A Day in the Life of a Fourth-Year Resident
Some mornings, I still can’t believe I get to design my own schedule. After three years of structured rotations, fourth year feels a little like getting the keys to the hospital and being told, “Go learn what matters to you.” For me, that’s meant building a year around my interests in reproductive psychiatry, consult-liaison, interventional, addictions, and neurodiversity — with room to explore movement disorders, Huntington’s disease, and psycho-oncology.
Right now, my mornings begin on the Women’s Inpatient Unit. Our patients are women navigating the complex intersections of mental health and reproductive life stages — postpartum depression, severe anxiety during pregnancy, mood changes in menopause. The work here is as much about listening to stories as it is about adjusting medications.
After lunch, I head to clinic. Some days, it’s the Neurodiversity Clinic, working with autistic adults on anxiety and mood concerns. Other days, I work with a Neurologist in the Movement Disorders Clinic, where I help evaluate and treat various (you guessed it) movement disorders — an important skill in psychiatry, since many psychotropic medications can cause or worsen these symptoms. I also spend time in a palliative care clinic, supporting patients and families as they define what quality of life means to them as well as helping evaluate and treat underlying psychiatric conditions.
Later this year, my mornings will shift. I’ll rotate on the Addictions Unit, learning recovery-oriented approaches; then the Consult-Liaison service, collaborating with medical teams across the hospital; and work in Interventional Psychiatry, providing treatments like ECT, ketamine and the recently added SAINT neuromodulation system. The variety is one of the best parts of this year — no two months, and often no two days, look the same.
Threaded through my schedule is a longitudinal therapy case using Acceptance and Commitment Therapy (ACT). Week by week, I get to see patients make small but meaningful shifts, a reminder that change in psychiatry is often quiet and deliberate.
One of the greatest benefits of fourth year is balance. With a more flexible schedule, I have time outside of work to be with my family, explore local events, and enjoy the hobbies I’ve missed during busier years — like getting lost in a good book (or, in my case, actually getting lost in a Brandon Sanderson book).
Fourth year is different from every year before it. The schedule is flexible, the learning is self-directed, and the work feels more like my future career than ever before. Each morning, I walk into a space I chose, with patients whose stories shape the psychiatrist I’m becoming. That, to me, is the best part of fourth year.