No, not the DSM. That obsession largely ends with clerkship. Once you get into residency and have learned the basic diagnostic criteria, you don't think about it much.
If you are at a decent program, residency IS largely what you put into it. And by decent, I mean just that: a residency that is not poor. A residency that has a decent amount of different inpatient and outpatient services, approachable faculty, and is used appropriately by the system/university.
What you put into it means that you don't just sit passively and wait for someone to anoint you a great psychiatrist. You seek out to answer questions by lit searches and reaching out to those in the know. You stay late as needed to help with a particularly challenging case. You select some cases that particularly speak to you and go above and beyond. You get involved in services and offerings you may have few chances to outside of residency.
Psychiatry, in my mind, is one of the easiest specialties to do poorly and one of the hardest to do well. Folks can take a suicidal patient, ask SIGECAPS, and throw an SSRI at him. Or you can do more and actually be a good psychiatrist. Do it with passion, creativity, and intensity and you can be a great psychiatrist. The top programs often attract top applicants because of the nature of things, but an ambitious and insightful resident at a solid community program will turn into a better psychiatrist if they give it their all than will a resident of the same talent who coasts through doing the bare minimum at MGH.
Make sense?
