Residency Patients per day for adult inpatient? Amt of time with attendings?

[MrChance2]

How many patients per day do you see on an adult inpatient residency rotation?

How much time do you spend with attendings discussing patients etc on an adult inpatient residency rotation (not formal didactic time)?

How much formal didactic time?

When do you begin practicing psychotherapy and learning about it enough to practice it (if that happens) in your program?

Where would you roughly rank your program in terms of competitiveness?

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[ExcaliburPrime1]

Patients: Varies. In home program, up to 7 per day, but average would be 5. At the VA, depends on how many residents, average 2-6.

Time: In both settings, I'll typically pre-round for a few minutes (more if it is a new patient) then we'll spend about 10 minutes (again, more time if new) in a conference room on the unit with the attending and patient in the same room. Depending on the patient, we may spend an additional few minutes after the interview further elucidating the plan.

Didactic Time: Only 3 hours/week (get the afternoon off that day of the week, each year has its own didactic schedule)

Psychotherapy: PGY-3. We get a smattering of lectures (e.g. "Principles of Psychodynamic Psychotherapy" and "Motivational Interviewing") in PGY-2, but the real learning/practice is only in PGY-3.

Rank: Not sure, probably mid-tier.

 

[J ROD]

Patients: Inpatient unit at home program, 52 bed unit. See 8 patients as mandated by program max, but we round on all 13 patients each attending has so there have been times I have done notes on all of them. At VA, I usually would have 6-7 patients per day.

Time: Home program we have treatment team 3 times per wk. It really depends. I am generally more independent so I believe I do and get less "planning". Usually do 15 minutes per day. VA - do about 15-20 min talk after rounds. I usually run my plan and they go okay. Or add a point here and there.

Didactic Time: Only 3 hours/week (get the afternoon off that day of the week, each year has its own didactic schedule)

Psychotherapy: PGY-3. We do about 8 days outpatient 2nd year to get familiar with the process. We get most of our Therapy lectures in 2nd and 3rd year. Did Motivational Interview end of 1st. We do a mix which I think is better so I don't get as bored. But, I would still say it is weak.

Rank: closer to the bottom. But, clinically I feel my program allows one to see more than most places. We are worked hard but well prepared that way. Didactics could be better. Psychotherapy is decent though. Not bad.

 

[clausewitz2]

How many patients per day do you see on an adult inpatient residency rotation?

Varies somewhat by rotation. Intern year 5-6, now in second year 7-8. On at least one rotation that intern year the expectation was we would do an MI session in the morning with each patient and then return in the afternoon to do 30+ minutes of MI with each patient again, as it was a dual diagnosis unit. Number of notes I writes depends on how many medical students/psychology interns also happen to be on the team.

How much time do you spend with attendings discussing patients etc on an adult inpatient residency rotation (not formal didactic time)?

Depends on attending and patients. When I am tending a rock garden, we are spending maybe a few minutes per patient. When there is more turnover or complicated disposition issues, more like an hour or two a day. Some days we have treatment team meetings where we talk in more depth about every patient, and from time to time we have disposition meetings involving outpatient teams, insurance, and county administration people that tend to drag on.

How much formal didactic time?

3 hours a week

When do you begin practicing psychotherapy and learning about it enough to practice it (if that happens) in your program?

We start getting MI training first year that is reasonably intensive, with formal psychotherapy lectures starting first year as well. We are strongly encouraged to pick up a psychodynamic case as early as possible in second year with the proviso that we can take on more if we can fit it into our schedules. Not sure our formal didactics in psychodynamic approaches are very strong but the program is actively working to correct this. CBT/IPT didactics are stronger.

Where would you roughly rank your program in terms of competitiveness?[/QUOTE]

Not very tippy top but top decile for sure.

 

[clozareal]

Patients: In PGY1, it's about 1-7 patients per day, typically we each carry around 4-5 patients.

Time with attendings: 10-15 minutes per new patient on average, and then a lot less time after that to discuss plan if it doesn't change much.

Didactic time: 6 hours per week required, and then random case conferences/sessions add about 0-3 hours to that time per week.

Psychotherapy: Begins PGY-2 and you get 1-4 patients along with a psychotherapy supervisor for 6 months. CBT, Interpersonal, and Dynamics are required with those patients. Motivational interviewing is also strongly encouraged with all relevant patients. We can also choose to do exposure and response prevention therapy, imagery rehearsal therapy, EMDR, and ACT. Many (half) the class are part of the local analytic institute as well by PGY2-3. We have outpatient rotations in our PGY-1 which you theoretically can also do psychotherapy, but our training is a bit more limited there.

Rank: Upper-tier range

 

[FlowRate]

Patients: 4 as an intern, 6 as a resident. Honestly, most days I feel that's too few, but there aren't enough patients on the units for residents to have more.

Time w/ attending: Team rounds for about 30 minutes every day. More with attending PRN. I often check in with my attendings to run things past them. I feel like we don't get pushed enough to be more independent (during the day... at night it's a different story.) This is somewhat resident and attending dependent, though. (Something I could work on.)

Didactic Time: A little too much. Didactics 8-2 on most Wednesdays, with the afternoon off for scholarly time. Would prefer a greater mix of scholarly time. A lot of people feel pushed into using their scholarly time toward doctor's appointments and psychotherapy patients, although I think that's actually more a reflection of those people and less a reflection of the program (I haven't had problems doing those things on non-didactic days.)

Psychotherapy: Very small amount of didactic introduction in PGY-1. Extensive didactics in PGY-2, along with a weekly psychodynamic patient. Ample space in 3 and 4 to carry plenty of therapy patients, if desired.

Rank: Makes a lot of top-10 lists.

 

[thoffen]

Not a resident anymore, but I'm an attending at the same institution so I'll answer anyway

Patients: 6? as an intern. Can't remember, It was definitely not more, might be 4. As a resident, PGY-2 cap is supposed to be 8 but depends on inpatient census and likely averages 5-6 and very rarely 8+.

Time with attending: Probably 4 hours daily on avg as PGY-2, less as PGY-1 (varies).

Didactic: half-day didactics every week. Each rotation has additional educational time, probably 1-2hrs / wk on average there. Additional 2-3hr/wk psychotherapy training in 3rd & 4th year.

Psychotherapy: has changed a lot in last few years, but each resident gets supervision, up to 3hrs supervision/wk + didactics as above. 2 pt slots in PGY-2, not sure about PGY-3/4 anymore but used to be 6. However, only the dedicated residents filled up their slots.

Rank: upper but not top tier.

 

[DisorderedDoc417]

Patients: Inpatient psych is PGY1-2. You see up to 2 new work-ups, depending on how much comes in overnight (fellow residents see the rest on your team if they don’t get 2 and you’re full). Everyone sees a minimum of 6 follow ups as a PGY1 or 8 as a PGY2. So 7 or 9 patients daily.

Time: If I have 2 new work ups I’ll come in earlier (7:15) or if not 7:45. Team meetings differ by attendings but you generally try and see patients by priority: D/C today, New, follow up. If you have your team meeting at 8am you’ll obviously see less than if at 11am. Generally team meetings with pharm, nurses, SW, attending and resident. These are done without patients. Then, residents see most of the remainder on their own for the rest of the morning/afternoon. You generally approach the attending at the end of the day to compare plans and touch base. Some attending may have you see a few with them but that is the exception. Teaching is mostly via observing management decisions in EMR and through team meetings if you have questions.

Didactic Time: Wednesday’s 8am to 1pm.

Psychotherapy: One clinic day per week as PGY2, more intermixed with med-management as a PGY3-4. Depends on site.

Rank: Average

 

[Seroquel]

Patients: On inpatient psych you typically have 5-6 patients which I think is an appropriate number. Some rotations might have you only take 4 patients. There are always patients!

Time: Highly dependent on the attending. Generally at least 10-20 min per patient, sometimes more depending on how much teaching an attending might do. Rounding at the county hospital is about 2-3 hours plus maybe 30 min in the afternoon to run the list. Rounding at the fancy hospital depends on the attending. I feel like I can easily get a hold of my attending for questions and most give me their number, etc.

Didactics: 4-5 hours in one chunk which is great.

Psychotherapy: Starts PGY2!! There are dedicated therapy clinics. Not sure about the hours.

Rank: Not sure and not something I care about lol

 

[MedMan80]

Patients: 12 patients at both major hospitals, even in intern year. VA varies 4-8 per resident.

Time: Usually round on patient's yourself, then quick rounds with the attending. Really with 12 patients, as complicated as they were you spend minimal time with them.

Didactic Time: 2 half days protected, however actual didactic time would average maybe 2h a week i would say.

Psychotherapy: Start longitudinal patients PGY-2, get some courses on CBT, pretty weak tbh.

Rank: IMG hotspot, east coast. Mid-tier for IMG i would say, lower tier for AMG. I had a horrible time here.

 

[NickNaylor]

In my program, a lot of this is variable depending on the site and the attending you’re working with.

I’d say at most sites, each resident is responsible for 4-6 patients on average, though there is some variability depending on the census. The maximum number of patients a single resident would be carrying is 9; at one of our sites we cover up to 4 inpatients and 5 consults from the secured medicine unit, which is adjacent to the inpatient unit.

Discussion time for individual cases is again variable. For straightforward cases, usually no more than a few minutes. For complicated cases, perhaps 15-20 minutes. Much of it also depends on the presence of other learners (i.e., medical students), as with other people the discussions will tend to be lengthier to facilitate their learning. Some attendings are quite talkative, others aren’t. There’s a lot of variability on this front.

We have a half-day (4 hours) of protected didactic time each week. During PGY-3, there’s an additional ~2 hours of didactic time in the form of case conference. If there’s no case presentation scheduled, then the time is filled with didactics instead. You are expected to attend didactics, and attendance is tracked and included in your biannual evaluation, so simply not coming to didactics isn’t acceptable. All of the psychiatry faculty know that didactics occur on Tuesday afternoons and you are expected to be released on time to attend didactics (and this does typically occur with rare exception).

We begin seeing psychotherapy patients in PGY-2, coinciding with methodology-focused didactics. By the end of PGY-2 you’re expected to be carrying 2 long-term psychotherapy patients with a psychodynamic focus, and in PGY-3/4 you’re expected to be carrying 6 psychotherapy patients: 4 psychodynamic and 2 others depending on what’s necessary. We’re expected to “complete” 2 CBT cases, so if you’re working on CBT cases then that’s what your other 2 patients will be, otherwise they can be whatever you want. During PGY-3, you also run a group, with groups in a variety of settings and different foci (for example, I do the conversion disorder group for our hospital’s conversion disorder/PNES clinic). We also have electives for DBT, family therapy, marital therapy, etc. that you can explore in the PGY-3/4 years, but these are not strict requirements for the program, and you do not have to do any additional therapy training beyond the cases above.

 

[Liquid8]

Very interesting to read what is done from an overseas perspective.

Patients per day: In the public setting the total patient load can be 5-10. Involuntary patients needed to be seen daily, but voluntary patients could be seen every second or third day depending on severity – would probably see 5-7/day. Later on when I did a private inpatient rotation, patient load would be around 10-15, with the expectation to see 8-10/day.

Time with consultants: Minimum mandated hours is 5: this includes 1 hour weekly 1:1 supervision plus 4 hours supervision; which may include seeing patients, ward rounds and clinical review meetings. In practice this would be more – a daily half hour ward round (2.5 hours), plus a 2 hour clinical review as well as seeing 2-3 patients with a consultant when they were there.

Formal didactics: 6 hours per week. This included a formal college teaching programme held externally (3 hours), and on-site psychiatry teaching programme (lecturers/journal clubs/case presentations etc – 3 hours).

Psychotherapy: Can potentially start in Year 1. One of our requirements is a 40 hour long case that can span the training, and patient drop out is a major issue. This requires formal psychotherapy supervision (1 hour/week), which can be sourced internally or externally. We had a psychotherapy modules and topics in both our formal and institutional teaching. Practically, we did some formal CBT cases in Year 2, and other therapies are done in specific rotations eg. family therapy in child; MI on an addiction rotation.

Rank: Not applicable