March 15th of 2019 is a day that will always remain in my calendar—and my memory—as one of the happiest days of my life. I still remember the “emotional cocktail” I went through on that day, when I learned I had matched to the MGH/McLean Psychiatry Residency Program: my dream program! On one hand, there was a feeling of pride and accomplishment, accompanied by the excitement that I was in fact starting my training as a psychiatrist! On the other hand, I was humbled by the fact that, being an International Medical Graduate, I was considered to be part of such a great program. I remember closing my eyes and envisioning experiences in my life that brought me to this point: It’s been a long journey! Immediately, I started thinking of the potential challenges I would face during my intern year. Given that I hadn’t practiced clinically in about 5 years that I devoted to research and had been trained as a doctor in the Dominican Republic in a different language and sociocultural context, I was expecting several challenges. As I started residency, I realized I underestimated some of the challenges that I would face!
I started intern year rotating at the Clinical Evaluation Center (CEC) at McLean Hospital. This is a facility with a very particular role: the CEC specializes in the assessment and stabilization of individuals in acute psychiatric crisis who are thought to need inpatient level of care. In accordance with this role, patients seen at the CEC are in need of both a psychiatric and an internal medicine evaluation in order to (1) decide whether they meet admission criteria and (2) if they are medically cleared for psychiatric hospitalization. There was not a better place for me to start. The CEC was the perfect environment to “re-enter” both medicine and psychiatry. Like an adult who is re-learning to ride a bike, I started re-gaining my clinical skills. One essential component to my success in this rotation was the constant support I received from my attendings, peer residents, and program directors.
There were several highlights for this rotation: development of autonomy, diversity of the cases, direct feedback and working with efficiency. One of the major goals of intern year is developing independence. My CEC attendings practiced graduated autonomy, ensuring my responsibilities grew alongside my confidence. Moving from the direct supervision of my patient encounters to providing me with autonomy to interact with patients on my own, the system allowed me to continuously learn and grow. In terms of the day to day, after seeing the patients, I would present the cases, make my diagnostic formulation and risk assessment, complete the medical clearance and then elaborate my own therapeutic plan. This experience was very challenging as I was encouraged to make my own management decisions. Importantly, my attendings ensured I was exposed to a wide variety of cases (e.g., mood, anxiety, psychosis, addiction, trauma, personality, dementia, etc.), so my interview and diagnostic skills were consolidated in a versatile fashion. Another core ability I had the opportunity to work on was my efficiency. Because of the nature of the CEC, we were required to respond quickly to the patients and ensure they were seen by a physician in a timely manner. I learned to navigate the system with efficiency by understanding my role in the psychiatric healthcare team, interact with the other members (e.g., nurses, social workers, mental health staff, insurance associates, pharmacists), perform a proper chart review, and increase my understanding of the legal aspects of psychiatry. This may seem like a lot for a single rotation, but it was made possible by the constant feedback from the whole team. The feedback I received was very targeted and accompanied by specific strategies to help me improve my skills and consolidate my knowledge.
As I advance through my intern year, I realize there will be more challenges to face and that each rotation will bring its own learning opportunities. Despite any challenges that may come my way, I am confident I made the right decision to train in psychiatry at MGH/McLean. Every day I reflect on how fortunate I am to be part of such a wonderful team. MGH/McLean and the Harvard Medical School offer an unparalleled set of opportunities for clinical training and a unique nurturing environment for research. However, as I move forward in residency, I realize that what makes this program truly great is not the endless array of resources or its prestige. What makes this program truly great is the diverse interests of residents and attendings, how we work as a team, the emphasis on empathy, respect and compassion. In summary, it’s the people!
