How important is it to make a strong impression on off-service rotations?

[Psychferlyfe3000]

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I am wondering how much I should try and take on outside of patient care during my 6 months off-service. I plan to apply to fellowship, so is it important to really blow everyone away during off-service months, or should I invest some energy in research projects and other extra-clinical things? Thank you for your advice sdn!

 

[Mass Effect]

I am wondering how much I should try and take on outside of patient care during my 6 months off-service. I plan to apply to fellowship, so is it important to really blow everyone away during off-service months, or should I invest some energy in research projects and other extra-clinical things? Thank you for your advice sdn!

You should give it your all regardless of what your plans are only for the purpose of doing well in residency. Why wouldn't you? I don't know what you mean by taking stuff on outside of patient care. Like what?

You also don't need research for psych fellowships.

 

[Taddy Mason]

Do a ****ty/half-assed job and you’ll likely gain a reputation. Do a reasonable to good job and don’t be annoying and you’ll be appreciated and likely make friends outside your department. That’s about it.

 

[CalmAndCollected]

I am wondering how much I should try and take on outside of patient care during my 6 months off-service. I plan to apply to fellowship, so is it important to really blow everyone away during off-service months, or should I invest some energy in research projects and other extra-clinical things? Thank you for your advice sdn!

You aren't a medical student who is trying to win over people to get good LoR or good evaluations. During residency, you have set duties and expectations and you should try to fullfill them to the best of your ability. I don't think anyone is expecting you take on duties that fall outside of this even if you are on an in-service rotation (assuming your program isn't too toxic...). You should invest energy in research projects and extra-clinical things if they are of interest and relevant to YOU and YOUR career developement.

Fellowships in general are nowhere near as competitive as residency, and you should have a reasonable access to whatever fellowship you want without having to take on work or research you do not find fullfilling.

 

[FiveTwoFifty]

I wouldn't look at them as separate from your "main" residency. Everything plays a factor in our reviews but especially our perception as a "good" or "bad" resident. Separate from that (and to me, the most important factor): you're only doing this once. I would try to learn as much as you can while you're there - you'd be surprised by how much of that knowledge you'll use later on.

 

[BiscoDisco]

I was wondering about this the other day. I'm halfway through my two required wards months and I can say I feel pretty far behind the medicine interns. I have forgotten so much and it shows. It feels really bad.

On the other hand I am always commended for my level of effort and desire to learn. I get along with everyone I worked with and we joke around and have good convo.

I'm hoping my ability to hold conversation and strong work ethic are enough to keep me in people's good graces. Time will tell.

 

[Bartelby]

Many if not most off-service intern year rotations require pretty much all the time and energy you have anyway. If you have time and energy left over for side projects that is nice, but I wouldn't count on it.

 

[Monocles]

When I was an intern one of our medicine attendings was notorious for being "old school" and loved pimping psych interns and showing off in front of his staff. I knew I wanted to work with kids and teens exclusively and he was fairly offended that I didn't "show enthusiasm" for geriatrics (his supposed passion) or internal medicine in general. One day during the midst of furious typing notes to finish clinic on time (which was already 2 hours behind because attending has no sense of time flow), he goes loudly "hey psych intern, imagine you are running your own practice as an attending, and a patient comes in and says, doc I have COPD. what do you do?"

I stare him right in the eye, say "kids don't have COPD." and go back to typing my notes. Dude's red turned beet red and he looked like he was about to pop an aneurysm. All the other docs and support staff were trying to suppress their chuckles.

I ended up getting three "professionalism" talks from him within a single month. But he couldn't say anything about my clinical skills (did fine with patients) so my PD just laughed during my quarterly eval.

Apparently to this day (four years later), that attending still says "I'm glad to have an intern who is actually interested in medicine" to the new pgy-1s and **** talks about me. lol

 

[Evidence Based]

Medicine months are busy, and you'll be your patients' main physician. Don't half ass it for their sakes. Doesn't mean you have to brown nose your attending or pretend to love renal physiology, but do a solid job and learn some bread and butter IM.
That, and you'll probably be a consultant with these residents and attending later, so it's important to build collegial relationships so they trust your judgment.

 

[adiradirim]

People talk, so if you build up a reputation on an off-service rotation, it can get back to your program director and affect you negatively.

Overall it's most important to show that you're taking it seriously and putting in effort. Nobody will expect you to know everything, but you should be a functioning member of the team.

That said, I'd avoid getting roped into projects you're not interested in. If you seriously have an interest then do it, but don't be anyone's work horse because they just need a warm body to write up a paper. I've had no problems telling them "Sorry, I have too much going on right now to be able to focus on that. Thank you for the offer." They usually don't push it and I've never had anything negative happen. I've even done that in front of my PD when an off service attending asked me to write up a paper for them... lol

 

[clausewitz2]

Do your best and don't be that gal/guy who everyone makes everyone groan when they get assigned to the same call shift. Also don't let them give you all the "psych patients", you have many more years for all that. Get stuck into real clinical medicine as much as possible. They will want to feed you the complicated psychosocial cases and this will feel more comfortable, don't give in.

Generally while you are in training you should run, not walk, towards the thing that makes you uncomfortable or you are feel ignorant about. As a trainee always aspire to be the dumbest person in the room. That's where learning happens.

 

[BiscoDisco]

As a trainee always aspire to be the dumbest person in the room.

No aspiring needed here.

 

[Psychferlyfe3000]

Mainly, I'm referring to research because I want to make that a significant part of my career (not just for fellowship apps). I am also of course not referring to being negligent with patient care, just competent, but maybe, eg, without spending every waking moment outside of the hospital reading up on off-service patient care, but instead doing research things I want to do. But, then again, perhaps that will be necessary just to be competent in the short time I am off-service!

You should give it your all regardless of what your plans are only for the purpose of doing well in residency. Why wouldn't you? I don't know what you mean by taking stuff on outside of patient care. Like what?

You also don't need research for psych fellowships.

 

[Mass Effect]

Mainly, I'm referring to research because I want to make that a significant part of my career (not just for fellowship apps). I am also of course not referring to being negligent with patient care, just competent, but maybe, eg, without spending every waking moment outside of the hospital reading up on off-service patient care, but instead doing research things I want to do. But, then again, perhaps that will be necessary just to be competent in the short time I am off-service!

There's a thin line between negligent and competent and I've found that many interns don't know where that line is. Something to consider.

 

[Evidence Based]

Mainly, I'm referring to research because I want to make that a significant part of my career (not just for fellowship apps). I am also of course not referring to being negligent with patient care, just competent, but maybe, eg, without spending every waking moment outside of the hospital reading up on off-service patient care, but instead doing research things I want to do. But, then again, perhaps that will be necessary just to be competent in the short time I am off-service!

Believe me you are not going to have much time or mental energy to do research on your off-service months unless you are much more motivated AND need much less sleep than the average intern. By the time I got home after my ~12 hour day, all I wanted to do was eat dinner with my wife and maybe watch a movie before falling asleep.

There's a thin line between negligent and competent and I've found that many interns don't know where that line is. Something to consider.

+1. You might think you're dong a good enough job and that when you ask your senior to leave at 4PM no one will notice or care, but you might be wrong. Strive to have nobody know or remember that you're not a medicine intern when you're on the medicine service. Doesn't mean you need to be a brown noser or read every chapter of Harrison's when you get home, but work hard and remember you're going to need this knowledge the rest of your career much more than you'll need to make a little progress on a research project that might slightly help you apply to a fellowship in 4 years.

 

[Taddy Mason]

...Strive to have nobody know or remember that you're not a medicine intern when you're on the medicine service....

This.

 

[samac]

Can I just use this moment to say I'm super scared for my off service rotations? I haven't been on medicine wards since early 4th year and I feel like I know next to nothing now.

 

[BiscoDisco]

Can I just use this moment to say I'm super scared for my off service rotations? I haven't been on medicine wards since early 4th year and I feel like I know next to nothing now.

Don't be scared. I hadnt done inpt medicine since third year. I felt like I knew nothing. Turns out I was right. I actually knew nothing. I was definitely behind the other interns who had been doing this for 7 months already. I compensated by doing little things to help out/working hard, asking insightful questions, and joking around with people and generally being likeable to everyone. If you struggle with this, just ask people questions about themselves and be (or at least act) super interested in what they tell you. In the end that's what people remembered and everything was okay.

It's really amazing how much hard work and a likeable demeanor can make up for such glaring weaknesses. Hopefully that makes you feel at least a little better.

 

[Marasmus1]

You should give it your all regardless of what your plans are only for the purpose of doing well in residency. Why wouldn't you? I don't know what you mean by taking stuff on outside of patient care. Like what?

You also don't need research for psych fellowships.

Depends on where you do your fellowship, I do not think programs like stanford, Yale , Harvard, Johns Hopkins would let anyone in without any research exposure.

 

[Taddy Mason]

Depends on where you do your fellowship, I do not think programs like stanford, Yale , Harvard, Johns Hopkins would let anyone in without any research exposure.

You think wrong. I know residents and fellows at 3 of the above without research or anything particularly unique or outstanding.

 

[Marasmus1]

You think wrong. I know residents and fellows at 3 of the above without research.

That I do not understand. Even the program curriculum says you need to finish minimum one research project before graduating. The ones that I know either have PHD or masters and zillions of papers.

The ones that I know are mainly International Medical Graduates so not sure if it reflects the general population

 

[Taddy Mason]

The ones that I know are mainly International Medical Graduates so not sure if it reflects the general population

There’s your answer.

 

[Mass Effect]

Depends on where you do your fellowship, I do not think programs like stanford, Yale , Harvard, Johns Hopkins would let anyone in without any research exposure.

I personally know two people with zero research experience who did fellowship at one of those institutions within the last 4 years.

 

[Evidence Based]

Can I just use this moment to say I'm super scared for my off service rotations? I haven't been on medicine wards since early 4th year and I feel like I know next to nothing now.

Everyone feels like this when starting internship, including the medical residents. I did my first medicine rotations in August and was worried about it, but it became clear pretty quickly that all the interns were in the same boat. Work hard, do your best, and you'll be fine.

 

[Stagg737]

That I do not understand. Even the program curriculum says you need to finish minimum one research project before graduating. The ones that I know either have PHD or masters and zillions of papers.

The ones that I know are mainly International Medical Graduates so not sure if it reflects the general population

Depending on the program you’re at “research project” may have some very loose definitions.

 

[Monocles]

Can I just use this moment to say I'm super scared for my off service rotations? I haven't been on medicine wards since early 4th year and I feel like I know next to nothing now.

Dude no worries this is like every intern in every specialty ever.

Something that nobody ever tells you is how much of pgy-1 year is learning to put in orders and be a cog in the system. Unlike some of the posters above I loathed anything remotely "medicine-y" and so my three goals during my pgy-1 IM months were

- Do my best to keep patients alive
- Survive the rotation
- Get home early as possible

Somewhere in that order. I found out that interns essentially make virtually close to ZERO medical decisions on a medicine team, and the best thing you could do is to help out the team be as efficient as possible. There will always be seniors (2s, 3s, fellows, attendings) that you can run decisions past.

Your attending will likely tell you what the plan is each morning. If not your senior will and have the attending run by it.

As soon as I figured out the plan for each patient I basically took off sprinting. A lot of it is figuring out where SW is, where the nurses sit, when grand rounds are so I could duck out and get my notes done, etc. I quickly got efficient enough that my notes and orders were finished and ready for co-sign by LUNCH. Then after lunch I would go check on my more unstable patients and update the senior and/or attending, put out fires and make adjustments to the plan if necessary.

During my entire rotation I made sure our team was #1 finished, patients safely and happily tucked in, and I was FIRST IN LINE for sign out to night float so I could sprint out of the hospital at 4:00 on the dot. Towards the end my senior felt comfortable enough with my skills as a glorified EMR monkey that he would go home between 2-3 pm. Were there days where **** hit the fan and all of a sudden a patient deteriorated so I had to stay late? or we get stuck with an attending who is not even halfway through rounds by lunch? yes but rarely.

Through sheer luck, I made it through my IM months without a single patient passing away. Aside from being known as "the psych intern who just wants to survive the rotation", I got along with people, was known as a good team player, and felt like I did the best I could at taking care of patients while (willfully) learning ZERO medicine along the way.

So... your mileage may vary, but there is more than one way to get through your rotations.

 

[CalmAndCollected]

That I do not understand. Even the program curriculum says you need to finish minimum one research project before graduating. The ones that I know either have PHD or masters and zillions of papers.

The ones that I know are mainly International Medical Graduates so not sure if it reflects the general population

Most fellowships programs do not emphasize research. Most fellowship programs focus on clinical competence, although some require QI projects. Not sure what you are talking about when saying "ones I know", though. You mean the fellows you know? Or people you know who have done research?

There's a thin line between negligent and competent and I've found that many interns don't know where that line is. Something to consider.

I would argue there is a large seperation between negligent and competent that is often labeled "incompetent". Negligence is more of an active avoidance of obvious clinical duties. Most people in general are not negligent, nor anywhere near negligent at their jobs, and physicians are no different. I think scaring interns into thinking that being less than competent constitutes as "negligence" will just lead to them feeling hesistant to acknowledge gaps in knowledge in fear of being labeled as "negligent".

 

[Mass Effect]

I would argue there is a large seperation between negligent and competent that is often labeled "incompetent". Negligence is more of an active avoidance of obvious clinical duties. Most people in general are not negligent, nor anywhere near negligent at their jobs, and physicians are no different. I think scaring interns into thinking that being less than competent constitutes as "negligence" will just lead to them feeling hesistant to acknowledge gaps in knowledge in fear of being labeled as "negligent".

Might want to wait til you actually start residency before making this claim.

 

[Taddy Mason]

I would argue there is a large seperation between negligent and competent that is often labeled "incompetent". Negligence is more of an active avoidance of obvious clinical duties. Most people in general are not negligent, nor anywhere near negligent at their jobs, and physicians are no different. I think scaring interns into thinking that being less than competent constitutes as "negligence" will just lead to them feeling hesistant to acknowledge gaps in knowledge in fear of being labeled as "negligent".

There’s quite a bit of overlap between negligence and incompetence.

 

[CalmAndCollected]

Might want to wait til you actually start residency before making this claim.

I have already done an intern year in my home country and worked as a doctor prior to coming to the USA. I have also worked in non-medicine fields. I can count very few people who have been negligent. Of course, I assume I am still younger than you, and I might have been lucky to be exposed to different quality of physicians and workers than you have, leading to different view-points.

In general I think we should be able to recognize and address gaps of knowledge openly without beating ourselves up over being “negligent” for doing so. I also often find that people who are so quick to judge others on their gaps of knowledge often have difficulty recognizing their own knowledge gaps, which can lead to toxicity and unhealthy competition.

There’s quite a bit of overlap between negligence and incompetence.

I’ll give you that much. An “all negligent interns are incompetent, but not all incompetent interns are negligent” sort of thing.

 

[Mass Effect]

I have already done an intern year in my home country and worked as a doctor prior to coming to the USA. I have also worked in non-medicine fields. I can count very few people who have been negligent. Of course, I assume I am still younger than you, and I might have been lucky to be exposed to different quality of physicians and workers than you have, leading to different view-points

I am fresh out of training, so no it isn't that you were exposed to a "different quality of physicians" based on age. I have no idea what happened in your country, but might want to wait until you hit graduate medical training in the US before making bold statements like that.

In general I think we should be able to recognize and address gaps of knowledge openly without beating ourselves up over being “negligent” for doing so. I also often find that people who are so quick to judge others on their gaps of knowledge often have difficulty recognizing their own knowledge gaps, which can lead to toxicity and unhealthy competition

Gaps in knowledge is not the same as negligence. You can have tons of gaps in your knowledge without being negligent. Likewise, you can be a walking, talking medical textbook and still be negligent. You're debating an issue you don't even understand.

 

[CalmAndCollected]

I am fresh out of training, so no it isn't that you were exposed to a "different quality of physicians" based on age. I have no idea what happened in your country, but might want to wait until you hit graduate medical training in the US before making bold statements like that.



Gaps in knowledge is not the same as negligence. You can have tons of gaps in your knowledge without being negligent. Likewise, you can be a walking, talking medical textbook and still be negligent. You're debating an issue you don't even understand.

I'm sorry, I'm not sure what you are trying to say here. Maybe our definitions of negligence are dissimilar? My understanding of negligence in medicine would be deviating from what a reasonable healthcare professional would do in a given situation. I am arguing that most interns would act as reasonably as would be expected of a healthcare professional at their level, and therefore, would not be negligent.

I also brought up the point that I am concerned that being quick to label people as "negligent" can make it difficult for them to admit mistakes or gaps of knowledge, out of fear to being labeled "negligent", as I personally believe that this is not an ideal environment for a trainee.

Your only reply to this is telling me my opinion is less valid than yours because I have not completed training in the USA, which while true, completely diminishes my experiences in training in my own country as well as any experiences I have had in the medical system in the USA up to this point. I even offered the potential explanation that I might have been lucky to have been exposed to trainees who were not negligent and this has given me an overly positive world-view of the medical field.

Maybe you are arguing that you feel trainees in the USA are very likely to be negligent? My experience in the both the USA and outside the USA is that trainees in general act reasonably, but maybe being more immersed in residency in the USA will prove to me otherwise as you say.

 

[Mass Effect]

I'm sorry, I'm not sure what you are trying to say here. Maybe our definitions of negligence are dissimilar? My understanding of negligence in medicine would be deviating from what a reasonable healthcare professional would do in a given situation. I am arguing that most interns would act as reasonably as would be expected of a healthcare professional at their level, and therefore, would not be negligent.

I also brought up the point that I am concerned that being quick to label people as "negligent" can make it difficult for them to admit mistakes or gaps of knowledge, out of fear to being labeled "negligent", as I personally believe that this is not an ideal environment for a trainee.

Your only reply to this is telling me my opinion is less valid than yours because I have not completed training in the USA, which while true, completely diminishes my experiences in training in my own country as well as any experiences I have had in the medical system in the USA up to this point. I even offered the potential explanation that I might have been lucky to have been exposed to trainees who were not negligent and this has given me an overly positive world-view of the medical field.

Maybe you are arguing that you feel trainees in the USA are very likely to be negligent? My experience in the both the USA and outside the USA is that trainees in general act reasonably, but maybe being more immersed in residency in the USA will prove to me otherwise as you say.

All interns have gaps in knowledge. That's why an attending overseas them. An interns negligence tends to happen on routine everyday stuff that isn't always run by the attending first, not due to gaps in knowledge that an attending would likely catch. When your goal is simply competence (which is a goal no intern should aspire to), it is easy to be negligent without realizing it.

You're seeing a patient on the wards. Later, you get paged that the patient has a headache. You tell the nurse to give him Tylenol. Since your goal is only competence, you hang up the phone and you're done. Except, the patient's allergy list has Tylenol listed. You missed it, not due to gaps in knowledge, but because your goal is only competence and you're ready to call it a day so you can work on the stuff you actually want to do, like your research.

Another one - when I was an MS3, I showed up for morning signout. An intern on the inpatient psych unit had been paged overnight about a patient who wasn't feeling well. This patient was very personality disordered and often threw herself on the ground and moaned and groaned only to recover a few minutes later when staff paid her attention. On that evening, the intern was paged around 3 am and told the patient wasn't feeling well and was diaphoretic and nauseated. The intern ordered something for her nausea, but didn't go down to examine the patient and didn't even order vitals. Luckily, the nurses got vitals and EKG on their own. Patient had an MI as the intern went back to sleep. On morning signout, the resident was clearly not happy that he hadn't been woken during all this and that the intern didn't even ask for vitals and didn't bother to examine the patient. The patient was transferred to medicine obviously and did well.

Both of these cases are negligence and neither is due to lack of knowledge, but lack of effort. Granted, the above can happen to residents and attendings too. But when you're an intern, you're more prone to mistakes, which is why you should strive for more than just competence and give it your all on whatever rotation you're on.

 

[CalmAndCollected]

All interns have gaps in knowledge. That's why an attending overseas them. An interns negligence tends to happen on routine everyday stuff that isn't always run by the attending first, not due to gaps in knowledge that an attending would likely catch. When your goal is simply competence (which is a goal no intern should aspire to), it is easy to be negligent without realizing it.

You're seeing a patient on the wards. Later, you get paged that the patient has a headache. You tell the nurse to give him Tylenol. Since your goal is only competence, you hang up the phone and you're done. Except, the patient's allergy list has Tylenol listed. You missed it, not due to gaps in knowledge, but because your goal is only competence and you're ready to call it a day so you can work on the stuff you actually want to do, like your research.

Another one - when I was an MS3, I showed up for morning signout. An intern on the inpatient psych unit had been paged overnight about a patient who wasn't feeling well. This patient was very personality disordered and often threw herself on the ground and moaned and groaned only to recover a few minutes later when staff paid her attention. On that evening, the intern was paged around 3 am and told the patient wasn't feeling well and was diaphoretic and nauseated. The intern ordered something for her nausea, but didn't go down to examine the patient and didn't even order vitals. Luckily, the nurses got vitals and EKG on their own. Patient had an MI as the intern went back to sleep. On morning signout, the resident was clearly not happy that he hadn't been woken during all this and that the intern didn't even ask for vitals and didn't bother to examine the patient. The patient was transferred to medicine obviously and did well.

Both of these cases are negligence and neither is due to lack of knowledge, but lack of effort. Granted, the above can happen to residents and attendings too. But when you're an intern, you're more prone to mistakes, which is why you should strive for more than just competence and give it your all on whatever rotation you're on.

I’m sorry you had to see those experiences. I agree that not reporting important information to attendings and not doing a proper follow-up when paged about a patient is negligent. I guess I was lucky that I have been exposed to trainees who haven’t done that or been in places where attendings or more experienced residents were more easily available.

 

[Mass Effect]

I’m sorry you had to see those experiences. I agree that not reporting important information to attendings and not doing a proper follow-up when paged about a patient is negligent. I guess I was lucky that I have been exposed to trainees who haven’t done that or been in places where attendings or more experienced residents were more easily available.

This isn't a me thing. The point in telling you that is that there's a thin line between "just competent" and negligence. As an intern, you're more prone to errors and you should be giving your all.

That's my final word on this subject.

 

[CalmAndCollected]

This isn't a me thing. The point in telling you that is that there's a thin line between "just competent" and negligence. As an intern, you're more prone to errors and you should be giving your all.

That's my final word on this subject.

I don’t think the examples you presented refer to someone being anywhere near “just competent”. I guess my final word on the matter is that I believe most medical professionals (trainee or otherwise), don’t make grossly uninformed medical decisions nor refuse to inform other physicians of important and vital information.

If were to explore this a bit more, I would wonder what failings exist in the system these interns are practicing in. How was a someone able to order Tylenol that was in the patient’s allergy list? Did he not send an order through the EMR? If he did, why did he not get an allergy warning? And if he got no allergy warning, why didn’t that information get registered during the patient’s intake? And in general, why did this intern work in an environment where he couldn’t or wouldn’t investigate this? It sounds a bit like there are many systematic failings that should have been in place to prevent this mistake from happening. A root cause analysis would reveal that, assuming all blame wouldn’t just go to the intern without further exploration.

To your second example, as well; why did the intern not receive pertinent information that made this clear of the severity during the call from the nurse? Why was the EKG order reliant on an intern or nurse wanting it to happen rather than it being an automatic response to chest pain? Why was the information of the EKG not then shared with the intern, resident, or attending after it was found? Maybe the culture in this hospital is to penalize interns for “unnecessarily” calling attendings or other residents? Maybe the patient had an atypical heart attack with mild symptoms and the intern made an appropriate clinical decision at the time, but was then not told of a patient’s further presentation or decompensation that would have changed his course of action? Isn’t the above likely considering she was medically stable (on a psych floor), female, and likely younger than your average hospital patient population? Maybe her psychiatric disorder made it difficult for her to communicate symptoms as well?

I guess the point I an trying to make is that these errors arise in these complex systems due to failures on multiple levels, and I wouldn’t generally blame the intern any more than I would the nurse or the attending. I don’t think interns should feel the need to shoulder the burden of a failing system (nor should any medical professional) and the expectation that they should overcompensate at their levels for deficiencies in other levels is completely unreasonable. Supervising authorities have to share blame with their subordinate for a mistake that could have been prevented with reasonable supervision as well.

But that is all a subject for a different time and thread.

 

[Psychferlyfe3000]

Do you have any examples of how you've used that knowledge later on? I feel as though this might be the most motivating thing to know!

I wouldn't look at them as separate from your "main" residency. Everything plays a factor in our reviews but especially our perception as a "good" or "bad" resident. Separate from that (and to me, the most important factor): you're only doing this once. I would try to learn as much as you can while you're there - you'd be surprised by how much of that knowledge you'll use later on.

 

[FiveTwoFifty]

Do you have any examples of how you've used that knowledge later on? I feel as though this might be the most motivating thing to know!

For sure! I work with a county population ... and psychiatry can often be one of the few medical professionals patients see. Keeping tabs on routine chronic medical conditions can be lifesaving for patients. Our inpatient unit is also separate from our main hospital system and knowing some general things from medicine wards has been helpful in managing medical conditions while people are inpatient (with internal medicine help, of course). Routine things like diabetes management, patients with new hypothyroidism, syphilis treatment, etc. etc.

I think a big area where it has been helpful is in consult work. One CL service we have is at a quaternary hospital so people are typically highly medically complex... meaning, if you need to use psychiatric interventions, you have to consider more than just if their kidney or liver function is normal. Knowing the language, being able to sift through the information, and keep on top of all of the medical management that is ongoing with your patients - all of this was more helpful having gone through medicine wards.

Nothing earth shattering and if it comes down to having to manage a medical condition, you're likely to get internal/family medicine involved anyway. But there's an extra level of absorbing knowledge/practice quirks that comes with being an intern vs. medical student on wards that I didn't really appreciate. Going through the slog that is the off-service months is tough but given that you're the main one ordering things, coming up with plans with the senior, implementing them, etc. - there's a higher level of retention there. And it's satisfying when you're on CL the next year and you realize you can focus more on the psych aspect of things and not be bogged down by trying to learn what's happening medically (or neurologically).

Hang in there! It will be tiring and you won't have time for much else. Learn what you can and you may find it coming up again in the not too distant future. 🙂

 

[Psychferlyfe3000]

Thanks for the response! Definitely good to know because, where I went to med school, I never saw attendings or residents managing anything but psych meds (never did CL either), so it wasn't immediately obvious as to why IM knowledge was useful.

For sure! I work with a county population ... and psychiatry can often be one of the few medical professionals patients see. Keeping tabs on routine chronic medical conditions can be lifesaving for patients. Our inpatient unit is also separate from our main hospital system and knowing some general things from medicine wards has been helpful in managing medical conditions while people are inpatient (with internal medicine help, of course). Routine things like diabetes management, patients with new hypothyroidism, syphilis treatment, etc. etc.

I think a big area where it has been helpful is in consult work. One CL service we have is at a quaternary hospital so people are typically highly medically complex... meaning, if you need to use psychiatric interventions, you have to consider more than just if their kidney or liver function is normal. Knowing the language, being able to sift through the information, and keep on top of all of the medical management that is ongoing with your patients - all of this was more helpful having gone through medicine wards.

Nothing earth shattering and if it comes down to having to manage a medical condition, you're likely to get internal/family medicine involved anyway. But there's an extra level of absorbing knowledge/practice quirks that comes with being an intern vs. medical student on wards that I didn't really appreciate. Going through the slog that is the off-service months is tough but given that you're the main one ordering things, coming up with plans with the senior, implementing them, etc. - there's a higher level of retention there. And it's satisfying when you're on CL the next year and you realize you can focus more on the psych aspect of things and not be bogged down by trying to learn what's happening medically (or neurologically).

Hang in there! It will be tiring and you won't have time for much else. Learn what you can and you may find it coming up again in the not too distant future. 🙂

 

[FiveTwoFifty]

Thanks for the response! Definitely good to know because, where I went to med school, I never saw attendings or residents managing anything but psych meds (never did CL either), so it wasn't immediately obvious as to why IM knowledge was useful.

Makes sense! And just to uber clarify: on inpatient, we are making regular use of our in-house internist - so not flying by the seat of our pants or doing something not in our wheelhouse. 🙂 And on CL, we provide recommendations only for psychiatric management. But I found the best learning cases were those that were medically complex. So your awareness and knowledge of what was going on with them medically (including why the primary team was choosing the management they were choosing) was highly relevant to our work for the psychiatric issues.

And then there are times that the teams decide not to implement our recommendations... and chaos ensues that makes you think even harder! 😉