Clinical Research Unit) and one 4-month inpatient rotation (Washington Heights Community Service). PGY-2 residents are also the Doctor-On-Call (DOC) and these overnight calls are roughly q12 (every twelfth night). As a DOC, the PGY-2 handles inpatient issues on the psychiatric floors, and is also responsible for evening psychiatric admissions.

I started my PGY-2 year in the CPEP, which is the psychiatric emergency room. In the CPEP, I treated a wide variety of patients with acute psychiatric illness. My CPEP experiences prepared me well for dealing with overnight DOC emergencies.

Currently I am on the IOP (outpatient rotation) and I arrive to my office at 8:30am. In the IOP, I learn how to provide supportive psychotherapy and psychopharmacology in a private practice-like setting. During a typical day I have sessions with patients, a meeting with my attending, and co-lead group therapy sessions with patients. My day ends at 5:00pm and I am home by 5:30pm. In the evenings, I go to the gym and then I study for an hour or so. By 8:00pm, I have time for other activities, such as meeting up with friends in the West Village, going to SoHo to hear my favorite DJ spin, or meeting up with business school friends to work on entrepreneurial projects.

Throughout the PGY-2 year, we have daily classes, with topics including interviewing skills, psychopharmacology, DSM IV disorders, and psychodynamic psychotherapy. Once a week my class meets for process group, during which we informally talk about our individual weekly experiences.

So far my year has been challenging, but extremely rewarding. I look forward to participating in psychiatric research projects later in the year and I am excited to be a part of such an amazing program.

A Day in the Life of a PGY-3 Resident

Nasir NaqviWelcome to our web site. My name is Nasir Naqvi and I am here to tell you about how I spend my time as a PGY-3.

My schedule is different every day, so here is an overall view of my week: I spend two half-days per week in the Columbia University Psychiatry Service (CUPS) Clinic, seeing a combination of psychotherapy and psychopharmacology cases. For each case, I choose among a roster of supervisors, each of whom specializes in a different kind of treatment. I also spend one half-day per week at the Audubon Clinic, a community psychiatry clinic serving mostly patients with severe and persistent mental illnesses. In addition to these clinics, I see two patients for long-term psychodynamic psychotherapy, along with an adolescent patient. We are responsible for making our own schedules and setting our own fees, which is an invaluable training experience. In addition to my outpatient practice, I cover the emergency room at night for a total of four one-week blocks, as well as 8 weekend days during the year. In addition to clinical work, I spend one and a half days per week in the laboratory of Kevin Ochsner, using fMRI to examine neural activity during regulation of methamphetamine craving and the ability of this activity to predict relapse to methamphetamine use.

Here's how a typical day goes: I usually wake up at around 6:30am to get a jump on traffic. I am one of the few residents who lives in the suburbs of New York City. My wife and kids are usually still asleep when I leave, but leaving this early also means that I get home earlier and get to spend more time with them in the evening. I usually begin my workday at 7:30am in my office, tying up loose ends from the day before, and I start seeing patients at 8:30am. Every day there is a one-hour break for class or Grand Rounds, which is one of the most rewarding parts of the day - both because of the high quality of didactic material, as well as the opportunity to connect with my classmates. The rest of the day is split among the clinics, supervision (one on one discussion of cases with expert mentors), meetings with researchers, and the laboratory. I am usually done by 5 or 6pm.

In the PGY-3 year we begin to see what life looks like after residency, including the challenges of combining clinical practice with a research career. For me, this is also a time to learn how to negotiate the balance between my career and my family life. I have found tremendous support from the faculty, the administration and my classmates in this process.

A Day in the Life of a PGY-4 Resident

Suzanne GarfinkleMy name is Suzanne Garfinkle, and I am a PGY-IV resident in psychiatry. For the past several weeks, I have begun each day going to work as a Junior Attending on 9 Garden North, the inpatient psychiatric unit at New York Presbyterian-Columbia Center. There, I carry several patients together with a PGY-I resident, Alan Hsu. I elected to do this rotation for a few reasons: to bolster my skills as a psycho-pharmacologist, to gain experience managing a team, and to teach, which has come to be one of my greatest joys as a psychiatrist.

At noon every day, I go to class. It still feels like a treat to escape in the middle of each afternoon, to socialize with my classmates, have a chance to sit down, and to learn something new. This year, we have had very good courses in ethics, education, and neuropsychiatry, among other topics. There is so much to learn in this field, and I appreciate every opportunity to solidify my knowledge base before venturing into the real world.

From 1pm on, my afternoons are packed with outpatient clinical work and supervision. I have two patients whom I have been treating for approximately two years in long-term psychodynamic psychotherapy, and several others I work with in psychopharmacologic and supportive psychotherapeutic treatments. For each psychotherapy patient, I have a different supervisor, which allows time to discuss each case in depth and to explore different perspectives on theory and technique.

The beauty of our PGY-IV year is that you can devote yourself to anything that interests you, and over the course of this year, I am working on a project that has been constantly engaging. I am developing a course in psychiatric writing, focusing on how to write a history, and working with trainees at the CC4, PGY-I, and PGY-II levels. I began working on this project over the summer, and will return to it with greater intensity once I have finished one more clinical rotation at our Intensive Outpatient Program, as a junior attending. At the end of each day, I return to my apartment on the Upper West Side, where I live with my husband, Michael, who is a clinical psychologist. I am pleased to report that after over three years of residency, I feel well-prepared for each new professional challenge and am excited to move beyond life as a trainee.


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