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SUNY Downstate Medical Center

Residency Program

A Day in the Life

…a PGY 1 Psychiatry Resident

Hey, I am Rishi Gautam, a PGY-1 resident. At present I am rotating in the Internal Medicine department at the Kings County Hospital, which is one of the largest public hospitals in NYC. It is definitely a busy, but fun filled rotation. My day starts at 5:30 am as I wake up and have just enough time to shower, grab a quick bite and take the train.

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photo of Rishi Gautam

I live in Jersey City, which leads me to have a bit of a commute, but I like living here so it is worth it. My work as an intern involves getting the patient sign outs from the night float team, rounding on the patients and then working with the team which includes me, another intern, a resident (usually PGY-3), medical students and the attending. The medicine rotation has been a thrilling time as we encounter a plethora of pathology in patients and our input towards patient care is greatly appreciated and encouraged by the different team members. Teams are on call every 5th day, which involves taking in new admissions and attending to any critical care issues that arise on the floors. Most of the days in medicine end around 5 pm, after which I go to the Downstate Students Center to play some Ping-Pong with my co-interns or a quiet dinner near my place. I start with Neurology next week and I am definitely looking forward to it.

The Intern year in our program is divided into 5 months of Inpatient Psychiatry, 2 months of Inpatient Medicine, 2 months of Inpatient Neurology, 1 month of Inpatient Detox, 1 month of Out Patient Medicine and 1 month of Primary Care clinic which has been instituted specifically for patients with psychiatric comorbidites and functions out of the Psychiatry wing of the hospital. My inpatient psychiatry experience till now has been divided between the Kings County Hospital, Kingsboro Psychiatric Center and the St. Johns Episcopal Hospital in Far Rockaway. These rotations give us a comprehensive experience for working in different systems, which include a public hospital, a state hospital and a private one. We have CPEP (Comprehensive Psychiatric Emergency Program) calls on the weekends and in the evenings on weekdays. Working there involves a quick evaluation of the patient presenting with a psychiatric emergency, making decisions about the disposition and discussing it with the attending physicians who are always in house. Floors let us spend more time with the patients as we go along working with them over weeks, its exciting to get a perspective on different treatment modalities which involve pharmacological interventions, psychotherapy, play therapy, music therapy and many more. Our department is very accommodating to our needs and encourages us to explore different avenues of learning such as a concurrent course of MPH at Downstate Medical College or Psychotherapy Fellowship at NY Psychoanalytic Institute amongst others.

Like a lot of people I do look forward to the weekends, which involves hanging out with friends in Manhattan, movies and of course a lot of cooking (I pride myself in being a huge foodie and a chef!!!). I am definitely in love with NYC, which I believe is the most cosmopolitan city in the world and a great place to live and work. Look forward to seeing you around. Have a great day.

…Starting Out

My name is Sarah Fajgenbaum and I'm a PGY-1 resident at SUNY Downstate's Psychiatry residency program here to tell you a little bit about my life as a first year resident. Our first year of residency introduces us to working in a variety of settings.

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photo of Sarah Fajgenbaum

A total of 6 months is spent rotating through in-patient Psychiatry at 3 different sites: Kings County Hospital, St John's Episcopal Hospital and Kingsboro Psychiatric Center. During those months, we also take weekend call at Kings County's Comprehensive Psychiatric Emergency Program (CPEP). The other half of our first year provides invaluable exposure to Internal Medicine and Neurology. Currently, I'm completing a 2 month rotation in Internal Medicine at King's County Hospital, across the street from SUNY Downstate.

In my current role as an Internal Medicine intern, my day begins around 5:30am when I wake up at my apartment in Bay Ridge. Located in southern Brooklyn, Bay Ridge isa popular neighborhood with residents, thanks to its eclectic mix of stores and restaurants, beautiful shoreline and easy commute to work. At 6:20am, I am sitting on the subway where I spend my commute reading the newspapers and sippingon coffee; this is my chance to relax before the busy day ahead. By 7am, I'm on the unit, decked in my white coat, stethoscope dangling from my neck. My first task is to touch base with the night float team to discuss any events that occurred with my team'spatients over-night, then I'm ready to pre-round on the patients that I've been assigned to. As an intern, I carry up to six patients at a time. During the pre-round, I check in on each of my patients to find out how they're feeling, do a quick physical exam and check the computer system for their vitals. After pre-rounding on my own patients, I meet with the rest of the team which includes third and fourth year medical students, my co-intern, senior resident and attending. The team rounds on all our patients together thendiscusses the plans for each patient. The rest of the day is spent following up labs and other tests, writing orders, liaising with other specialists who share in the care of our patients, coordinating discharges and writing daily progress notes. The Internal Medicine rotation is also a chance to sharpen our clinical skills by performing blood draws and inserting naso-gastric tubes and IV lines. During the Internal Medicine rotation, each Psychiatry resident is paired with a co-intern who is also a Psychiatry resident. Not only is this helpful in getting the work done but it also maintains the sense of support and camaraderie which defines the Psychiatry residency program at Downstate. On most days, the work is completed by 3:30pm, at which point, we sign out to the night float team. Every fifth day, the team is on call, working until 8 pm to admit new patients under our care. On Thursdays, the Psychiatry residents complete their tasks by noon in order to attend didactics.

Throughout the Psychiatry residency program, every Thursday afternoon is devoted to didactics. One of the things which we residents value highly about our program is the fact that didactics time is strictly protected, regardless of which rotation the resident is on. Every Thursday at noon, the residents from all 4 year groups meet collectively over lunch with the chief residents to discuss any pertinent issues or up-coming events. This is a wonderful opportunity to connect with other members of the program and to voice our opinions on any work-related issues. The next hour is devoted to Journal Club where one of the residents presents a clinical trial to the entire group for discussion. The remainder of the afternoon is spent with our own year group in classes which cover a range of subjects from interviewing skills to pharmacology and psychotherapy. Classes typically finish by 5pm but most of the time, we opt to stay back for a while, catching up with each other and with our chief, often while sharing cake to celebrate the most recent birthday in the group.

When the work day is over, it's time to commute back to Bay Ridge. My free time in the evenings is filled with exercise, on-line catching up with friends and family, cooking and enjoying dinner with my partner. Before I know it, it's time to catch some sleep before the next busy day begins.

…Consults and walking the dogs

Hello everyone! My name is Kendra and I'm currently a PGY-2 resident in psychiatry at Downstate. The PGY-2 year basically involves rotating through every sub-specialty in psychiatry, which keeps things fresh and exciting! This month, I'm rotating on the Consultation Liaison Psychiatry service at SUNY Downstate. We also do a one-month rotation in CL psychiatry at the Kings County Hospital Center.

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photo of Kendra Campbell

My day usually begins around 6:30 a.m., as I'm awoken by my iPhone alarm and am then subsequently covered in doggy licks. (I have two, very cute "rescue" doggies.) Next up, I have my coffee and breakfast and then shower and prepare for the day. Before leaving for work, I take my two doggies for a walk in the beautiful Prospect Park. I have an absolutely ideal living situation, as I live literally on top of the park and am also only a 15-minute walk away from Downstate.

Once I'm prepared for the day, I head out into the world on foot. I'm somewhat of an amateur documentarian, and I usually snap a few interesting photos on my iPhone during my walk to the hospital.

I arrive at Downstate at around 8:00 a.m. and receive the consult pager and any sign-outs from the attending and/or resident on call the night before. Throughout the day, I respond to both STAT and routine consults from the emergency department and the floors. I usually have two medical students with me as well, and I enjoy teaching them and providing guidance throughout the day. Many of the consults involve decisional capacity or diagnostic assessments or "safe-mothering" requests from other departments. However, I also frequently see a variety of consults, which end up being very fascinating cases involving medication side effects or psychiatric manifestations of medical illnesses. I also see any follow up cases throughout the day. It's never boring!

On Wednesdays, I go to the psychiatry Grand Rounds from 1:00 - 2:30 p.m., which is located right inside Downstate. It's always refreshing to take a break from the daily grind to learn something new or gain a fresh perspective on relevant topics (and of course, it's also nice to enjoy lunch at the same time).

My workday usually ends around 5:00 p.m. On Tuesdays, I then go to the Evening Clinic, which is a unique outpatient clinic that provides free psychiatric care to patients in the community. I will see my patient for psychotherapy and medication management, while my supervisor and another fellow resident watches the session live on video in another room. The other resident then takes their turn, and then both of us receive feedback and guidance from our seasoned supervisor.

After work, I walk home and then usually take my doggies on a nice 5-mile run around Prospect Park. My evening is then spent catching up on emails, blogging, and reading (usually for our Thursday classes, but sometimes for fun, as well!)

My night ends with a yummy dinner (I indulge in sushi delivery way more often than I'd like to admit, and living in Brooklyn with a million options for food and online services like GrubHub.com, it's entirely way too easy to get delicious food in minutes!), a shower, and either more reading or indulging in some mindless Netflix watching.

Then it's bedtime and sleep to rest my mind and body for the next day!

…a PGY 3 Psychiatry Resident

With the requirements of inpatient out of the way, the diverse outpatient experiences one gets at SUNY Downstate are all about ample exposure.

A typical day starts at 8:30 AM in Kings County with morning report, where we get together, have coffee, and discuss interesting and challenging cases with each other and different supervisors.

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photo of Lama Bazzi

We spend one and a half days in outpatient clinic at the County, seeing our patients for medication management, therapy, group and family sessions, as necessary. We also have Clozapine patients who we manage. Our time in the clinic is where we get supervision on our cases, and have weekly journal club.

Mondays are divided into 6 month blocks, with six months spent at Kings County Outpatient Hospital Center doing new intakes and 6 months at the VA hospital. It is during the first six months that we take on new patients in the OPD, depending on our interests, as well as gaps in our knowledge base. The other VA hospital months are where we get exposed to treating veterans with post traumatic stress disorder, anxiety, and depression, both in the clinic setting and in group therapy. The experience is unlike any other, as there are veterans from Vietnam, Iraq, and Afghanistan, and their experiences are heterogeneous yet similar in so many ways.

My Wednesdays are spent running the CBT for psychosis group, which my colleague and I coordinate. We put it together from scratch, choosing our topic, supervisor, and the direction that it would take. It has morphed into a group for young patients with psychosis, learning new techniques to cope with auditory hallucinations and paranoia and the results have been great. The resources available to residents in the clinics are boundless, and one simply has to express interest in a topic before some one says, "I know how I can help you do that!"

In the afternoon, after Grand Rounds, the 3rd year residents set out for the greatest experience of the year. The Project For Psychiatric Outreach to the Homeless (PPOH) is where we spend half a day a week in shelters, drop in centers, and residences all over Brooklyn and Manhattan, working with homeless or previously homeless mentally ill men and women, performing psychiatric evaluations, administering medications, and doing psychotherapy with patients that they usually would never get the chance to work with. This, for me, has been one of my favorite parts of my week. Working at Coalition for the Homeless is where I have learned the most of real life challenges of psychiatry.

Thursdays are for didactics, and it is also the day I have my evening clinic, where I have two long term psychodynamic psychotherapy patients, who I see weekly. Again, the diversity of experiences is so streamlined that it fits so smoothly with the rhythm of the week, but overall, it is fulfilling to feel that my training is well rounded.

In the meantime, as the weekend approaches, I prepare for the research that I am working on, as well as factor in some relaxation and fun time, if I am not on consult call, which as a 3rd year, does come into play 2 or 3 times a month.

The diversity of 3rd year, as well as the opportunities to find out what kind of a psychiatrist you are and who you want to be, open up like a waterfall here at Downstate. The faculty and supporting staff are always available and there is no shortage of people to turn to for advice and guidance on the path to independence.

…Research in Mind

Hi, my name is Mohamed Sherif. I am a PGY-3 resident in psychiatry. I am at a special research track that gives me the opportunity to direct my research time towards obtaining a PhD degree in biomedical engineering (computational neuroscience as the specific area of my research).

My days differ according to whether it is one of the research days or one of the clinic days. So an overview of a week would give an idea about how this track works.

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photof of Mohamed Sherif

Monday is one of the research days. I am usually at the lab by around 9 AM. Our lab is working on computer models of hippocampus and neocortex in schizophrenia and epilepsy. I prepare the code for our hippocampus model to run with various NMDA receptor antagonists. I then start some simulations, and as they run I study for my PhD courses. This semester I am taking a directed readings course in mathematics that we use in modeling. After the simulations finish, I start analyzing the data obtained from the simulation. This would continue to around 7 PM when I head to Downstate's students center to swim for an hour, then head home. I usually practice my flamenco guitar for around an hour, have dinner and sleep.

Tuesday is one of my clinic days. I start seeing my patients by 9 AM. Then I meet with my supervisors for medication management and insight oriented psychotherapy. I continue to see my patients till 5. I then have my evening clinic, where I see 2 patients for psychodynamic psychotherapy.

Wednesday starts with my lab. I a m working on my simulations. At 12 there is a neuroscience seminar. This week's speaker is from Princeton University, and she spoke about the interactions between the immune system and brain development, and how this advances our understanding into the pathophysiology of schizophrenia and autism.

After that we had lunch with the speaker. It is interesting to see how her research trajectory changed over the years. After that I head to my lab for an on-line session with my Professor who is teaching the math course. I return to my studies and my simulations after that till around 7. I then head then to my guitar lesson in Brooklyn.

Thursday is our didactics day, in addition to the residents' meeting. We meet with our chief residents and our program director and associate program director to discuss various issues. The didactics end at 5 pm, and this week I am on-call from 5 pm till 10 pm.

Friday morning starts in the clinic, where I see patients till 12, then head to the OPD psychiatry journal club. After I pray the Jom'a prayer in the mosque at the hospital, I head to the lab. At 3 pm, we have the physiology journal club till 5 pm. I head back to the lab. This week, my day ended with some of my colleagues teaching me how to play pool in a billiard place in Bay Ridge.

It might sound busy, since doing 2 tracks at the same time makes use of most of the time. However, I have a unique chance of having my clinical experience fueling my passion for my research, and research fueling my hope when I am with my patients.

With this special track, the residency is for 5 years instead of 4, and I will be doing 2 more years after that to finish my PhD.

Weekends? Might work on some course work for the PhD, talk to my family in Egypt, and may head to a nearby theater for a nice movie with some of my colleagues from the residency, or fellow PhD students.

PGY 4…Preparing for Life Beyond Residency

Moving from PGY 3 to PGY 4, our residency program really prepares you for what will be our life beyond residency-be it fellowship or getting a job.

Our fourth year is divided into two halves. One half consists of 2 days of electives a week, one day of didactics on Thursdays, and 2 days in our outpatient clinic, caring for patients we kept from our 3rd year caseload. This is a unique opportunity to follow the same patients for 2 years, delve into psychotherapy with some, and experience their journey to recovery with others. It is during these 6 months that we also do intakes with our supervising attending at Kings County, allowing us to hone our interview skills, do CSV evaluations, and learn what it is like to work as an attending in the outpatient setting.

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I am currently enjoying my elective half of the year, and I spent 3 months with 2 full days on Forensic Psychiatry elective, my particular area of interest. I was matched with a supervisor who does both civil and criminal evaluations as part of his private forensic practice, and worked with him closely. I conducted criminal evaluations, did retention cases, and did civil evaluations as well. The breadth of experience I amassed in 3 months was astounding, and I felt very confident that I would be able to perform well in a forensic psychiatry fellowship.

I also am doing my second elective in addiction psychiatry, at the VA hospital in Brooklyn. The chance to work with Veterans with addictions has opened my eyes to the plight these patients endure while struggling with both their addictions and the fact that they have survived and fought through wars. It is very enlightening to see them through detoxification and inpatient rehabilitation, as well as to work with them in outpatient specialized programs, both in therapy, groups, and prescribing medications such as Suboxone.

My final elective will be in research, a particular passion of mine, and I am excited to get a chance to work with my research mentor closely. We get a chance to pursue our interests in fourth year electives, both honing the skills we will need in fellowship and beyond, and working on several projects such as research papers.

The two days we have in clinic are just like 3rd year, but with more independence. Although there are supervisors on site at all time, it is very rewarding to work with patients we have known for a while at this point, and see their progress through therapy and treatment. Supervision and intakes are once a week, and that is where we complete an intake, and go over our cases. We also attend team meetings weekly, where we get to see what being part of a complete treatment team is like, and collaborate with our social workers, case managers and nurses in our patients' care.

The second half of fourth year is where we get to do our leadership rotation, and get the true experience of being a senior resident on one of the units we have previously worked on as juniors. We get to put in our first, second and third choices for leadership rotations, and our program directors try to match us up with our interests-be it inpatient, outpatient or consult liaison psychiatry. This allows us to supervise our junior residents, mentor them, and to get a taste of what being an attending on a rotation is like.

Didactics in 4th year are focused on family therapy, sex therapy, dynamic theory, neuropsychiatry and neuroimaging, and a great class in medication management of challenging patients. We share cases that have presenting some difficulties in psychopharmacology, and discuss them in depth with one of our expert psychopharmacologists on staff. The advanced psychopharmacology class is wonderful and very informative.

I also continue to see my two long term psychodynamic psychotherapy patients in evening clinic weekly. This endeavor on the part of our program really fits into the concept of well rounded training, and continuity of care, with all of the advantages to our development that brings.

Fourth year of residency is a busy and stimulating year at Downstate, and one that is tailored to allow residents to pursue their individual and unique goals, as well as hone their skills in leadership. We get the chance to see what being a supervising resident is in practice, while we interview for fellowships, and jobs. The faculty and staff support us in all our choices, and are always ready to give guidance and advice in making life and career decisions.