General residencies with good C&L experience/reputation

[masterofmonkeys]

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Curious about this as although I don't plan on doing a C&L fellowship, I think this aspect of psychiatry is pretty freaking awesome. The lectures, presentations, and case reports I've seen are some of the more fascinating in a specialty I find intellectually stimulating from top to bottom. And as I want to tailor my practice and research toward those suffering from serious physical illness, it would seem appropriate to have a solid foundation in C&L.

I know Doc Samson is going to say Harvard Longwood.

I'm also interested in the strength of several other programs including Cambridge, Cornell, Columbia, Brown, UTSW, Yale, UCSF, UCSD, and UCLA. If anyone can think of other programs with strong C&L as well as child exposure, feel free to throw their names out there.

 

[Doc Samson]

Apparently I'm getting predictable in my old age. Yes, I would receommend Longwood (among others), but here are the criteria I'd look for:

1) More than the basic 2 month requirement (e.g., Longwood residents rotate on CL for 6 months, MGH/McLean residents for 4 months)

2) CL service in a large tertiary care medical center, preferably with all specialties and important subspecialties represented (esp. neurology, neurosurgery)

3) Ideally a level 1 trauma center

4) Ideally with solid organ transplant programs

5) And if you want to see the real zebras (and conversion/factitious/malingering cases), a quaternary care hospital that takes referrals from all over the world.


The only real outlier from your list is Cambridge (which is an excellent overall program), since they're based in a community hospital.

 

[MBK2003]

Just a point of bias from my C/L training in residency and something that may be hard to sort out as an applicant, but
1) What years of residency do you do C/L - is it during 3rd and 4th years when your psychiatry knowledge is more consolidated and you can take more independent role in the consults
2) How much of the C/L teaching staff is on the speakers bureaus for the pharmaceutical companies - if I had a nickel for every time I was instructed to use Abilify IM for delirium and agitated dementia by the attending in the pocket of BMS I would live in a much nicer house right now. Transparency in the teaching staff is also quite important.

 

[Doc Samson]

Just a point of bias from my C/L training in residency and something that may be hard to sort out as an applicant, but
1) What years of residency do you do C/L - is it during 3rd and 4th years when your psychiatry knowledge is more consolidated and you can take more independent role in the consults
2) How much of the C/L teaching staff is on the speakers bureaus for the pharmaceutical companies - if I had a nickel for every time I was instructed to use Abilify IM for delirium and agitated dementia by the attending in the pocket of BMS I would live in a much nicer house right now. Transparency in the teaching staff is also quite important.

I totally agree with point 1. As for point 2, I am without words. 😱😡

 

[atsai3]

Just a point of bias from my C/L training in residency and something that may be hard to sort out as an applicant, but
1) What years of residency do you do C/L - is it during 3rd and 4th years when your psychiatry knowledge is more consolidated and you can take more independent role in the consults
2) How much of the C/L teaching staff is on the speakers bureaus for the pharmaceutical companies - if I had a nickel for every time I was instructed to use Abilify IM for delirium and agitated dementia by the attending in the pocket of BMS I would live in a much nicer house right now. Transparency in the teaching staff is also quite important.

I agree with point 1 as well. However, you should realize that deferring C/L to 4th year effectively precludes short tracking eg. into child psych. Hard to know as a medical student whether this is something you definitely want to do, and things change a lot during residency, so I wouldn't necessarily exclude programs from your consideration because of structural barriers to short tracking (eg., at Columbia your C/L rotations occur 4th year).

-AT.

 

[Hurricane]

Well then I guess UTSW fits Doc Samson's criteria. (although I don't know what it means to officially be a quartenary care center, but there is no shortage of the weird and bizarre at Parkland.)

We do 2 months as PGY2s + 2 months as PGY4s. (That was a recent change to provide more opportunity for upper and lower level residents to work together.) The C/L service also has a presence at trauma, burns, and PM&R rounds, and some of the outpatient clinics - palliative care, transplant, HIV, etc. Some of that is part of the rotation, others you can probably do as an elective if you wanted.

Personally, C/L is not my thing, but even myself and others who aren't into C/L all admit that it's an excellent learning rotation. 😉

 

[Doc Samson]

Well then I guess UTSW fits Doc Samson's criteria. (although I don't know what it means to officially be a quartenary care center, but there is no shortage of the weird and bizarre at Parkland.)

One step higher than tertiary care - i.e. where other big fancy hospitals send the cases that are too tough/specialized for them. Typically a major teaching hospital might have a couple of departments like this - examples that spring to mind are pulmonology at Denver Jewish, neurosurgery at the Barrow, peds at CHOP, etc.

 

[cleareyedguy]

There's debate about when c/l should be done. While you have more consolidated knowledge as a pgy 3 or 4, you are closer to medicine as a pgy 2, and you'll know more of the medicine residents who call the consults. C/L is a great place to learn interviewing skills and consolidate psychiatric skills that can then be used as a pgy 3 and 4.

When you take c/l as a 3 or 4, you are often given 4 or 6 months. Imprtantly, you are ALSO doing outpatient psychiatry at the same time, so the c/l experience becomes part time. C/L can then become a distraction from outpatient work. I'd say that 3 months of full time c/l > 6 months of part time.

Finally, doing it as a 4 means you can't leave early to do child.

 

[BobA]

Just a point of bias from my C/L training in residency and something that may be hard to sort out as an applicant, but
1) What years of residency do you do C/L - is it during 3rd and 4th years when your psychiatry knowledge is more consolidated and you can take more independent role in the consults
2) How much of the C/L teaching staff is on the speakers bureaus for the pharmaceutical companies - if I had a nickel for every time I was instructed to use Abilify IM for delirium and agitated dementia by the attending in the pocket of BMS I would live in a much nicer house right now. Transparency in the teaching staff is also quite important.

Yeah - I have an attending who gets in patients' faces just to prove "how irritable" they can become when they react negatively to him (they are usually involuntary). . . and if they're on medicaid then a little abilify will smooth that irritability right out. . . . he happens to be a paid speaker. . .

It's so bad that other attendings won't use abilify in completely appropriate candidates (Bipolar Grad Student) just so residents get "experience with other medications"

 

[Doc Samson]

There's debate about when c/l should be done. While you have more consolidated knowledge as a pgy 3 or 4, you are closer to medicine as a pgy 2, and you'll know more of the medicine residents who call the consults. C/L is a great place to learn interviewing skills and consolidate psychiatric skills that can then be used as a pgy 3 and 4.

When you take c/l as a 3 or 4, you are often given 4 or 6 months. Imprtantly, you are ALSO doing outpatient psychiatry at the same time, so the c/l experience becomes part time. C/L can then become a distraction from outpatient work. I'd say that 3 months of full time c/l > 6 months of part time.

Finally, doing it as a 4 means you can't leave early to do child.

The official recommendation of the Academy of Psychosomatic Medicine is that CL be a PGY-3 or 4 rotation.