First rotation in a field I'm interested in - how to do well?

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LovelyMed

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So I got assigned my first rotation for my 3rd year, in a field I'd like to go into (psychiatry). I'm really nervous because I want to do well, but it'll be my very first rotation ever and I really won't know anything!! Does anyone have any advice for how to rock the first rotation, whether it's something you did or something you would have done in retrospect? Is it unreasonable to hope for a LOR out of someone's first rotation? Any input would be great appreciated, thanks!

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Sure, you're actually poised to do really well because you're enthusiastic and it's early in the year so people understand you don't know much yet. Psych is generally considered an easier clerkship because the overall amount of material to learn is much smaller (compare the size of a psych review book and a surgery review book!). You should have had some psych during M1/M2 covering all the major disorders, personality disorders, defense mechs, etc. You should have also covered the major psych drugs in your pharm course. If you were interested then and really learned the material, then you've already got a great foundation knowledge-wise. The more clinical skills side of things should be taught during your clerkship and obviously you'll want to continue reading and learning.

As far as rocking out a rotation, the rules that apply to one apply to all.
1) ALWAYS be on time. This means early. People senior to you should arrive and find you already there.
2) Express your interest early and tell them you want to see and do as much as possible. You may want to email the clerkship administrator/director and let them know your interest in the field and ask if you could be placed on a busier service that sees a wider breadth of disease. Ask if there are any attendings who particularly like to teach and see if you can get assigned to their teaml
3) Know EVERYTHING about your patients. Know everything that happened overnight, know how many meds they needed, talk to nursing about them, etc. Again, the only way to do this well is get there early enough. I find the easiest way to know stuff about patients is to ask them directly because it sticks in my brain better than just reading it.
4) When there's free time, go spend time talking more with your patients. Psych is definitely a rotation where a med student can help gather important info that directly impacts management decisions.
5) Always be up for working up a new admission or seeing a consult and helping write the note. I find the most valuable thing on clerkships is this part because it's where you learn what disease looks like and how it comes in the door. This is also how all your shelf questions will start, and there's nothing quite like reading a shelf question and recognizing your own patient and knowing you're going to answer correctly.
6) Always ask what else you can do to help. Psych residents are particularly nice about letting students go early, but make sure they know you're really interested in the field and would like to stay and help get work done. Volunteer for any scut work and do it with a smile.
7) That said, if all of your residents tell you there's nothing left to do, no new admissions, and that you need to go home, by all means go home.
8) If there's time and they aren't overwhelmed with their own work, you can ask the intern or resident if you can present to them before the attending gets there. This can be helpful early on when you're learning how to present well.
9) Try and present from memory
10) Always stay in the circle. On rounds, make sure you're always right there in the main circle. Don't be shy and stand/sit off to the side. Be aware of your body language and your location in the space. You don't have to say anything; just being in the circle is another sign that you're interested.
11) Get through 2 different question sources completely. I did lange and pretest and UWorld. Which ones don't matter, just that you get through all of at least 2.
12) Read like a fiend.
13) Absolutely ask for a LOR. Make an appointment to sit down and talk career plans with any attending you feel you really gel with.

Others may have more ideas, but that should get you started. Good luck!
 
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Thank you SO much for taking the time to write such a thorough and helpful post! I really appreciate it and will be doing my best to follow your pointers :)
 
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No problem, happy to help!

One other thing I thought of -- psych management hinges a LOT more on the social history than just about any other rotation, and this is often the part of the history that doesn't get a lot of attention. When it comes to knowing everything about your patients, going back in the afternoons and sitting down and taking a thorough social history and even family history (especially family psych hx and drugs family members tried/liked etc) can be really helpful. Ideally there will be a social worker on the team who is especially good at this and can help you learn what to ask, but you'll look like a star if you know all this stuff when asked. Don't put everything you know in the presentation ("know more, say less" is a good motto), but when the attending wants to know about work history, how he/she gets around, caregivers, daily activities, social circle, sources of support, location of family/friends, etc., you look really good if you know it. I promise you the residents won't know all of this stuff because they're REALLY busy and just don't have time.

I remember one patient who had been in and out of the inpatient psych unit for awhile with a nice laundry list of diagnoses. Another med student had this patient and went and spoke with them at length in the afternoon and learned all about family and other sources and locations of support. When it came time to discharge, due to a few things that I won't go into, this information because REALLY important to the team and the med student looked awesome because he was the only person who had gathered all of this info. Ultimately, the final plan we went with was based on the student's findings and the student came out looking like gold.

Good luck! No matter what you ultimately end up doing, psych is a fun rotation and 100% applicable to any field and life in general!
 
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A good social history is often overlooked and can be an integral part of management for many specialties. Medical students usually have the time to go into these details and it can be very valuable to the team when discussing discharge management.

I recall a patient that had been admitted to our service without a detailed social history and whom needed to go home on long term ABx. Thank goodness the medical student piped up about his IVDU, asking if there would be a problem with him going home with a PICC. Why yes, there would be. :smack:
 
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The above is great advice for nailing any rotation.

The most important thing is to let everyone know that you are interested in this rotation. All the time.
 
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Thank you all, your responses have really helped take away all these jitters I have, and I feel a lot more motivated and excited about starting clinical rotations! :)
 
A good social history is often overlooked and can be an integral part of management for many specialties. Medical students usually have the time to go into these details and it can be very valuable to the team when discussing discharge management.

I recall a patient that had been admitted to our service without a detailed social history and whom needed to go home on long term ABx. Thank goodness the medical student piped up about his IVDU, asking if there would be a problem with him going home with a PICC. Why yes, there would be. :smack:

You mean like when a patient came in with a seizure and no one could figure out why until someone asked if she drinks/how much she drinks and it turns out she'd been drinking a 1/5 of vodka/day for 2 months and was recently laid off the past 4 days so she couldn't afford liquor and said she was just 'having the flu with vomiting'?
 
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Also - play this song every damn time:

 
My wife (psych resident) got a LOR from her first rotation, just as you hope to do. Totally possible. You can always shine as a hard-working all-around-awesome person. That's #1,2,3 for a medical student. Advice above is solid. Interested and pleasant is a big part of the picture. A really good psychiatric interview is a really impressive skill, so try to soak up what you can for your own skillset. For the shelf, I'd recommend First Aid and Case Files, keeping in mind these pearls for the exam.
 
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