Way to Study for 6 months of med internship for psychiatry residency

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murmurhum

murmurhum

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I intend to apply to psychiatry residency for the 2010 match. I've been out of medical school for about 10 years, doing work in a medically-related field and teaching at a few institutions.
I've talked to some folks from a few residencies, and basically I think I make a strong candidate.
The piece of the puzzle that I want to put together before I begin interviewing is being able to show that I'm ready for ward medicine for the six months of internship required in Psychiatry. The rest of the residency doesn't concern me - psychiatry is what I'm interested in and I think my background and knowledge-base is just fine.
Does anyone know of a test that I could prepare for that shows competence in all the areas required to do just fine as a medical intern? Not blow the doors off, not show that I'm ready to become an internal medicine resident or a hospitalist, but just be competent and fulfill the requirements of the program.
Internal Medicine part of the boards II might be a place to start. Seems too broad-based though. Does anyone know of an institution that prepares students for internship year with any kind of coursework, and especially testing of some kind?
Since money and time are presently on my side, I've even thought about crazy ideas like hiring an attending to test me on my knowledge-base of whatever body of knowledge would be required. (e.g. MGH pocket Handbook by Sabatine, etc.) Seems like something creative like that might fit the bill.
Don't want to learn too much, but definitely don't want to enter unprepared. Most importantly, I want to be able to succinctly show programs that I have this knowledge covered to their satisfaction.

Thanks,
Murmurhum
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Did you ever take Step 3? You only have 7 years to complete the Step 1-3 cycle although many states will extend that to 10 years for MD/PhDs.

Being 10 years out of medical school, it would appear that its been more than 7 years since you've taken Step 1 and 2. Check here for each state requirement on the time frame:http://www.fsmb.org/usmle_requirementschart.html

If you are licensed, there are some steps to measure clinical competence (but you have to have an unrestricted medical license AFAIK): http://www.fsmb.org/m_plas.html
 
Hey W. Scap
Thanks for the tip. I went to Medical school in Washington State, where, according to the site you linked me to, there is "No limit for first takers of USMLE Step 3 (see instructions for specifics)".

If I match to a residency program outside of Washington State, do I still sit for step 3 under the auspices of Washington State licensing? When I talked to my med school, they didn't see this as a problem- wondering what you know.

Thanks,
Murmurhum
 
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murmurhum said:
Hey W. Scap
Thanks for the tip. I went to Medical school in Washington State, where, according to the site you linked me to, there is "No limit for first takers of USMLE Step 3 (see instructions for specifics)".

If I match to a residency program outside of Washington State, do I still sit for step 3 under the auspices of Washington State licensing? When I talked to my med school, they didn't see this as a problem- wondering what you know.

Thanks,
Murmurhum
Click to expand...

You can sit for Step 3 under the auspices of any state you want. But if you want a license in a specific state, you need to go by their rules. As such, you are limited in the states in which you can train and ultimately practice. Your profile states that you're MD/PhD which may help you out in some places as most states allow for an extension in their time limit if you're MD/PhD and some states waive the limit altogether.

Ignoring waivers though, you can get a license in the following states (assuming you pass Step 3 and do the appropriate amt of PGY training for that state):
DE, FL, KY, LA, NE, NH, NY, PA, VA, WA and WY

States that may or do provide waivers include:
AL, MA, MO, MT, ND, OR and TX

That still leaves you a reasonable number of places you could train and practice but it cuts you out of >60% of the states. Not a deal breaker, just something to be aware of because you will NOT EVER be able to get a license in states not listed above.

Since you will not be able to get a license in other states, training programs will likely be loathe to have you, especially if the program, or the state, requires you to have a full medical license during your training.

I'm not trying to talk you out of anything here but you should know that this is not necessarily going to be a cakewalk, at least from the bureaucratic side of things.
 
gutonc said:
That still leaves you a reasonable number of places you could train and practice but it cuts you out of >60% of the states. Not a deal breaker, just something to be aware of because you will NOT EVER be able to get a license in states not listed above.

Since you will not be able to get a license in other states, training programs will likely be loathe to have you, especially if the program, or the state, requires you to have a full medical license during your training.

I'm not trying to talk you out of anything here but you should know that this is not necessarily going to be a cakewalk, at least from the bureaucratic side of things.
Click to expand...


Thanks for the good info. In the part where you say: " ... training programs will likely be loathe to have you, especially if the program, or the state, requires you to have a full medical license during your training." are you referring to all training programs, or just training programs in states where I could never be licensed?

i.e. in Washington state, if I did a residency there, and could get fully licensed there, wouldn't that training program be behind me b/c I would be able to practice in the area they serve (Washington state)? Likewise, the other states you list would be in a similar position, and not otherwise prejudiced to my candidacy...?

Trying to take this all in,
Murmurhum
 
murmurhum said:
Thanks for the good info. In the part where you say: " ... training programs will likely be loathe to have you, especially if the program, or the state, requires you to have a full medical license during your training." are you referring to all training programs, or just training programs in states where I could never be licensed?
Click to expand...

gutonc is right on. What he/she is referring to is that one of the first rules of any residency is that you have to be eligible for a medical license in the state.

Some programs REQUIRE that you have an unrestricted license during residency, others only require a training license. If you are not eligible for any license, programs are not likely to offer you a position as you would not be able to work. This is only for states in which you are not eligible for a license.

i.e. in Washington state, if I did a residency there, and could get fully licensed there, wouldn't that training program be behind me b/c I would be able to practice in the area they serve (Washington state)? Likewise, the other states you list would be in a similar position, and not otherwise prejudiced to my candidacy...?
Click to expand...

If you are eligible for a license (and it sounds as if you would be in Wash State), then the issue of licensing would not contribute to any prejudice.
 
murmurhum said:
i.e. in Washington state, if I did a residency there, and could get fully licensed there, wouldn't that training program be behind me b/c I would be able to practice in the area they serve (Washington state)? Likewise, the other states you list would be in a similar position, and not otherwise prejudiced to my candidacy...?

Trying to take this all in,
Murmurhum
Click to expand...

See WS's comment above but basically, yes. If you can get a license in that state, you shouldn't have any problem getting a training program in that state. You will however need to convince any program that a 10y gap in your training won't be a problem or that you can overcome it.

Finally, just something else to be aware of is that (based on a quick FRIEDA search), you will be limited to a total of 53 programs (1/3 of them in NY) to which you can apply (of 180 psych programs). May not be a big deal for you but it certainly lowers your odds.
 
I've received some good advice on this thread, and I'm still out there asking the question, pounding the virtual pavement of the internet.

This came across in an email yesterday, from a PAID service for IMG's:

I do not see a reason for restricting your search to the states that allow more than 10 years between the steps. This restriction applies to permanent licensing only and does not affect in-training licenses.

While in residency and preparing for Step 3, you may consider retaking Step
1 and 2 clearing your way to permanent license in any state.


So, now I'm wondering where the real truth lies. I've tried calling USMLE and NRMP a few times, but can't get anyone authoritative on the phone. Next up I think I'll try to work some of my connections to talk with PD's who can tell me how they would look at my case.

But the question now crops up: will programs in states where I can't currently get licensed still look at me? (I s'pose I'll find out soon enuf) and can I (masochist hat firmly on) retake boards 1, 2 3 at a future date to open up my licensing options to more states?

Inquiring minds want to know!

Murmurhum
 
murmurhum said:
But the question now crops up: will programs in states where I can't currently get licensed still look at me? (I s'pose I'll find out soon enuf) and can I (masochist hat firmly on) retake boards 1, 2 3 at a future date to open up my licensing options to more states?

Inquiring minds want to know!

Murmurhum
Click to expand...

I actually did not know about this (and I imagine many others don't as well) but here's a quote from the USMLE FAQ about Retakes:
http://www.usmle.org/General_Information/bulletin/2008/eligibility.html#tl
If you pass a Step or Step Component, you are not allowed to retake it, except to comply with the time limit of a medical licensing authority for the completion of all Steps or a requirement imposed by another authority recognized by the USMLE program for this purpose. The medical licensing or other authority must provide information indicating that you are applying to retake the passed Step or Step Component in order to comply with its requirement. If you are repeating a Step or Step Component because of a time limit, you may apply to retake the examination only after the applicable time limit has expired.
Click to expand...

So yes, you could re-take the Steps if you wanted to but I actually can't imagine anything more painful than taking those over again.

As far as whether programs will look at you because of the time between Steps, I'd be more worried that they won't look at you because of the time since med school. I understand you've been doing related work but 10 years is a long time to be out of med school and they may be more concerned that you won't have the necessary clinical knowledge and skills.

Your situation is pretty unique so I would recommend sending some emails to Psych PDs at a variety of programs (do it now, before the poop hits the fan in a month when ERAS opens again) and see what they think. After that...just do it. Residency apps border on free (compared to the rest of this process) so just run a bunch of apps up the flagpole and see who salutes.
 
RE: licensing

I suppose that it may be true that the licensing restrictions are relevent to full and unrestricted licenses, my worry would be that you would be required, by a residency program to have the full and unrestricted license and/or a DEA by the time you were Chief resident.

My program required that any Chief in house after hours had one, because the interns were always forgetting to get scripts from attendings for those patients being discharged after hours.

So the in-training license is fine, but if you program requires more, then it still won't help. I'd contact some programs and see what they think about this issue and retaking the Steps. (ughh..doing Step 1 again.)
 
Thanks to everyone following this thread and helping me think this through. I just had lunch with a prof. of Psychiatry at one of the upper tier residencies. Interesting. As far as the 10-year absence from hospital-based clinical medicine, this prof. didn't think it was a problem. He himself had taken 10+ years to do his PhD (as part of his MD/PhD) and so considered my case to be not outside the range of normal.
In fact, he told me that if I wanted a spot in this particular residency, he would pretty much make it happen. Very reassuring for me. May or may not come through, but it shows that these things can happen through personal connections and not through the more impersonal screening tools like the ERAS app and board scores, etc.
In case of point, this same prof. had taken his step 1 & 2 boards over again because of the years required for his PhD. He had never heard of anyone else, *ever*, doing the same thing, and didn't wish it on me or his worst enemy. Luckily in my case, so it seems, if I pursue residency in the states without a time limit, I should be ok without retaking steps 1 & 2.

Feeling encouraged,
Murmurhum
 
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