What do you want out of your psych rotation?

[Nasrudin]

I'm a resident who will be with a few medical students on my next block. I specifically chose a less academic program because I don't like formal academics--culturally or practically. But am in the position of being with a few medical students regardless.

I love psych. I want you to have enough respect for my field to not consult me for a crying patient. I'd love for you to want join the field. But I would never hold it against you for not.

I don't mind brushing up on few shelf-worthy topics to present a few key things to you. I don't care if you want to go home early. I did. Still do, but can't. I'll try to send you home early as often as possible.

How do I puncture the facade of med student fake interest to get to a point where we can both get something we want. I just want to facilitate that process quickly. You're presence slows me down more than anything. So all I want is to deliver a good bargain between us and keep it moving.

What do you want out of this rotation? And how do we figure that out quickly and get to it?

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[Psai]

I thought that the most important thing I learned in a psych rotation was when to consult psych. Next most important was how to take a better history, especially the social history. Learned how to read brain MRIs a little better, maybe you can go through the differences between t1, t2 and all that because I suck at that. Also understanding meds, especially for depression because everyone and their mothers is on an ssri. Besides that, I just wanted to go home early but never did.

 

[J ROD]

I am a 4th yr going into Psychiatry so I have a different perspective. I love Psy and will only do that.

But, I think as a recent 3rd yr that just completed his Psy rotation within the last 3 months. I will say overall the best thing you can do is teach and show things that will come up most often in say IM/FM. Like depression, anxiety. I would also do some bipolar/schizo. Meds in Psychiatry are key. I think it is very important to teach as much as you can about those. Especially side effects. Also, depending on what area you are in with these students, appropriate consulting is good too.

To keep the students off your nerves, let them come in and do what they need to and then let them go. Don't make them write notes or just hang around. Let them round and go home. And get the feel for doing a Psy interview.

 

[Law2Doc]

i think for those going into other fields the most useful thing one can get out of ones psych rotation are some interesting stories. You won't remember much of the details from your med school rotations-- in a matter of months after the match it's all a blur--, but you will remember some of the more outlandish patients.

 

[RustBeltOnc]

I thought psych was great. I elected not to do 2/2 the ol' "consult liaison" component of the training. All students who like the specialty need to know "the whole deal" about the residency.

 

[URHere]

Psych is a great rotation for medical students to learn how to take a difficult history (with patients who are tangential and difficult to direct) and to learn how to break bad news. (Or to learn how to tell a violent patient that they are being discharged. Tactfully.) Those skills are all vital.

Sure, you get some of this on medicine, but telling someone they've had a first break of schizophrenia seems worse to me than telling someone they have cancer. These are difficult things for students to learn.

Don't compromise your patients by letting students do this if they aren't ready and don't care, but I would suggest talking through these scenarios with the students on your service, and letting them steer these conversations whenever you can.

 

[Cytarabine]

-ability to take an adequate social history

-ability to do an adequate MSE

-ingrain criteria for MDD, manic episode, bipolar I, adjustment disorder, bereavement vs MDD, ADHD, GAD

-assessing suicidality / homicidality and when to file a PEC

-antidepressant selection, stimulant selection, dosing adjustments, important side effects

-when to consult / refer to psychiatry vs ology vs SW

Basically, I think a student should come out of psychiatry with skills necessary to handle bread and butter primary care psychiatry issues

 

[Nasrudin]

thanks y'all.

Great stuff here. I'll just select some things from these lists and go for it. Also I think doing interviews is a great idea. Notes, less so. Plenty of time for busy work later. And the interview won't be a complete waste of my time either. Might help me refine my own technique by discussing their's afterwards.

 

[grt398]

From someone going into a surgical subspecialty: I had a great attending for the consult part of my rotation who asked what I was going into, then tried to focus it appropriately on things like post-op delirium, how to properly assess it, as well as options for treatment etc. It was extremely helpful and I truly appreciated it. I also thought learning to assess suicidality etc was quite useful.

 

[Snorfelkack]

What do you want out of this rotation? And how do we figure that out quickly and get to it?

I finished my psych rotation a few months ago and honestly felt it was JUST okay. I went in excited about Psych but the experience was definitely lacking.

I rotated through a private inpatient hospital without residents and a relatively small population. I spent most of the day in groups or writing notes. The one time I was about to get to do an interview I got pulled for my midterm eval.

The only real time I had with the docs was if I had a question about a case and could catch one of them or during treatment team with the nurse, social worker and attending. One of the attendings made a point to explain certain disorders and answer questions, but the rest pretty much ignored students. I kind of got the feeling that they didn't really want us there. BUT after talking with one of the other attendings, he said that the students often have a "deer in the headlights" look or just generally appear like they don't want to be there. So in their defense I'm guessing they've just gotten used to having students with little to no interest.

I would have loved to have been more hands on and go more in depth. One thing I think would have helped would have been the docs assuming that we had a baseline of psych knowledge instead of trying to explain everything like we had never used big grown up words before. I don't mean this in a rude way, it just seemed like they expected students had no knowledge of the specialty. I would have liked to cut out the Psych 101 stuff and skip to the nitty gritty.

I also think that no matter what specialty students choose, the Psych rotation can be invaluable if you take advantage of it.

 

[Nasrudin]

I finished my psych rotation a few months ago and honestly felt it was JUST okay. I went in excited about Psych but the experience was definitely lacking.

I rotated through a private inpatient hospital without residents and a relatively small population. I spent most of the day in groups or writing notes. The one time I was about to get to do an interview I got pulled for my midterm eval.

The only real time I had with the docs was if I had a question about a case and could catch one of them or during treatment team with the nurse, social worker and attending. One of the attendings made a point to explain certain disorders and answer questions, but the rest pretty much ignored students. I kind of got the feeling that they didn't really want us there. BUT after talking with one of the other attendings, he said that the students often have a "deer in the headlights" look or just generally appear like they don't want to be there. So in their defense I'm guessing they've just gotten used to having students with little to no interest.

I would have loved to have been more hands on and go more in depth. One thing I think would have helped would have been the docs assuming that we had a baseline of psych knowledge instead of trying to explain everything like we had never used big grown up words before. I don't mean this in a rude way, it just seemed like they expected students had no knowledge of the specialty. I would have liked to cut out the Psych 101 stuff and skip to the nitty gritty.

I also think that no matter what specialty students choose, the Psych rotation can be invaluable if you take advantage of it.

That's a terrible rotation. As much as I prefer working environments that are pure clinical operations these make for terrible rotations for students. You really need the type of people who prefer to educate around in excess and this only happens at big university programs with attached medical schools.

 

[quickfeet]

I finished my psych rotation a few months ago and honestly felt it was JUST okay. I went in excited about Psych but the experience was definitely lacking.

I rotated through a private inpatient hospital without residents and a relatively small population. I spent most of the day in groups or writing notes. The one time I was about to get to do an interview I got pulled for my midterm eval.

The only real time I had with the docs was if I had a question about a case and could catch one of them or during treatment team with the nurse, social worker and attending. One of the attendings made a point to explain certain disorders and answer questions, but the rest pretty much ignored students. I kind of got the feeling that they didn't really want us there. BUT after talking with one of the other attendings, he said that the students often have a "deer in the headlights" look or just generally appear like they don't want to be there. So in their defense I'm guessing they've just gotten used to having students with little to no interest.

I would have loved to have been more hands on and go more in depth. One thing I think would have helped would have been the docs assuming that we had a baseline of psych knowledge instead of trying to explain everything like we had never used big grown up words before. I don't mean this in a rude way, it just seemed like they expected students had no knowledge of the specialty. I would have liked to cut out the Psych 101 stuff and skip to the nitty gritty.

I also think that no matter what specialty students choose, the Psych rotation can be invaluable if you take advantage of it.

They didn't even let you interview patients?
Why are they even a teaching affiliate?
Isn't this a mandatory part of the M3 curriculum set by LCME? Or do they think you pay them to shadow all day

 

[notbobtrustme]

a good SSRI dartboard

 

[Oo Cipher oO]

One of the more useful things I learned on my psych rotation was the many ways organic illness can mimic or invoke mental illness. Very applicable in different medical fields.

 

[hmockingbird]

I just got off my psych rotation. I agree with a lot of the other posts but in terms of notes, the one thing I found really useful was how to write up a good MSE. That will be useful for certain patients in other specialties, so knowing what to include (and drilling it by writing it up for multiple patients) was helpful for me.

 

[Kaustikos]

The best? Make them pick topics and teach it to each other. Have informal lectures reviewing things.
Have them identify which personality disorder they have lol
But the topics and teaching were money. Especially since we split patients and didn't experience all the pathologies.