Andrew Melaragno

Residency continues to be an immensely formative and rich experience. Since the last time I wrote an update, I have experienced the remaining months of PGY-2 year, and I am now a few months into PGY-3.

I finished off the remaining three quarters of the PGY-2 year by rotating through AB2 at McLean, the Community and Blake 11 PGY-2 roles, and shorter rotations in Adolescent Psychiatry, Addictions, and Geriatric Psychiatry. Each of these experiences had valuable lessons to teach and many enjoyable aspects.

AB2 was likely the most learning-intensive experience I had in residency, and I experienced rapid and dramatic growth in myself as a psychiatrist. This is owed to a combination of several factors, not least of which are incredibly dedicated faculty with interests in and unparalleled talent for clinical education, patients with a diverse array of presentations of psychotic and mood disorders both new onset and more chronic, and the presence of a good component of unstructured time in the afternoons to spend really getting to know patients. The latter is a rare privilege in inpatient psychiatry.

The PGY-2 Community Psychiatry rotation was a unique experience that offered an opportunity to focus on a few individuals with severe mental illness and develop a more global view of their psychosocial context and the resources available in the community to help them. This rotation featured a nicely balanced mix of thought-provoking reading and writing, direct patient care experiences, and samplings of more global and systematic ways of formulating patients who are often severely psychiatrically ill, under-resourced, and facing a disproportionate burden of medical illness. Highlights include the clozapine clinic, and “Street Rounds” with a team from Boston Healthcare for the Homeless, led by Dr. Jim O’Connell, a down-to-earth physician and a fierce advocate for the population of chronically homeless individuals.

The Blake 11 rotation of PGY-2 was an important and fun experience because it allowed me to revisit a familiar place in a different role with more supervisory and teaching responsibility. Having more time to teach medical students and interns was a huge plus. In this role, I realized how much my knowledge base and skill set had advanced since I was there just a year prior.

Geriatrics, Adolescent, Addictions, and two weeks of McLean night float were the remaining rotations of last year. Spring was a perfect time to be at McLean during some of the lighter months in terms of workload and hours. The enjoyment from scenic walks of the grounds and often leisurely lunches with colleagues outside could not be surpassed. Each of the shorter rotations above offered a brief, but deep, dive into the relevant specialty areas and allowed space for exploring and visualizing a possible specialty career.

July marked the beginning of PGY-3 year, during which some PGY3 residents start on the Consult-Liaison psychiatry rotation, but most begin to practice almost exclusively outpatient psychiatry. The expansion of our patient panel from a small group one a half-day a week to a much larger set of patients brings a whole new set of opportunities to learn about the treatment of specific disorders. The clinic experience features enriching patient relationships, intensive outpatient-specific didactics, and new challenges in terms of managing patients outside of a controlled setting. I have enjoyed it greatly so far, and a couple months in, am beginning to feel more of a sense of mastery.

The other important part of PGY-3 is our Thursday experience, which rotates between a public psychiatry setting, the Nashua Street Jail, and the McLean Addictions Partial Hospital Program. Currently, I am doing the community and public psychiatry experience, and I have been very fortunate to rotate at the Massachusetts Mental Health Center. While there, I have been performing supervised intakes of new patients or co-leading group therapy for people with severe mental illness in the mornings, and seeing follow-up patients in the psychopharm clinic in the afternoon. My afternoon supervisor is a psychiatrist who graduated from MGH/McLean herself and is an incredible role model and teacher. Working at Mass Mental has been an eye-opening and enriching experience, and has awakened me to how rewarding it is to work in the community with the population of patients with mood and psychotic disorders. Keeping people healthy certainly represents a great challenge as well, and I have seen my supervisor model a type of flexibility and patient-centeredness about medications that is extremely successful in building trust and a therapeutic alliance.

Outside of my direct clinical experience, I have begun spending a half day once per week pursuing my own interests in research related to anxiety disorders at the Center for Anxiety and Traumatic Stress Disorders (CATSD). I am not in the Research Concentration program, but very much wanted to become more involved in psychiatric research. Despite my initial impression that it would be hard to jump into research as someone without extensive experience, I found that getting started was surprisingly easy. Our program leadership sends out a listing periodically of research programs seeking resident involvement, in addition to individual faculty members and their research interests. I saw the listed projects CATSD is working on and emailed the director; after a brief meeting with him, I was rapidly welcomed into the work of the clinic and introduced to numerous psychiatrists and psychologists doing important work in the realm of anxiety disorders. I am writing a book chapter on medication management for anxiety disorders for non-psychiatrist practitioners, and am in the process of becoming certified as a psychopharmacologist for two studies. My mentor, who practiced for years in France before coming to MGH, is fantastic to work with, and I have enjoyed interacting with the CATSD staff as well.

When not working, I have found that PGY3 year allows plenty of time to be with my fiancée and our beloved dog, as well as to see other friends and engage in non-residency related fun. Furthermore, my class has gotten to know each other very well by this point, and I feel solidly integrated into the greater residency community by virtue of working side by side with residents from other classes on call. The frequency of PGY3 call is totally reasonable, and I have most of my weekends completely off. I have started dabbling in moonlighting, and the financial boost is certainly welcome. Boston remains a very enjoyable place to be, not least because of the amazing day and weekend trips that can be made to places nearby such as coastal Maine, New York City, and even Canada. Even better, as I write this we are gearing up for fall here, which is the best season in one of the best places to experience it. With all of the experiences I have had up until this time, I can say with 100% confidence that I could not be happier I ended up coming to MGH/McLean.



Education

Ohio State University, M.D., 2016

Stanford University, M.S., 2009

Stanford University, B..S, 2008