Curriculum By Year

Vimita Patel, PGY-1

Rotation: VA Outpatient Clinic

Hi, my name is Vimita and I am a SLU Psychiatry intern. We see our first patient at the VA Internal Medicine Same Day clinic typically at 8 a.m. Patients call in advance, including the day of, to schedule an appointment. On this rotation, I work with residents from various other specialties (such as Anesthesia, IM and Neurology) as well as with medical students. We each take turn seeing patients as they come and then staff with a VA IM attending. We see lots of different patient presentations ranging from MSK issues to mild infections to more serious illness that requires more triage (think of an Urgent Care type setting!). In between patients, I get some down time to read, or we discuss interesting pathologies as a group. The attendings love to teach, so you truly feel better equipped to handle urgent medical issues after this rotation. At lunch time, we head to the cafeteria (pro tip: the VA cafeteria has excellent sushi) and grab a drink from the in house Starbucks. 3:30 p.m. is the last appointment of the day. After finishing notes and orders, I am home by around 4:15 p.m.

Del Safari, PGY-1

Rotation: Inpatient Internal medicine

This was the rotation I was most afraid of during Intern year, but it turned out to be very enjoyable. Usually I get to the VA Hospital at 6:45 am and I review the chart on my patients for about 30 minutes. I then see and exam my patients and am prepared for rounds by 8:00 am, asking my senior resident any questions I have regarding my patients. The nice thing about this rotation is that there are 2 medical students on the team who usually care for 2-3 patients each and they do the oral presentations during rounds. Usually, I only have 1 oral presentation during rounds and can focus more on the goals of the day for my patients. The attendings usually start rounding at 8:30 am and the length of rounds is attending dependent lasting anywhere from 1-3 hours. After rounds we run the list and put in orders/consults then start on notes.

Usually there is plenty of time to teach the medical students and/or learn from the senior resident. The day usually ends at 5 pm on weekdays, 1 pm on weekends, and 7 pm on call days. During this rotation you work 8 days straight then have 2 days off. During your 8 days you will be on call on the first and fifth day. This rotation allowed me to work on my Physical Exam skills and helped me study for Step 3. This rotation is considered the toughest rotation and although it is more work than the other rotations, the days go by very quickly. After the end of the day there’s plenty of time to relax and read up on topics pertaining to your patients.

Laura Butler, PGY-2

Rotation: Night Float

The dreaded night float is not as bad as you’d think here at SLU! Everyone is different, but I flipped my nights and days so my “morning” starts at 4-5 p.m. I catch a little sunlight while eating breakfast and then head to work. On night float, you work four days a week: Sunday through Wednesday. Sundays are 8 p.m. to 7 a.m., and the rest of the nights are 9 p.m. to 7 a.m. (the interns cover the evening shift).  You get Thurs-Fri-Sat off.

On a typical night, I usually see 2-3 patients in the first few hours and then get another few throughout the night. My heaviest night was 8 patients – most of them consults from the ED (suicidal thoughts, psychosis, etc) although some can come from throughout the hospital. Hospital consults overnight are usually for capacity to leave AMA or agitation recommendations. Between seeing patients and writing notes I get a few calls from the psychiatric units about patients needing things like Tylenol or one-time medications for anxiety. You are the only one there overnight, so if patients are agitated and need restraints I go and see them face-to-face and put in any additional medications they need.

The cafeteria is open from 10 pm to midnight so I try to catch lunch in there (you get 200 dollars per six months for food). The pace of night float is usually more relaxed than daytime call because there tends to be less consults overnight. On lighter nights I catch up on reading, play guitar (there is one always in the call room now) or game on my Switch Lite. I like to stay awake throughout the night to keep a regular schedule, but some people sleep during those down times so they can be awake during daylight hours as well. It can get busy occasionally, but I never found it to be overwhelming. Overall, it’s great rotation to practice all my skills on my own and foster independence. If I’m ever unsure about anything the attending on call overnight will be a phone call away.

Kirkland Polk, PGY-2

Rotation: Child Psychiatry

Our child psychiatry experience as second-year residents is on an inpatient consultation service at the Cardinal Glennon Children’s Hospital which is located right next to the university hospital. This service typically has a lower census, but is balanced with a complex and wide range of pathologies which lead to a great learning environment.

7 am- I will wake up around this time, and have some morning coffee/breakfast to get ready for the day. I cannot start my day without a good cup of, preferably large, Dunkin’ Donuts coffee-I have no shame for this preference :)

8 am- I arrive to the child consult work room around this time, and I will then start pre-charting on my patients and then pre-round on them with medical students. We typically have 2-3 third/fourth year medical students on this rotation who are great to work with. Our census on this service can vary, but typically is very manageable.

9:30 am- Usually around this time is when we will table-round with the attending physician on our patient list. After which we will then go in-person round on our patients in the main hospital with the attending.

12 pm-We will be done with in-person rounds around this time, at which point I will take a break to go grab a bite to eat from the cafeteria in the children’s hospital, which low-key has amazing food-no lie!

1 pm- Start wrapping up notes from patients we saw that day, teaching medical students, and calling in recommendations to the primary teams. We love to keep a fun vibe on this service!

2-4 pm- Usually the afternoons on this service can be pretty quiet and low stress, but any urgent new consults that arise in the afternoon we will make sure to evaluate with the attending physician.

4 pm- Time for me to head home! I live near Forest Park where I will go on a run in the park to decompress from the day which is always beautiful and my favorite part of the city. Then my wife and I love to have dinner together and watch some of our favorite shows; we love The Office, Parks and Rec, and currently are working our way through The Soprano’s (which I know is long overdue…)

Allison Montgomery, PGY-3

Rotation: Outpatient Year

I usually wake up around 6am most weekdays (sometimes earlier when my puppy Ollie says it's time to play). I will take my dog for a short walk, and on some days take him to daycare for the day. If I am feeling particularly ambitious, I will do a short morning workout. I will arrive at outpatient clinic a little before 8 am when my first patient of the day will usually be scheduled.

On Mondays, I will be at BJC Behavioral Health outpatient clinic, which is a community psychiatry clinic where we work closely with many patients who have community support specialists (case workers). Tuesday through Friday, I will be at Monteleone Hall, which is SLU's outpatient psychiatry clinic. From 8-4:30, I will see a combination of new and follow up patients in the clinic, come up with my plan for the patient then staff the patient with an attending physician. This is usually a great opportunity for in-depth discussions and learning from the experience of the attending physicians.

We have an hour lunch break, which I will sometimes spend walking over to Crave, a cafe on campus, with some other PGY-3s. A few days per month, I will supervise intern call shifts at SLUH from 4:30 pm to 9 pm. Otherwise, my workday will end by 5pm, and I will spend my evenings going for walks with my dog, taking him to the dog park, cooking dinner or trying a new restaurant, squeezing in a little PRITE review, then relaxing with some Netflix before going to bed.

John Flo, PGY-4

Rotation: Fourth year in general

The transition into PGY-4 is a wonderful experience! Not only are you honing your own diagnostic skills and treatment approach, but you have more time for mentoring, studying, and career planning.

As a fourth year, I get to supervise junior residents and medical students on all the inpatient services. This typically involves assigning patients, helping troubleshoot logistic issues, and discussing complicated cases. On these services, I normally wake up around 5 am in order to have enough time to drink coffee, eat breakfast, chart review, and arrive at work around 6:45 am. Since I live in Chesterfield (~20-25 min), I enjoy listening to psychiatry and news podcasts on my drive to and from work each day! We chart review all our patients and see them prior to the attending arriving for table rounds, which is normally around 8:30 am. After seeing all the patients together, we place orders, finish notes, and call collateral. There is normally an opportunity to complete some education activities with medical students each afternoon. Other things that occupy the day include my outpatient clinic on Monday afternoons, didactics on Tuesday afternoons, and Grand Rounds at noon on Thursdays. We also get to spend a half day each week at an off-site location, either the St. Louis Forensic Treatment Center or the student health clinic at St. Louis University. The work day ends at sign out to the evening call team at 4:30 pm. At that time, I either go home or moonlight. We are privileged to be able to moonlight internally at St. Louis University Hospital on evening and weekend calls to make additional income and practice more independence.

In addition to these inpatient services, PGY-4s spend 2 months at the VA hospital inpatient service and 4 months on elective rotations. On these work days, the schedule and work load depend on the elective. I have scheduled electives in perinatal psychiatry, TMS/ketamine clinics, administrative medicine, and an additional inpatient month at the VA. For most of these electives, the work day is approximately from 8 am to 2-3 pm. There is a lot of flexibility in designing these electives to target your specific interests which is great for career preparation.

To that point, fourth year is all about preparing for the end of residency and launching into your career. There is time to attend career fairs, schedule interviews, network, and brainstorm employment options with faculty. It’s amazing how much we change from PGY1 to PGY4, and each step is so important. All that being said, I can honestly say that I’m enjoying fourth year the most of all the years so far!

Amy Gallop, PGY-4

Rotation: ED/Acute psychiatry unit rotation

I wake up at 5:30 am and squeeze in a quick run. I then put on my scrubs and head to work! Start time for all the inpatient services (CL and our psych units) is 7 am and sign out is at 4:30 pm. I am currently the senior covering the emergency departments. In the morning, I round on patients in the emergency department who are awaiting disposition and then see new consults throughout the day.  I try to do some more formal medical student teaching after rounds a few days a week as well.

Being the senior resident means I’m overseeing the junior residents on our acute psychiatry unit as well and am available for questions and teaching. The PGY1 on the unit is capped at 6 patients by the end of the year and the PGY2 resident is capped at 8 patients, and I will divide patients between them. I get done with work at 4:30 and will wrap up any chief stuff I need to do by 5 or 6 pm. In the evenings, you can find me hanging out with my husband and dogs and trying out new restaurants! I also moonlight on weekday nights and weekends a few times per month. I need an inordinate amount of sleep so I try to go to bed by 930 pm! On weekends, I'm usually at the tower grove farmers market, hiking, going to a free event or watching theater! Like PGY1 and 2 years, we rotate every month.

We get elective time during our fourth year and I’m looking forward to sleep medicine and perinatal psychiatry! Our fourth year is a great chance to hone our skills as a mentor, advisor and teacher. I have had plenty of time to remain involved in my other interests during fourth year including my APA fellowship, community psychiatry board, medical student advising and research. I am currently applying for a child psychiatry fellowship so that will be my next step!