What do you do on your psych rotation?

Started by Waysensei
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Waysensei

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I am an extremely well-dressed and well-educated wallflower. My psych rotation is at an inpatient hospital ward, but there are no residents or no rounds. I basically just sit in and observe the doc do interviews and try to ask questions/make comments when possible. What did you do during your psych rotation and what would you recommend to allow me to learn more and have more fun?
 
You're not being allowed to interview any patients at all? That's ridiculous. Even when I rotated in a hospital where the psych ward didn't have any residents we still had some patients that we were expected to follow ourselves. I'd definitely ask the doctor if he could let you follow at least one of the patients and interview the patient every day.
You could also ask about being allowed to observe some of the group therapy sessions on the unit.
 
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Three-to-four basic things you can do at a psych inpatient ward.

1. Avoid getting assaulted
2. Do MMSE's
3. Psych SOAP notes
4. Just talk to some of the non-aggressive patients and take in the 'double rainbow' of responses
 
i'm on IM psych now and pretty bored/disconcerted by the docs. they have a super flat affect when talking to the patients.

here's my routine:
- do reading on one disorder per day, eg. all mood disorders today, their features, ddx, management
- if its a new pt the doc hasn't seen before, I read up on the pt's previous visits & current labs to get a good hx so i can update my attending
- help the nurses call up relatives/other health facilities to get a better history on pt
- look up drugs & side effects on epocrates as doc talks about them with pt
- read thru old charts, try to learn something....
 
My Psych rotation: show up at 6, preround on (2-3) patients, write a SOAP note for each one organized by axis, sit down rounds 8-10 (calling in 1-2 patients to discuss their case), sit in on group meetings from 10-11, early lunch, and scut work and/or educational activities until 2-3. Afternoons and weekends were off, and since there wasn't a whole lot to study they were really off.

I thought it was a pretty interesting rotation. It was nice to have patients that could actually talk back. I'm on IM now and a big chunk of my patients were comatose nonagenarians.

To the OP: talk with the doc, ask to follow patients and to discuss their treatment plan with him rather than just shadowing him. If you're having a problem psych is a good rotation to have it on: the docs generally won't penalize you for tell them your concerns.
 
Mostly, I went to the gym and had time to cook dinner and see my family.

In at 7 (30 minutes before everyone else), quick glance at all of "my" patient's overnight events / made the SOAP templates for the resident, then rounding / intake interviews, then usually out by noon. I tried to do as little as possible while still being friendly and pretending to care.

Those hours were sweet, but I swear it still felt like I was there for eternity. 👎
 
I wouldn't sweat this rotation too much. Essentially everyone says that the Psych rotation only matters if you want to do Psych...otherwise, no one really cares.

I wouldn't worry too much about not getting to do stuff on your own...I got the bright idea to "volunteer" to pre-round on my attending's patients at a local private psychiatric hospital and ended up almost getting attacked by a patient.

So, enjoy your somewhat shorter days and just hope that the rotation goes by more quickly than mine did. It was a painful 6 weeks.
 
mumd2011 said:
I wouldn't sweat this rotation too much. Essentially everyone says that the Psych rotation only matters if you want to do Psych...otherwise, no one really cares.
I wouldn't worry too much about not getting to do stuff on your own...I got the bright idea to "volunteer" to pre-round on my attending's patients at a local private psychiatric hospital and ended up almost getting attacked by a patient.
Click to expand...

It's hard to know if you really want to do Psych unless you get a chance to actually do something on the rotation though. 🙂
Patients can be out of control and aggressive on a normal medicine ward or the emergency department (especially the ED), so I think it is a good thing to try to learn how to conduct a safe interview with an agitated patient who is potentially combative.
Nobody wants to see a medical student get hurt on a rotation, so if you do have a patient that seems really out of control and potentially dangerous, definitely don't hesitate to ask for a nurse or other staff member to accompany you when you see the person.
As a psych resident, I wouldn't hold it against a medical student if they told me that they would prefer to have me present while talking to a patient for safety's sake.
 
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We have a Inpatient Psych ward... So I basically Got there By 8 am, my doc would give a presentation for about an hour or so about a topic he had told us to read (This was the only interaction I had with my attending). Then from 9-11 round on couple patients of my own (we are supposed to carry 3-4 pts a week), 12 attend hospital lecture... Out by 1 😀

Wednesdays we did ECTs which I thought was kind of cool, I got to bag some patients and write the ECT notes. Follow the Attending doing ECTs when he did his hospital rounds on the IM floors. It was weird the next day when I talked to one of my patients who had an ECT done, she actually did have Amnesia... It was a nice rotation for me as I was studying for my usmle Step 1 and needed the time, but I wish my attending would actually take the time to teach how to interview psych patients, we kind of were just thrown into the crazy ward and were like go to talk to whoever...:laugh:
 
Waysensei said:
I am an extremely well-dressed and well-educated wallflower. My psych rotation is at an inpatient hospital ward, but there are no residents or no rounds. I basically just sit in and observe the doc do interviews and try to ask questions/make comments when possible. What did you do during your psych rotation and what would you recommend to allow me to learn more and have more fun?
Click to expand...
Ask the doc to let you interview patients. Ask to do initial interviews and workups on new inpatients. When you meet an inpatient you feel you can communicate with, ask to follow that patient on a daily basis. You can also ask you attending if the hospital has a consult service. As a medical student, I got to do a lot on the consult service. I got to see the patients first, present them to the attending, interview significant others, interview the nurses and house staff to get more of a handle on the problem, read about the problem, check old records, and then see the patient every day. Sometimes the family too. One consult can keep you pretty busy! Good luck.
 
I did my rotation in consult psychiatry. You basically go around the medicine floors to patients that they need a consult on. Usually for depression, schizos, suicide, and patients who need to be deemed competent to make medical decisions (capacity if you will). It's been pretty enjoyable. I wouldn't say that I am necessarily cut out to do it for life, but consult psychiatry is a good mix of mentally sick patients who also need constant medical care. It's a good mix of both worlds. You continue to follow patients that you consult on, so you show up and follow up on patients if you feel they need to be followed. Typically get a new consult or two a day, and have between 5-8 patients in the census to follow up on (usually alternating days, so 3-4 follow ups a day). Show up at 830, leave between 3-5. I'm at a very busy hospital. Consult psychiatry is normally even more laid back than what I have described. Not really anything like what people think of when they hear psychiatry.
 
Inpatient consult service. Showed up at 9am 😀 and looked to see if there were any new consults in the printer. If so, I'd start looking up their file, go see the patient(s), and we'd round at 1-2pm and again later if needed. I was usually done by 4-4:30 😀
 
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