Dartmouth Psychiatry

[PsychROLBurner]

I am trying to figure out where to place Dartmouth on my ROL. The name brings prestige for private practice, but previous posts about Dartmouth have described it as a weaker program. On my interview day, they expressed they are smaller than some places, but touted more research $ per faculty member. As someone interested in academics and research, I was wondering what the current thoughts were on this program.

Additionally, Dartmouth is frequently brought up on the Reddit Google doc for comparison to other programs (Wisconsin, UVA, Cleveland Clinic, WashU, UMass), so I believe that others are also trying to figure out its place among second or third-tier programs, many public, for training and opportunities vs the prestige of the name.

Thank you.

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[wolfvgang22]

How do you feel about Dartmouth? What does your gut tell you? What did your own observations tell you when you interviewed? Do you think you will fit in there? I wouldn't worry what everyone else thinks as much about "prestige", but gathering specific information about what you personally need is good.

I interviewed there and ranked them highly 11 years ago. I also did an "audition" elective rotation. My only concern was it was far from my home state, and cost of living is a little on the higher side. I felt their program was more than fine academically.

 

[PsychROLBurner]

Thank you for your response. I have weighed my feelings and I am most interested in understanding actual vs perceived opportunities in research and academia compared to programs without the Ivy affiliation obscuring people's perceptions.

 

[SmallBird]

Dartmouth has a strong research department and should offer good opportunities if you are motivated. The location provides an extremely unique but specific experience and you should think about whether that works for you?

 

[Zolift!]

Dartmouth was very high on my ROL. My PD and faculty told me it was a top tier program with excellent training.
Personally, its hard to go wrong with a program with the fourth oldest hospital and medical school in the US dating back to the 1700s.
The training hospital looks like a mall, if you have been there.
Its very prestigious for a reason. Also, it being considered middle of the pack Ivy league in general and with the first business school in history, will only add to its reputation.
New England is a great place to live but not for everyone. I am a four seasons kind of person myself.
Dartmouth is the smallest IVY and is in a rural setting. That explains the research money and ranking in US news for research. I think it is the third or fourth IVY league with most money to faculty ratio. In Primary Care it is still in top 20.
US news has a lot of flaws in its ranking system and bases a lot of its ranking on research money. So programs tend to go up and down frequently. If you look at Dartmouth's rank list for psychiatry fellowships, almost all end up in amazing programs like MGH, Dartmouth, Brown, Yale, Stanford etc.
Hope that helps.

 

[Doctorows]

Dartmouth is a solid program. Their call schedule is quite intense (I think it was something like q3 night call, though I may be wrong as it's been a while since I interviewed there) and it's cold/lonely up there. They also don't have a locked inpatient unit, if I remember correctly.

 

[Mad Jack]

Dartmouth is a solid program. Their call schedule is quite intense (I think it was something like q3 night call, though I may be wrong as it's been a while since I interviewed there) and it's cold/lonely up there. They also don't have a locked inpatient unit, if I remember correctly.

A psych residency without a locked inpatient unit?!

 

[Ironspy]

A psych residency without a locked inpatient unit?!

It’s a state quirk. The inpatient units were unlocked and all patients were voluntary when I interviewed

 

[Evidence Based]

It’s a state quirk. The inpatient units were unlocked and all patients were voluntary when I interviewed

The only locked units are at the state hospital, which I believe the residents rotate at. All the units at Hitchcock are unlocked.

 

[Doctorows]

A psych residency without a locked inpatient unit?!

Yeah. That was one of the biggest reasons why I ranked them lower, and in hindsight, glad I did so. I feel like my training would be lacking without exposure to the severely mentally ill patients that I see on a daily basis in residency. I understand that Dartmouth residents rotate at the state hospital and have no doubt that the program produces fine psychiatrists, just something to think about.

 

[eaglepsych]

Excellent faculty and great residents across all specialities. Great for outdoor athletes (skiing, hiking, etc). 45 minutes to nearest Killington gondola. Great psychotherapy training. PM me if you want any details about my experience.

 

[Mass Effect]

A psych residency without a locked inpatient unit?!

The residents rotate at other hospitals within the state that do have locked units.

 

[doggums]

A psych residency without a locked inpatient unit?!

Just FYI the voluntary units are definitely locked.

 

[Mad Jack]

Just FYI the voluntary units are definitely locked. With the way NH does involuntary admissions, most patients are volun-told to come in or are sitting in the ED for a few weeks awaiting an involuntary bed at the state hospital. Frequently patients also come in voluntarily, then decide they want to leave, and are kept under an involuntary emergency admission. Dartmouth definitely has their share of very sick patients who don't want treatment!

Sounds like a nightmare from a logistical perspective

 

[Monocles]

Dartmouth is a solid program. Their call schedule is quite intense (I think it was something like q3 night call, though I may be wrong as it's been a while since I interviewed there) and it's cold/lonely up there. They also don't have a locked inpatient unit, if I remember correctly.

Hol up what

Q3 calls should make anyone stop and pause. That's no joke. Could we get someone to verify this?

 

[Mass Effect]

Hol up what

Q3 calls should make anyone stop and pause. That's no joke. Could we get someone to verify this?

I didn't attend Dartmouth and don't remember much about them, but I don't see how it's possible call is Q3. Unless they have multiple residents on call at once, it just doesn't seem to work out numbers-wise.

 

[Doctorows]

Hol up what

Q3 calls should make anyone stop and pause. That's no joke. Could we get someone to verify this?

Again, my interview season is a blur at this point and I can't remember all the details, but for whatever reason I'm associating q3 call with Dartmouth as something I remember from my interview day. Found this in an interview review thread within the past couple years:

"PGY-2: VA call is overnight call from home where you just have to go in for consults and admissions, not sure how often that is. Psych call is basically overnight 1-2 times per week and 24 hour weekend call every other week.

PGY-3 and 4. Supervisory call on weekends, holidays, probably some VA and state hospital call mixed in too, but it wasn’t very clear.

All the residents said it was very call heavy, but they learned the most on call and feel extremely prepared for life after residency. DHMC call sounds very busy and everyone unanimously said you won’t get any sleep overnight. "

2 nights per week is essentially q3... that's a LOT.

 

[antslpth]

I did a sub-I there bc of the ivy connection. The program may have changed, so I can't comment too much (vaguely remember that call was somewhat on the heavier side and some residents were unhappy?), but I remember the area to be VERY rural with minimal diversity (which also affects pt diversity) aside from the students/GME staff. There was a significant lack of good ethnic foods and cost of housing is very high compared to other areas with equal offerings. Talking to the existing residents, the cold/snow was something that I could also not get past given minor bouts of SAD.

 

[Monocles]

All the residents said it was very call heavy, but they learned the most on call and feel extremely prepared for life after residency. DHMC call sounds very busy and everyone unanimously said you won’t get any sleep overnight. "

Anytime I hear "call has made be extremely prepared for work haha... ha" I know it's the most interview-approved way of saying call is BRUTAL. 😱

 

[Zolift!]

I think most of these top tier programs can be call heavy.
To find a good blend of good academic training/big name program with a decent call schedule would be ideal.

 

[doggums]

Hol up what

Q3 calls should make anyone stop and pause. That's no joke. Could we get someone to verify this?

Call at Dartmouth can be brutal, but works out to five ~27 hour calls per month on average. Obviously more when other residents are on vacation. If everyone is around, it's no more than q4 call.

 

[simon_sparrow]

I’m one of the current Dartmouth chiefs. To clarify the call situation:

PGY2 breaks down like this:
For the 8 weeks you rotate at the State Hospital, you are on call overnight on Thursday and have a post-call Friday off.

For the ~ 20 weeks at the VA, you’re in a pool of 3 PGY2s who are on home call on Sundays, Tuesday, and Wednesday, which ends up being one call per week for the most part.

for the 24 weeks on DHMC call, you’re in a pool of 4 PGY2 s responsible for Sunday through Thursday nights. This ends up being once a week, except for every fourth week when you have Sunday call and then Thursday call. (In my experience, that wasn’t a bad deal, because the post-call FRIDAY gives you a little bit of a long weekend).

Having looked into lots of other places call schedules, we found that ours was pretty middle of the road overall, though perhaps loaded more towards PGY1 and 2. PGY3 call ends up being ~ one weekend a month (either a Friday in house at DHMC or a Friday/Saturday home call plus a weeknight VA home call every 3 weeks.

Having said all that, we’ll be matching an additional resident next year, so the call will be even more spread out going forward, and the PGY2 twice a week calls will be less frequent.
Feel free to PM with any other questions.

 

[meow1985]

Call at Dartmouth can be brutal, but works out to five ~27 hour calls per month on average. Obviously more when other residents are on vacation. If everyone is around, it's no more than q4 call.

At my program (not Dartmouth), I had q8 call on average, so a little less than once per week for a year. The average call night was no sleep and had you up for 24+ hours. Let me tell you, the sleep disruption induced mood dysregulation was real by the end of the call-heavy year. Did I learn a lot? Perhaps, depending on what you mean by learn. Did I get flooded with stressful, wft type of situations such that by the end I was desensitized to most everything? Absolutely. Ironically, the anxiety I am famous for on this forum was better during my call-heavy year because I didn't have time or mental space to overthink things. From the standpoint of preparing for practice, though... Do I learn actual psychiatry? Probably less so, since sleep and time to reflect and read up on stuff is kind of crucial to retaining things and making sense of them. Call is basically psychiatric triage, really basic urgent care/emergency medicine type stuff for those already on your unit and de-escalation of behavioral stuff, but that's far and away not all there is to psychiatry.

 

[Mass Effect]

Call at Dartmouth can be brutal, but works out to five ~27 hour calls per month on average. Obviously more when other residents are on vacation. If everyone is around, it's no more than q4 call.

My entire PGY 3 year, I was on call 5 times.

 

[Alemo]

Just a PGYII but I’ve realized that overnight/extended hour call in psychiatry offers rapidly diminishing educational returns. These settings might have residents more abrupt and direct, “quick thinking,” or “juggling a lot of things” which is great in surgical services or with lots of medically ill floor patients. But psychiatry?
The art of interviewing and developing rapport seems far more valuable than the ability to make quick decisions about medication, hasty safety evaluations, and limited diagnostic evals.
That’s why dedicated PES rotations are great.

 

[Mass Effect]

Just a PGYII but I’ve realized that overnight/extended hour call in psychiatry offers rapidly diminishing educational returns. These settings might have residents more abrupt and direct, “quick thinking,” or “juggling a lot of things” which is great in surgical services or with lots of medically ill floor patients. But psychiatry?
The art of interviewing and developing rapport seems far more valuable than the ability to make quick decisions about medication, hasty safety evaluations, and limited diagnostic evals.
That’s why dedicated PES rotations are great.

It's not really about making quick decisions about medication. It's about triaging and learning how to care for patients properly by yourself. You should be learning how to efficiently do a safety risk assessment, how to determine someone's need for inpatient versus partial versus outpatient, what to do in cases of emergency, how to change, adjust, or initiate meds, and basically function independently with the cushion of having an attending to call/fall back on if needed.

These skills are important no matter what field you go into. Psych is no exception. Whatever job you get after residency will likely require some kind of call, whether at home or in the hospital, and you'll be doing all of these things.

 

[Alemo]

Sure, but I’d argue that months of overnight call are far more valuable to surgeons, OBs, and internists than psychiatrists. Of course there is value in learning efficiency and self-sufficiency for any specialty. But pattern recognition and rapid diagnosis just doesn’t have the same importance in psychiatry as it does in something like neurology, for instance (with notable exceptions in settings such as the emergency room where “safe/not safe” or “admit don’t admit” are the big questions).

Good evals take time, no matter how efficient the psychiatrist is. You want to learn under good teachers, with awareness of nuance and subtleties, and lengthy interviews. Is it a luxury? Yeah. But capturing SIGECAPS and POSITIVE SI on the CSSRS night after night while juggling floor patients who are agitated or want Tylenol etc does not a good diagnostician make.

 

[Mass Effect]

Sure, but I’d argue that months of overnight call are far more valuable to surgeons, OBs, and internists than psychiatrists. Of course there is value in learning efficiency and self-sufficiency for any specialty. But pattern recognition and rapid diagnosis just doesn’t have the same importance in psychiatry as it does in something like neurology, for instance (with notable exceptions in settings such as the emergency room where “safe/not safe” or “admit don’t admit” are the big questions).

Good evals take time, no matter how efficient the psychiatrist is. You want to learn under good teachers, with awareness of nuance and subtleties, and lengthy interviews. Is it a luxury? Yeah. But capturing SIGECAPS and POSITIVE SI on the CSSRS night after night while juggling floor patients who are agitated or want Tylenol etc does not a good diagnostician make.

Who taught you that you have to do SIGECAPS and CSSRS to do an accurate risk assessment? A risk assessment is actually listening to your patient and understanding the risk factors that lead to suicide/self-harm, not just going through a survey of questions with them to check a box. The more you do this, the more efficient you will be.

But that isn't the purpose of call. You should be learning how to do this during the day. Call is valuable because you learn to function independently and I disagree that it's not necessary in psych. It absolutely is.

 

[Alemo]

I didn’t say it wasn’t necessary. I’m trying to express that I do think it’s important, just relatively less so.
A call heavy psychiatry training program might not be as good a thing as some might think.
Maybe this is a question for another thread, but I wonder what everyone’s thoughts are on call rotations (eg overnight float months). Is one month in residency enough? Do practicing psychiatrists wish they had more rotations like that?

 

[Merovinge]

I didn’t say it wasn’t necessary. I’m trying to express that I do think it’s important, just relatively less so.
A call heavy psychiatry training program might not be as good a thing as some might think.
Maybe this is a question for another thread, but I wonder what everyone’s thoughts are on call rotations (eg overnight float months). Is one month in residency enough? Do practicing psychiatrists wish they had more rotations like that?

One month of night float and no other call is absolutely not enough. The purpose of spreading this over at least 2, ideally 3 years, is that you are able to see your personal growth in managing these situations. A lot of crazy @#$% happens after hours in our field and I can't imagine being comfortable with someone who's never been the first line for those things (from a legal, medical, colleague, and personal standpoint).

Now do you need q3 24 hour calls? Absolutely not, although I don't that schedule is beneficial to OB or surgery either and more about having cheap labor that gives academic attendings a better lifestyle in exchange for their terrible pay. I do think a q7 call for 2 years even if some of that is daytime on the weekends (or 12 hour shifts like my program did instead of all 24s) is a worthwhile learning experience.