Vivek Gorijala, MD

My name is Vivek Gorijala, MD, and I am a current PGY-4 resident at Lehigh Valley Health Network (LVHN). Our fourth year of residency is split between elective time and time leading our teaching services on both the adult inpatient psychiatric unit and the Lehigh Valley Hospital (LVH)–Muhlenberg consult service, while we also maintain an outpatient continuity clinic for a half-day every week. This broad experience provided through the year ensures that we are ready to step into whichever role we may choose as attendings, while also allowing us time to further hone skills in specific aspects of psychiatry that we choose.

I am currently in my elective blocks, and I have had a chance to do my neuromodulation block, meaning that I have been administering electroconvulsive therapy at LVH–Muhlenberg and mapping TMS patients at our primary outpatient clinic sites at at LVPG Adult and Pediatric Psychiatry at both Cedar Crest and Muhlenberg. I am currently on my teaching block, meaning that I have a chance to teach our new interns and rotating MS-3s and MS-4s, floating between services to focus on teaching. Later in the summer and next spring, I will be doing a toxicology rotation, repeating a second year required rotation, and will also be doing an e-consults rotation, among others. With program leadership approval, we are also allowed to create our own elective block – giving us another opportunity to tailor our 4^th year experience to reflect our unique interests within psychiatry.

In the fall, I will move on to leading the inpatient psychiatry teaching team, meaning I will be working directly with PGY-1s and medical students in a junior attending role under a supervising attending. The day starts at 7 a.m., so that I can chart-review my own patient roster and begin to oversee the work of the interns on the service and assist in coordinating the care of all the patients on the team. Mixed into each day will be teaching specific to the medical students, multidisciplinary collaborative rounds later in the morning, and management of each patient’s stay with our case management team, along with addressing acute concerns that arise for any patient throughout the day. The day ends at 4-5 p.m., once all patient tasks are completed. This role functions as a return to the inpatient unit which we have rotated through as PGY-1s and PGY-2s, but in a more senior position, which allows us to practice our team coordination and leadership skills in preparation for a possible job as an inpatient attending.

In the winter, I will transition to leading the resident-run consult service at LVH–Muhlenberg. As the PGY-4 senior resident, I will be responsible for a daily 8 a.m. meeting to update the team on ongoing patient cases and seeing patient consults that come to the service. I will also be assigning and overseeing patient cases to our PGY-1s and PGY-2s on service, in addition to any rotating medical students. Throughout the day on the consultation-liaison service are various opportunities for teaching via discussions during rounds, and collaboration with the primary services regarding patient care. Teaching also occurs during lunch, with discussions with the entire rounding team. The day ends at approximately 4 p.m., once we have seen all consults that have come to the service that day. Returning to the consult service after rotating through the service as a PGY-1 and PGY-2 in a leadership position allows us to prepare for being a consult attending seeing patients while also supervising the work of others.

Throughout the year, I also maintain a continuity clinic on Wednesday mornings, which starts at 9 a.m. I have been able to continue my psychodynamic therapy case which I started during my PGY-3 year, along with seeing a smaller roster of my outpatient medication management patients continuing from my PGY-3 year. This allows for us to continue with our outpatient roster and experience their progression over a span of two years, mimicking the experience as an outpatient attending.

There is also no call during PGY-4! That means that I can spend my weekends and evenings relaxing, job searching and spending time with friends and family. I have several trips coming up to travel, visit friends and go hiking, which I’m very excited about. Overall, the PGY-4 year allows you to put a capstone on your experiences throughout all previous years of residency and prepare for the upcoming responsibilities as an attending.