Question about didactics and clinical duties

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

bunbury

New Member
10+ Year Member
Joined
Sep 16, 2009
Messages
6
Reaction score
0
In our program we have a half day of didactics once a week. After didactics, residents are required to return to clinical duties afterward and see a full caseload of patients in the afternoon. I would be interested to hear other residents’ experiences, so if you could please indulge me by answering the following questions:

1. Do you have clinical responsibilities on didactic day, or is that day fully protected?
2. What is your maximum caseload while on inpatient psychiatry?

Thanks.

Members don't see this ad.
 
Residency for me was a few yrs ago, but we had the same schedule on didactic days.

My intern year, we had a ward with 36 pts and 4 residents, so the basic split was 8 per resident.
During my residency it became obvious that some residents were dragging their feet discharging people in part because it kept them from getting new patients. So we started a new system:
There was no maximum. New admits are given to residents on a rotating basis no matter what. So if you don't discharge patients, you could end up with 9, 10, 11, 12 patients. If, through no fault of your own, you had someone who is difficult to discharge, it is usually someone stable but with a placement problem. And such patients usually don't require a lot of decisions or effort per day. In the case that such a patient became a real drain on the resident, another resident would agree to take over the patient - sometimes for a "fee" of agreeing to a call change, or swapping another difficult patient, etc. by leaving it for us to work out, it forced us to work more as a team.
 
There was definitely a difference at the various programs I interviewed.

I want to say Cambridge has a full didactic day (correct me if I'm wrong). Northewestern does as well, but apparently to get medi-something funding, the residents do "lightning rounds" for a couple of minutes before didactics. Otherwise, no clinical duties one day a week.

Every other place had about a half day of didactics, which varied from being truly protected to saying it's protected but people getting paged.

At Columbia, they have a didactic hour a week.

Oh, and I think most places carried about 6-8 inpatients on psychiatry.
 
Members don't see this ad :)
At Columbia, they have a didactic hour a week.

Oh, and I think most places carried about 6-8 inpatients on psychiatry.

Correction re: Columbia.

Didactics are every day for 1 protected hour at lunch time, not 1 hour per week, as I understood it.
 
For anyone who is using this as a criteria for your rank list, please keep in mind that more does not necessarily equal better. My program does what seems to be a pretty typical half day of didactics each week. And by the end of it, I'm pretty spent. The thought of anything more than a half day didactics, sounds like nails on chalkboard. Might just be me.

I think a much more worthwhile indicator is how protected programs make their didactics. Trying to be engaged in the learning process while juggling pages is just bad juju, regardless of length…
 
edited.
 
Last edited:
I've got to say I would love to have a whole day of didactics and think it's really awesome that some programs do that. If it were a tie-breaker between two programs, I'd go for the one with the whole day.

At my program, we have didactics in the afternoon, which means when you're on inpatient services that you do pretty much a full day's work in half a day. Didactics days are frequently pretty darn miserable on inpatient services. I guess doing then in the afternoon is somewhat better, though, in that attendings do the admissions that come in during the afternoon. If we had morning didactics, I suspect we'd still do all those admissions plus all of our regular daily work. When not on inpatient services, you do get a little more support and generally do more of a half days work on didactics days.

As for carrying patients, we cap at 7 patients on our university service and 8 (although it can be 9 with bouncebacks) at the VA. The cap increases to 10 at the university when someone is on vacation or off service for whatever reason, which occurred for 6 full months in the past calendar year (long story, not ideal and hopefully something that will never happen again). At the VA, the cap never increases because faculty cover patients for residents who aren't there. AFAIK, there are no caps on admissions/discharges on either side aside from limits imposed by total patient caps.
 
We have a half-day afternoon a week as well as 4 days with noon conference-type experiences, generally protected. Pretty much still have to get the same work done every day. Most of our services we cover 8 patients, sometimes a few more, sometimes a few less.
 
It is very difficult to balance coverage and resident protection.

At our program, we had 1/2 day of didactic learning in the afternoon. On didactic days, residents had to rush to see patients, discharge them, etc before leaving for didactics. The work was expected to be done before residents left (e.g., if a patient was supposed to be discharged that afternoon and the paperwork was not done, then the attending would not do it).

I have seen programs that have didactics in the morning. Not clear to me that this would be a better setup. Clearly the attendings could just sit on their hands all morning and then the residents would need to rush in the afternoon.
 
At our program, we had 1/2 day of didactic learning in the afternoon. On didactic days, residents had to rush to see patients, discharge them, etc before leaving for didactics. The work was expected to be done before residents left (e.g., if a patient was supposed to be discharged that afternoon and the paperwork was not done, then the attending would not do it).

I have seen programs that have didactics in the morning. Not clear to me that this would be a better setup. Clearly the attendings could just sit on their hands all morning and then the residents would need to rush in the afternoon.
Our didactics are in the afternoon as well (in addition to scattered morning didactic hours here and there). Our place was good about didactics being sacred time and when you checked out at noon, you were checked OUT. Your patient load and duties were juggled accordingly and it hasn't been a problem.

I debated whether morning didactics would be better but decided they wouldn't. With afternoon didactics, you are done at noon and gone after didactics. With morning didactics, the potential for 8 hours of work waiting for you when you stroll in at 1pm is just way too great...

I think how well programs handle didactics is very, very hard to view from the outside. Full day is not better than half-day and vice versa. Morning is not better than afternoon and vice versa. It's dependent on the quality of the didactics themselves, how protected they are viewed by the PD down, and how well the program is able to juggle priorities accordingly. Tough stuff to evaluate if you don't work there or have someone close who does.
 
Top