A Day in the Life of a PGY 4 Resident
Hi, my name is Bryan Shelby, one of the fourth-year residents. Prior to specializing in forensic psychiatry, I wanted to have a broad exposure to different patients prior to fellowship. One of the best things about the fourth-year is there are no required rotations. Therefore, we can tailor the fourth-year to our own interests. This allows an excellent opportunity to incorporate a variety of clinical and/or research experiences. In my fourth year at Yale, I am participating in several different treatment sites with different patient groups.
On Mondays, I travel to Silver Hill Hospital in New Canaan, CT, where I begin my day at 8am working with patients who have eating disorders. I start the day during breakfast at the eating disorder’s table, focusing on developing behavioral strategies for healthy eating. I then spend the next portion of the morning and the early part of the afternoon on the adolescent inpatient unit, participating in rounds with the inpatient team. One of the great opportunities being at Silver Hill is the transitional living program, which focuses on helping adolescents with various disorders transition from an inpatient milieu. I follow several patients from inpatient through completion of this program. In addition to significant dialectic behavioral therapy (DBT) skills exposure, this environment allows a unique adolescent treatment focus. In the later afternoon, after patient meetings and patient rounds, I end my day co-leading groups devoted to eating disorders. Right now, I am helping to develop a group specifically to meet the needs of dual-diagnosis patients—both with eating disorders and substance abuse.
On Tuesdays, I start around 8:30am at my primary training site - the West Haven VA Hospital. Here, I work with patients from diverse age groups and backgrounds. The VA clinics provide opportunities to engage with patients in different time frames: some on a weekly basis, some on a biweekly basis and some monthly to bi-monthly. I have many patients who are seen for psychotherapy alone in a variety of modalities: psychodynamic psychotherapy, cognitive-behavioral therapy, brief dynamic psychotherapy, problem-solving psychotherapy, couple’s therapy and supportive psychotherapy. Because I had the opportunity of training at the VA in my third year, I am following many of these patients into the fourth year as well. The experience of treating patients over time with an understanding of the longitudinal course of illness has been extremely rewarding. Later in the afternoon, I participate in the forensic case conference at the Connecticut Mental Health Center (CMHC), where Dr. Howard Zonana leads a discussion on issues unique to forensic evaluations. I then end the day with psychotherapy supervision or by meeting with Dr. Robert Ostroff at the Yale Psychiatric Hospital to discuss ongoing research with patients suffering from obsessive-compulsive disorder and psychotic features.
On Wednesdays and Thursday mornings, I am primarily at the VA. On these days, I am working with patients in a variety of clinics: mood disorders, PTSD, geriatric, neuropsychiatry and new patient screening. The range of disorders for medication management covers a wide gamut. It can range from working with older patients on complicated neuroleptic regimens of depot shots or clozapine to medication startup for patients just entering into the clinic. Thursday mornings are devoted entirely to the geropsychiatry clinic where I see elderly patients, focusing on issues unique to them. Very importantly, there is always an excellent balance between resident autonomy and faculty supervision. In the later afternoons, I see my long-term individual psychotherapy patients as part of the Yale Psychiatry Department’s long-term psychotherapy program, some of which by the end I will have seen for over two years.
Ending the week, I participate in the Friday morning forensic psychiatry case conference at CMHC. Then, right afterwards, it is the program-wide Grand Rounds. I finish in the afternoon at the VA, seeing patients for couple’s therapy, individual psychotherapy or medication management. Overall, my days usually end in the early evening around 6pm depending on whether I am meeting with patients or working on research. My experience at Yale has been excellent: a tremendous and readily available faculty, a great commitment to teaching, many opportunities for clinical exposure and research, and a diverse group of training sites with opportunities to serve different patient populations. One week is just one piece of a very exciting and enriching fourth-year.
