Journal Article: Analysis of Extracurricular Behavior of Duke Psychiatry Residents. Mehul Mankad, M.D.

ABSTRACT: Objective: This study examines the habitation and extracurricular activities of a cohort of psychiatry residents who claim to be happy, quite a controversial notion. Method: Twenty five residents who showed up at the weekly residents' meeting filled out a self-report instrument, the Schedule of Behavior of Residents (SOBeR). Results: As it turns out,Duke psychiatry residents primarily live in houses (76%), own gas grills (60%), and go to the beach and/or mountains several times a year (mean =3.04). Conclusions: Attendance of the Duke psychiatry residency does not inhibit leisure activities. In fact, there is evidence to suggest that Duke psychiatry residents may actually be happy.

BACKGROUND: When people typically think about residency, they imagine long hours in the hospital, sleep deprivation, and years of misery before the "big pay off" of finally finishing the training that began decades ago. You could call PGY-IV residents twenty fourth graders, and you really wouldn't be incorrect. When choosing a specialty, and especially when choosing a specific residency program, lifestyle choices become more and more important. Do I want to keep paying crazy amounts of rent each month, or do I want to buy a house? Where can I afford to buy a house? Do I want to live in a place where I can find some choice diversions on my weekends off? Do I really want to go to a program where residents spend their free time writing fake journal articles for their own amusement? And most importantly, where could I find a group of people who share my interest in barbecue grills? No doubt these questions sound familiar. Hence, the following study was undertaken.

METHOD: Subjects: Unwitting residents from all four years of the residency who showed up for weekly residents' meeting were selected for this study. People were not given a choice whether they wanted to participate and the IRB was not notified. In fact, residents who did not want to complete the survey were threatened with having to proofread last year's chief resident's newly completed novel. Procedures: The author stared menacingly at each resident in the room until they checked off boxes on each of the five questions in the Schedule of Behavior of Residents (SOBeR). This instrument, designed by the author approximately five minutes before residents' meeting, provides data on housing and recreational activities in a five item, self-report format. The author was a bit surprised that no one complained about filling out yet another survey. But then again, the brain of a physician is so used to frequent multiple choice exams that learned helplessness should be expected. Data analysis: The author's calculator on Microsoft Windows does standard deviations. He was going to do the p values himself but decided that the readers would "take his word for it".

RESULTS: There were twenty five residents (N= 25) at that particular residents' meeting, so about half of the entire residency. Not bad. Nineteen of those people (76%) live in houses. So six of them (24%) live in apartments. Sixteen of those surveyed (64%) own their residence. When it comes to weekend or vacation activities, Duke residents like to go to the beach (2* hour drive) or to the mountains 3* hour drive). The mean number of times residents go to these places is 3.04 per year. The mode is 2.

Remember the mode? (Hint: it has nothing to do with ice cream). The median is also 2, I think. The most important issue in the opinion of the author regards the choice of barbecue grill. He was shocked, really shocked, that 40% of residents (10/25) did not own a grill. It's warm nine months of the year down here. Interestingly, 6/25 (40% of grill owners) use good old charcoal. 9/25 (60% of grill owners) have left the dark ages and moved on to gas grills. Please note that the author may be biased in this portion of the study.

DISCUSSION: It's pretty clear. Life is comfortable in the Triangle. And when the Triangle becomes too familiar, there are great escapes and time to make use of them. Of course, there may be selection bias in the sample as these residents were not randomly selected. Yeah, right. The author doesn't have THAT much free time. A follow-up study (you have to mention these) could look at why there are so many people who do not own grills in the residency. Maybe they are afraid of fire. From a psychodynamic perspective, they may have substituted anxiety about grilling their food for some unresolved conflict. The cognitive perspective would hypothesize that avoidance of grilling is a negative automatic thought that has no basis in reality and needs to be challenged. Maybe they are sushi fanatics and have no need for heating their food prior to consumption. Further research needs to be performed in this avenue.

"My Life is an H + P" -- by Michael Slifer

ID: 33y/o MWM, NSC with no prior psychiatric diagnosis despite daily contacts with Duke/VA Psychiatry for the past several months.

CC: "I have no complaints about my Chief Resident...for she is the diaper to my emotional incontinence."

HPI: Pt was doing well until he went on a spending spree several years ago. He borrowed thousands of dollars hoping to be called "doctor". Recently, he has suffered crying spells. He presents today because his name came up on a "list". Despite his obvious misery, feels compelled to come to the VA whenever he gets the "Call". He has numerous admissions every week for the past couple of months, but he claims they were "always for other veterans". Pt states that he has an electronic signaling device attached about his waist. Psychiatrist on Duty is concerned about possible genital mutilation, since he threatens to "rip it off, throw it out the window, and run over it with his car". (Incidentally, vascular surgery assures that reattachment would be a minor" procedure. Pt seems disappointed by the assessment.) He also describes an auditory hallucination of buzzers or bells that cause him to startle and run to the nearest phone. This seems to occur whenever he tries to relax. He now worries that if he relaxes, he will cause the device to activate. As he relates this story, he looks suspiciously at the "evil beast". Additionally, he reports that the device "feeds me the news when I push its buttons". He states that this is its only useful purpose. Further, he tells of a conspiracy by "computer people" to make him desperately search the building for working printers. Finally, he complains "sometimes my internal dialog externalizes."

Substances: coffee -- "'till I seize, then I have just one more cup for that post-ictal rush."

Social: says there is no time to be social; is married, and works in the doleful shades.

Military: was in the service during the Reagan administration and claims he was "the only barrier between the U.S. and the Red Menace"

MSE: Appearance: White coat, occasional foul odor s/p an awful falafel from the cafeteria. Speech: he's silent... but deadly.

Behavior: no eye contacts, but he does wear glasses. TC: pt is not currently suicidal nor homicidal but says "I'll try anything once." TP: when coherent, he is not goal directed (doesn't know what he's trying to do); he displays looseness of associations but says "I'm doing my best to tighten them up...or down...I'm not sure which way to go with them at this point." Mood: "Moody", intense angry affect swearing at "the beast", but this seems entirely appropriate. I/J: poor judgment as evidenced by his very presence. MMSE: 27/30 (still not oriented to date/time s/p daylight savings time change, constantly confused about which floor he is on).

Assessment: He is (in the words of Brig. Gen. Anthony McAuliffe at the Battle of the Bulge) "nuts".

I Psychotic Disorder NOS vs. Mood Disorder NOS vs. Anxiety Disorder NOS

II He's definitely cluster B material

III none yet(!?)

IV severe: currently living at a VA

V 40

Plan: 1. Admit to Psychiatry 9B. 2. Meds: haldol as much as can fit in a syringe. 3. Labs: VDRL (...ya just never know).