The skillset of a succesful PGY3 and 4

[thepoopologist]

What is a "good" PGY3 or a PGY4 for that matter? I guess I'm wondering what I should be aiming for to feel confident in myself when I am sitting across the table from a prospective employer. I'd like to do inpatient and/or CL combo. Should I moonlight to sharpen the skills? Does moonlighting experience matter when I start looking for post-residency jobs? Part of me wants to, part of me does not because I enjoy my free time.

Good:
I've been fairly successful with my PGY1 and 2 psychiatry rotations and have seen a lot of good outcomes from my efforts. I've had a good experience teaching students in a clinical environment, and can walk into a room with a white board and teach them about fundamentals of psychopharm, the major disorders, psychology, and then some without any prep. I think a lot of it can be attributed to reading my ass off my 1st two years.

Bad:
I carry around a template that I use to review diagnostic criteria with patients. I wonder if it is a crutch
I am sometimes called out on basic medications, i.e. Tegretol and osteoporosis, which a patient pointed out to me the other day. CYP450 interactions between medications sometimes escape me, i.e. Strattera and Zoloft
I do not have the exuberance and natural interpersonal skills my co-residents have. My attendings will tell me when I fumble over my words and of course I self flagellate.
I sometimes wonder if I am too conservative with my approach, "wait and see" or too vague with my diagnoses "mood disorder" vs. "depression."

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[thepoopologist]

I don't know why I started this thread. I guess I'm wondering how I'm going to hang when I graduate.

 

[Shikima]

You'll be fine, keep diagnosing people correctly rather telling everyone they have bipolar. Keep developing your knowledge and start to figure out where you'd like to live and what jobs are available in that market.

 

[notdeadyet]

Re: moonlighting- for most positions suitable for new graduates, you won't need to have moonlighting gigs on your resume. That said, if confidence is one of your issues (and by your report it appears to be), moonlighting can be a big help. Regardless of how independent you may feel as a PGY-3 or PGY-4, you operate in the cradle of your program. At an external moonlighting gig, you are expected to be actually independent. A good gig may do wonders for developing your clinical confidence in a lower stress environment (since you don't have to go there every day).

Re: carrying around templates- yes, it is a crutch. But crutches are good things. You will likely reach a point where you realize you don't need them, but I don't think there's any particular reason to force the issue. I still carve out a cheat sheet when I'm discussing a diagnosis with a patient I don't meet every day. For the common ones, making out a few flash cards to commit things to memory is a good idea.

Re: drug-drug interactions- you need to know these or at least know how to know these. As you practice independently, people will not necessarily be looking over your shoulder to check your medication combinations. Again, a few flash cards go a long way (and you'll need to know the biggies for your board exam anyway), and a app on your phone will handle the rest.

A healthy dose of imposter syndrome is normal. You'll gain skills with time. You're still in training, so you're not expected to be the finished product you will be one day. Work hard and give it time.