electing to do an emergency medicine rotation in PGY-1

[americanidiot]

Hey guys...as you have come to know and love me as mr. nervous regarding clinical skills, i realized that my soon-to-begin psych residency program offers emergency medicine as an option for one of our required medicine months in PGY1...part of me is thinking that since i didn't do an EM rotation as a med student that i would look like a total idiot and that i shouldn't select it. buuuuut the go-getter in me is saying "elect to do the thing you're nervous about! it will make you stronger!"...

maybe i'm answering my own questions about what's "right" but i would love to hear your feedback. as per the other thread, i realize from you guys that we all start at the same level not knowing our left from our right...but should i elect to do something more hands-on if its not required? will it make me better?

p.s. congrats to all who matched and to all who didn't, keep your head up!

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[VMSmith]

How many total months of medicine do you have? Are they all inpatient?

 

[americanidiot]

How many total months of medicine do you have? Are they all inpatient?

we have 3 mandatory inpatient months and 1 outpatient month (the outpatient month is the month that may be substituted with EM)

 

[VMSmith]

With 3 inpatient medicine months I'm not sure a month of EM will add much for you, and the outpatient experience may be more relevant career-wise. Plus the hours will likely be a lot better in outpatient, especially if you have to switch between day/night shifts during your month in EM.

You might not think of that as a factor right now having just matched, but trust me, you'll appreciate it next year.

 

[americanidiot]

With 3 inpatient medicine months I'm not sure a month of EM will add much for you, and the outpatient experience may be more relevant career-wise.

good call.

Plus the hours will likely be a lot better in outpatient, especially if you have to switch between day/night shifts during your month in EM.

You might not think of that as a factor right now having just matched, but trust me, you'll appreciate it next year.

double good call. i'm chomping at the bit a little here.

 

[Doc Samson]

I'd actually advise the opposite. Your call on Psychiatry will involve covering the ED, so familiarizing yourself with the environment, procedures, and people (read: nurses who have the potential to make your life miserable or not) could serve you well in the later months/years of your training. Plus, ED rotations can be pretty sweet on the schedule front in terms of 3 or 4 day weekends if you plan your shifts right.

 

[psychfun]

people (read: nurses who have the potential to make your life miserable or not) could serve you well in the later months/years of your training.

DS,

Could you please explain this point? And on how to tackle/prepare for this?

Thanks,
PF

 

[OldPsychDoc]

I'd actually advise the opposite. Your call on Psychiatry will involve covering the ED, so familiarizing yourself with the environment, procedures, and people (read: nurses who have the potential to make your life miserable or not) could serve you well in the later months/years of your training. Plus, ED rotations can be pretty sweet on the schedule front in terms of 3 or 4 day weekends if you plan your shifts right.

I think that the level of acuity one sees in an ED, the particular dramas of borderlines in crisis, med seekers, and acute substance users, as well as an understanding of how the ED establishment views and responds to psychiatric illness would all combine to make a good ED rotation very good training for psychiatrists. In our hospital, there is a certain tension that develops when psych patients start accumulating in the ER. ED docs are trying to push them out or push them up to the floor, we start seeing admissions that appear unnecessary to us, patients feel inappropriately treated and resentments can quickly build. Our leadership has worked hard on this, but I think if more of "us" thought like "them", and more of "them" understood how "we" think, the hospital would be a more harmonious place--and patients would be more likely to get appropriate treatment.

I'm not saying that your particular ED would necessarily fulfill this in your case, however. YMMV.

 

[Doc Samson]

DS,

Could you please explain this point? And on how to tackle/prepare for this?

Thanks,
PF

The advice I give to all starting interns is to make sure that the nurses LOVE you. They really do have the power to make your life miserable (lots of pages at 3 a.m.) but if they like you, they'll do their best ot protect you. in my experience, this is easily accomplished by:

1) Not bossing them around because you're "the doctor" now
2) Soliciting their input on what might be helpful to the patient and to their ability to care for the patient
3) Treating them as colleagues and taking an interest in their lives
4) Having a sense of humor

If that doesn't work then there's always Dunkin Donuts (a dozen donuts will earn you major points). The caveat here is NICU nurses - they're never nice to trainees, ever.

 

[peppy]

Personally I'd go with the month of the ED. But, then, I've always enjoyed the ED...even took extra EM electives just for fun.
Most of the time they will not expect a psych rotator to deal with the really acute situations. In fact, they may like you more if you are willing to see the lower acuity "BS" stuff that the EM residents would rather not have to focus on.
In addition to the many, many patients you will get to see in the ED who present with straight up psych problems, I think a lot of the kinds of problems people bring to the ED are more likely to be encountered in psych inpatients than a lot of what you see in inpatient IM.

 

[psychotrope]

I think that the level of acuity one sees in an ED, the particular dramas of borderlines in crisis, med seekers, and acute substance users, as well as an understanding of how the ED establishment views and responds to psychiatric illness would all combine to make a good ED rotation very good training for psychiatrists. In our hospital, there is a certain tension that develops when psych patients start accumulating in the ER. ED docs are trying to push them out or push them up to the floor, we start seeing admissions that appear unnecessary to us,

I guess I'm confused here....."admissions that appear unnecessary to you"? Don't we(the psych resident who is paged and the attending he/she confers with over the phone) decide whether that psych patient who was triaged through the ED an admit, a discharge, a state hospital involuntary transfer, etc?

I've never rotated through a place where ED physicians get to admit to psychiatry inpatient units....

 

[kugel]

I'm a big believer that ER training is vital to psych, because it's VERY important to understand who is "sick" enough to need medical care NOW and who can wait for the IM consult. To develop a feel or "instinct" for who needs you to PUSH for proper and thorough medical care. Psych pt's very often cannot voice medical complaints effectively and their medical problems are often ignored because many professionals dismiss their medical problems as if anything they have "must be psych."

 

[nancysinatra]

If it were my choice, I'd go with EM. I'd also pick up all the cases that are as far removed from psych as possible, because you will learn stuff you'll never get the chance to properly learn again.

I know some people will say you should be doing clinic and learning to manage hypertension etc, but really that will only benefit you as an inpatient psych intern since psychiatry attendings don't manage DM, HTN, etc, and one month of it won't teach you much beyond what you already know anyway. The tricky points of HTN, DM, HLD, etc. are interesting but they'd take a whole FM residency to learn!

I had to do a whole month of OP clinic and it was my most boring month of intern year so far. It was somewhat useful for learning to characterize rashes and r/o serious causes of back pain (back pain being as ubiquitous in psych as it is elsewhere), I'll say. I also would have liked to get more in-depth DM exposure, but for it to actually be useful for treating psych inpatients whose DM is hard to manage, you'd need an endocrine rotation. HTN also--you do not need a month of exposure to essential HTN. Beyond that, the differential is not something you'll be working up, ever, in psychiatry.

But EM could be useful! Patients come to psych with weird problems. From my experience, I'd say you can count on manic patients having their share of toe fractures and needing tetnus shots and xrays. Pts try to kill themselves so they come to floor s/p various procedures. And don't forget the all important OD.

And good grief, the sunburns and frostbite our patients get.

Then again, check with residents at your program to see what their experiences have been.

 

[mathilda25]

I did ER, outpatient medicine and inpatient medicine - and the best learning of all 3 was the ER - I felt like it was most relevent to psych in that when you are called about medical issues on the psych floor you often have to decide how urgent they are - these are things you learn best in the ED (at least at my program....maybe in other programs you learn this on inpatient)

besides ED is fun and you get a lot of practice doing different skills which you may be doing on psych floors.....

 

[hippiedoc13]

I vote for the month of EM! I am a FM/Psych resident so I had to do an EM rotation during my intern year. First of all, it was a great learning experience for the amount of medicine I learned and the skills that it fostered in terms of triage, quickly evaluating acuity, multitasking, etc. But secondly, as others here have pointed out, it was tremendously beneficial in terms of the camaraderie I built with the EM residents and attendings. Now they know me, they know my work, and they show a lot of respect. Likewise, now I know what it's like to do their job, especially the patient flow pressures they face, and I have a great deal of respect for them. It has made my life soooo much easier when taking call and seeing psych consults in the ED. Some of my psych colleagues have very tense relationships w/ the ED and that tends to make their lives miserable on call.

Plus, I totally subscribe to the OP's philosophy of "the thing that makes me most nervous, is exactly the thing I should do"