Psychiatry Residency - Clinical Training

PGY-1 residents on the inpatient psychiatry rotation at Tufts Medical Center care for 4 to 5 patients at a time within an 18-bed unit called Pratt 2. The unit is divided between two attending-led teams, each supported by one intern and one senior resident. The patient population is diverse and includes a wide range of psychiatric illnesses and severities, reflecting the hospital’s role as a safety-net center in Boston.

Morning pre-rounding and team rounds

The typical day starts around 8:00 am with pre-rounding. Residents review patient charts in the electronic medical record and communicate with overnight nursing staff to gather updates. Based on this information, they develop assessments and care plans for each patient. Just before 9:00 am, residents meet with their medical students to review patient care and provide teaching.

Rounds begin at 9:00 am and include the attending physician, social worker, nurses, co-residents, and medical students. Each resident interviews their assigned patients individually while the attending may join for part of the interview. After the patient leaves, the team discusses the case and treatment plan. Faculty use rounds to provide teaching, explaining medication choices and clinical reasoning. Residents are responsible for preparing discharge summaries and orders when patients are ready to leave.

Patient care and documentation

After rounds end around 10:30 am, residents spend the day seeing patients individually, with visit times ranging from 10 to 45 minutes depending on each patient’s needs. They write clinical notes, attend to family meetings and care coordination, and teach their medical students about relevant clinical topics.

Evening and “long day” call duties

PGY-1 residents also take “long day” call about 1 to 2 times per week, staying until 8:00 pm to support the overnight team by admitting patients and managing any issues on the inpatient unit. They may also be called to assist in the emergency department or consultation-liaison service.

Weekend call schedule and days off

On weekends, PGY-1 residents work two call days per month from 8:00 am to 8:00 pm, covering the inpatient unit, emergency psychiatry, and consult psychiatry services with a senior resident and medical student. On non-call weekend days, residents have time off without clinical duties.

PGY-2 residents work primarily on the Consultation-Liaison (CL) psychiatry service at Tufts Medical Center. They manage a diverse range of consults from hospital floors and the emergency department, collaborating closely with attending psychiatrists and an interdisciplinary team including nurse practitioners and social workers.

Morning sign-out and pre-rounding

The day begins around 8:00 am with sign-out from the overnight residents about new cases and overnight events. Residents review their patient list with co-residents and medical students, who assist with pre-rounding. This time provides valuable teaching opportunities and ensures thorough patient care.

Consultations and patient care

Throughout the day, residents receive new consults related to capacity evaluations, delirium and agitation management, and psychiatric medication optimization for medically ill patients. Attendings such as Dr. Montalvo and Dr. Radhakrishnan are on site to provide guidance as residents develop their assessments and treatment plans. Regular staffing sessions allow for case discussion and follow-up.

Outpatient clinic responsibilities

In addition to inpatient consult duties, PGY-2 residents maintain an outpatient clinic schedule with one to two patients per afternoon. During outpatient clinic times, co-residents cover the consult service. Residents receive supervision and teaching from outpatient faculty, gaining experience in longitudinal outpatient psychiatry care.

Call responsibilities and wrap-up

Clinical days typically end with sign-out to the overnight resident at 5:00 pm. PGY-2 residents take call about 2–3 times per month, covering multiple services overnight, including addictions, inpatient units, and consult psychiatry. Post-call days follow these shifts. While overnight work can be demanding, attending physicians provide readily accessible support, helping residents build autonomy and confidence throughout their training.

PGY-3 residents have a primary focus on outpatient psychiatry while continuing to build advanced clinical skills. They manage a growing panel of longitudinal patients in outpatient clinics, participate in psychotherapy supervision, and take on greater leadership roles within the clinical teams.

Morning routine and team collaboration

The day often begins with reviewing the outpatient schedule and coordinating care with clinic staff. PGY-3 residents collaborate with attendings, social workers, therapists, and administrative staff to ensure comprehensive patient management. They also supervise junior residents and medical students during clinical activities.

Outpatient clinical work

PGY-3 residents typically see multiple patients in outpatient settings, including medication management and psychotherapy sessions. They develop individualized treatment plans, adjust psychotropic medications, and provide psychotherapy under supervision. They also coordinate referrals to subspecialty services and community resources as needed.

Leadership and teaching roles

At this level, residents take on increased teaching responsibilities for junior residents and medical students. They often lead case conferences, participate in quality improvement projects, and help coordinate clinical operations within their outpatient clinics.

Call and additional responsibilities

PGY-3 residents continue to participate in call rotations, typically with less frequency than earlier years. They provide backup support to inpatient and consultation-liaison teams as needed. Post-call days allow for rest and catch-up on outpatient duties.

The Administrative Chief Resident is a senior resident who balances clinical duties with leadership and administrative responsibilities within the residency program. This role includes a reduced outpatient caseload compared to earlier years to accommodate increased administrative duties. Residents typically see a few outpatient appointments daily, maintaining flexibility to manage psychotherapy sessions and closely follow acute patients.

Administrative and leadership duties

The Administrative Chief Resident acts as a liaison between residents and program leadership, helping to coordinate communications, support resident needs, and contribute to program development. Weekly meetings with outpatient supervisors and the residency program director focus on program management, recruitment, and curriculum planning. Current initiatives often include piloting new electives, such as ketamine clinic programs.

Teaching and curriculum development

A major component of the role involves developing and delivering educational content for junior residents. This includes preparing foundational lectures on topics like psychopharmacology to enhance the residency’s didactic curriculum.

Work-life balance and additional activities

PGY-4 residents in this role balance clinical, administrative, and teaching responsibilities while pursuing career development activities such as job interviews and moonlighting opportunities.