Interested in child psych...peds first year?

[CIO316]

Hi All,

I'm a current psych applicant who was originally going to apply into pediatrics but decided child psych is the way I want to go. On the interview trail, I've noticed a range in the pgy1 offering of pediatrics from none at all to the whole year (two years if you do triple board). I ultimately want to work with chronically ill kids with psychosocial issues so I'm wondering others thoughts on how beneficial it is to have a clinical foundation in pediatrics before delving into the psych/child psych world.

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[maranatha]

If you know you want to do child psych, I would recommend getting as much exposure to children and adolescents as you can. I think, however, that unless you have a clear reason to do the triple board (i.e. want to work as a pediatrician or only focus on an area of child psych such as eating disorders), that you're much better off going to a program that lets you do peds as an intern and then move into the traditional route of adult psychiatry then a child fellowship. I'm not in the triple board, so take this with a grain of salt. But I think the triple board is a bit overkill and you will actually loose valuable training in basic psychiatry. I'm just not sure how one can be adequately trained in adult psych, child psych, and pediatrics in 5 years.

 

[GmailQueen]

I'm also interested in Child and am confused about the whole peds vs medicine thing as well. I've had program directors tell me that they choose not to offer peds during intern year b/c they feel that medicine prepares you better for the nights that you're on call and you're the only doctor (ie, you know how to run a code/do lifesaving techiniques), and because it makes C/L and taking care of adult inpatients easier because you understand adult medical problems and how to manage them. (Whereas, in contrast, a lot of children only have acute medical problems, such as infections, or if they have a chronic condition it's asthma, so they're not as medically complicated as adults and you learn less). However, I also think that exposure to "normally developing" children during intern year would be helpful prior to exposure to children with developmental and psychiatric problems, to help clarify what normal is, and to get used to working with kids.

Are there any residents who did peds rotations instead of medicine rotations and felt at a disadvantage because of it?

 

[atsai3]

I'm also interested in Child and am confused about the whole peds vs medicine thing as well. I've had program directors tell me that they choose not to offer peds during intern year b/c they feel that medicine prepares you better for the nights that you're on call and you're the only doctor (ie, you know how to run a code/do lifesaving techiniques), and because it makes C/L and taking care of adult inpatients easier because you understand adult medical problems and how to manage them. (Whereas, in contrast, a lot of children only have acute medical problems, such as infections, or if they have a chronic condition it's asthma, so they're not as medically complicated as adults and you learn less). However, I also think that exposure to "normally developing" children during intern year would be helpful prior to exposure to children with developmental and psychiatric problems, to help clarify what normal is, and to get used to working with kids.

Are there any residents who did peds rotations instead of medicine rotations and felt at a disadvantage because of it?

If you can go halvsies (half inpatient peds, half inpatient adult med), then I would do that. At UW, the interns can choose the number of peds months vs. number of medicine months.

Your inpatient peds experience will be pretty useless on call and on consults.

-AT.

 

[Regnvejr]

We had 4 mth. 2 mth Neuro, and electives IM and/or peds. I did use my Peds to really figure out how pediatricians think and work. And I really didn't use my IM very much. You do not typically learn codes on IM rotations, you do not end up doing that much intense medicine as a resident either (At least I didn't, but we had an IM residency on site as well, so they did all of that).

Peds is something I have used a lot more during and after residency. After all you'll get a lot of their kids if things end up strange. When I came here, the first thing that happened was that a local Pediatrician referred the 6 autistic kids that he had cared for over several years. And did a pretty good job with, btw. So having at least some exposure to Peds will help you sort through past treatments and why Pediatricians do thinkgs the way they do.

 

[Thorazine]

id recommend doing some adolescent medicine if you can. helpful to introduce you to the medical side of eating disorders, medical workups for new onset psychosis, etc.

 

[DrLady]

Thought I'd chime in with my 2 cents...

I'm a psych intern who will be pursuing a career in child psych, and who recently finished her adult (only) medicine rotations. IMHO, if doing some peds is an option during your medicine rotations, take advantage of that. But adult medicine is really the more important skill at this point in training, because when the inpatient psych nurses call you at 2AM because so-and-so is having chest pain, it's really important that you know how to appropriately manage that patient.

You'll have plenty of exposure to both "normal" and abnormal child development during C&A fellowship, and it seems to me (based on my multiple child psych rotations) that a lot of your diagnostic skills in child psych come from seeing and recognizing the same types of behaviors and symptoms over and over.

Bottom line, not having an option to do a month or two of pediatrics as an intern shouldn't be a deal-breaker!

 

[psychotrope]

I'm also interested in Child and am confused about the whole peds vs medicine thing as well. I've had program directors tell me that they choose not to offer peds during intern year b/c they feel that medicine prepares you better for the nights that you're on call and you're the only doctor (ie, you know how to run a code/do lifesaving techiniques

someone who does 2 months of inpatient IM as an intern(which is about the average for psych interns....yes I know some programs require at least 3 or even 4 months of inpatient IM, but some also require 0 or 1) probably isn't going to be super proficient at running codes or doing lifesaving techniques....at least not from those couple of months as a medicine intern on wards.

 

[psychotrope]

Thought I'd chime in with my 2 cents...

I'm a psych intern who will be pursuing a career in child psych, and who recently finished her adult (only) medicine rotations. IMHO, if doing some peds is an option during your medicine rotations, take advantage of that. But adult medicine is really the more important skill at this point in training, because when the inpatient psych nurses call you at 2AM because so-and-so is having chest pain, it's really important that you know how to appropriately manage that patient.

An upper level psych resident told me that when it comes to chest pain patients on the psych floor, initially divide them into three groups:

1) very high risk(ie it just looks like the person is having an MI based on a classic presentation)
2) low to moderate risk(probably msk or reflux or malingering, but you still get an EKG and cardiac enzymes on the psych floor, which doesnt require a lot of thought)
3) extremely low risk and even a non-medical person could see it's probably nothing

For the first group(which will obviously be the least common on a psych ward), immediately call the IM on call team or night float and get them down...even before you order anything.

For the second group, contact medicine if something is wacky with the enzymes or the patient seems to be getting worse.

For the third group, don't order an immediate cardiac workup and just have someone contact you if they seem to be getting worse or the pain doesn't go away.

 

[Saluki]

Are there any programs other than MGH that let you do a full intern year in peds?

 

[maranatha]

Are there any programs other than MGH that let you do a full intern year in peds?

The only other one that I'm aware of that lets you do all peds is the combined Adult/Child Psych program at UMass. I think most of the other programs that allow you do do peds instead of medicine still have you do adult neuro.

 

[billypilgrim37]

Are there any programs other than MGH that let you do a full intern year in peds?

They don't really "let" you. They have two slots for a track that allows it. Those two slots are the two most competitive slots in all of psychiatry, and I'm fairly sure they have only gone to HMS grads since they started the track a few years ago.

 

[Saluki]

They don't really "let" you. They have two slots for a track that allows it. Those two slots are the two most competitive slots in all of psychiatry, and I'm fairly sure they have only gone to HMS grads since they started the track a few years ago.

That's really disappointing. I had gotten the impression from their website that you applied to MGH general psychiatry program and that if you got in you had the choice of whether you wanted to do it....

 

[CarleneM]

Hey guys- I haven't posted in awhile but got a PM that directed me to this thread. Anyways, I'm currently an intern in the MGH/McLean 5 year child track and am happy to answer any questions that anyone has.

The program is only 2 spots and while for the past 2 years they have gone to HMS grads, this is not always the case and I would encourage anyone interested to apply and to do an away elective in psych @MGH (child or adult). This year, intern year is 9months of peds, 1 month of adult neuro and 2 months of adult psychiatry. However, next year the intern year will be 8 months of peds, 1 month of adult neuro and 3 months of adult psychiatry. There is a year long child neurology continuity clinic as part of the intern year as well, which has been an awesome experience.

Regarding lack of exposure to adult medicine- Because I anticipated doing a peds intern year, I loaded up the end of 4th year of med school with adult electives such as Emergency Medicine and geriatric medicine and got ACLS certified through my school. Also, the adult neuro month at MGH is on an inpatient service with medically complicated adult patients so you get exposure to managing them prior to being in situations where you are the only medical doctor on the floor. I think its great to be able to do a combo of peds and medicine but its also nice to feel like I'm a part of the pediatric residency this year and really get a solid pediatrics foundation. Also, I'll be taking step 3 at the end of the intern year so I'll be reviewing a bunch of adult medicine.

Some of the other non-triple boards programs that allow peds exposure in the intern year are Brown, umass, and UCLA. I'm sure there are others but those are the ones that come to mind. And of course Yale, but that's through their 6 year research track. Also, I know in the past a resident at MGH did some months of peds during intern year as part of the regular non-child track but I'm not sure if that is an option that would be open to anyone in the program. Its certainly worth asking the program director about at whatever programs you are looking at.

Oh, and when you apply to MGH/McLean, its one application for both the child and regular track. Then, if you get offered an interview you indicate whether or not you are interested in the child track so they will set up interviews accordingly. When you go to rank, there are two separate rank numbers for the adult and child tracks and you can rank both or one.

 

[GmailQueen]

Brown, Yale integrated and WPIC allow you to replace all medicine months with peds months. Penn, UMD, Duke and Harvard Cambridge allow you to replace at least one month of medicine with peds.

 

[CarleneM]

That's really disappointing. I had gotten the impression from their website that you applied to MGH general psychiatry program and that if you got in you had the choice of whether you wanted to do it....

Just to be clear- when you rank the MGH program there are separate rank numbers for the child track and the adult program so you can rank one or both however you like. If you match into the adult program, you can express a preference for medicine at Newton Wellesley or medicine at MGH but you are not guaranteed to get that either as there are only 4 MGH medicine spots.

I don't know why the past two years have been all HMS but the years above are not like that. I know one current PGY-3 went to Yeshiva, one PGY-4 went to Yale, etc. I would guess it has to do with just being known to the program so if you do a rotation at MGH or McLean and ask to meet with Dr.Beresin(child director) and Dr.Sanders (adult director) during your away rotation, this can be very helpful when it comes time to apply.

 

[psychdrop]

Unrelated but wanted to share my joy of finding my calling to do c/a!! Took me over a year of residency but I am loving my experience in child this year and am so happy. Whoo! I did some peds in 1st year (I was leaning the c/a way) and felt that was valuable.

 

[CarleneM]

Unrelated but wanted to share my joy of finding my calling to do c/a!! Took me over a year of residency but I am loving my experience in child this year and am so happy. Whoo! I did some peds in 1st year (I was leaning the c/a way) and felt that was valuable.