Quoted: Concern about MS3 psych rotation

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Hi all,

First, thanks for your time in fielding these questions. I'm a second year medical student and am about to set up my schedule for MS3. We have two options, in general, for psychiatry: 1) inpatient, and 2) a consult service where you exclusively work with the psych residents who are consulting on other patients in the hospital.

I'm definitely not interested in psychiatry as a career, but I am interested in getting as much as possible out of this rotation. With respect to choosing an option, the consensus among the MS3s and 4s seems to be that the inpatient experience is better. A minority argues that students who don't see them themselves in psychiatry will have a more relevant experience on the consult service.

The reason I'm posting is that I have a family history of depression. Specifically, an immediate family member attempted to commit suicide a few years ago. Thankfully, that family member is doing significantly better with treatment. I've been doing fine and am not at all concerned about myself, but I can't help but wonder whether spending 4 weeks in an inpatient setting wouldn't lead me to start ruminating on the past, thinking of my patients somehow differently, etc.. Those thoughts make me want to prefer the consult service, but it would be a shame to knowingly pick the weaker (going by upperclassman reviews) experience because of a problem that might not even come up.

So what do you all think I should do? Is there an obvious answer?

Thanks again.

I don't have the answer for this, but I'd do what you're most comfortable with, even if the learning experience is slightly less

As a psychiatry resident, I would encourage you to give the inpatient rotation a chance if that is where the best teachers are. I've worked with a good number of medical students on inpatient psych and most seem to find it a fun experience even if they don't want to go into psych (our inpatient unit luckily has some very friendly attendings who are good teachers). I'm not sure how much you were exposed to inpatient psychiatry because of your family member's illness, but it's been my experience that often people who haven't had a chance to see inpatient psych as it really is picture it as being worse or scarier than it actually is.
It's not unusual to feel uneasy at first on the inpatient unit because it is a different kind of environment, but you're going to see these patients in EVERY specialty ( mentally ill patients still have primary care doctors and sometimes need surgery, etc. ) so the inpatient unit is a great place to learn to become comfortable dealing with this population in a controlled environment. If you're planning on a specialty that involves patient contact, I think that having a good foundation in psych will serve you well.
Hope that helps with your decision.

I did both inpatient and consulting psych rotations, and man, my experience on inpatient sucked. I was pretty much used to do the physical exams that were technically necessary for admission, but that everyone knew would be ok because someone in the ED already pre-screened the patient. They just needed a warm body to put stethoscope to chest.

Both consult service and outpatient psych OTOH were were interesting, and I say that as someone with no real interest in psych.

Not saying your inpatient service would suck like that, and as a med student you probably wouldn't be used to examine patients anyways. But find out why the students who recommend either option do so.