In Their Own Words
PGY1 - Anna Dickerman, M.D.
Hi, my name is Anna Dickerman, and I'm excited to be a PGY-1 at Payne Whitney/Weill Cornell. After majoring in the History of Art and Architecture at Harvard, I decided to return home to New York City to attend medical school and pursue my career goal of becoming a psychiatrist. I am thrilled to have matched at Cornell, and feel honored to now be able to take a place among its superb housestaff and renowned faculty.
The intern year is divided into two distinct segments: one is a six month stretch which includes four months of Medicine and two months of Neurology, while the other six months is exclusively devoted to Psychiatry. Half of the class begins with Medicine/Neurology, while the other half starts with Psychiatry. I began on the General Medicine service, where I encountered a broad spectrum of patients reflective of the rich cultural, ethnic, socioeconomic, and religious diversity found within New York City. Some diagnoses on the service included histoplasmosis related to renal transplant immunosuppression, Behçet's Disease with neurologic manifestations, and polycystic kidney and liver disease. A typical day on General Medicine commences with work rounds with housestaff and medical students. The resident who was on-call overnight then presents new admissions to the team and its attending physician. The remainder of the day is mostly spent following up labs, calling consults, writing notes, and participating in all aspects of patient care. A multidisciplinary collaborative approach, with close working relationships among social work, nursing, and the medical team, helps facilitate the smooth daily functioning of the service. Members of the medical team consider the Psychiatry intern to be an equal and integral part of the team. In fact, peers will often "consult" you on your opinion regarding psychiatric issues which often come up on the service, as a good number of the patients have some psychiatric comorbidity.
Needless to say, I'm very much looking forward to starting the Psychiatry portion of my intern year in the coming months. These rotations will include one month in the Psychiatric ER, as well as time split between Payne Whitney Manhattan and Payne Whitney Westchester. On the Manhattan campus, the inpatient unit is located within the main general hospital, while the Westchester campus is a solely psychiatric treatment facility. These rotations are highlighted by intimate didactic sessions taught by renowned psychiatric clinicians and researchers, and by work with patients suffering from a broad range of psychiatric disorders.
As one of the nation's oldest asylums, the Payne Whitney Westchester campus is a designated National Historic Landmark located in a beautiful multi-acre setting. The residents assigned to Westchester leave together in a van which departs from New York at 7:30 am. Rounds begin around 8:30 am, and are followed by interdisciplinary work rounds. The housestaff traditionally meet for lunch on the grounds. Lunch is followed by a scheduled didactic case conference or lecture. In the afternoon, there is daily supervision with the ward attendings covering both the patient plan and the relevant teaching points generated by the case. Each resident takes call approximately once a week until 10 pm, while the other residents return to the city by van at 5 pm.
On 11N at Payne Whitney Manhattan, the day's schedule is rather similar, with the addition of a morning signout led by the senior housestaff. This meeting covers the cases that were admitted overnight. PGY-1s take call on the Manhattan campus only during the weekend, which amounts to approximately five calls during the six months of the Psychiatry rotations. Call responsibilities include coverage of the two inpatient units at Payne Whitney Manhattan. This involves admitting patients who have been seen in the ER, as well as taking care of medical and psychiatric issues arising on the ward in previously admitted patients. Didactics at the Manhattan campus include a weekly course during which residents practice the skill of psychiatric interviewing under the watchful observation of an attending psychiatrist. There are also weekly Grand Rounds, after which the housestaff meet with the Grand Rounds speaker and discuss the conference over lunch.
The Psychiatry program at New York-Presbyterian Hospital/Weill Cornell Medical Center is distinguished by its faculty, who provide first-rate supervision within an unusually nurturing environment. What also makes this place so special, I believe, is the exceptional caliber of my fellow residents. They have a rich diversity of backgrounds, and a broad spectrum of prior experiences. Each and every one contributes uniquely to the character of our program. They're also a wonderful group of people whom I'm proud to call my friends!
PGY2 - Ben Zebley, M.D.
My name is Ben Zebley, and I am one of the PGY-2 psychiatry residents at NewYork Presbyterian Hospital/Weill Cornell Medical Center.
Cornell was my first-choice program for several reasons. The culture here engenders a mutual respect between the biological psychiatrists and more psychodynamically-oriented clinicians, as well as an integration of these different, important perspectives on psychopathology and its treatment. We obtain a strong foundation in neuroscience, psychopharmacology, and evidence-based psychiatry, but there is also a deep commitment to teaching the rich intellectual history of our profession. Lastly, the relatively small size of the department allows for ready access to its world-class faculty.
My fellow second-years are intellectually curious, engaged, and have a wide range of clinical and research interests. In my class, we have three MD-PhDs, each of whom is studying a different area of biological psychiatry. Others are interested in child psychiatry, forensics, and psychoanalysis. Despite these varied interests, we are all committed to learning the skills needed to become able, thoughtful clinicians, as well as leaders in academic psychiatry. To this end, we read extensively, work hard, and spend a considerable amount of time in supervision. There are numerous opportunities to participate in research projects, and we are strongly encouraged to publish -- whether in an academic journal or elsewhere.
I started my second year on the Consultation-Liaison Psychiatry service. The attendings on this service are expert in different areas of psychosomatic medicine, providing an environment particularly well-suited for academic inquiry. We are expected to review literature relevant to our patients, and to incorporate this into our presentations. Every Thursday, during Òacademic rounds,Ó the residents prepare formal presentations on a wide range of topical issues in psychiatry. These presentations have, on several occasions, served as a springboard to publications: several months ago, for example, one resident published an essay on a C/L patient in the New England Journal of Medicine. Every week, we also present to Dr. Milton Viederman, who teaches us the skills used in the brief psychodynamic intervention he developed for the medically ill, but which are useful in a variety of settings.
Currently, I am working in our psychiatric emergency room. It is here that we hone our diagnostic skills, and learn how to assess and manage patients in crisis. Before we can formulate the problem, we must do detective work, including careful review of medical records, telephone calls, and conversations with friends and family members (and often, the NYPD or EMS workers). Once the problem has been established, we can turn to therapeutics Ð from an admission to one of our inpatient units to overnight monitoring and initiating pharmacotherapy. The brief psychodynamic intervention skills acquired on the C/L service are particularly useful in the ED, and there is ample opportunity to employ this approach in a way that is beneficial for our patients. In the PGY-2 year we also develop in our role as managers of the ER, as we oversee a team of trainees (psychiatry interns, medical students, social work students, and psychology Ph.D candidates). We become well-acquainted with the patients, propose interventions, and learn to de-escalate volatile, potentially violent, situations. While all of this may sound daunting, we are guided through it all by our experienced and highly talented emergency psychiatry attendings. Our catchment area attracts patients from a wide range of racial, socioeconomic, and diagnostic groups, making the patient population in the ED, as on all of our units, one of the most diverse of any hospital in the country.
After the ED, I will have an elective block, followed by rotations through the various inpatient services, including an affective disorders unit and a dual-diagnosis unit, and in Westchester, a personality disorders unit. At the end of the year, I will return to the consultation-liaison service, consulting to medical and surgical teams at NewYork-Presbyterian Hospital, the Hospital for Special Surgery, and Memorial Sloan-Kettering Cancer Center.
One of the highlights of second year is presenting to Dr. Otto Kernberg, arguably the most prominent living psychoanalyst. Once or twice weekly, we present to Dr. Kernberg on our personality disorders unit rotation, allowing us to see how his theories apply to particular patients on the unit.
Second-year didactics, focusing on the fundamentals of psychiatry, are superb. Dr. Robert Michels, a renowned psychoanalyst and academic psychiatrist, leads a class on psychopathology. Our program director, Dr. Elizabeth Auchincloss, teaches a course on the psychoanalytic model of the mind, where we read and discuss numerous works by Freud and other pioneers in the field. Dr. Richard A. Friedman, an expert in psychopharmacology and a regular contributor to the New York Times, leads a class on biological psychiatry. Other classes cover subjects as varied as neuropsychiatry, substance dependence, and outpatient management of psychotic disorders.
Despite the rigor of the second year, the call schedule is quite reasonable, with fewer than 25 overnight calls in the entire year. For the first time in many years, I am free for the vast majority of my weekends. During the inpatient months, call is as frequent as Q5 or Q7, but during other rotations, we may take call as infrequently as once per month.
Residents here also enjoy a high quality of life outside of the hospital. Cornell has outstanding subsidized housing options, ranging from modest studios to luxury penthouses, all located within two blocks of the hospital on the Upper East Side of Manhattan. Even after the long, stressful days of internship year, the close proximity to Central Park (and the lack of a commute), allowed me to go for a long run to decompress. And perhaps most importantly, we live and work in New York City. I feel fortunate to have the opportunity to train with dynamic, diverse, and committed colleagues in a program that provides an outstanding academic and clinical experience but also affords us the opportunity to take advantage of all that living in New York has to offer.
PGY3 - Christin Drake, M.D.
Hi I'm Christin Drake, one of the PGY3 residents in psychiatry at New York-Presbyterian Hospital/Weill Cornell Medical Center. Our PGY3 year is distinguished from the PGY1 and 2 years by an exciting transition from the inpatient and consultation services to the outpatient department where we spend much of our time treating patients in the general adult psychiatry clinic. In addition to our work in the general adult clinic, our class is responsible for covering the Psychiatric Emergency Room at night and on weekends and we have the opportunity to work in several specialty clinics including the child and adolescent evaluation clinic, the adult evaluation clinic, neuropsychiatry clinic and women's clinic. We also, along with a co-resident, lead a weekly therapy group that runs for the entire year and spend one month working in the partial hospital program, a program for patients who are transitioning from the inpatient unit or who require more support than can be provided in the general outpatient setting.
On a typical day, I might spend the morning seeing patients in neuropsychiatry or child evaluation clinics. During the PGY3 year, we have opportunity to participate in several evaluation clinics to which patients present looking for consultations or initiation of care in one of the areas of the outpatient department. This opportunity allows us to see a wide variety of patients and to further develop practical diagnostic skills in patients who may or may not be displaying obvious signs of illness. At the end of each session of an evaluation clinic, a senior supervising attending leads a discussion about the cases seen. So, not only do we get to learn from our own patients, we also have a chance to learn from our colleagues' experience on that day.
I generally spend the early afternoons meeting with one or more of my supervisors. In the PGY3 year, we have the chance to work closely with a supervisor in each of the modalities that we are training in this year, including adult and child long-term psychodynamic psychotherapy, adult and child psychopharmacology, group therapy, CBT, supportive therapy and interpersonal therapy. Supervision is conducted in small groups or individually depending on the modality, and to me, this is proving one of the most intensive learning experiences of the year. During supervision, a case or particular challenge is explored in depth and our supervisors provide practical guidance with the aim of developing a strong experience base on which to build for the remainder of our careers.
For the rest of the afternoon, I am generally occupied by seeing patients in the general psychopharmacology clinic, or meeting with long-term therapy patients. Patients in the adult psychopharmacology clinic comprise most of our patient roster and the population of patients varies significantly in demographic, diagnosis and severity of illness, providing a rather diverse and exciting experience. On one afternoon each week, we meet as a class to present and discuss a patient with a particular psychopharmacologic challenge in the psychopharmacology case conference with Dr. Richard Friedman. This conference is designed to promote expertise in a particular area of psychopharmacology through ongoing discussion and consultation with Dr. Friedman and our co-residents.
Mornings and afternoons that are not spent seeing patients are spent in didactics on a wide variety of topics including psychodynamic psychotherapy, psychopharmacology, Cognitive Behavioral, Dialectical Behavioral, Supportive and Interpersonal psychotherapies. Our didactics this year also include several continuous case seminars in which we present process notes from sessions with our long term therapy patients and begin to hone our skills in developing a psychodynamic formulation of our patients.
For me, one very appealing aspect of the PGY3 year is the development in autonomy Ð as I learn to evaluate, formulate and treat patients independently. Gratefully, my supervisors are only an office or phone-call away, for discussion and guidance as needed. This growth in autonomy is an important aspect of the learning in this year. The flexibility in my schedule also provides an opportunity to explore research and career interests in a more dedicated way. I am using this time to begin a research project in the area of HIV psychiatry and to continue to gain experience in the area of global mental health that I hope will ultimately prove valuable in my career as a psychiatrist.
PGY4 - Jennifer Halper, M.D.
I'm Jennifer Halper, one of the PGY4 residents. It's only August, but the fourth year of residency feels very different from the third year already. I've noted a real shift in becoming a "senior" again (for the 4th and hopefully last time!). While some of my responsibilities have not changed all that much from my role as an outpatient psychiatrist as a third year, there have been some significant changes.
For one, we shift more into the role of a supervisor. Over the summer, I have been teaching and assisting the PGY1s, 2s, and 3s in their overnight calls both in the psych ED and on the units, helping things run smoothly for those first nerve-racking calls where you can't believe that you're the one in charge. Later in the year, I will directly supervise PGY1s and 2s in their academic rotations. As I do more supervision, I can really feel how much knowledge I've acquired over the past three years of training and how I've grown as a psychiatrist.
Another shift in the forth year involves looking to the future Ð thinking about the next step as practicing psychiatrists, teachers, researchers and leaders. Fourth year of residency gives me the time and flexibility to focus on my professional future. As PGY4s, our year is divided up into two 6 month blocks: selective time and assistant chief time. Currently, I am in my selective part of the year where I have 50% time dedicated solely to further investigating the things that I have become most interested in over the past few years of training. Each resident is required to do a senior project; past projects have varied from conducting lab research, to writing a book chapter based on a literature review, to creating an educational video game for psychiatrists in training. I am getting started on a project idea related to Reproductive Psychiatry or Women's Mental Health, one of the fields of psychiatry in which I imagine myself working when I graduate. I have a collaborative, retrospective study in mind and I am receiving a lot of support from faculty mentors and the department. Should things work out, I hope to publish my findings when I am done. I am also using my selective time to continue rotating in the Women's Program, an elective evaluation clinic where I spent 6 months of my 3rd year seeing patients and getting experience in Reproductive Psychiatry. In addition, from September through November, I will spend one afternoon a week teaching a small group of second year medical students in their first psychiatric interviewing course of medical school.
Our caseloads are significantly reduced in the fourth year, and most residents carry about 25-30 psychopharmacology cases, 2-3 long term therapy cases, and often one or two cases from other modalities including CBT, IPT, couples, or child long term cases, all of which have been continued from our work as third years. At the end of third year, we were asked to select the cases that we wanted to keep, and were encouraged to keep a cohort of patients with a diversity of diagnoses and levels of challenge (both personal and academic). Each fourth year resident also acts as a medication back-up for a non-MD therapist on the permanent staff. This is a great learning experience as in "the real world" psychiatrists often function in this role. I am doing my back up at the CDTP - the Continuing Day Treatment Program - which is a long-term, intensive, daily program dedicated to treating and rehabilitating some of the most complicated and difficult to treat patients we encounter.. Working at the CDTP is an excellent opportunity to experience team-based work with very ill patients as outpatients. I continue to have supervision on all of my cases in psychopharmacology and psychodynamic psychotherapy from a number of faculty members, all of whom are different from my supervisors last year. Changing supervisors allows us to form new relationships with mentors, gain new perspectives and learn new styles or approaches to treatment.
In the second half of the year, I will be an Assistant Unit Chief in the Psych ER and on the Dual Diagnosis Team of the inpatient unit, 3 months for each. Starting in January I will have 50% of my time dedicated to attending rounds, supervising other residents, and participating in and overseeing some of the didactic components for each of these rotations. The rest of my time will be spent continuing to treat the outpatients as described above.
Classes, e-group, and Grand Rounds will begin again in September. The didactic program for fourth year of residency continues with topics in advanced psychopharmacology and psychodynamic psychotherapy, while adding concentrations in administrative psychiatry, leadership roles, and preparing to leave residency.
Other parts of my days are spent attending meetings. I have chosen to participate in the Residency Research and Writing Group, an intimate group of residents and faculty that meet every other week to brainstorm and discuss research projects and how to be involved in research during residency. I have also begun attending meetings of the Education Committee which meets monthly to review and develop the education component of the residency program. This year will have a special focus on integrating Evidence-Based Medicine into our curriculum and clinical work in a way that is functional and accessible. Of course, there continue to be weekly Friday lunches for the entire residency which are a time to eat good food, catch up with friends, and hear about relevant issues in a more relaxed setting, and the impromptu meetings in the neighboring offices of my colleagues to chat about anything from our imagined future careers to a problem we are having with a patient to our plans for the evening. Because even as full and as stimulating as my days are as a fourth year resident, I have plenty of time to go for a run after work, cook dinner, and spend time with my husband and friends.