We have required psych and VA/behavioral related rotations during PGY-2 or 3 years depending on the schedule and the way one schedules things. Admittedly, given my specialty switch, it has been pushed to PGY-3 (current year).
I'd venture to say that I definitely have lots of experience with depression, anxiety and some bipolar patients. However, when it comes to bipolar and schizophrenia, we should not be actively involved in managing the patient. We should be ensuring compliance and stability, but the psychiatrist should be on board in the outpatient setting. If they aren't, I do whatever I can to ensure the patient is plugged in with a provider and in the interim do what is needed in the form of scripts, labs, social worker involvement, and at least ensuring a psychologist is involved in that person's care. We are not trained in dose titrations of anti-psychotics or mood stabilizers and we should not be doing them just because of lack of access in care. That is in the domain of psychiatry. I do not see neurologists starting and uptitrating on dosages despite being similarly boarded to psychiatrists "ABPN"
It is difficult to be able to manage complicated psych issues in a 15 min visit when you are also managing other medical problems that may also exist. My main issue with these patients is med non-compliance and at that point I really stress the importance of compliance and ensure there are no associated symptoms like sucidality/risk of harm with hallucinations and if so then I BA-52 them and refer to the ED for further eval and inpatient care.
Vascular surgery is key especially for outpatient management. I did a brief wound care rotation not for the inpatient experience but rather for the outpatient experience so I may adopt what I learned from the specialist to my own practice. Opthalmology, ENT, urology, etc. same way. Having had anesthesia experience, I can pretty much answer a lot of my patients' questions about the surgery (and the anesthesia), inform them what to take and not take, do appropriate preop testing as indicated, etc. I also have a general idea of when to refer to gen surg or another surgeon sub-specialist if needed, etc. A lot of times, if the patient wants a surgical opinion, I won't deny them that option. If they are that passionate about it, so be it. I can only counsel them and guide them, but I will not deny them their options. I will however put in that the patient requested a surgical opinion for a certain diagnosis.
I have derm coming up. I plan to set up some cosmetic rotation if possible for a week just to get a feeler for what they do. Also, I am looking forward to my GYN rotation coming up in a few months since I want more experience when it comes to perimenopausal patients and hormones. I often prescribe non-hormonal agents for symptoms and will provide estrogen creams or tablets if lubricants fail. However, I do want more experience from the experts.
Will I ever look to perform a c/s? No. Colonoscopy? No. Appy? No. It's good to have some experience, that's not the point of surgical rotations.
The point of psych rotations is to be able to appropriately manage bread and butter issues, assess for mental disorders, assess for stability of symptoms and recognizing when a patient is not stable, know the side effects of meds and what the various options are. However, it is not for us to start adjusting dosages of psych/mood stabilizing meds with regular reassessment follow-ups. That is on the psychiatrist. Just like operative management is on the surgeons.
At the end of the day, my goal is to be as close to being a "one shop doc" when it comes to medical issues. My goal is DPC. I don't want my patients seeing a specialist for every issue unless they need to.