C&A fellowship

[psychman]

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Hi,

I am considering applying to C&A fellowship. I was always interested in this population but I had a bad experience during my 6 month rotation mainly because of an anal-retentive OCD attending. I wanted to get some feedback regarding other's experience in this field. Can you tell me how do you like it? what are the positives & the negatives? Do you do a lot of scut work or do the SW's (social workers) actually contribute? During my rotation I was more or less expected to do everything from SW to being on the phone as a secretary. Any & all info. and experience in this fellowship is appreciated. Also, did you apply through the NRMP & what time table is applicable here?

 

[swanny]

In my own experience as a resident, I had a hard time during my C&A rotation-I found the patients and their families were more complicated and required more effort to understand the multiple layers of issues. Nevertheless, I went into C&A, and it has been a great fit.

The positives include the interactions with kids, the need to work with with a number of different systems (ie. family, school, medical, social), and the opportunity to observe kids grow up and develop. I like spending time with kids and their families, and I have plenty of time to do so.

The negatives include the fact that kids with psychiatric problems are often chronically ill and struggle developmentally. This can be difficult to be close to (imagine what their families go through). Many students think that intervening early will make a bigger difference. However, early onset of psychiatric disorders may also mean a worse prognosis. It is also hard to be effective in some situations (e.g. really dysfunctional homes). You also have to be comfortable working with a variety of agencies and providers-you can't be a one man show.

You should be prepared to do a lot of social work- even though you will have social workers on your team, it is important to develop those skills for yourself. I still need to help families negotiate the mental health system, and help them to address their own issues.

The timetable for the C&A match is earlier than the regular match. Programs can start to accept applications already, and are generally done interviewing by November (the match is in December). Programs may commit to their own residents a year early (telling them in June 07 that they'll have a spot for July 08), but uncommitted spots are then put up in the child match.

Hope that helps and good luck!

 

[MBK2003]

I would also emphasize that inpatient C&A is different from outpatient C&A. My fellowship has only 4 months of inpatient and 2 months of child ACT team, with the remainder being a mix of C/L, outpatient, and legal & school consultations. You definitely make more calls in C&A than adult psychiatry to get parallel and to coordinate care. I also agree that the early onset of psychotic disorders and bipolar disorders can be the most difficult cases to care for, however a lot of C&A outpatient work is treatable mental illnesses that respond to meds and/or short-term therapy, e.g. anxiety disorders, unipolar depression, and ADHD.

MBK2003