As a PGY-2 psychiatry resident, I’m in the thick of residency training, looking forward to where my career path will take me. Right now, I’m drawn to inpatient psychiatry, consultation-liaison work, and medical education. I’m also excited for outpatient work in PGY3. Recently, I joined the Medical Education Track, which I anticipate will be a rewarding experience. The track is designed to provide me access to mentorship focused on teaching, opportunities to work with medical students, and a chance to grow as an educator. Plus, I will help lead and coordinate PRITE reviews next year, which feels like a like an exciting challenge! On top of all that, I was recently asked to prepare for the APA MindGames competition with two of my co-residents. MindGames is the national residency competition where we test our knowledge in psychiatry—it’s intense but also a lot of fun, and I’m hoping we can make our program proud!
This month at BUMCT, I’m on one of the two daytime consult psychiatry rotations of PGY2, which is notoriously one of the the busiest rotations. The hours are long (8 AM–8 PM), and the patient load is heavy, but I’ve already seen so much growth in myself as a physician. Each day starts with sign-out from the night float resident at 8 AM, where we catch up on new consults and follow-ups, and usually share a few laughs and inside jokes. The consult team includes me (as the PGY2 and team leader), a MS3, a MS4 (sub-I), a PGY4 (as junior attending), and the attending. My team is fantastic. Between consults, I try to teach the medical students about psychiatry—things like psychopharmacology, aspects of the mental status exam (MSE), and how to think through cases. It’s been a great way to solidify my own knowledge while helping others learn. Here’s how my week went:
Monday
- Morning: Started the day with sign-out from the night float resident. Along with the list of patients we are following, I picked up two new consults: a patient in the ED with acute psychosis and another on the medical floor with SIADH requiring medication changes. The psychosis case was fascinating—a young guy with no prior psychiatric history came in with paranoid delusions and auditory hallucinations. After evaluating him, we started an antipsychotic and petitioned for admission to the psychiatry unit at BUMCS.
- Afternoon: Followed up on a delirium case in the ICU. The patient, was agitated and confused with a form of sepsis. We advised the team to treat her underlying infection, implement delirium precautions, and provided agitation medication recommendations. Later, I saw a patient in the ICU with refractory pre-procedure anxiety which turned out to be a fascinating case full of medical complexity due to rare illnesses.
- Evening: Covered VA call remotely from 5–8 PM, which mostly involved putting in nursing orders for patients on the psychiatry unit and admitting patients from the VA ED to the psychiatry unit. I also kept up with BUMCT consults during this time. When I got home, I hopped on my Peloton bike for a quick ride, made dinner, and crashed for the night.
Tuesday
- Morning: Sign-out included updates on a patient with dementia who had been aggressive toward family and staff. The family was financially strained and couldn’t afford placement, which made the situation even harder. We started the patient on low-dose Haldol, and it worked wonders—their agitation improved significantly, and the restraints were discontinued. I also picked up a new consult for a capacity evaluation in the medical ICU.
- Afternoon: Saw a patient in the ED with suicidal ideation (SI) after they lost their job. After a thorough risk assessment, we felt comfortable discharging them with close outpatient follow-up. I also checked in on the SIADH case from Monday to make sure the medication adjustments were effective. At lunch, I caught up with a co-resident, which was a nice break in the middle of a busy day.
- Evening: VA call and consult was pretty quiet. Once home, I used the evening to review some MindGames material before heading to bed.
Wednesday
- Morning: After sign-out, I picked up a new consult for a patient with mania in the ED. The patient was hyperverbal, grandiose, and hadn’t slept in days. We started a mood stabilizer and antipsychotic and arranged for inpatient psychiatric admission.
- Afternoon: I headed to BUMCS for didactics from 1–5 PM, where we covered psychopharmacology and psychotherapy. It’s always nice to step back and focus on learning. Afterward, I returned to BUMCT to follow up on consults and cover VA call.
- Evening: I was exhausted after a long day, but I managed to squeeze in a quick weightlifting and stretching session and made a simple dinner before calling it a night.
Thursday
- Morning: Sign-out included updates on our list of patients and a new consult for a patient with delirium in the surgical ward. The delirium case was complicated by polypharmacy, so we simplified the medication regimen and emphasized treating the underlying infection. I also followed up on the dementia case, providing recommendations for ongoing management.
- Afternoon: I saw a 30-week gestational age gravid female with moderate depression. We increased her SSRI dose after discussing risks/benefits. For lunch, I met with our visiting sub-I and talked about their interest in psychiatry. It was fun to share my experiences and hear their perspectives.
- Evening: VA call and consult was straightforward. I spent the evening relaxing with a home-cooked meal and some light reading.
Friday
- Morning: Sign-out included updates on all the patients. I picked up a new consult for a patient with SI in the ED. The patient had a history of multiple suicide attempts and was dealing with a lot of interpersonal stress. We recommended inpatient admission for safety and stabilization.
- Afternoon: I also saw a patient on the medical floor for a capacity evaluation and determined they lacked decision-making capacity after a thorough assessment.
- Evening: VA call was quiet besides an order for a patient experiencing a migraine. The patient had consumed cocaine less than 24 hours prior, therefore I had to be careful of the treatment option selected. I was also consulted on an intoxicated patient with SI in the ED which I signed out to my night float co-resident because their BAL was too elevated to perform an accurate evaluation. Sign-out took longer tonight because my night float co-resident and I had to prepare for handing off to the weekend team. I ended the week with a workout, meal prep, and some downtime to recharge.
Saturday
- Morning: One of the best parts of being on daytime consults is having weekends off! I slept in and then went for a hike at Tumamoc Hill. The weather was perfect, and the views were incredible—it was exactly what I needed.
- Afternoon: I ran errands, did laundry, and caught up on chores around the house.
- Evening: I met up with friends for dinner and a movie. It was so nice to unwind and laugh after a busy week.
Sunday
- Morning: I started the day with a workout and then spent some time studying for the MindGames qualifying exam. I reviewed pertinent topics while sipping on matcha.
- Afternoon: I did some grocery shopping for family and friends who are visiting next weekend (I won’t have time during the week). It felt good to get organized and plan ahead.
- Evening: I attended a yoga session. Afterward, I headed to a friend’s house for a Super Bowl Sunday gathering. We had great food and company—a perfect way to end the week.
This week was a mix of challenging cases, teaching opportunities, and much-needed personal time. The consult psychiatry rotation continues to push me to grow, and I’m so grateful for the support of my friends, faculty, and family. Here’s to another week of learning and growth!