I am a second year child psychiatry fellow at the University of Texas Medical School at Houston, TX. As I near graduation, the gap between residency and "real life" grows smaller. The transition is easier than I once thought, as I am more independent than when I started this process. Here is a brief glimpse into one of my days.
I start the day with rounds at Harris County Psychiatric Center, around 7:45 a.m. I arrive on the adolescent unit to meet with the rest of the team, which consists of the attending physician, social worker, general psychiatry resident and three medical students. The morning consists of rounds, phone calls to parents, family meetings and educating medical students. I struggle with balancing enough teaching time for the medical students with patient care demands. I worry about the medical students feeling "scutted." I hope all of them will consider the psychological aspects of patient care, no matter what specialty they choose in the future. I feel like accomplishing this is partly my responsibility. Also, a good rotation experience can help retain students in psychiatry.
We meet with each patient on the unit to review the prior evening’s events, medication effects, and everyone’s goals and progress for treatment. The team then meets with the new patients on the unit, alternating the interviewing process between the residents and medical students. Afterward, we discuss differential diagnosis, the treatment plan, and the style of the interview. Although this team approach can be overwhelming for some, the different perspectives help to provide a more thorough evaluation. As a physician in training, the immediate feedback is valuable.
After a nursing report and writing notes, the resident, medical students and I split up the work. This entails phone calls to families for medication explanations, gathering new information and reassuring worried family members. Between calls, one student and I meet with the aunt of a depressed teenager who attempted suicide. This is the family’s first contact with psychiatry. We listen to her concerns and discuss major depression and its treatment and the implications for the family. We also bring the patient to meet with her aunt, which goes well this time. Some of the family meetings are volatile, but I am relieved today, as the aunt is supportive and would like a family therapy referral.
After the meeting, we find the other third year medical students rotating on the service. I try to provide mini-lectures for them several times a week, and today I am discussing personality disorders. Sometimes, these lectures are spontaneous, but I had prepared today’s topic. They usually choose the topic, but I try to incorporate these with patient issues we are dealing with.
By the time I’m finished, it is noon, so I drive to the outpatient building for didactics and clinic. I meet with the rest of the fellows and the faculty member for our weekly PBL (problem-based learning) conference. Our current case focuses on a preschool child that has been sexually abused. The objective of this case is to cover topics related to posttraumatic stress disorder, abuse, and working with various systems, such as Children’s Protective Services. We present our learning issues from the previous session. At times, we grumble about having an "assignment," but these sessions reinforce the information, especially when you have to teach it to other residents. PBL is also based on actual clinical cases, so it simulates real clinical experiences. I like the active role we are required to take in the learning process.
After PBL, I have family therapy clinic. The team is made up of a licensed marriage and family therapist (our supervisor), child psychiatry fellows, general adult psychiatry residents, a psychology resident, and a pediatric resident. We each carry about two cases per afternoon. We briefly discuss the main issues with our first set of cases. My cotherapist, a psychology resident, and I meet with a family we’ve been seeing for awhile. Our supervisor, along with other team members, watches our session from behind the one-way mirror. After the session is over, we all meet for further discussion. This portion is really helpful, because the feedback on the process of the therapy and alternative techniques gives me new insight. I also like family therapy because of the opportunity to learn from the other cases by observing from behind the mirror.
When family therapy clinic is over, I head home. The day has been busy, but productive. Along with the supervision from faculty, I was responsible for a large part of my learning today. I believe those skills will serve me well as I continue my own education and also educate patients, their families and others in my field.