From their first year through the fourth, psychiatry residents learn to balance full work days and educational training with busy home routines. Learn more about how a typical day looks for each of our resident classes.
Nick Reed, MD, PhD, PGY 1
7:30 a.m. — Chart review
I begin the day by arriving at the unit and reviewing patient charts for morning rounds.
8:30 a.m. — See patients, start notes
I see my patients and open my notes for the day. If time allows, I get started with a couple of notes before the treatment team meeting to make the rest of the day go smoother.
10:45 a.m. — Multidisciplinary treatment team meeting
This meeting includes representatives from nursing, pharmacy, occupational therapy, social work, patient care coordination and other support staff. Interns are expected to lead the discussion for each patient, present a preliminary assessment and treatment plan, and incorporate feedback from the team and the attending psychiatrist. Treatment orders are finalized by the end of the meeting and are ready to be implemented to guide patient care.
11:45 a.m. — Place orders, continue notes
I put in orders based on finalized treatment plans immediately following the team meeting to get things started without a delay. Then, I continue working on notes until lunch.
12:30 p.m. — Lunch
At the clinical site where I’m currently rotating, there is a cafeteria with a salad bar, a hot food bar, a station for sandwiches and wraps, and more. Residents receive a 40% discount on all items from the cafeteria at this location!
1:00 p.m. — Finish notes
After lunch, I finish patient notes. Depending on the day’s workflow, I am sometimes able to leave early, provided that all notes and orders are complete and I remain available to address any additional patient care needs remotely.
4:30 p.m. — End of day
Most work days conclude by 4:30 p.m., except when I am scheduled for a call shift in the Crisis Intervention Unit (CIU), about once every two weeks on average.
4:30 to 10:30 p.m. — Crisis Intervention Unit (CIU) call shift
About once every two weeks, interns are assigned an evening call shift in the CIU. These shifts involve evaluating patients who are in a mental or emotional crisis and deciding whether or not an admission to the inpatient floor is needed. There is no weekend call for psychiatry rotations during the PGY-1 year, so all of these shifts fall on weekdays.
Other considerations for the PGY 1 year
Half of the PGY 1 year is spent on inpatient psychiatry rotations, while the other half of the year is divided between off-service rotations such as emergency medicine, family medicine, internal medicine and neurology. Daily schedules and call responsibilities while on non-psych rotations would be different from those described above and would vary from service to service.
The schedule described above reflects the busiest inpatient psychiatry rotation of the PGY 1 year. Other psychiatry rotations typically involve an even lighter workload, allowing for a great work-life balance during intern year.
My experience as an intern so far
As a medical student, I was told that the intern year of residency would be the most difficult and least enjoyable part of my training. My experience as a PGY 1 psychiatry resident at IU has been the opposite! The faculty are supportive, my co-residents are amazing and the environment has been great for learning. It has been a fascinating and inspiring experience working with the patients. There is seldom a dull moment. I feel so lucky to be here, and this is without a doubt my favorite job I’ve ever had.
Manal Piracha, MD, MS, PGY 2
The second year of residency has been off to a great start! I am so relieved with getting the off-service rotations out of the way and just focusing on psychiatry. Second year is a great time to explore the different subspecialties within psychiatry, including consult, child and adolescent, geriatric, forensic and addictions. This year, we will also do a 24-hour call covering the VA, University Hospital and Goodman Hall. During the weekends, we also help cover the consults at Riley Children’s Hospital. I have averaged about four to five calls per month (including weekends). The call day can vary, with some being busier than others, but the post-call day is pretty nice. You have the flexibility to be more independent with your patient plans and can always reach out to an attending physician if you need help with more complex cases.
6:00 to 7:30 a.m. — I like to start my day with a walk/run outside and my morning cup of coffee. Most days, I will make coffee with my Nespresso. Some days I like to treat myself to a coffee before heading to the hospital. It takes me about 10 minutes to get to work. This month I’m at IU Health's University Hospital with consultation-liaison psychiatry.
8:00 to 8:45 a.m. — I start the day chart reviewing the patients I’m following from the list and reading up on any new patients we were consulted on from the day before. For each patient I like to check the MAR to see if any PRNs were given. I review the primary team’s note and take note of any changes to the plan. I like to take the time to read the physical therapist and occupational therapist notes for their observations of the patient’s behavior, overall interactions, mobility and/or abnormal movements.
8:45 to 9:30 a.m. — During this time, the team meets to table rounds on the patient list. The team includes myself (the resident), Chad (the PA), the third- and fourth-year medical students, and the attending physicians (Dr. Holmes or Dr. Diaz). We discuss a brief overview of the patient history, overnight events and potential changes to the patient’s plan/medications depending on the patient’s condition.
9:30 to 11:30 a.m. — See all the patients as a team. After each patient, I will reach out to the primary team with medication recommendations.
12:00 to 1:00 p.m. — I work on notes and usually grab a bite to eat.
1:00 to 4:00 p.m. — During this time, I am usually finishing up my notes. New consults roll in throughout the afternoon. New patients are usually split between Chad and myself. When there is downtime, I spend the afternoon teaching the medical students about psych-related topics. At University Hospital, delirium is seen pretty often, which provides a great teaching opportunity.
4:00 to 4:30 p.m. — At this point, we are usually wrapping up, making sure we have reached out to all the teams about each patient. If we get a consult during this time we usually chart review the patient so that we are prepared to see them in the morning.
On call days:
4:30 p.m. to 8 a.m. — I head over to the VA and check my Teams message for sign-out on all the patients on the unit. I make sure my Diagnotes notifications are on in case I get a message from Goodman Hall or University Hospital. If there is a patient for me to see in the VA ER, the social worker usually pages me to give me a quick rundown of the patient. After I interview the patient, if I think admission is necessary, I will discuss that with the patient and put in admission orders. However, if I think the patient doesn’t need to be admitted, I will reach out to my on-call attending to staff the patient and make sure they agree with my plan. Call has been a crucial part of my learning because I am the one responsible for the patients. It has helped increase my confidence in responding to any psychiatric issues that may arise.
I am enjoying my second year a lot! The attendings have been great to work with, and I have learned so much already. I feel very supported by my staff and co-residents, and I am excited to see what the rest of second year has to offer.
Audrey Todd, MD, PGY 3
Third year is an excellent time to build confidence in the outpatient setting. With a full year of outpatient clinics, you'll enjoy continuity in your work, allowing you to really see the progress your patients make. The best part is that you get to choose clinics that align with your interests, which makes the experience even more rewarding. You'll also deepen your understanding of psychopharmacology, rounding out the strong foundation you've built during the first two years. By the end of third year, you'll feel ready to step into a junior attending role in your fourth year. A typical day in my life as a third-year psychiatric resident at Indiana University School of Medicine is both demanding and rewarding.
Monday
My week kicks off on Mondays at Goodman Hall, where I work in the adult psychiatric outpatient clinic. Here, I encounter a wide variety of complex psychiatric cases, often complicated by significant medical comorbidities. The diversity of these cases challenges me to integrate my knowledge of both psychiatric and medical principles, pushing me to think critically and apply my training in real-time.
In the afternoon, I shift my focus to psychoanalytic psychotherapy. These sessions are a crucial part of our training, as each resident is assigned to one patient for the whole year, allowing us to connect with patients on a deeper level and address the psychological aspects of their conditions. After each session, I staff with my attending, discussing the patient's progress and refining our approach. This collaboration is invaluable, providing me with insights and guidance that help me grow as a psychiatrist. By the end of the day, I feel a sense of accomplishment, knowing I've made meaningful strides in my patients' care.
Tuesday
I am on the research track, so I have protected research time on Tuesdays. As a research fellow in radiology imaging sciences, I work at the neuroimaging core of the Indiana Alzheimer’s Disease Research Center, one of the largest and most renowned centers for Alzheimer’s research internationally. My work involves studying the brain microstructural changes in patients with Alzheimer’s through analyzing MRI images. Our residency program provides robust support for research initiatives, offering ample opportunities to contribute to cutting-edge projects, which enhances my clinical training and deepens my understanding of neuropsychiatric care.
Wednesday
Wednesdays bring me back to Goodman Hall, where I spend the morning working in the addiction clinic. Here, I treat a variety of addiction psychiatry cases, working with patients navigating substance use disorders and related challenges. This experience is vital for keeping my knowledge of addiction medicine up to date, and it gives me the confidence to manage these challenging cases effectively. The hands-on experience I gain in the addiction clinic is something I truly value, as it allows me to apply evidence-based practices in real-world scenarios. In the afternoon, I transition back to the general adult clinic, where I oversee a broad spectrum of psychiatric cases, addressing various mental health conditions ranging from mood and anxiety disorders to more complex, co-occurring psychiatric and medical issues.
Thursday
I start my day once again at Goodman Hall, this time in the ECT/TMS clinic. My work here involves evaluating patients with treatment-resistant depression, determining their suitability for treatments like transcranial magnetic stimulation (TMS) or electroconvulsive therapy (ECT). This aspect of my residency is particularly fulfilling, as it allows me to work with cutting-edge treatments that can significantly improve the lives of patients who have not responded to traditional therapies.
In the afternoon, I continue my clinical responsibilities at the VA, delivering psychiatric care to veterans and addressing the distinct mental health challenges they face.
Friday
By the time Friday rolls around, it's a bit of a breather since the day is fully dedicated to didactics with protected time for learning. We start the morning with PGY-3 psychotherapy didactics, diving into different therapeutic approaches. Around noon, we gather for our weekly resident business meeting, where lunch is provided, and we catch up on updates from committees and sites. The meeting usually wraps up early, giving us a chance to chat and unwind with our co-residents. In the afternoon, we join the other residency classes for didactics, where we cover a variety of topics that change throughout the year.
Saturday and Sunday
Our weekend is mostly free, with just three or four weekends a year where we're on call at Riley Hospital for Children. Other than that, we have those days completely off, which gives us a great work-life balance — something our program really values. Many residents use those weekends to moonlight, while others take the time to relax, unwind and enjoy their hobbies. Personally, I love cycling, so I often hit the trails around Indianapolis and the suburbs.
Lindsey d'Arnaud, MD, PGY 4
Fourth year is all elective time, and I chose a variety of educational opportunities. I want to do addictions and general adult outpatient psychiatry when I’m all done with graduate medical education, and about half my clinical time this year is in the outpatient setting. I have a longitudinal-style schedule, so I do something different every day of the week. I’ll take you guys through a typical Wednesday.
6:45 a.m. — Rise and shine
Hello, alarm clock. My husband usually departs before me due to his work schedule. I enjoy the light roast coffee he made; feed, walk and water our Labrador retriever; devise a stylish outfit because fashion is a hobby of mine; and head to work.
8:00 a.m. — Pre-charting
Before clinic starts, I preview my patients for the morning. For new patients, this includes a review of their mental health referral, past engagements with psychiatry, etc. For follow-ups, I’m usually looking for any pertinent medical updates, medication fills, controlled substances reporting, etc. I like to make a skeleton of my notes beforehand.
8:30 a.m. — See clinic patients
I have a mix of intakes and follow-ups, for which the appointments are 60 and 30 minutes, respectively, either virtual or in-person. We discuss their concerns, and they leave with prescriptions and various non-pharmacological recommendations. I spend a good chunk of each visit on lifestyle counseling because the data show that diet and exercise make a difference in improving mental health.
11:00 a.m. — Staffing
The VA Medical Center is a bit unique in that we staff all our patients at the end of the half-day, rather than during each visit. Some attendings work remotely, but I think most are on-site, as mine is. I learn a lot from this attending, which is a main reason I kept the clinic as an elective.
11:45 a.m. — Write notes
I aim to finish all my clinic notes before the end of lunch hour. It’s much better with the on-site computer vs. remote access on my laptop. I appreciate the didactics we’ve had about the importance of notes for billing and medicolegal purposes; such lessons helped me to be more efficient and thoughtful about what I write.
12:15 p.m. — Chiefs meeting
I’m our Eskenazi Hospital site chief this academic year. Every Wednesday, the program director, assistant program directors, program coordinator, chief, assistant chief and site chiefs meet via zoom to discuss pertinent news and goals of the residency program, raise resident concerns and talk through some decisions as a leadership team. Earlier in my career, a mentor from med school and residency told me that direct involvement in how one’s workplace is run tends to increase workplace satisfaction. Anecdotally, I’ve found that advice to be true. Regardless of leadership involvement, our program takes resident feedback very seriously, and there have been several positive changes in the last few years that were driven largely by resident feedback.
12:45 p.m. — Lunch
Always make time for lunch. The VA Medical Center has shockingly good sushi available, which is my usual pick. Otherwise, I may bring a protein shake or other light meal.
1:00 p.m. — Eskenazi Hospital CIU
As my required senior subattending elective for the year, I work in the Crisis Intervention Unit at Eskenazi Hospital, which is our county safety net hospital. There’s a PGY1 present during the day on Wednesdays, so I get to do psychiatry in an emergency setting and teach some of my junior colleagues. We also work with an excellent team of social workers and some cool attending psychiatrists.
4:30 p.m. — Go home
Another pleasant workday on the books. My house is about 15 minutes away at baseline and 20 minutes during traffic. Add music or an audiobook, and the drive goes quickly.
6:00 p.m. — Pilates
I’m obsessed with Pilates — hyperbole, not a self-diagnosis. Really though, I started going three times a week during PGY2, and I still love it. There are a lot of Pilates, barre, and yoga studios in Indy and its surrounding communities.
Concluding thoughts
Thanks for reading about a typical day-in-the-life! I am so happy to be at IU, and I’m grateful for the education gained and friendships built since starting residency. Most of my weekends are free, and there is a lot of fun to be had. I’ve sincerely enjoyed our residency’s social and wellness events over the years, such as yoga at the art museum, hikes at Eagle Creek, book club, brunches, game nights, volleyball, post-didactics local brewery visits, boating at Monroe Lake, conferences and dinners with the state psychiatric society, pumpkin patches, a sledding and hot chocolate gathering, chili cooking competitions, Friendsgivings, winter holiday and Halloween parties, occasional filmmaking and, of course, our annual retreat. Overall, residency is a beautiful life chapter, and I’m happy it’s at IU.
