IM portion of psychiatry

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sara1234

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hi guys.....for those who i know.....most psychiatry programs have 4 monthes internal medicine and 2 monthes neurology before going to psychiatry.....I wonder does the psychiatry resident has the same responsibilites as the internal medicine resident?......will he be on call ? will he be under the supervision of internal medicine residents or work independently? Im asking this question because i hate IM so i just want to finnish these 4 monthes quickly and i dont need to study and read hard for IM?
ANY FEEDBACK
 
Different programs are different. Most seem to have you integrated as an official medicine intern...which can really suck. You'll take their call, carry the same amount of patients, and be expected to know just as much. You're essentially divorced from the psych department for that amount of time, and you're stuck with being all things medicine.

Other residencies have specialized medicine rotations for psychiatry residents. Still others put a cap on the amount of patients, or something similar. I think that is relatively rare though.

In my program, you're 100% medicine for those four months. Q3-4 nightmare calls, enough scut to choke a horse, and in some cases, larger caseloads than even the internal medicine interns.

Medicine sucks, but it's a necessary evil to be able to fully understand how to be a doctor and feel comfortable dealing with medical problems for the rest of your career, both on and off the wards, clinics, and private practices. Besides, your medicine months will help you greatly in dealing with step III.
😀
 
sara1234 said:
hi guys.....for those who i know.....most psychiatry programs have 4 monthes internal medicine and 2 monthes neurology before going to psychiatry.....I wonder does the psychiatry resident has the same responsibilites as the internal medicine resident?......will he be on call ? will he be under the supervision of internal medicine residents or work independently? Im asking this question because i hate IM so i just want to finnish these 4 monthes quickly and i dont need to study and read hard for IM?
ANY FEEDBACK
Click to expand...

As with Anasazi23's response, it varies from program to program (and at some programs, you may be able to do pediatrics instead of IM). At my program, for good or ill you are generally treated like the IM & peds interns. Haven't heard any feedback from any of the IM higher-ups, but several of my friends who are peds residents or who graduated from the peds residency tell me that the peds seniors generally liked having psych interns on their teams because the psych interns were generally of high quality. (That will of course depend also on your program. If the program you end up at is generally regarded as a not very competitive storehouse of lower quality applicants relative to the IM & peds programs, then the IM & peds services may be less than enthusiastic about having psych interns on their teams.)

Also, not all psychiatry residency programs require 4 months of inpatient IM. UCSF, for example, only has 1-2 inpatient IM months, and the rest of the 4-month "medicine" requirement is fulfilled with a mix of ER and outpatient IM rotations.

-AT.
 
Thanks for your reply...I dont know why they expect from psychiatry resident to know as much as the IM resident.....I agree with you about what you mentioned about feeling comfortable about dealing with patients in general and in step 3 but Im escaping from IM to psychiatry because I dont want to deal with IM cases......the other thing is that do you think fresh graduate who just finnish medical school will be able to deal with IM cases especially the mergency ones .....what I know is that IM residents needs at least one year with hard studying to get used to the system and the routine of dealing with each case.e.g ..indications of admisions..emergency cases..prescribing medications for common IM cases....I dont KNOW what a psychiatry resident gonna do in 4 monthes.....THIS IS JUST CONFUSING FOR ME
 
sara1234 said:
Thanks for your reply...I dont know why they expect from psychiatry resident to know as much as the IM resident.....I agree with you about what you mentioned about feeling comfortable about dealing with patients in general and in step 3 but Im escaping from IM to psychiatry because I dont want to deal with IM cases......the other thing is that do you think fresh graduate who just finnish medical school will be able to deal with IM cases especially the mergency ones .....what I know is that IM residents needs at least one year with hard studying to get used to the system and the routine of dealing with each case.e.g ..indications of admisions..emergency cases..prescribing medications for common IM cases....I dont KNOW what a psychiatry resident gonna do in 4 monthes.....THIS IS JUST CONFUSING FOR ME
Click to expand...

You will need to know a core base of medicine in order to be an effective psychiatry resident. Especially for your inpatient psych rotations. And especially for your C-L rotations.

Generally speaking, all interns are clueless right out of the gate. So psych interns should be on equal footing with the IM interns. Of course, as the years go on and the IM residents accumulate a broader knowledge base in medicine and gain experience managing sicker patients, then no, folks should not expect psych residents to know as much as IM residents. But I think it is reasonable for seniors to expect the same competencies of the psych interns as the IM interns.

If your school does not require medical students to do a sub-I in medicine, I would suggest that you sign up for one.

-AT.
 
well im not saying psych residents are of lower quality than IM residents some of them are even better.....and i definitely agree that i need to learn the basic medicine to be able to deal with psych patients later on.....but you are saying i must learn....how do you expect me to deal with IM cases independently if im learning.......and what if my judgement was not right.....here is the real proplem IM an old graduate and i have been away from the inpatient/outpatient for 7 years doing basic reasearch.........Im also IMG which means i dont know the exact system here and the names of medication and ....etc.......so that is why i dont feel comfortable dealing with a patient independently in these sophisticated IM cases........Im not going to psychiatry for this reason of course...i love it...but that is my proplem
 
You will be a medical intern. You won't manage cases independently. You'll do what your resident tells you, and you'll do minor stuff on your own. You're not there for your brain the first year, but for your scut-ability and ox-cart.

Nobody's gonna drop you off with a floor full of end-stage AIDS patients, COPDers, chest pain pts. and SOBs. Although the latter is likely true under a different moniker.

By the end, you'll be comfortable dealing with these, but not at the beginning on your own.

You'll be ok.
 
sara1234 said:
well im not saying psych residents are of lower quality than IM residents some of them are even better.....and i definitely agree that i need to learn the basic medicine to be able to deal with psych patients later on.....but you are saying i must learn....how do you expect me to deal with IM cases independently if im learning.......and what if my judgement was not right.....here is the real proplem IM an old graduate and i have been away from the inpatient/outpatient for 7 years doing basic reasearch.........Im also IMG which means i dont know the exact system here and the names of medication and ....etc.......so that is why i dont feel comfortable dealing with a patient independently in these sophisticated IM cases........Im not going to psychiatry for this reason of course...i love it...but that is my proplem
Click to expand...

I'm not sure if this is helpful...At my institution (I'm a 4th-y med. student), we've had a few psych residents in their intern year who had been away from medicine for a few years. Others on the medicine teams and neuro. teams knew this and treated them with more "kid gloves" then the rest of the interns--they got more supervsion and less pimping then the rest! Can't say the scut work was any less, though. 😉
 
In my program, we do one month of IM inpatient and three months of IM outpatient clinics.

I just did my IM inpatient month in September. I did not look forward to it, and now that I'm done, I thank my lucky stars I didn't go into medicine every time I see a haggard, sleepless medicine intern come to the psych ward for a consult. 🙂

If you have to do more than one month of inpatient IM, I'm so sorry. It can literally be hell for a psych intern.

During my month, I had a good resident, he was tough but he gave me (and the other intern) direction when we needed it. The best (and rare) thing about him was his philosophy that the care of every patient on his team reflected upon the resident. And he made sure every patient was well taken care of, and that we were doing the right things. That is pretty much the key, if you have a good resident you should learn and have fun. If your resident isn't interested in the patients, and wants to go off to sleep on call and not be called down, you will have a harder time.

Over all, it's the one rotation most psych intern dread, but for me it was only a month (and I counted the days), now it's over. I really feel bad for those medicine interns sometimes... :scared:

Addendum: Let me add this about preparation for the rotation. I only found out on the 27th of the month that I would be starting IM due to a last minute schedule change. I almost wanted to start an SSRI (WITH loading dose) lol. So I didn't have time to prepare, but you might want to pick up your washington manual and read up on Pneumonia, SOB, COPD, MI, Cardiology, GI bleeds, AND DIABETES. Jeebus christ every single patient of mine had DIABETES I cursed that disease every day! Read up on controlling glucose levels. Pancreatitis and liver failure wouldn't hurt too, and review your ACLS. You most likely won't be running a code, but you may participate in one or two..or three or four LOL...I hate medicine.
 
Solideliquid said:
In my program, we do one month of IM inpatient and three months of IM outpatient clinics.

I just did my IM inpatient month in September. I did not look forward to it, and now that I'm done, I thank my lucky stars I didn't go into medicine every time I see a haggard, sleepless medicine intern come to the psych ward for a consult. 🙂

If you have to do
Click to expand...

I'll never forget my internal med experience. Some of the hardest nights of my life...deciding which person will receive emergent treatment first when you have 3 people near crashing, isn't the best feeling. And solide's right. If you have an unhelpful resident, it can be hell. Oh yeah, and while all this is happening, you have 12 medication orders that need to be evaluated and changed (you don't know any of the patients since you don't carry them), and 4 admissions waiting with two more on the way, 2 deaths to pronounce in hospice, 3 irate families that want to ask the Dr. why their mother's diaper isn't changed, a nurse that can't get an IV on the 96 year old rehab patient on the PM&R floor, and more.

Fun, fun.

But Solide, I seem to remember that psychiatry does not allow "non-continuous care" rotations as medicine. I'm too lazy to look up the requirements now, but I don't think outpatient clinic for that length of time is even allowed. Technically, I was told that we can't even do ER, as this is not continuous care medicine. My understanding was that outpatient clinic was not acceptable either. I'm sure none of your graduates have licensing problems, but it might be worth it to check it out on the residency guidelines.
 
Anasazi23 said:
But Solide, I seem to remember that psychiatry does not allow "non-continuous care" rotations as medicine. I'm too lazy to look up the requirements now, but I don't think outpatient clinic for that length of time is even allowed. Technically, I was told that we can't even do ER, as this is not continuous care medicine. My understanding was that outpatient clinic was not acceptable either. I'm sure none of your graduates have licensing problems, but it might be worth it to check it out on the residency guidelines.
Click to expand...

News to me. Most psych residencies have residents working in family medicine or internal medicine or even peds outpatient clinics for a few months.

On the other hand, we were just inspected by the ACGME, I think. We passed so...



Here is PGY-1 from Morehouse SOM

This is a transitional year during which residents complete two months of inpatient medicine at Grady Memorial Hospital, two months of outpatient clinical experience in the Department of Family Medicine and two months of Neurology. Residents complete a six month rotation in psychiatry at the Central Alabama Veterans' Healthcare System in Tuskegee, Alabama which include inpatient, outpatient and geriatric psychiatry training.
 
I don't doubt that residencies are doing this.

Here's the link to the training requirements in psychiatry:
http://www.acgme.org/acWebsite/downloads/RRC_progReq/400pr1104.pdf

I had heard, and I could be completely wrong, that continuous and comprehensive medical care constitutes inpatient medicine or pediatrics. This is the rationale for allowing only one month of ER training, according to the guidelines.

However, you're probably right in that they probably consider family medicine to be continuous comprehensive medical care. Though it's certiainly not anywhere near as comprehensive as internal medicine overall.
 
At my program, we do 2 months of inpatient medicine (or peds, depending on your preference), one month of adult or peds ER, and one month of a medicine specialty like endocrinology or whatnot, which may include some outpatient. I'm doing palliative care for my specialty month, which is new this year - a combination of inpatient consults and outpatient clinic, and is very well-liked by the psych interns who have done it so far.

And as others have said, you are expected to know as much as a medicine intern, which early in the year isn't a whole heckuva lot. I suspect the disparity increases later on in the year, so I'm glad I'm getting mine out of the way early. At my program, there are one and two intern teams, and they make it a point to put rotating interns from other services like psych and OB on the two intern teams, as well as FMG medicine interns who are new to the system, which is nice because your cap is a couple patients less than for one-intern teams. And they don't pimp you in conference because the faculty doesn't know your name. But otherwise you're treated just like any other medicine resident.

Day to day life kinda sucks, but you learn a lot, so it's worth it, and it makes you that much more grateful there are people out there who want to do this every day for 3 years of residency so you don't have to. 😉 I don't think substituting some of the inpatient medicine with outpatient is an entirely bad idea though, since most of us will end up with mostly outpatient practices and thus be dealing with mostly outpatient medicine problems as well. I hope to god I never have to do a paracentesis in my office!

And I agree with whoever said to do a medicine sub-I if you're not already required to do so. At my med school, we were required to do 2, which of course I grumbled about a lot at the time, but ultimately I was very well-prepared.
 
A psych resident here at Wake told me that they don't do any inpatient IM or Peds. All outpatient. If you want to avoid dealing with inpatient, think about applying here. I'm pretty sure they are IMG friendly too since it is a non-competitive program and last year had to scramble for one or two residents. The worst call here is first year Q7-Q10.
 
At my program, which a pretty competitive one in the northeast, we do 6 months of medicine (including ICU). Yeah, everyone complains about it...but I feel like we're that much more prepared when taking call, handling issues on the inpatient units, taking step III, and moonlighting. I didn't want to have to feel that I was paging the medicine team for every little medical issue coming up on my patients. To be honest, programs with the barest minimum of medicine training kind of scared me...
 
THank you guys for your input.....all of this led me to another question.....if for some reason i dont get a match this year...do you guys advise me to apply for the transitional year.....i will get more experience in medicine and i will be in a team or with a resident to help me.....is this year counted for the training in IM if i wana go to psychiatry....I mean will i enter to psychiatry as second year or i have to start again from the begining just like all psych residents.....is it late now to apply for this year......do they pay them the same money as residensts.....thanks
 
I have the same sentiments about doing IM-my god I can hardly imagine having to do ICU-I just do not think it is fair since those going into IM generally do lots of electives, sub-is in IM and ICU so would know how to handle these-v. psych hopefuls, atleast in my case have done all psych electives or super cush electives in neuro or something.

Anyway I like UCI's flexibility-you can either do
-2 months IM inpatient and 2 months Peds inpatient
-2 months IM inpatient and 2 months IM outpatient
-2 months IM inpatient, 1 month ED, 1 month peds inpatient

Personally I do not think 2 months in patient and 2 outpatient would be bad. I actually enjoy outpatient medicine. And 2 months inpatient is less than I did in medschool and it went by quickly so to me that is far.
 
okay I have applied for 10 programs in pscyhiatry and recieved rejection from 2 until now....all of them in texas and new york......although it is too late to apply now but i want to give it a shot and apply for another 10-20 now.....but i just want to apply for these so called IMG-friendly hospitals....can anybody tell me some of these hospitals please .....I dont want to waste my money on those programs who do not even look at my application...........
 
I know all the programs in Phoenix, arizona, which is kind of near texas-not sure what texas and NY have in common. But there are 2 programs in phoenix that are extremely IMG friendly. Good luck
 
Sazi,

From the pdf you posted (thanks, BTW):

"First Year of Training
A psychiatric first postgraduate-year must include at least 4
months in internal medicine, family practice, and/or pediatrics.
This training must be in a clinical setting which provides
comprehensive and continuous patient care."

So now then, how does the last line mean only inpatient rotations? It seems to be open to interpretation. Anyway, as long as the ACGME approves the program we are OK right? ....right? lol
 
Solideliquid said:
Sazi,

From the pdf you posted (thanks, BTW):

"First Year of Training
A psychiatric first postgraduate-year must include at least 4
months in internal medicine, family practice, and/or pediatrics.
This training must be in a clinical setting which provides
comprehensive and continuous patient care."

So now then, how does the last line mean only inpatient rotations? It seems to be open to interpretation. Anyway, as long as the ACGME approves the program we are OK right? ....right? lol
Click to expand...

It definetly does not have to be all inpatient-evidenced by what I posted-you can check out UCI's site and a couple others I have ran across and they clearly give you options-one of which is having 2 inpatient and 2 outpatient months-so definetly not a must. Man I hate inpatient anything.
 
Solideliquid said:
Sazi,

From the pdf you posted (thanks, BTW):

"First Year of Training
A psychiatric first postgraduate-year must include at least 4
months in internal medicine, family practice, and/or pediatrics.
This training must be in a clinical setting which provides
comprehensive and continuous patient care."

So now then, how does the last line mean only inpatient rotations? It seems to be open to interpretation. Anyway, as long as the ACGME approves the program we are OK right? ....right? lol
Click to expand...

Yes, I think that either you're completely right, or that this isn't enforced. Or both. I had heard from a PD that outpatient medicine isn't considered "continuous care." That statement, according to him, was to mean care on a daily basis, assuming a relatively stable turnover to allow continuity. The ER, for example, doesn't allow for this...hence you're only allowed one month of it.

Believe me, if I had the opportunity to do a month of outpatient medicine instead of 3 months of medicine floors (I did one month of ER med), I would have.

A month of outpatient htn, dm, asthma, viral syndromes, cerumen disempaction, etc, with no long notes, no call, relatively little pimping, simple and fun procedures, over ABGs, CP and SOB workups, and the myriad other miseries of inpatient medicine? Sign me up. Although, when I did family med in med school, I grew tired of that too.

I had the exact thoughts as what was outlined above, "Thank God other people like this, so that I don't have to do it."

Yes, you'll graduate and be fully board eligible. I'm sure of it. :laugh:
 
Anasazi23 said:
Believe me, if I had the opportunity to do a month of outpatient medicine instead of 3 months of medicine floors (I did one month of ER med), I would have.
Click to expand...

Sazi, are you saying this b/c you think outpatient is more practical for psychiatiry or b/c inpatient just sucks? Or both...
 
maranatha said:
Sazi, are you saying this b/c you think outpatient is more practical for psychiatiry or b/c inpatient just sucks? Or both...
Click to expand...

Is it just me or didnt he make it pretty clear-there is no call, no pimping, no long hours, no crappy procedures/tests (just the fun easy ones) and in genereal it is easy. that is my take-have you not done any outpatient medicine and thought all of the above was true-I dont think he cared if he saw one psych patient that month-he enjoyed it cause it was easy-I guess not all of us always need a reason to enjoy something easy-atleast I dont
 
Braingames said:
Is it just me or didnt he make it pretty clear-
Click to expand...

OOOK..Kinda of tough crowd 🙂 I'll rephase what I was really getting at:

Anyone that is either an attending or psych resident, which is more useful for future psychiatry practice, outpatient or inpatient medicine?
 
maranatha said:
OOOK..Kinda of tough crowd 🙂 I'll rephase what I was really getting at:

Anyone that is either an attending or psych resident, which is more useful for future psychiatry practice, outpatient or inpatient medicine?
Click to expand...

Interesting question. And of course, you could argue either way.

I think that ultimately, FP is sorta like medicine-lite. For all intents and purposes, family med is probably more practical, as we're less likely to be dealing with more severe inpatient medicine issues while in practice. This is less true in hospitals, but still. I'm not going to treat acute cholecyctits by myself. But I will manage some patients with DM, HTN, psoriasis, some derm conditions, some endocrinological conditions, neuro, etc.
 
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