A Day in the Life
A Day in the Life of a PGY-1 Resident
Shifting from being a medical student to a PGY-1 is a challenging and exciting transition. I started my first month at Mount Sinai on inpatient psychiatry, on the duel diagnosis unit, where patients are treated concurrently for psychiatric and substance abuse problems. Here, you develop therapeutic relationships with patients who have complex psychosocial histories, and learn to treat those suffering from an interplay of diagnoses/pathologies.
My day begins with a 15-minute walk from my apartment (Mount Sinai housing) to the hospital. I start by pre-rounding on my patients, checking notes from the night before for any new developments, and at 9:00 am team interdisciplinary rounds commence. All clinicians, including the attendings, residents, nursing staff, social workers, group therapists, and medical students participate. Patients are presented, cases are discussed, and then the work begins. I put in orders, write notes, and admit new patients throughout the day (the work is shared with my fellow residents on the unit). Once a week we also have formal didactics, which cover everything from practical issues on the floor to medical ethics. My workday typically ends at around 5:30 pm, unless I’m on call.
The call schedule is reasonable at Mount Sinai. In total, I had four call days in the last month, which really felt like the perfect amount—enough time to gain enriching clinical experience and a sense of independence without feeling overwhelmed. This seems to be a theme of Mount Sinai Psychiatry more generally. This is a world-class program with incredible educational opportunities, but the support we receive from the faculty and staff is equally exceptional. As residents, we are persistently encouraged to nurture our creative interests, and our personal well-being is never overlooked.
Each month a new rotation begins, and I’m about to start emergency medicine. In total, interns rotate through six months of psychiatry, four months of medicine, and two months of neurology, and each month is unique. After the ER, I’m eager to start forensic psychiatry, which deals with the intersection of psychiatry and law, and is the specialty I’m personally most interested in (notably, exposure to forensics this early in residency is uncommon at other programs). At the moment, I’m gearing up for the change and look forward to the fresh set of experiences that await me!
A Day in the Life of a PGY-2 Resident
Living in Mount. Sinai housing certainly has its benefits: affordable space, great neighbors, and a short walk to the office where I function as a PGY2 in the psychiatry program. Intern year went by so quickly I can't believe that I'm finally a second year. After working in multiple inpatient psychiatric settings, the psych ER, the med ER, internal medicine, and neurology, it's time to settle down. Second year is primarily focused on sharpening clinical skills on inpatient psychiatric units at Mt Sinai in Manhattan and at the Bronx VA. As expected, the privilege of moving up a year in residency brings more responsibility. I now care for my patients at a higher level, take on further teaching roles with med students, and help interns get acclimated to being doctors.
In terms of patient care, it's important that each resident knows everything that is going on in the lives of their patients. The first thing I do in the morning is check the charts to make sure I am aware of anything that occurred overnight when I wasn’t in the hospital. Once I feel comfortable with all of the new information, I go and speak with the patients, assessing mental status and answering any questions that may have arisen since we last spoke. During morning rounds everyone shares information regarding each patient’s assessment and plan. This is why I love psychiatry - it’s the only field where med students, residents, social workers, nurses, therapists, and attendings all take the time to discuss the patient together. We discuss mental status, medical issues, family dynamics, medications, and create a plan as a team. After rounds end we break to put our plan into action.
At any point in the day I could be calling consults, speaking with outpatient providers, talking to family members, writing notes, or ordering tests and medications. All of this is done while constantly checking in with the patients and other members of the team to make sure our plan is going smoothly.
PGY2s have dedicated didactic time for the entirety of Wednesday afternoon, which can take the form of lecture, discussion, or watching seasoned attendings interview patients. Additionally, we have journal clubs, grand rounds, and special interviewing sessions peppered throughout the week.
The second year call schedule is relatively light, with approximately 20 weeknights of short call and 13 weekend days of long call. I intend to take full advantage of this schedule by enjoying all that New York has to offer. On any given night you can meet up with friends or family, go to a concert, or grab a bite at a new restaurant. Regular psych resident happy hours give us all the opportunity to relax outside of the office in one of the many great watering holes on the Upper East Side.
Mount. Sinai psychiatry residency has been excellent so far and it will only get better. I know that I am getting a world class education in the greatest city in the world.
A Day in the Life of a PGY-3 Resident
Add an espresso shot of relief to your daily Keurig brew, second year has arrived! Gone are the days of schlepping to the hospital for outside rotations. Now is the time to immerse yourself in psychiatry. Cheers to that!
You will find that summer of PGY-2 is a lot sunnier-- both at work and outside. Blessedly, your schedule will permit enjoying some well-deserved free-time. I’ll get right down to the skinny-- my colleagues and I each worked a total of twelve (yes twelve!) weekend call shifts for the entire year-- that means you have ¾ weekends free every month. I used the summertime to address my first-year pallor (derived from a combination of arduous rotations and self-imposed winter hibernation) with some restorative rays. I also opted to get Step 3 out of the way ASAP! Central Park picnics, seeing my favorite actress Cate Blanchett in Uncle Vanya, and a welcomed vacation provided me with the rejuvenation to hit the ground running.
Second year rotations offer a variety of clinical exposures as you continue to explore your professional interests. In the psych ER you are directly involved in managing myriad clinical challenges, but fear not, you will be bolstered by the support of an excellent staff. Outpatient substance abuse provides the opportunity to initiate buprenorphine treatment, follow patients on complex Librium tapers, learn about methadone maintenance, and develop invaluable motivational interviewing skills. CL draws upon your PGY-1 medicine and neurology repertoire and ensures your diagnostic skills don’t get dull. Inpatient months are scheduled between Sinai and the Bronx VA-- with each rotation serving diverse patient demographics with unique diagnostic presentations, furthering your clinical confidence and preparing you for the autonomy of 3rd year. And there’s your two week elective period-- I opted for the psychoanalytic elective, which centered on the psychoanalysis of Hitchcock’s Rear Window. Not bad, indeed.
The one-liner takeaway: Welcome to second year, you’re movin’ on up! Enjoy!
A Day in the Life of a PGY-4 Resident
On Monday mornings I wake up around 8:30am, eat breakfast with my family, and then walk from my Mount Sinai owned two bedroom apartment on Park Avenue and the upper nineties to my office in the Mount Sinai psychiatry outpatient clinic on fifth avenue and 97th Street. My patient load at the outpatient clinic includes medication management and therapy cases. The diagnoses of my patients includes: schizophrenia, social anxiety disorder, major depressive disorder, borderline personality disorder, and dythymic disorder. I have about an equal number of self-pay and Medicaid patients.
At 11am on Mondays I have a lab meeting at the Seaver Autism Center, an interdisciplinary Center for research and treatment of autism spectrum disorders (ASD). During this meeting, psychiatrists, psychologists, research assistants, and post-docs discuss the clinical exams and scheduling of patients enrolled in any of the more than 10 current clinical, translational, and basic science research studies being conducted at the Seaver Center each week. I complete the psychiatric evaluations and follow up psychiatry visits scheduled on Tuesday afternoons and Thursday mornings for patients in any of the ongoing studies at the center. I also have my own research project which is entitled “An Open Label Pilot Study of IGF-1 in SHANK 3 Deficiency and in ASD without SHANK3 Deficiency.” SHANK3 is an example of a form of autism caused by the deletion of a single gene. My research project and the research training plan I developed with my mentor around my project earned me a National Institute of Health Loan Repayment Award that will provide me with a total of $70,000 in loan repayment over my final two years of residency.
After my lab meeting I go home for lunch and then return to work about 45minutes later. On various days throughout the week, I meet with supervisors for each of the therapeutic models I use. This includes dialectice behavior therapy, cognitive behavior therapy, psychodynamic psychotherapy, and couples therapy. I also meet regularly with my research mentor, Alexander Kolevzon MD, and my clinical mentor, Craig Katz MD.
As one of the chief residents I coordinate the neuroscience course for the second and third year residents as well as mentor junior research track residents in the program.
Please feel free to contact me if you have any additional questions about: working with the Latino community around Mount Sinai (I ran a psychotherapy group in Spanish at the free medical student clinic last year), the research track, or raising a child on a budget in Manhattan.
Icahn School of Medicine
Department of Psychiatry
One Gustave L. Levy Place
New York, NY 10029