4th year electives

[honsano]

M4 year is rolling around and with it comes the opportunity to take whatever the heck I want next year. Is there such thing as taking too many electives in one field even if that field is the one we plan on pursuing?

I want to take an elective in Psychoanalysis, Neuropsych, Child&Adolescent Psych and if they'll let me Forensics. The first 3 are for sure, but would it look bad if I didn't explore other fields as well or if I did too much in one field? I am also going to take an elective in Family Medicine, on top of my SubI in Medicine, to give me a decent foundation going into my intern year.

What do you guys think? Any recommendations on courses? Thanks yall.

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[OldPsychDoc]

M4 year is rolling around and with it comes the opportunity to take whatever the heck I want next year. Is there such thing as taking too many electives in one field even if that field is the one we plan on pursuing?

I want to take an elective in Psychoanalysis, Neuropsych, Child&Adolescent Psych and if they'll let me Forensics. The first 3 are for sure, but would it look bad if I didn't explore other fields as well or if I did too much in one field? I am also going to take an elective in Family Medicine, on top of my SubI in Medicine, to give me a decent foundation going into my intern year.

What do you guys think? Any recommendations on courses? Thanks yall.

This has been discussed before if someone can dig up the thread.

As general advice, you have the next four years to learn psych.
It's not so much about "looking bad", but it's just not necessary.
I'd pass on the Freud and Forensics, but maybe keep the C&A.

Try to pile on electives in things like Neuro, Pain, Sleep, Endocrine, etc if they are available. Maybe EM if you haven't had some of that yet. Common co-morbidities.

 

[Doc Samson]

This has been discussed before if someone can dig up the thread.

As general advice, you have the next four years to learn psych.
It's not so much about "looking bad", but it's just not necessary.
I'd pass on the Freud and Forensics, but maybe keep the C&A.

Try to pile on electives in things like Neuro, Pain, Sleep, Endocrine, etc if they are available. Maybe EM if you haven't had some of that yet. Common co-morbidities.

Agree with OPD re: the non-psych rotations. Would add that some time in the psych ED would help prepare for a lot of what your call will look like as a pgy-1 and 2.

 

[smokie]

First, I'd just like to say thanks to everyone that frequents this site and provides advice to us medical students with questions (oftentimes advice comes from other med students too!). It's always nice to get advice from many different sources.

As a follow up question to this thread, I understand that doing electives in psych is not incredibly important when applying to a psychiatry residency. How about doing a psych sub-i? Would having a good performance in one of those strengthen an application?

Also, I've read from different sources online that give different advice for the medicine sub-i. One sources says that it should be completed before interview season, and another says that it is not crucial. My logic is that having done a psychiatry sub-i before interviews would be of greater importance.

Any input would be greatly appreciated. Thanks in advance!

 

[CarleneM]

First, I'd just like to say thanks to everyone that frequents this site and provides advice to us medical students with questions (oftentimes advice comes from other med students too!). It's always nice to get advice from many different sources.

As a follow up question to this thread, I understand that doing electives in psych is not incredibly important when applying to a psychiatry residency. How about doing a psych sub-i? Would having a good performance in one of those strengthen an application?

Also, I've read from different sources online that give different advice for the medicine sub-i. One sources says that it should be completed before interview season, and another says that it is not crucial. My logic is that having done a psychiatry sub-i before interviews would be of greater importance.

Any input would be greatly appreciated. Thanks in advance!

Here's my take as an MSIV: I think the importance of doing psych electives early is to get LORs and potentially to do away "audition" rotations. You should have at least one letter from a psychiatrist. I agree one does not need to do a ton of psych electives. I did a psych ED rotation in July and this was by far the most valuable psych elective for me- exposes you to a very wide range of pathology and a lot of acute and intense stuff. Timing of a medicine sub-i doesn't matter unless you want to boost a lower medicine grade or something. There are so many ways to do fourth year but as long as it is fun and consists of stuff you are excited about doing, I think you can't go wrong.

 

[Kazema]

I did a psych sub-i early in fourth year because psych was one of my first 3rd year clerkships (because I thought I wasn't going to do it) so I needed a letter. Also, I was trying to decide between psych, vascular surgery, and anesthesiology.

I'm serious. My last 3rd year rotation was in vascular surgery, and I also did an anesthesiology sub-i right after my psych one. Boy am I glad my sub-i confirmed to me that I really did want to be a psychiatrist.

I did one away elective in psychodynamic psychiatry, and for the rest of the year I've been doing medicine electives.

 

[atsai3]

First, I'd just like to say thanks to everyone that frequents this site and provides advice to us medical students with questions (oftentimes advice comes from other med students too!). It's always nice to get advice from many different sources.

As a follow up question to this thread, I understand that doing electives in psych is not incredibly important when applying to a psychiatry residency. How about doing a psych sub-i? Would having a good performance in one of those strengthen an application?

Also, I've read from different sources online that give different advice for the medicine sub-i. One sources says that it should be completed before interview season, and another says that it is not crucial. My logic is that having done a psychiatry sub-i before interviews would be of greater importance.

Any input would be greatly appreciated. Thanks in advance!

I'm a resident now at a California program. I agree with a lot of what people have posted already. A few more thoughts:

• There's very little about your medical school record that contains power to predict with any degree of precision your overall future success as a psychiatrist or potential for leadership in the field. With that in mind, our selection committee does look for clues that are suggestive of your ability to complete at least the first two years of the program (eg., medicine, inpatient psych rotations, etc). Thus, evidence of rigor is helpful: honors in 'hard' clerkships like medicine and surgery.
• Signing up for psych electives in addition to the required clerkship is helpful, generally for two reasons. One: In my experience it has usually been the letter of recommendation (from the psych elective attending) that are more of a focus for discussion in selection committee rather than the actual grade. Two: Your having more psych experiences in medical school is taken as evidence of a more thorough decision-making process and therefore of potentially greater commitment to completing residency training.
• A psych sub-I at your own institution is basically viewed as another elective. A psych sub-I at our institution (and the evaluation of our faculty) is regarded as more informative.
• We generally don't really even talk about stuff that you have scheduled after interview season. So for example, it doesn't really help your application if you have a psych sub-I and an addiction elective scheduled for March and April.

 

[anesthesiarocks]

M4 year is rolling around and with it comes the opportunity to take whatever the heck I want next year. Is there such thing as taking too many electives in one field even if that field is the one we plan on pursuing?

I want to take an elective in Psychoanalysis, Neuropsych, Child&Adolescent Psych and if they'll let me Forensics. The first 3 are for sure, but would it look bad if I didn't explore other fields as well or if I did too much in one field? I am also going to take an elective in Family Medicine, on top of my SubI in Medicine, to give me a decent foundation going into my intern year.

What do you guys think? Any recommendations on courses? Thanks yall.

it's not so much a question what will prepare you better or what will look good or bad.......it's more a question of what you want to do.

Myself....my medical school makes us do 4 "electives" our fourth year and then four required "mediciny" type of things(like em, critical care, a sub-i, etc). I did all 4 of my allowed electives in psych since they all had the best schedule and thats what I enjoyed most........yeah I could have done an elective in cardiology consults instead, but that would have sucked relative to doing a month elective in substance abuse disorders and basically coming in at 9 and leaving at 11 every day.

So make sure you get your psych letters, but above all do what you will like doing best. Personally, I couldnt find a good reason not to schedule nothing but psych electives.......now for schools who dont require 4 medicine-type required things fourth year, I could maybe see an issue with doing like 7-8 psych electives and nothing medicine.

 

[honsano]

it's not so much a question what will prepare you better or what will look good or bad.......it's more a question of what you want to do.

Myself....my medical school makes us do 4 "electives" our fourth year and then four required "mediciny" type of things(like em, critical care, a sub-i, etc). I did all 4 of my allowed electives in psych since they all had the best schedule and thats what I enjoyed most........yeah I could have done an elective in cardiology consults instead, but that would have sucked relative to doing a month elective in substance abuse disorders and basically coming in at 9 and leaving at 11 every day.

So make sure you get your psych letters, but above all do what you will like doing best. Personally, I couldnt find a good reason not to schedule nothing but psych electives.......now for schools who dont require 4 medicine-type required things fourth year, I could maybe see an issue with doing like 7-8 psych electives and nothing medicine.

Yeah my logic for the electives is that A) multiple psych electives offer me the greatest chance at excellent psych letters B) shows my interest and C) because I'm genuinely interested in doing those electives. I mean yeah I could do ICU instead, but that would be torture. I just don't want to miss anything before applications and interviews and end up finding out that I was supposed to have branched out much more with my electives before interview season.

 

[JabsterL]

Hey guys, I'm just finalizing my electives for next year and am having trouble deciding between a few and am looking for some wisdom. I'm planning on child & adolescent pysch, but as I won't be applying for the triple board track I know the first 3 years of residency are still going to be Adult. Thus, I was wondering if you think it would be more helpful for me to do Peds or Adult Endocrine, peds or adult GI, ambulatory or inpatient peds or medicine, and medical/surgical ICU vs. neuro ICU? So far, I got a child & adolescent away, an away psych sub-I, I'm debating between a home psych outpatient vs. C-L psych elective (as unforuntately we don't have a psych ED here -- Any suggestions for which of these? Maybe a regular ED rotation would be even better than these psych electives?), neuroscience class TA, adult neurology, and then I was maybe thinking Peds neuro as well (can someone in the field or familiar with Child & Adolescent Psych tell me if you think a Peds Neuro elective would have any benefit please?)

Any advice would be much appreciated to make the most of this year to prep for residency and a CAP career. Thank you!

 

[OldPsychDoc]

Hey guys, I'm just finalizing my electives for next year and am having trouble deciding between a few and am looking for some wisdom. I'm planning on child & adolescent pysch, but as I won't be applying for the triple board track I know the first 3 years of residency are still going to be Adult. Thus, I was wondering if you think it would be more helpful for me to do Peds or Adult Endocrine, peds or adult GI, ambulatory or inpatient peds or medicine, and medical/surgical ICU vs. neuro ICU? So far, I got a child & adolescent away, an away psych sub-I, I'm debating between a home psych outpatient vs. C-L psych elective (as unforuntately we don't have a psych ED here -- Any suggestions for which of these? Maybe a regular ED rotation would be even better than these psych electives?), neuroscience class TA, adult neurology, and then I was maybe thinking Peds neuro as well (can someone in the field or familiar with Child & Adolescent Psych tell me if you think a Peds Neuro elective would have any benefit please?)

Any advice would be much appreciated to make the most of this year to prep for residency and a CAP career. Thank you!

If adult neuro is not a required rotation at your school, that's a must.
Then off your list I'd prioritize peds neuro, general ED, and either of the ICU rotations. I don't know that you really need three psych electives, home or away. (And I think the general opinion here is that away rotations in psych are mostly overrated...)

 

[JabsterL]

If adult neuro is not a required rotation at your school, that's a must.
Then off your list I'd prioritize peds neuro, general ED, and either of the ICU rotations. I don't know that you really need three psych electives, home or away. (And I think the general opinion here is that away rotations in psych are mostly overrated...)

Thanks OldPsychDoc for the great advice! So if I go for peds neuro and I have one more elective month, which do you all think generally has the most benefit for psych residency/career of these: radiology (with 1 wk neurorads), ICU, and ED? I feel I could definitely stand to improve in all 3 areas before becoming an intern...

 

[kugel]

Thanks OldPsychDoc for the great advice! So if I go for peds neuro and I have one more elective month, which do you all think generally has the most benefit for psych residency/career of these: radiology (with 1 wk neurorads), ICU, and ED? I feel I could definitely stand to improve in all 3 areas before becoming an intern...

My vote: ED.
In the ED you get experience in the difference between who is "very sick" and who "complains of being very sick." This is enormously helpful for the rest of your career, since you will be seeing patients who may have psychiatric presentations of medical illnesses or who may have hidden medical comorbidities or who simply cannot make clear complaints of medical problems because of their psychosis or agitation or mania or intoxication.

In the ED, see as many of the vague medical complaints as possible. The patients with "abdominal pain for 3 weeks," or "vomiting for 3 days," or other medical complaints without an overtly obvious cause. Everyone else will be angling to try and see the traumas and acute chest pain and other "exciting" or "sexy" cases. No one will compete with you for the "forty, fat, and fecund with abd pain" or the "drunk c/o diarrhea."

 

[OldPsychDoc]

My vote: ED.
In the ED you get experience in the difference between who is "very sick" and who "complains of being very sick." This is enormously helpful for the rest of your career, since you will be seeing patients who may have psychiatric presentations of medical illnesses or who may have hidden medical comorbidities or who simply cannot make clear complaints of medical problems because of their psychosis or agitation or mania or intoxication.

In the ED, see as many of the vague medical complaints as possible. The patients with "abdominal pain for 3 weeks," or "vomiting for 3 days," or other medical complaints without an overtly obvious cause. Everyone else will be angling to try and see the traumas and acute chest pain and other "exciting" or "sexy" cases. No one will compete with you for the "forty, fat, and fecund with abd pain" or the "drunk c/o diarrhea."

Agreed. And these are the patients whose medical complaints you will be managing daily on inpatient wards as well.

 

[digitlnoize]

What about rotations for a DO student? In DO-land, away rotations are often thought of as the holy grail that will land you a spot at your coveted institution, if you do well (or sink you if you don't).

I did my required psych rotation (inpatient) and a psych elective (inpatient child). Next year, I am required to do 2 months of ED, but Aug-Dec is all electives for me. I am definitely planning on doing 1 neuro, but what else should I do? I was thinking of doing at least 1 or 2 psych aways (maybe C-L or Psych ED?) if I can.

Thoughts?

 

[JabsterL]

My vote: ED.
In the ED you get experience in the difference between who is "very sick" and who "complains of being very sick." This is enormously helpful for the rest of your career, since you will be seeing patients who may have psychiatric presentations of medical illnesses or who may have hidden medical comorbidities or who simply cannot make clear complaints of medical problems because of their psychosis or agitation or mania or intoxication.

In the ED, see as many of the vague medical complaints as possible. The patients with "abdominal pain for 3 weeks," or "vomiting for 3 days," or other medical complaints without an overtly obvious cause. Everyone else will be angling to try and see the traumas and acute chest pain and other "exciting" or "sexy" cases. No one will compete with you for the "forty, fat, and fecund with abd pain" or the "drunk c/o diarrhea."

Thank you kugel and OldPsychDoc - I will choose ED over ICU then! I still am trying to find a way to include an extra month for neuro ICU and wish I could also do a month each of adult endocrine and peds GI but alas I fear I'll just have to rely on book knowledge for these as I won't have a month to dedicate to them (unless I do one during my November interview month instead of "clinical nutrition" (ez online class). I've noticed what you're talking about in the ED during my other core rotations as well...most residents and attendings could care less for patients without the classical medical/surgical diagnoses, esp. if the patient had a PMH of any any psych problems. I felt like the only one on those teams who wanted to get to the bottom of these vague complaints and not just write them off as "a crazy psych patient who we can't do anything for or who just wants drugs and who is a waste of our time/resources..."

 

[OldPsychDoc]

Thank you kugel and OldPsychDoc - I will choose ED over ICU then! I still am trying to find a way to include an extra month for neuro ICU and wish I could also do a month each of adult endocrine and peds GI but alas I fear I'll just have to rely on book knowledge for these as I won't have a month to dedicate to them (unless I do one during my November interview month instead of "clinical nutrition" (ez online class). I've noticed what you're talking about in the ED during my other core rotations as well...most residents and attendings could care less for patients without the classical medical/surgical diagnoses, esp. if the patient had a PMH of any any psych problems. I felt like the only one on those teams who wanted to get to the bottom of these vague complaints and not just write them off as "a crazy psych patient who we can't do anything for or who just wants drugs and who is a waste of our time/resources..."

Adult endocrine is way overrated as an MS rotation--95% or more is chronic diabetic and/or lipid management, 4.5% thyroid, <1% anything interesting or psychiatrically relevant. I remember completely mentally checking out of it...

 

[JabsterL]

That's great to know OPD because a few CAPs have recommended Endocrine as the most important rotation to be sure to take but I was thinking the others mentioned (peds neuro, ED, ICU, and even rads/neurorads) sound better to me in terms of relevance and enjoyability. One of the CAPs said dermis would be her 2nd choice after Endo, I suppose the thinking being Endo, Derm, Rads, and I've heard even Rheum mentioned before as being fields we wouldn't have as much exposure to learning in residency but which are important to have in our back pocket. Have you found this to be the case at all?

 

[Chimed]

That's great to know OPD because a few CAPs have recommended Endocrine as the most important rotation to be sure to take but I was thinking the others mentioned (peds neuro, ED, ICU, and even rads/neurorads) sound better to me in terms of relevance and enjoyability. One of the CAPs said dermis would be her 2nd choice after Endo, I suppose the thinking being Endo, Derm, Rads, and I've heard even Rheum mentioned before as being fields we wouldn't have as much exposure to learning in residency but which are important to have in our back pocket. Have you found this to be the case at all?

Hi. My vote would be peds neuro, hands down. There is a lot of overlap between what the peds neuro folks see and what we see in child psych. After all, psych is a neuroscience discipline, IMO. I saw some very interesting cases on peds neuro including Retts, rare genetic syndromes, DD, and some interesting autistic kids with seizures. If you have a developmental/behavioral pediatric department, I would highly recommend that. Peds endocrine will be useful as it tends to have more developmental disorders vs. what OPD was talking about in the adult endocrine clinics. Derm is an interesting choice. I'd say that being familiar with Derm can help in regards to being able to know the difference between a benign drug rash vs. Stevens-Johnson. There can also be other interesting psych/derm cases that they see.

In general, if you KNOW you want to do CAP, I'd recommend doing as much general peds (including sub-specialties) as possible rather then psych. You'll be spending the rest of your life in psych, but this is the time to really get as much peds/medicine as possible.

Good luck!

 

[JabsterL]

Hi. My vote would be peds neuro, hands down. There is a lot of overlap between what the peds neuro folks see and what we see in child psych. After all, psych is a neuroscience discipline, IMO. I saw some very interesting cases on peds neuro including Retts, rare genetic syndromes, DD, and some interesting autistic kids with seizures. If you have a developmental/behavioral pediatric department, I would highly recommend that. Peds endocrine will be useful as it tends to have more developmental disorders vs. what OPD was talking about in the adult endocrine clinics. Derm is an interesting choice. I'd say that being familiar with Derm can help in regards to being able to know the difference between a benign drug rash vs. Stevens-Johnson. There can also be other interesting psych/derm cases that they see.

In general, if you KNOW you want to do CAP, I'd recommend doing as much general peds (including sub-specialties) as possible rather then psych. You'll be spending the rest of your life in psych, but this is the time to really get as much peds/medicine as possible.

Good luck!

Thank you Chimed for your words of wisdom, which are beyond helpful! Based on what you OPD and kugel, and the 2 CAPs I've asked have said, I've narrowed it down to 6 possible electives to complete in 3 1-month rotations: being a TA for the Medical Neuroscience class for the first-year med students (do you think teaching experience like this is very valuable heading into residency because part of me feels I'd just be reviewing the same course I already completed a few years back and would be missing out on being able to complete a more valuable clinical month?); Peds Neuro or Peds Endocrine (the former which is super helpful but I'd have exposure to during residency/fellowship, but the course description includes Peds Endocrine cases so...); definitely ED, and probably Diagnostic Rads (including exposure to neurorads); and then ICU and Derm on the outside looking in. I agree Derm was an interesting choice I hadn't considered until the CAP attending who you may well know brought it up. I definitely see the value in learning to distinguish between a benign drug rash vs. Stevens-Johnson, and that's cool that there could also be other interesting psych/derm cases. If you could, would you mind please giving a couple specific examples of how being familiar with Derm could help a psychiatrist (particularly a CAP) because I'm not too familiar with what other conditions are included in the interface between Psychiatry and Dermatology but I'd love to know? This CAP also mentioned to me that genetics would also be very helpful because "we see lots of funny-looking kids".

She also mentioned to me that to remember that med school is not just about preparing for residency, but for life as a physician; that patients, family members and just generally, people are always asking dermatologic questions, so she advised to pick things that we may never have a chance to learn or see in residency. It's very interesting to me how there's these competing philosophies for choosing electives: to do rotations to prove your worth/fit for residency (particularly the audition rotations), vs. to learn things to help prep you for residency/fellowship/career because you want to up your familiarity/competence and improve your skill set heading to the next level in your chosen field, vs. to learn things you enjoy or won't get to learn more of once you move on to residency and beyond...

Thank you to everyone who is chipping in for all your time and help!

 

[st2205]

I'm not a resident, but I'd have to say that being a TA would be a wasted opportunity considering the rotations you could otherwise do.

 

[digitlnoize]

I'm not a resident, but I'd have to say that being a TA would be a wasted opportunity considering the rotations you could otherwise do.

I dunno. I TA'd organic chemistry my senior year of undergrad, and thought the experience really improved my understanding of the subject. You will never know a subject as well as when you have to explain it to others...and answer their questions about it.

 

[Chimed]

Thank you Chimed for your words of wisdom, which are beyond helpful! Based on what you OPD and kugel, and the 2 CAPs I've asked have said, I've narrowed it down to 6 possible electives to complete in 3 1-month rotations: being a TA for the Medical Neuroscience class for the first-year med students (do you think teaching experience like this is very valuable heading into residency because part of me feels I'd just be reviewing the same course I already completed a few years back and would be missing out on being able to complete a more valuable clinical month?); Peds Neuro or Peds Endocrine (the former which is super helpful but I'd have exposure to during residency/fellowship, but the course description includes Peds Endocrine cases so...); definitely ED, and probably Diagnostic Rads (including exposure to neurorads); and then ICU and Derm on the outside looking in. I agree Derm was an interesting choice I hadn't considered until the CAP attending who you may well know brought it up. I definitely see the value in learning to distinguish between a benign drug rash vs. Stevens-Johnson, and that's cool that there could also be other interesting psych/derm cases. If you could, would you mind please giving a couple specific examples of how being familiar with Derm could help a psychiatrist (particularly a CAP) because I'm not too familiar with what other conditions are included in the interface between Psychiatry and Dermatology but I'd love to know? This CAP also mentioned to me that genetics would also be very helpful because "we see lots of funny-looking kids".

I suppose learning stuff like cafe au lait spots and ash leaves spots could be helpful. Dermatologist reportedly see a fair amount of trichotillomania and impulse control disorders. Otherwise, I'm not sure how helpful it would specifically be to psych. I wasn't necessarily recommending you take it...only said it might be "interesting." But as you mention below by one of your attendings, one could argue that derm is a good general medicine area to be half way familiar with. If you think it might be interesting, then go for it.

She also mentioned to me that to remember that med school is not just about preparing for residency, but for life as a physician; that patients, family members and just generally, people are always asking dermatologic questions, so she advised to pick things that we may never have a chance to learn or see in residency. It's very interesting to me how there's these competing philosophies for choosing electives: to do rotations to prove your worth/fit for residency (particularly the audition rotations), vs. to learn things to help prep you for residency/fellowship/career because you want to up your familiarity/competence and improve your skill set heading to the next level in your chosen field, vs. to learn things you enjoy or won't get to learn more of once you move on to residency and beyond...

Thank you to everyone who is chipping in for all your time and help!

My thought is that you really shouldn't over think this either way. I'd advise just taking as much non-psychiatry rotations as you can, assuming you're 100% settled on what you want to do. I'd also opted to getting as much rotations in general medicine/pediatrics as possible. Just my two-cents.

You'll be fine no matter what you do next year!

 

[digitlnoize]

What are the opinions on doing these electives at academic vs community sites. I have done most of 3rd year at community sites and feel it's been an excellent learning experience. I should add that doing academic rotations will involve leaving my wife and child for that month and paying for lodging, since to academic hospital in my town doesn't take DO students...

I'm just worried about residencies looking poorly on my app if it lacks academic experience. Does this happen?