What to Expect After Crossing the Finish Line

What to Expect After Crossing the Finish Line

An interview with early career psychiatrist Dr. Kathleen Sheehan, conducted by Cory Kowal, PGY5 University of Manitoba.

The MIT committee collaborates to create content for the Psych-E quarterly newsletter, and we think it is important to connect with early career psychiatrists, to give you, the reader, insight into what to expect on the other side of this long journey of medical education. For this edition we have interviewed Dr. Kathleen Sheehan, a psychiatrist who has been on the other side for the past few years.

CK: Can you tell me what you thought your practice might look like during your 4th and 5th year of residency?

KS: Through my final two years of residency, I became increasingly interested in pursuing a career in CL psychiatry. I had started to grasp the extent of need and opportunity to provide better physical health care for individuals with serious mental illness (SMI) and optimal mental health care for those with physical health issues. I also wanted to stay in Toronto; to stay close to family and friends, and continue the academic relationships that I had been establishing in residency. In Toronto, at the academic centres, CL psychiatrists usually combine inpatient work with an outpatient practice. I envisioned doing a mix of outpatient neuropsychiatry work, so did electives with our acquired brain injury clinic, and set up my PGY5 to do additional CL training at sites with neurology inpatient units. I had long known that I wanted to combine clinical, research, education and administrative work, but was not sure exactly what that would look like as a staff psychiatrist. Being a chief resident in PGY4 gave me insight and experience into academic administration and I continued to work with several supervisors on research projects that could possibly continue when I completed residency.

CK: What did your practice actually look like, that first year after graduation?

KS: I took the summer off, from July until September! My father had some health issues, at the end of the summer, which led to a bit of a delay in me starting back to work. While that was a really tough time, it confirmed that I had picked a great place to work, as I was well supported by our Chief of Psychiatry and my CL colleagues. I was hired as a clinician-investigator, so I devoted half my time to clinical work and the majority of the remaining time to research. Clinically, I had blocks of time where I was the staff physician leading the inpatient CL service. I provided outpatient consultation to our neurology, rheumatology, and stroke clinic several days a week. I supervised trainees who rotated on our CL service and also supervised residents in interpersonal and psychodynamic therapy. Research-wise, I was working on building collaborations and submitting grant applications with colleagues in neurology and general internal medicine, focused on delirium and quality of stroke care for individuals with SMI.

CK: Has your practice changed at all over the past few years, and if so, what does it look like now?

KS: About two years ago, I made a relatively significant change to my practice. We were awarded several of the initial grants that I applied for, and research opportunities were growing. Following residency, where the structure of work life was dictated by others, I learned more about how I worked best and realized that it was by blocking longer chunks of time for research and clinical activities. I also realized that I really enjoyed working in an inpatient, team-based model. There was some synergy in terms of staffing changes at our hospital network, and I was able to take on blocks of time on our psychiatric inpatient unit and decrease my outpatient practice over time. So now I have blocks of several weeks at a time dedicated to inpatient CL, inpatient psychiatry, and research. I have become more involved with national and international organizations in my field, including being lead of Continuing Professional Development for the Canadian Academy of Psychosomatic Medicine (CAPM), involved with the Early Career Psychiatry Working Group at the Canadian Psychiatric Association (CPA), and on several committees at the Academy for Consultation-Liaison Psychiatry.

CK: Were there any big surprises or things that you didn’t expect in your initial transition to practice?

KS: I read somewhere that medical training can feel like a protracted adolescence, in terms of how it is structured and how it makes you still feel “like you’re in school”; but then suddenly it’s over, and you move into the world of “independent practice”. It can sometimes feel like a big shift! The most challenging thing for me was being in charge, to some extent, of how I was going to set up my schedule on a daily and monthly basis, and figuring out time for vacation. Additionally, you are now responsible for choosing how to complete further training to keep yourself up to date on emerging research and guidelines, which had previously been accessed in a structured format during residency.

CK: Have you been able to stay involved with medical education, if so, what is it like being on the other side?

KS: I have stayed involved in medical education and it is awesome! I get to teach clinical clerks and residents when they rotate on our inpatient clinical services, and I participate in some mentorship activities for pre-clerkship medical students, such as the University of Toronto’s “Making Every Encounter Therapeutic” program. Over the last three years, I have taught the psychopharmacology and psychotherapy lectures at the London Review Course, which is a really exciting experience and it is fun to see residents that are so close to completing training and nearing “peak” Royal College exam knowledge. As I mentioned, I also do CPD education – locally on delirium at our hospital network and with the University of Toronto, and nationally with CAPM and CPA.

CK: I understand that you are involved with the CPA. Can you please describe your involvement, and how membership in CPA can benefit Canadian psychiatrists?

KS: I am a member of the Early Career Psychiatry Working Group, which was established fairly recently to engage psychiatrists transitioning from residency training to independent practice. I had attended the CPA annual conference as a resident, and since then, as a practising psychiatrist, and I realize how essential it is to be part of this organization, to advocate for our patients and profession at the national level. With Canada being so large geographically, our national organization is truly a network that can connect us, and help us to maintain good clinical practice through the dissemination of education and research. Being involved helps me ensure that CPA remains relevant throughout all stages of training and practice, which is critical and is exciting to be part of!

CPA: What are some of your favorite aspects of finally making it to practice?

KS: Honestly, one of my favourite aspects is collaborating with people that I met in residency – reading their notes, calling someone for some “phone a friend” advice about a case, helping with a patient’s transition from hospital to the community or vice versa, writing a paper together or developing a workshop for a conference. It makes me really happy to see each of us having found our way and working in settings that allow us to help people and to put our well-earned knowledge to good use. I now practice where I did a lot of my training. It is really fun to be part of the staff physician team that trained me and I now continue that tradition!

CPA: Do you have any sage advice for us residents in our final years of residency as we move towards graduation?

KS: Like most things in medicine, the final years of residency are a marathon not a sprint. Make sure you pace yourself as you look for jobs or consider further training, prepare for the Royal College and other exams, and complete all your other life tasks. Just like a marathon, make sure you plan for and take plenty of rest before and after the race, and some take breaks for water and nutrition to fuel yourself along the way. Enjoy yourself, try to appreciate the journey, and stop to take some pictures with family, friends, and loved ones who are cheering you on!