During our intern year, we split time between psychiatry, internal medicine, and pediatrics, as well as helping to cover call shifts in our Psych ED also referred to as AU (Assessment Unit). By the end of my intern year, I will have spent 2 months covering our inpatient units at the university (MUPC), 1 month covering the inpatient unit at the VA (2B), 2 months on our consults and liaison service, 1 month of geriatrics and consults at the VA, 1 month on our outpatient long-term drug and rehabilitation service at the VA (ATP), and finally 1 month of child psychiatry. In between this, I’ll have also spent a total of 3 months on internal medicine and 1 month of outpatient pediatrics.
My day starts with me waking up anytime between 6:30 AM – 7:00 AM and heading out to the hospital by 7:30 AM. Depending on the service I am assigned that month; I may have up to 10 patients to pre-round prior to inter-disciplinary rounds that usually start between 8:30 AM – 10 AM. Rounds finish up by noon, and afterwards I’m writing notes, getting collateral information, talking to social workers, answering pages, and following up with patients. By 4:30 PM I’m usually getting ready to head out the door and go home!
On adult inpatient at MUPC, we see all patients with a wide range of psychiatric illnesses and participate in their care with a multi-disciplinary team. We also participate in extension of involuntary commitments of these patients by testifying for 21-day commitments in a tele court, held every Tuesday and Thursday which is a unique forensic psychiatry experience in a civil setting. We have an adult inpatient unit of a capacity for 45 patients distributed between 4 attendings who have 2 residents under them each. We can also shadow our attendings for ECT in the afternoons during our time at inpatient.
On 2B at the VA, we see our veterans who may also have a wide range of psychiatric illnesses, comorbid PTSD, neurocognitive disorders and TBIs. It is an enriching experience to treat veterans of all ages. On our inpatient child month, we manage children and teenagers while working closely with their families, social workers and therapists as a team. We see children suffering from depression, PTSD, new onset psychosis, catatonia, eating disorders, Bipolar Disorder along with neurodevelopmental and cases with behavioral issues like Conduct Disorder and ODD. This early experience in child psychiatry as an intern allows several residents to consider this subspecialty for fellowship in this field, several of who pursue it from our home program at Mizzou.
During University consults, we see patients on all different services throughout the hospital (including our integrated medicine floor) where we treat challenging cases like Delirium-Catatonia, Conversion Disorder, Factitious Disorders as well as patients with depression, suicidal ideation/attempt, psychosis, and decision-making capacity on medical/surgical floors. We are lucky to have a separate Psych ED at the University Hospital that caters to over 20 counties of the state, as the sole academic center at Mid-Missouri, this provides us ample experience and confidence in managing a variety of cases. The consult service runs throughout the day, however once 4:30 PM hits, the evening call team takes responsibility until 9:30 PM when the night team arrives. During Geriatrics at the VA, we focus solely on patients over the age of 65 on our 2B unit as well as seeing consults throughout the hospital.
During the evening shifts, we see all adult and child patients who are admitted at the university and VA, and also cover any calls from the inpatient floors. I remember feeling terrified on my first call shift, but luckily interns are always accompanied by a senior resident to help guide us along. It’s also been a really great learning experience, helping me become more independent and confident in my decision-making skill.
On Wednesday afternoons we have protected time for didactics from noon to 4:30 PM. These 4 hours are not only a time where I get to see all of my friendly co-residents, but also time set aside for lectures on pharmacology, lectures from attendings, grand rounds, process-group, case conferences, journal club, and review for PRITE. We are lucky to have a thriving Physician Assistant Fellowship in our program which provides robust help at inpatient units, consults and calls.
Regarding the rotation off service, 3 months of Internal Medicine and 1 month of Pediatrics are rewarding as they further strengthen the role of collaborative care of our patients. During Pediatrics, we also spend 2 days a week at the Thompson Center, a premier institute for patients with Autism and Neurodevelopmental Disorders in Missouri where we gain experience in this special population while working with multidisciplinary staff.
Intern year has been an amazing experience as I feel extremely lucky to be in a community with amazing co-residents and supervisors, as well as kind and helpful nursing staff, social workers, and mental health techs! It has been a steep learning curve for me as I have built a strong foundation in psychopathology and psychopharmacology with a diverse exposure in consult liaison, adult and child inpatient, addiction, geriatric and emergency psychiatry while fulfilling my internal medicine requirements. I am excited and ready to be a senior resident in a few months.
Columbia is a beautiful and diverse college town and allows me to have a great lifestyle despite the hectic yet enjoyable residency at Mizzou.
-Ravali Poreddy, MD