Advice for PGY2 switching in to Psychiatry

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MTThrower

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So I spent the last year as a PGY2 Rad Onc resident at a malignant program and was successful making the switch into the Psychiatry program where I did my transitional year. I will enter as a PGY2. I loved psych as a med student and from the moment I decided to switch it was the obvious choice. I was still in touch with some willing mentors from my psych rotations as a med student which made the switch a lot easier. I couldn’t be more excited, but I am quite nervous about starting in a month. As an intern I saw a fair bit of acute drug intoxication, suicidal ideation, panic attacks, psychosis, etc on the wards and in the ED, but it’s been ~3 years since my last real psych rotation. And no overlap whatsoever this year as we tend to turf issues to our supportive oncology service.

I had good intentions of doing preparatory reading, but I’m still working as a Rad Onc resident through June. It always seems like there is less time/energy to be productive than you imagine. As an entering Rad Onc resident I had done aways and had a pretty good idea what to expect as far as duties and workflow. What proficiencies would be expected for a psych PGY2 right out of intern year? What might the biggest challenges be as far as initial base level knowledge acquisition and patient care? I’m a quick study but I’m anticipating a pretty steep learning curve out of the gait.
 
Congrats OP! 🙂 First and foremost I hope that you'll be happier in your training and later career.

Honestly you're not at THAT much of a deficiency compared to most pgy2 July psych residents. The ACGME requires 3-6 months of medicine anyway so at most you are maybe half a year behind on inpatient psych, etc. The only difference is in most inpt psych settings the 2s play more of a teaching role for the 1s.

Just relax, acclimate yourself to the culture, and have fun! You'll get the hang of it within your first half year. By the end of pgy2 you'll do just fine.

Also this

As an intern I saw a fair bit of acute drug intoxication, suicidal ideation, panic attacks, psychosis, etc on the wards and in the ED
will be super helpful!
 
Congrats OP! 🙂 First and foremost I hope that you'll be happier in your training and later career.

Honestly you're not at THAT much of a deficiency compared to most pgy2 July psych residents. The ACGME requires 3-6 months of medicine anyway so at most you are maybe half a year behind on inpatient psych, etc. The only difference is in most inpt psych settings the 2s play more of a teaching role for the 1s.

Just relax, acclimate yourself to the culture, and have fun! You'll get the hang of it within your first half year. By the end of pgy2 you'll do just fine.

Also this

will be super helpful!

Thanks! I hope so too, and for the first time in a little while I'm cautiously optimistic about my future career. In retrospect I chose rad onc for the wrong reasons and I feel strongly I am choosing psych for the right ones. I guess we'll see. I know enough about the system we all work in to realize it won't all be sunshine and rainbows.

I may have some unique contributions with regards to the clinical manifestations of brain tumors but other than that I fully expect to start at the knowledge level of a new PGY1 and will definitely be hesitant try much teaching, at least at first. I'll have decent grasp on discharges/admissions, dispo, care coordination tasks, in general how to be a good resident (not specialty specific) so hopefully I'll be able to help new residents in that regard.

I'm used to being proactive and staying ahead of the curve so it definitely provokes anxiety to feel like I'm starting half a lap behind my peers. I suppose there's no faster remedy than just diving right in on service.
 
Its probably my lack of understanding what is entailed in Rad-onc residency, but I'm struggling to envision what malignant looks like in that specialty.
 
How can they allow someone with no psych background to start as a pgy2? I think that in and of itself shows you how hard being a psych pgy2 is lol
 
How can they allow someone with no psych background to start as a pgy2? I think that in and of itself shows you how hard being a psych pgy2 is lol
You only do 6mo of psych as a PGY-1 and 4th year is basically straight electives, so you can make up for time lost then.
 
You only do 6mo of psych as a PGY-1 and 4th year is basically straight electives, so you can make up for time lost then.

IM would never let someone with no IM experience come in as a pgy2, just saying this residency is more relaxed
 
IM would never let someone with no IM experience come in as a pgy2, just saying this residency is more relaxed
Yes, and IM residencies are structured much differently. Some triple boarders don’t start psych rotations until the end of their PGY-2 year and they’re generally treated on par with their general psych counterparts.
 
You only do 6mo of psych as a PGY-1 and 4th year is basically straight electives, so you can make up for time lost then.

Ya I will be sacrificing a significant amount of elective time over 3 years to meet core requirements.
 
IM would never let someone with no IM experience come in as a pgy2, just saying this residency is more relaxed
This was alternative was actually offered to me by the associated IMR program. Granted, I had maybe 5 months of overlap with their intern year requirements, which is comparable to what I have in common with the psych intern year.
 
Its probably my lack of understanding what is entailed in Rad-onc residency, but I'm struggling to envision what malignant looks like in that specialty.
Departments are small enough that it only takes 1 or 2 malignant people in key positions to really have a big effect. It's certainly not an hours issue, definitely more of a culture issue. Rad onc as a field, especially in academics, tends to be pedigree-obsessed, elitist, intensely hierarchical, and nepotistic. Some places are worse than others with regards to this. Training is also very much focused on the modality rather than clinical interactions which is a shame.
 
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