4th Year Electives Question

[RaistlinMajere]

Hi all,

I'm planning out my schedule for 4th year and have a question. One of the psych attendings at my school mentioned that I should try to take a neuroradiology clerkship during 4th year. To do so means that I would need to take radiology first, then advanced radiology (where I would elect to do 4 weeks of neurorad). I'm interested in radiology and obviously it will be important for intern year and beyond. Or instead, should I focus on taking psych electives in those 2 blocks? I could take Adult ER Psych and Child Psych in the place of the 2 radiology clerkships. I'm already definitely doing a psych sub I, a psych C/L rotation and a psych sub I away rotation (3 rotations).

Thanks for your advice.

---

Members don't see this ad.

 

[diosa428]

Hi all,

I'm planning out my schedule for 4th year and have a question. One of the psych attendings at my school mentioned that I should try to take a neuroradiology clerkship during 4th year. To do so means that I would need to take radiology first, then advanced radiology (where I would elect to do 4 weeks of neurorad). I'm interested in radiology and obviously it will be important for intern year and beyond. Or instead, should I focus on taking psych electives in those 2 blocks? I could take Adult ER Psych and Child Psych in the place of the 2 radiology clerkships. I'm already definitely doing a psych sub I, a psych C/L rotation and a psych sub I away rotation (3 rotations).

Thanks for your advice.

Can you take neurorads somewhere else? Our school doesn't require prereqs like that (not necessarily saying you should come here, or that I even know if we offer it to outside students, but perhaps you can find somewhere else that will allow you to take it without all those extra electives).

 

[sunlioness]

You have the rest of your life to do psychiatry and will repeat those things as a resident anyway. On the other hand, it's kinda your last chance to try something different.

 

[RaistlinMajere]

You have the rest of your life to do psychiatry and will repeat those things as a resident anyway. On the other hand, it's kinda your last chance to try something different.

You've hit upon something that I've been wrestling with internally. On the one hand, I can't wait to immerse myself in the psychiatry. On the other, I think it's important to give weight to new and possibly unrepeatable experiences. My current schedule is a nice mix of both. Wasn't it Aristotle who said "happiness is the mean?" I'm leaning towards keeping my schedule the way it is.

Thanks for the advice.

 

[RaistlinMajere]

Can you take neurorads somewhere else? Our school doesn't require prereqs like that (not necessarily saying you should come here, or that I even know if we offer it to outside students, but perhaps you can find somewhere else that will allow you to take it without all those extra electives).

An interesting point. I'm not sure what my school's policy is on away rotations. I'm already planning one in psych. I'll look into it. Thanks.

 

[manwhoisthursdy]

Wasn't it Aristotle who said "happiness is the mean?"

Yes it is ... well actually I think he said virtue is the mean and happiness comes from being virtuous.

He also said that you can only know a man was happy after he's dead .

(Clearly for Aristotle happiness is not a mood state.)

 

[LadyGrey]

Neurorads seems like a strange suggestion to me for psych. I found my two weeks of general rads (required) fun and generally useful in other rotations (CXRs in medicine, mammos in surgery), but do psychiatrists often need to look at head MRIs and CTs?

Also, three psych electives is already a lot of psych! We can't do more than two electives in a given field, and I assumed other schools would have similar limits, so no residency can expect you to have done huge amounts of psych before you get there.

 

[billypilgrim37]

do psychiatrists often need to look at head MRIs and CTs?

Yeah, we usually just order them so we can crap ourselves when they come back with something crazy and consult neuro/neurosurg/podiatry, etc.

Neurorads was also suggested to me, but given that most of the fancy functional scanning we're hoping will be clinically useful for us 10-20 years from now isn't currently being done for other indications all that frequently, the utility of looking at a bunch of strokes and bleeds for 4 weeks sounded like about as much fun as watching paint dry. You'll learn a little anatomy, but nothing you couldn't learn with a neuroanatomy book and a few cups of coffee.

How about doing a general rads month, and seeing if they'd let you do a few days/week of neurorads near the end of the rotation?

 

[strangeglove]

You will find neurorads quite useful during your neurology rotations as a psych intern. The problem with doing a neurorads elective is that you'll spend a lot of time looking at the spine, which is not the seat of the soul, last time I checked.

 

[billypilgrim37]

The problem with doing a neurorads elective is that you'll spend a lot of time looking at the spine, which is not the seat of the soul, last time I checked.

Ah, did your school have a liver ultrasound rotation then?

 

[Doc Samson]

do psychiatrists often need to look at head MRIs and CTs?

<pauses to catch breath, tries to compose self>



... yeah, we do look at neuroimaging, especially those of us working in ER and consult settings.

 

[LadyGrey]

Ok, apparently a silly question/ assumption.

I guess I assumed that if it was something you expected to be able to see, neurology would be involved, and they'd be the neuroimaging experts.

Doc Sampson: so can I ask, fully admitting my ignorance, for some examples of how you use imaging?

 

[Faebinder]

I wish I was more broad in my electives.

Things I would absolutely do: Neurology, Family Medicine, EM, Radiology, Cardiology. I wouldnt do any subspecialties if you havent done all of these.

If you got weeks to spare I would look into doing: Pediatric Neurology or Child Psychiatry, Neuroradiology or Neurosurgery (Brain elective not spine), and MICU or more Internal Medicine (good for when you are an intern and for step 3).

 

[Doc Samson]

Ok, apparently a silly question/ assumption.

I guess I assumed that if it was something you expected to be able to see, neurology would be involved, and they'd be the neuroimaging experts.

Doc Sampson: so can I ask, fully admitting my ignorance, for some examples of how you use imaging?

It's really pretty central to the exclusion of organic causes of mental illness. Depending on the location of a lesion, it may present with s/s of depression, mania, psychosis, or dementia. I typically request at least a head CT if not an MRI in any case of delirium without an obvious precipitant. EEG is instrumental in differentiating delirium vs other causes of psychotic symptoms (and can even help identify the precipitant of a delirium). SPECT can be very useful in identifying complex partial seizures missed on EEG than can present as almost anything.

My personal list of diagnoses picked up on imaging on consults for "schizophrenia" includes:

GBM
astrocytoma
neurocystercicosis
Herpes encephalitis
Paraneoplastic limbic encephalitis
Complex partial epilepsy

Oftentimes I end up arguing with neurology over the "need" for neuroimaging or EEG when a presentation is, in their minds, "non-neurologic".

A basic but very useful text on the subject of imaging in psychiatry is:

Essentials of Neuroimaging for Clinical Practice

Edited by Darin D. Dougherty, M.D., M.Sc., Scott L. Rauch, M.D., and Jerrold F. Rosenbaum, M.D.

http://www.appi.org/book.cfm?id=62079

 

[Doc Samson]

... almost forgot NPH. Gait disturbance + MS changes = NPH until proven otherwise. Often the consult comes in for dementia, but nobody has walked the patient because they're old and frail and the team "doesn't have the time." You get them up OOB, spot the magnetic gait, recommend the scan, and hand them off to Neuro.