Fourth Year Rotations for a Psych Hopeful

[Mad Jack]

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I've looked around a bit, and there's questions here or there on this rotation or that sub-I, but nothing recent that addresses some really basic questions I've got. I'm a DO applicant, looking to stay anywhere within 200 miles of CT, Step 1 mid 220s, COMLEX 1 in the upper 500s. Clinical grades pretty much all in the HP range.

Question one- there aren't many sub-Is in psych near me that take DOs. The ones that are here I'm reluctant to rotate at because I'm a decent applicant on paper and would like to apply to then, but worry that a Sub-I had more potential to do harm than good. Do I absolutely need a psych Sub-I? How much does one actually help my application? If I do a sub-I, are there some that look better than others? And when should I do my Sub-I?

Question two- Aside from the question above, are there any rotations that will help my app? Are there any others that are pretty much required?

Question three- How much does Step 2 actually matter these days? I have to take Level 2 of the COMLEX so I'm getting that out of the way over the summer, but given the rest of my stats, is Step 2 necessary as well?

Question four- which letters work best? I've got an internist and a psychiatrist writing for me so far, both from community hospitals.

Thanks in advance for any help, you guys are the best!

 

[clausewitz2]

I've looked around a bit, and there's questions here or there on this rotation or that sub-I, but nothing recent that addresses some really basic questions I've got. I'm a DO applicant, looking to stay anywhere within 200 miles of CT, Step 1 mid 220s, COMLEX 1 in the upper 500s. Clinical grades pretty much all in the HP range.

Question one- there aren't many sub-Is in psych near me that take DOs. The ones that are here I'm reluctant to rotate at because I'm a decent applicant on paper and would like to apply to then, but worry that a Sub-I had more potential to do harm than good. Do I absolutely need a psych Sub-I? How much does one actually help my application? If I do a sub-I, are there some that look better than others? And when should I do my Sub-I?

Question two- Aside from the question above, are there any rotations that will help my app? Are there any others that are pretty much required?

Question three- How much does Step 2 actually matter these days? I have to take Level 2 of the COMLEX so I'm getting that out of the way over the summer, but given the rest of my stats, is Step 2 necessary as well?

Question four- which letters work best? I've got an internist and a psychiatrist writing for me so far, both from community hospitals.

Thanks in advance for any help, you guys are the best!

While I think the consensus is you do not need to load up on psych electives necessarily, not doing a psych sub-I of some kind is not ideal and should probably be avoided if possible.

Otherwise, other rotations that I personally found very useful were neuro (for obvious reasons) and derm (because it makes you way less scared of every single rash)

 

[sazerac]

At my MD school they de-emphasize doing psych sub-I's. Probably because for the last 10 years we didn't have many psych sub-I slots (just got some recently). They tell us a clinical sub-I like IM (or maybe Peds) is fine, and will demonstrate clinical acumen for those 6 months of intern year.

On the interview trail nobody asked much about my psych sub-I. Plenty asked about my most meaningful psych encounter, and a few asked about the psych elective I did and why (...because it was the only one available that month!).

LOR from both a psychiatrist and IM is awesome. Get another letter from somebody who really likes you, plus a fourth if you gotta go to Stanford. I only had 3 letters and I had interviews coming out my rear, including the northeast places I applied.

 

[Merovinge]

You can and should definitely get questions about your 4th year psych electives (I got a lot more than sazerac it appears). However, it being worded as a sub-I versus any other rotation is often just semantics. If you have good letters from psych electives that should cover you. I agree with your sentiment that a sub-I at a potential residency is risky; no way around it, but if you do pull it off well I have seen time and time again them help people match as well. Known quantity>unknown quantity is the PD way from my experience.

 

[JustAGuy]

How was your core rotation in psychiatry? Was it outpatient? If so, might be good to do an inpatient elective somewhere, or vice versa. I would consider doing an outpatient neuro month (if the option is there, maybe tbi, movement disorders, or epilepsy clinic), addiction, pain management, endocrinology.

 

[Candidate2017]

Audition rotations help you decide if a program is right for you because working with attendings and residents for a month provides more insight into a program than a half day of interviews. More data is better. All the different psychiatry programs I've rotated at run their services in vastly different manners. Teaching, culture, patient population, and philospohy towards psychiatry were all very different. Sampling several programs gives you an idea of what you want out of resideny. You will do fine on auditions if your classmates and previous residents don't consider you a douche bag and you've performed well on rotations. On interviews, people will ask about your psychiatry experiences. Being able to talk about your rotation at Brand Name Hospital is a big plus because no one has probably ever heard of Random Osteopathic Hospital where you did your 3rd year psychiatry . Name dropping works. No one ever asked about my other rotations.

Step 2 is up to you. I got lots of invites, some at top places, with just Comlex (a below average Comlex for applicants matched to psychiatey). I don't care about brand names, but maybe you do. I'd take Step 2 to maximize my odds if that's your case.

 

[MacDonaldTriad]

I think the answer to this discussion is that it varies. IMGs and to some extent DOs may have to jump up and down a little more to stand out and get noticed and sub-Is can help with this. Otherwise out of over 100 allopathic grads who are interviewed, the selection committee might say: “Oh look three of them did sub-Is with us.” So no, it isn’t by any way required. Besides, the communication between the undergraduate medical educators and the post graduate educators isn’t always there that much. Even if you do walk around and ask for opinions about so and so, the answers tend to depend on the people being asked and their expectations rather than the performance of the student. The feedback varies a lot when you have a conversation and it varies very little in writing. I still think we should find a blood test that correlates to graduate medical education performance. It would save big bucks.

 

[Mad Jack]

How was your core rotation in psychiatry? Was it outpatient? If so, might be good to do an inpatient elective somewhere, or vice versa. I would consider doing an outpatient neuro month (if the option is there, maybe tbi, movement disorders, or epilepsy clinic), addiction, pain management, endocrinology.

My core rotation was two weeks inpatient (psych unit and C&L), two weeks C&A IOP, and two weeks outpatient addiction and post-acute psych followup. It was a great experience all around, and I'm likely looking to do an extra couple of weeks of inpatient as a mini-subi sort of thing before 4th year in lieu of taking a vacation because I liked it so much and I'd like an opportunity to both see more inpatient work, take on more responsibility, and get some mentorship from the faculty (which are awesome).

I think the answer to this discussion is that it varies. IMGs and to some extent DOs may have to jump up and down a little more to stand out and get noticed and sub-Is can help with this. Otherwise out of over 100 allopathic grads who are interviewed, the selection committee might say: “Oh look three of them did sub-Is with us.” So no, it isn’t by any way required. Besides, the communication between the undergraduate medical educators and the post graduate educators isn’t always there that much. Even if you do walk around and ask for opinions about so and so, the answers tend to depend on the people being asked and their expectations rather than the performance of the student. The feedback varies a lot when you have a conversation and it varies very little in writing. I still think we should find a blood test that correlates to graduate medical education performance. It would save big bucks.

Do you think it would be alright to just do a rotation rather than a sub-i to get some exposure at different hospitals? I really want to do a sub-i later in the year in both inpatient psychiatry and medicine, but with the way my step 2 is scheduled, I worry I'll be shooting myself in the foot on the boards if I schedule am IM sub-I in the four weeks before my tests.

It really sucks, the way our schedule runs we only get one full rotation before ERAS gets submitted (we finish first year July 15th, halfway through most rotations), so it's hard to get 4th year grades and letters even in on time. Am I stressing about all of this too much if I've already got strong letters from a psychiatrist and two internists (inpatient and outpatient)? I'm not looking for super big name places, I really just want to match 🤔

 

[Mad Jack]

Thanks for your advice by the way, you guys are the best

 

[psychhopefull2016]

I did my Sub-I in June. I thought it was helpful for my application because I did something a little unique (eating disorders inpatient unit) and so I think it gave me something interesting to talk about on interviews. Otherwise I did a research month to study for CK, a month of primary care, and an outpatient psych elective prior to applying! People also asked about my peds sub I, and what interesting elective I had planned for after interviews!

 

[Seroquel]

Definitely a good idea to do a Sub I in Psych at the beginning of fourth year. One of the most common questions I got on the interview trail was "tell me about a patient/experience during your psych rotation.." and it would have been a little tough to think of if I was only relying on my third year clerkship. Also it shows that you are dedicated to the field if you take fourth year Sub Is in psych.
Some rotations I took that I found to be helpful: Endocrinology, Inpatient psych (I only did consult and some child so I wanted to have more inpatient experiences), General Medicine.
Some rotations I was told would be helpful but weren't: ICU (OMGGGG our psych dept lady insisted we try out a month and I have yet to see anything that I haven't already had exposure to)

 

[Amygdarya]

Deep inside I know this doesn't really matter in the big scheme of things, but I will appreciate it if you humor me by giving your opinions on the matter.

My question is whether I should schedule an advanced inpatient or advanced outpatient psych elective as one of my psych sub-Is.

My clinical experience in psychiatry so far:
- 3 weeks of inpatient as part of core rotation (didn't click with my attending, got a poor eval which is the *only* reason I didn't honor psych 🙁);
- 3 weeks of psych ED as part of core rotation (great evals, everyone loved me, planning to ask one or two psych ED attendings for letters);
I'm at a 1.5 years preclinical + 6 months of mandatory research school, and since I came to med school to become a physician I managed to arrange some informal psych clinical experience during my research block, so:
- by the time of residency application I will have 6 months of at least one 12-hour psych ED shift a week on average + learning higher level psych interviewing from one of our best faculty in partial hospitalization settings (1-2 interview sessions a week).

Psych electives I will do before residency application:
- a 2-week psycho-onc elective (just to get some C-L experience, not planning to get a letter or anything);
- a sub-I level 4-week elective at a specialized personality disorders inpatient unit (hoping to get a letter).

Now I'm deciding what to do for my second 4-week psych elective that I can schedule before residency application. The options are:
- Advanced inpatient on the same unit as I did my core psych rotation - kind of more of the same, but I'm considering doing it in an attempt to compensate for my core clerkship inpatient experience (by the way, that attending's narrative didn't make it to the cumulative psych clerkship narrative and thus won't be part of MSPE; it did affect the grade though);
- advanced outpatient with the same faculty member from whom I'm unofficially learning interviewing now (I expect to learn a lot from him and possibly get a letter, but I also worry that outpatient may be seen as easy/lazy/not robust enough compared to inpatient for the purpose of application).

I truly madly deeply want to stay at my home program, but the fact that one of the important attendings disliked me obviously complicates things (and I don't mind working with this attending as a resident if I match there; it's a big "if" though).

So, what do you guys think re: inpatient vs outpatient 4-week elective?

 

[psychhopefull2016]

Deep inside I know this doesn't really matter in the big scheme of things, but I will appreciate it if you humor me by giving your opinions on the matter.

My question is whether I should schedule an advanced inpatient or advanced outpatient psych elective as one of my psych sub-Is.

My clinical experience in psychiatry so far:
- 3 weeks of inpatient as part of core rotation (didn't click with my attending, got a poor eval which is the *only* reason I didn't honor psych 🙁);
- 3 weeks of psych ED as part of core rotation (great evals, everyone loved me, planning to ask one or two psych ED attendings for letters);
I'm at a 1.5 years preclinical + 6 months of mandatory research school, and since I came to med school to become a physician I managed to arrange some informal psych clinical experience during my research block, so:
- by the time of residency application I will have 6 months of at least one 12-hour psych ED shift a week on average + learning higher level psych interviewing from one of our best faculty in partial hospitalization settings (1-2 interview sessions a week).

Psych electives I will do before residency application:
- a 2-week psycho-onc elective (just to get some C-L experience, not planning to get a letter or anything);
- a sub-I level 4-week elective at a specialized personality disorders inpatient unit (hoping to get a letter).

Now I'm deciding what to do for my second 4-week psych elective that I can schedule before residency application. The options are:
- Advanced inpatient on the same unit as I did my core psych rotation - kind of more of the same, but I'm considering doing it in an attempt to compensate for my core clerkship inpatient experience (by the way, that attending's narrative didn't make it to the cumulative psych clerkship narrative and thus won't be part of MSPE; it did affect the grade though);
- advanced outpatient with the same faculty member from whom I'm unofficially learning interviewing now (I expect to learn a lot from him and possibly get a letter, but I also worry that outpatient may be seen as easy/lazy/not robust enough compared to inpatient for the purpose of application).

I truly madly deeply want to stay at my home program, but the fact that one of the important attendings disliked me obviously complicates things (and I don't mind working with this attending as a resident if I match there; it's a big "if" though).

So, what do you guys think re: inpatient vs outpatient 4-week elective?

So the faculty member at my school who is really helpful in planning and applying for psych strongly recommended I did not do a repeat rotation on the same unit I did for my 3rd year clerkship. For me, I was on inpatient child which is what I want to do with my life and I had a phenomenal experience and wanted to go back. He encouraged me to do something different to get a broader foundation and have something new to talk about for interviews. Also, if there was an attending you didn't jive with, you could wind up with that guy again which would be an issue. So I would recommend the outpatient elective!

 

[splik]

Now I'm deciding what to do for my second 4-week psych elective that I can schedule before residency application. The options are:
- Advanced inpatient on the same unit as I did my core psych rotation - kind of more of the same, but I'm considering doing it in an attempt to compensate for my core clerkship inpatient experience (by the way, that attending's narrative didn't make it to the cumulative psych clerkship narrative and thus won't be part of MSPE; it did affect the grade though);
- advanced outpatient with the same faculty member from whom I'm unofficially learning interviewing now (I expect to learn a lot from him and possibly get a letter, but I also worry that outpatient may be seen as easy/lazy/not robust enough compared to inpatient for the purpose of application).

I truly madly deeply want to stay at my home program, but the fact that one of the important attendings disliked me obviously complicates things (and I don't mind working with this attending as a resident if I match there; it's a big "if" though).

So, what do you guys think re: inpatient vs outpatient 4-week elective?

it doesn't matter BUT if you are hoping to make a good impression then you are not going to be able to do that in an outpatient setting since you would like be mostly shadowing. you would need to do inpt or inpt CL. do you really need to do more psych anyway sounds like you have done plenty? you don't need any more letters so i would suggest doing something else (like palliative medicine for example)

 

[st2205]

Deep inside I know this doesn't really matter in the big scheme of things, but I will appreciate it if you humor me by giving your opinions on the matter.

My question is whether I should schedule an advanced inpatient or advanced outpatient psych elective as one of my psych sub-Is.

My clinical experience in psychiatry so far:
- 3 weeks of inpatient as part of core rotation (didn't click with my attending, got a poor eval which is the *only* reason I didn't honor psych 🙁);
- 3 weeks of psych ED as part of core rotation (great evals, everyone loved me, planning to ask one or two psych ED attendings for letters);
I'm at a 1.5 years preclinical + 6 months of mandatory research school, and since I came to med school to become a physician I managed to arrange some informal psych clinical experience during my research block, so:
- by the time of residency application I will have 6 months of at least one 12-hour psych ED shift a week on average + learning higher level psych interviewing from one of our best faculty in partial hospitalization settings (1-2 interview sessions a week).

Psych electives I will do before residency application:
- a 2-week psycho-onc elective (just to get some C-L experience, not planning to get a letter or anything);
- a sub-I level 4-week elective at a specialized personality disorders inpatient unit (hoping to get a letter).

Now I'm deciding what to do for my second 4-week psych elective that I can schedule before residency application. The options are:
- Advanced inpatient on the same unit as I did my core psych rotation - kind of more of the same, but I'm considering doing it in an attempt to compensate for my core clerkship inpatient experience (by the way, that attending's narrative didn't make it to the cumulative psych clerkship narrative and thus won't be part of MSPE; it did affect the grade though);
- advanced outpatient with the same faculty member from whom I'm unofficially learning interviewing now (I expect to learn a lot from him and possibly get a letter, but I also worry that outpatient may be seen as easy/lazy/not robust enough compared to inpatient for the purpose of application).

I truly madly deeply want to stay at my home program, but the fact that one of the important attendings disliked me obviously complicates things (and I don't mind working with this attending as a resident if I match there; it's a big "if" though).

So, what do you guys think re: inpatient vs outpatient 4-week elective?

As far as an application standpoint I don't think it's going to matter and you may be overthinking this. As far as what may be helpful, I'd probably suggest outpatient depending on what you're actually exposed to. I didn't have any outpatient exposure until residency and even then I didn't get a real good feel for outpatient until halfway through second year. It's helpful to have a finer understanding for what the typical scope for outpatient is to be able to better guide your reasoning of inpatient and ED care that you'll be exposed to early on. Being better with outpatient helped a lot with handling and formulating inpatient issues, especially moonlighting. Obviously you'd have to be realistic about goals from an MS4 rotation but getting a flavor of the scope may be helpful.

 

[postbacpremed87]

Deep inside I know this doesn't really matter in the big scheme of things, but I will appreciate it if you humor me by giving your opinions on the matter.

My question is whether I should schedule an advanced inpatient or advanced outpatient psych elective as one of my psych sub-Is.

My clinical experience in psychiatry so far:
- 3 weeks of inpatient as part of core rotation (didn't click with my attending, got a poor eval which is the *only* reason I didn't honor psych 🙁);
- 3 weeks of psych ED as part of core rotation (great evals, everyone loved me, planning to ask one or two psych ED attendings for letters);
I'm at a 1.5 years preclinical + 6 months of mandatory research school, and since I came to med school to become a physician I managed to arrange some informal psych clinical experience during my research block, so:
- by the time of residency application I will have 6 months of at least one 12-hour psych ED shift a week on average + learning higher level psych interviewing from one of our best faculty in partial hospitalization settings (1-2 interview sessions a week).

Psych electives I will do before residency application:
- a 2-week psycho-onc elective (just to get some C-L experience, not planning to get a letter or anything);
- a sub-I level 4-week elective at a specialized personality disorders inpatient unit (hoping to get a letter).

Now I'm deciding what to do for my second 4-week psych elective that I can schedule before residency application. The options are:
- Advanced inpatient on the same unit as I did my core psych rotation - kind of more of the same, but I'm considering doing it in an attempt to compensate for my core clerkship inpatient experience (by the way, that attending's narrative didn't make it to the cumulative psych clerkship narrative and thus won't be part of MSPE; it did affect the grade though);
- advanced outpatient with the same faculty member from whom I'm unofficially learning interviewing now (I expect to learn a lot from him and possibly get a letter, but I also worry that outpatient may be seen as easy/lazy/not robust enough compared to inpatient for the purpose of application).

I truly madly deeply want to stay at my home program, but the fact that one of the important attendings disliked me obviously complicates things (and I don't mind working with this attending as a resident if I match there; it's a big "if" though).

So, what do you guys think re: inpatient vs outpatient 4-week elective?

WOW. Your experience was so much better than mine. If I had your experiences, then I would be doing other things. My grade dropped because of an eval too (Honors to High Pass). I absolutely destroyed the shelf. Both of my rotations were terrible (in quality) so it was an easy decision to sign up for 4 weeks of inpatient and 4 weeks of outpatient to start 4th year. I also need LORs so that makes me decision easier as well. Didn't you do the VCU Psych experience as well? That shows great commitment to the field too!

 

[st2205]

Also, I'd recommend doing neuro to get the basics out of the way so that you can dig a little deeper during residency as you'll only get two months. I did bare bones psych (since I knew that's what I was going in to) and did one rotation in 4th year. The rest was mostly IM (cardiology, nephrology, endocrine, ICU, FM, neuro, GI, derm, toxicology, ER... forget the rest). There are things you can theoretically learn from every rotation but honestly I think more neuro (in hindsight) is the highest yield. I got one week of outpatient neuro as a medical student and then residency was 2 months of a consult service. It was educational but I really think understanding a lot of the bread and butter of outpatient neuro would have helped rather than 2 months of strokes and pseudoseizures. As a PGY4 I recently spent a bit of time in a movement disorders clinic and it was very high yield, at least at this point in my training.

 

[clausewitz2]

Also, I'd recommend doing neuro to get the basics out of the way so that you can dig a little deeper during residency as you'll only get two months. I did bare bones psych (since I knew that's what I was going in to) and did one rotation in 4th year. The rest was mostly IM (cardiology, nephrology, endocrine, ICU, FM, neuro, GI, derm, toxicology, ER... forget the rest). There are things you can theoretically learn from every rotation but honestly I think more neuro (in hindsight) is the highest yield. I got one week of outpatient neuro as a medical student and then residency was 2 months of a consult service. It was educational but I really think understanding a lot of the bread and butter of outpatient neuro would have helped rather than 2 months of strokes and pseudoseizures. As a PGY4 I recently spent a bit of time in a movement disorders clinic and it was very high yield, at least at this point in my training.

Second the utility of neuro. You will have to do two months of it and I have enjoyed not feeling an utter prat when on their service.

Also want to register a vote for derm. Kbeoinf even a little bit about rashes will make you seem like a dark wizard on your medicine months and a straight up warlock the n a psych context.

 

[Mad Jack]

But like, will any fourth year rotation make or break whether I match successfully with my stats, or am I mostly good?

 

[st2205]

But like, will any fourth year rotation make or break whether I match successfully with my stats, or am I mostly good?

In theory? Sure. In reality? No. A lot of these things people stress about would be like the difference between wearing Axe or Old Spice deodorant on a first date. You could make several arguments for and against both, but your game is what will carry you.

 

[OldPsychDoc]

In theory? Sure. In reality? No. A lot of these things people stress about would be like the difference between wearing Axe or Old Spice deodorant on a first date. You could make several arguments for and against both, but your game is what will carry you.

 

[clausewitz2]

But like, will any fourth year rotation make or break whether I match successfully with my stats, or am I mostly good?

The only scenario where a particular rotation is going to make or break you is an audition rotation that you flub spectacularly, in which case you probably won't match at that particular program.

 

[Geraltofrivia]

Some really great advice in this thread. Thanks guys, I didn't consider doing Neuro month at all but now I'm gonna try to get a neuro month in and maybe two psych away-Is if possible! Planning on

July: Psych (at prospective residency)
Aug: Psych (at prospective residency)
Sept: IM (inpatient IM as my IM was quite weak... mostly shadowing)
Oct: Neuro
Nov: ?
Dec: Required elective by school
Jan Feb Required by school
March: EM
April: Random thing??

Any suggestions??

 

[psychhopefull2016]

Some really great advice in this thread. Thanks guys, I didn't consider doing Neuro month at all but now I'm gonna try to get a neuro month in and maybe two psych away-Is if possible! Planning on

July: Psych (at prospective residency)
Aug: Psych (at prospective residency)
Sept: IM (inpatient IM as my IM was quite weak... mostly shadowing)
Oct: Neuro
Nov: ?
Dec: Required elective by school
Jan Feb Required by school
March: EM
April: Random thing??

Any suggestions??

Something with super light attendance requirements in November for interview season!!

 

[prok]

Some really great advice in this thread. Thanks guys, I didn't consider doing Neuro month at all but now I'm gonna try to get a neuro month in and maybe two psych away-Is if possible! Planning on

July: Psych (at prospective residency)
Aug: Psych (at prospective residency)
Sept: IM (inpatient IM as my IM was quite weak... mostly shadowing)
Oct: Neuro
Nov: ?
Dec: Required elective by school
Jan Feb Required by school
March: EM
April: Random thing??

Any suggestions??

Are two aways really necessary? And you really want November and December available for interviews if possible, so can you take the required elective at another time?

 

[Merovinge]

Are two aways really necessary? And you really want November and December available for interviews if possible, so can you take the required elective at another time?

You definitely do not need to take Nov and Dec off of rotations completely. Just find light or reasonable rotations that understand you may miss 5-6 days of the month. You are an M4, that's a much more reasonable task than it sounds if you have a decent med school.

 

[prok]

You definitely do not need to take Nov and Dec off of rotations completely. Just find light or reasonable rotations that understand you may miss 5-6 days of the month. You are an M4, that's a much more reasonable task than it sounds if you have a decent med school.

I agree it's not necessary to have them off completely, but it's really nice to have the flexibility. 8-10 interviews seems to be the magic number for US MD's according to the most recent Charting Outcomes. Some people get mostly December interviews and wind up having to miss closer to 10 days or more that month, especially if travelling.You don't want to miss the pre-interview dinners either, so you can't just catch late flights the night before. It's fine if it's unavoidable, but having one or both of those months off makes the process so much easier.

 

[Merovinge]

I agree it's not necessary to have them off completely, but it's really nice to have the flexibility. 8-10 interviews seems to be the magic number for US MD's according to the most recent Charting Outcomes. Some people get mostly December interviews and wind up having to miss closer to 10 days or more that month, especially if travelling.You don't want to miss the pre-interview dinners either, so you can't just catch late flights the night before. It's fine if it's unavoidable, but having one or both of those months off makes the process so much easier.

I did 10 interviews. 4 Nov, 4 Dec, 2 Jan. I had great rotations in Nov and Dec and they totally understand because you provide no essential services as an M4 and they've all been through interview season before. Much better to have a month off to travel in May or get 1 extra rotation in that you'll never see again IMO but to each their own.

 

[psychhopefull2016]

Can you switch radiology and the psych elective so the easier thing is during interview season? Rads elective at my school is basically a joke.

 

[michiganpsych08]

Can you switch radiology and the psych elective so the easier thing is during interview season? Rads elective at my school is basically a joke.

No I can't. That's what I wanted actually for that very reason. But the easy radiology only had a spot open in September. I still took it because it's a easy 4 weeks

 

[Amygdarya]

i would like feedback on my schedule as well

july - finishing up peds rotation
august - psych elective
sept - radiology
oct - derm
nov - psych elective
dec - 2 week online advanced family med elective
jan - toxicology
feb - peds sub i
march - peds EM
april - required school elective

is it enough variety? I wanted to do peds neuro but nothing i want to give up for it (derm, radiology and em are required for graduation)

Can you schedule peds neuro instead of toxicology? From your schedule it seems like you're gearing up for child psych, and child neuro can be pretty useful there. (Though you'll have some child neuro rotations as part of CAP fellowship anyway.)

 

[Amygdarya]

@psychhopefull2016 @splik @st2205 @postbacpremed87 and @clausewitz2 thank you for your replies and my apologies for the late response - I've been digesting the info/making my decisions.

So the faculty member at my school who is really helpful in planning and applying for psych strongly recommended I did not do a repeat rotation on the same unit I did for my 3rd year clerkship. For me, I was on inpatient child which is what I want to do with my life and I had a phenomenal experience and wanted to go back. He encouraged me to do something different to get a broader foundation and have something new to talk about for interviews. Also, if there was an attending you didn't jive with, you could wind up with that guy again which would be an issue. So I would recommend the outpatient elective!

Right, repeating inpatient psych rotation on the same unit doesn't seem like a good idea for several reasons. Plus, I'll be doing an inpatient sub-I on a different unit (specialized personality disorders), so I'll have more inpatient experience (with a different attending!) anyway.

it doesn't matter BUT if you are hoping to make a good impression then you are not going to be able to do that in an outpatient setting since you would like be mostly shadowing. you would need to do inpt or inpt CL. do you really need to do more psych anyway sounds like you have done plenty? you don't need any more letters so i would suggest doing something else (like palliative medicine for example)

I'll be doing one inpatient sub-I (personality disorders), but unfortunately I couldn't register for CL because it's a popular psych sub-I and a lot of people are applying to psych from my school this year.
I'm doing a shorter psych-onc elective to have some CL experience and will do regular inpatient CL either formally or informally during the interview season - but, alas, not before my residency application submission.

Re shadowing in outpatient psych: that was my impression as well, and the reason why I didn't pick PHP as part of my core psych rotation. However, as I learned later, students actually get some useful learning experiences, as well as opportunities to impress attending on PHP. They work one on one with PHP attendings, they interview intakes and get detailed feedback on their interviewing skills from their attendings (something I didn't get on inpatient psych or in the ED), they submit their assessment and plan after the interview and get feedback on those, and they follow several patients during their PHP stint - talk to them daily/write daily notes/discuss them with their attendings (something I didn't get to do on inpatient since my attending was always too busy to hear what a student has to say; though I did present and discuss patients with ED attendings). This seems like a good opportunity to work on your interviewing and assessment skills - the attendings there give very useful thorough and specific feedback (if upsetting to some students, as they don't pull punches), and since I'm interested in psychodynamics and have been reading a lot, attending classes etc I expect to be able to discuss patients in a psychodynamically informed way and thus pleasantly impress my attending 🙂 Also, this particular attending I would be working with is known to appreciate an honest effort from students, and I have that in abundance as far as improving my psych skills are concerned 🙂
But I'm still considering other options for that month like outpatient neuro or some interesting psych subspecialty away unavailable at my school like neuropsychiatry.

Re palliative medicine: I did a geriatric inpatient medicine rotation that involved pain management and making comfortable of patients who should have been at the hospice weeks if not months ago but were instead brought to the hospital to die + I'll be doing an inpatient psych-onc elective at a cancer center, so I think between these two I'll cover some basics of palliative care.

WOW. Your experience was so much better than mine. If I had your experiences, then I would be doing other things. My grade dropped because of an eval too (Honors to High Pass). I absolutely destroyed the shelf. Both of my rotations were terrible (in quality) so it was an easy decision to sign up for 4 weeks of inpatient and 4 weeks of outpatient to start 4th year. I also need LORs so that makes me decision easier as well. Didn't you do the VCU Psych experience as well? That shows great commitment to the field too!

Sucks to have a grade dropped because of one subjective eval regardless of how well you did on everything else 🙁
I'm lucky that my school has a lot of opportunities in psych (also pointed out by our psych residents coming from other schools), though I also took initiative to create some opportunities for myself.
Yes, I went to the VCU summer school in psychiatry and loved it. I know I won't have any difficulty showing commitment to the field with 2 psych research projects started in MS1 (in different stages of presentation/publication now) and a significant involvement in a fairly unique psych related extracurricular that I'm planning to make a part of my future psych career, not to mention attendance of all kinds of psych lectures and conferences and stuff like that. I'm sure I'll match at a decent residency if I apply broadly enough; however, there is no guarantee that I match to my home program given how competitive things are.
Good luck on your sub-Is! Inpatient and outpatient sound like a good combination.

Also, I'd recommend doing neuro to get the basics out of the way so that you can dig a little deeper during residency as you'll only get two months. I did bare bones psych (since I knew that's what I was going in to) and did one rotation in 4th year. The rest was mostly IM (cardiology, nephrology, endocrine, ICU, FM, neuro, GI, derm, toxicology, ER... forget the rest). There are things you can theoretically learn from every rotation but honestly I think more neuro (in hindsight) is the highest yield. I got one week of outpatient neuro as a medical student and then residency was 2 months of a consult service. It was educational but I really think understanding a lot of the bread and butter of outpatient neuro would have helped rather than 2 months of strokes and pseudoseizures. As a PGY4 I recently spent a bit of time in a movement disorders clinic and it was very high yield, at least at this point in my training.

Outpatient neuro rotation is a great suggestion! I had a core neuro rotation that included inpatient, child and consults (which I loved, honored and received best evals from) but outpatient neuro is a really good idea and certainly doable, whether as a formal rotation or (semi-)informally with our awesome clerkship director who is very enthusiastic about teaching and providing students with good clinical neuro learning opportunities. Thanks for bringing this to my attention!

Also want to register a vote for derm. Kbeoinf even a little bit about rashes will make you seem like a dark wizard on your medicine months and a straight up warlock the n a psych context.

Yep, I'll be doing a Derm elective in the spring. Also a cardiology (I have seen it recommended here), EM and neuroradiology electives in the spring.