Getting into a Psych residency without inpatient psych rotation?

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RichterBelmont

RichterBelmont

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Hi all,

I am planning on pursuing psychiatry for my residency but am concerned because my only core psychiatry rotation was at an outpatient county facility and I don't have any inpatient psych experience yet. I am trying my hardest to get some sort of inpatient psych rotation but so far I haven't had any luck setting that up for my 4th year audition rotations.

Is it possible to match into a psychiatry program with only doing an outpatient psychiatry rotation during M3? I also received a letter of recommendation from this rotation.

My background: osteopathic medical student, 233 USMLE step 1.

thanks for all your help!
 
I'm in a similar situation with respect to my only psych rotation being entirely outpatient. There's a lot of advice on this site that recommends not doing any psych during fourth year and using that time to explore other things. Ultimately however I decided it was in my best interest to do a psych Sub-I to get the inpatient experience. And I'm super excited for it! As has been said, it's hardly a requirement, but it certainly provides a low risk opportunity to figure out the eb-and-flow of an inpatient psych environment!
 
This is quite the flip side of a common problem. We are trying very hard to get our core medical student rotations to include some outpatient experience. Most cores have inpatient, ER, C&L, but getting a meaningful outpatient medical student experience is very hard in a block system. 90% of psychiatry is outpatient and making medical students do inpatient work and then asking them if they are interested in becoming a psychiatrist is probably the worst thing we do for our specialty. I’m not fond of inpatient work and if I had to do it full time, I would not be a psychiatrist.
I guess the problem is in getting follow up with the same patients over a short period of time, and giving medical students anything that is realistically a kin to clinical responsibility. If students are not given some sense of autonomy, they might as well watch doctor shows on TV.
 
This was the problem with my rotation. Although I got to see the side of psychiatry that I'm most interested in and got along really well with the attendings, my level of clinical responsibility was nil. Therefore I feel I need a substantial inpatient month in order to confidently say that this is what I want to do and that I can handle it for the rest of my career.
 
MacDonaldTriad said:
This is quite the flip side of a common problem. We are trying very hard to get our core medical student rotations to include some outpatient experience. Most cores have inpatient, ER, C&L, but getting a meaningful outpatient medical student experience is very hard in a block system. 90% of psychiatry is outpatient and making medical students do inpatient work and then asking them if they are interested in becoming a psychiatrist is probably the worst thing we do for our specialty. I’m not fond of inpatient work and if I had to do it full time, I would not be a psychiatrist.
I guess the problem is in getting follow up with the same patients over a short period of time, and giving medical students anything that is realistically a kin to clinical responsibility. If students are not given some sense of autonomy, they might as well watch doctor shows on TV.
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Yeah, I tell my students this all the time. Something along the lines of "don't form your opinion of psychiatry based on this rotation, and take every possible opportunity to do things outside of the inpatient unit while you're on your psych rotation... and even if you like this rotation a little bit, you might like everyday psychiatry a lot."

Fabio001 said:
I'm in a similar situation with respect to my only psych rotation being entirely outpatient. There's a lot of advice on this site that recommends not doing any psych during fourth year and using that time to explore other things. Ultimately however I decided it was in my best interest to do a psych Sub-I to get the inpatient experience. And I'm super excited for it! As has been said, it's hardly a requirement, but it certainly provides a low risk opportunity to figure out the eb-and-flow of an inpatient psych environment!
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I'm not sure if people here necessarily recommend "not doing any psych"... just don't do all psych. It's completely reasonable to do a couple of months of psych in your 4th year... if nothing else, then just to make sure that you actually like it.
 
so in other words, it's not necessary to have an inpatient psych rotation to match into a psych residency, and while you should do other rotations besides psych in your 4th year, you CAN do psych electives if you want.
 
RichterBelmont said:
so in other words, it's not necessary to have an inpatient psych rotation to match into a psych residency, and while you should do other rotations besides psych in your 4th year, you CAN do psych electives if you want.
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You should probably do at least some psych electives in 4th year. One of the challenges for applicants to psych residency programs is proving that they're not choosing psych because they weren't competitive enough to do what they really wanted to do. One way to prove that is to do a couple of psych electives. Just leave enough time for some non-psych electives to ensure that your training is broad. And this probably isn't as big of a deal for you because you have a good Step 1 score.

It's definitely not necessary to have an inpatient psych rotation, but it's probably advisable. It doesn't have to be an "audition" rotation... you can do a rotation anywhere, even if it's not at a program where you'd like to match.
 
Ah ok, good advice about the other electives I will be doing! Another one of my classmates who matched psych this past year echoed that sentiment.

Is it OK to have these psych electives AFTER interview season (so long as I can just mention them during my interview if someone asks me about them?)

Thanks again for all your help!
 
I second Shan totally. He routinely gives solid advice, which I really appreciate, as it has been invaluable in getting me through this year's match. 👍

Don't do too much psych in 4th year, but surely do some. I went overboard and did too much psych (like 3.5 months), and while all of it was useful, I think I would have been better off doing 1-2 months of psych electives, to make time for other stuff I wanted to learn. (For me personally, I still wish I could go back and do an OMM clinic elective to learn more about osteopathy in a clinical setting... and am kicking myself for not doing that, as I was genuinely interested in learning some more OMM just to be better at it.) However, I think having an inpatient psych month in 4th year would be really important to complement your 3rd year outpatient experience. If your school doesn't offer this inpatient experience, there are plenty of places you can apply through VSAS.

RichterBelmont said:
Is it OK to have these psych electives AFTER interview season (so long as I can just mention them during my interview if someone asks me about them?)
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Why would you do this? I don't get it. The point is for you to be sure that psych is the right career path for you, so what is the point in doing all of these psych rotations after interviews are already over? If you see a pretty girl on a subway, would you tell her "Let's just get married now, and then we can date and learn if we are compatible afterwards"? Doing rotations is for your benefit first and foremost, and only secondarily for the sake of showing your residency interviewers that you are serious about being a psychiatrist.

I absolutely loved my outpatient rotation, but my inpatient not as much (although it was still enjoyable). The point is for you to have a balanced perspective on the field you are about to enter.
 
rkaz said:
I second Shan totally. He routinely gives solid advice, which I really appreciate, as it has been invaluable in getting me through this year's match. 👍

Don't do too much psych in 4th year, but surely do some. I went overboard and did too much psych (like 3.5 months), and while all of it was useful, I think I would have been better off doing 1-2 months of psych electives, to make time for other stuff I wanted to learn. (For me personally, I still wish I could go back and do an OMM clinic elective to learn more about osteopathy in a clinical setting... and am kicking myself for not doing that, as I was genuinely interested in learning some more OMM just to be better at it.) However, I think having an inpatient psych month in 4th year would be really important to complement your 3rd year outpatient experience. If your school doesn't offer this inpatient experience, there are plenty of places you can apply through VSAS.



Why would you do this? I don't get it. The point is for you to be sure that psych is the right career path for you, so what is the point in doing all of these psych rotations after interviews are already over? If you see a pretty girl on a subway, would you tell her "Let's just get married now, and then we can date and learn if we are compatible afterwards"? Doing rotations is for your benefit first and foremost, and only secondarily for the sake of showing your residency interviewers that you are serious about being a psychiatrist.

I absolutely loved my outpatient rotation, but my inpatient not as much (although it was still enjoyable). The point is for you to have a balanced perspective on the field you are about to enter.
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No, I completely understand that you're saying, but the issue is if I CAN'T get an inpatient psych rotation before interviews start. VSAS is a crapshoot and I go to a osteopathic school, and since we don't have our own hospital, it's really hard to get an inpatient psych rotation. I've been basically cold calling and contacting all these local attendings/preceptors who have at one point taken our students for psych rotations, but other than waiting out VSAS, this is about all I can do at this point (as far as I can tell). What I'm saying is if I CAN'T before interview season starts, is it OK to have them after the interview (so at least interviewers know I'm sincere about psych when I say have more psych electives down the road?)

Thanks for all your input everyone.
 
rkaz said:
I second Shan totally. He routinely gives solid advice, which I really appreciate, as it has been invaluable in getting me through this year's match. 👍
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Ha, thanks for the flattery, but I should include a line in my signature to say that all of my advice is speculation based on inadequate data.


If you see a pretty girl on a subway, would you tell her "Let's just get married now, and then we can date and learn if we are compatible afterwards"?
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This would be WAY better than the strategy that I'm currently using (i.e. waiting for the pretty girl to see me and say "let's just get married now").


RichterBelmont said:
No, I completely understand that you're saying, but the issue is if I CAN'T get an inpatient psych rotation before interviews start. VSAS is a crapshoot and I go to a osteopathic school, and since we don't have our own hospital, it's really hard to get an inpatient psych rotation. I've been basically cold calling and contacting all these local attendings/preceptors who have at one point taken our students for psych rotations, but other than waiting out VSAS, this is about all I can do at this point (as far as I can tell). What I'm saying is if I CAN'T before interview season starts, is it OK to have them after the interview (so at least interviewers know I'm sincere about psych when I say have more psych electives down the road?)

Thanks for all your input everyone.
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If you're really desperate, look into some of the agencies that place med students in rotations for money. It's expensive, but it's a drop in the bucket compared to the cost of med school.
Also, last time I checked, not all schools required you to use VSAS. That might have changed, but this was relevant to me as an IMG, since IMGs can't use VSAS. I had good luck with Tulane.
 
rkaz said:
If your school doesn't offer this inpatient experience, there are plenty of places you can apply through VSAS. Why would you do this? I don't get it. The point is for you to be sure that psych is the right career path for you, so what is the point in doing all of these psych rotations after interviews are already over? If you see a pretty girl on a subway, would you tell her "Let's just get married now, and then we can date and learn if we are compatible afterwards"? Doing rotations is for your benefit first and foremost, and only secondarily for the sake of showing your residency interviewers that you are serious about being a psychiatrist.
Click to expand...

Agree with above (and rkaz is also a great source of advice in addition to Shan). I got the impression that the OP is having trouble scheduling an inpatient rotation prior to interviews, which can be tough. I remember praying that I got my sub-I when I did (with the attending I wanted), so I can bank on a letter. If you can't score an inpatient Sub-I through VSAS, you can also choose C-L or ED psych to complement your outpatient experience. (I'm thinking of Bellevue's CPEP) Psych is starting to be less and less inpatient based anyway, as evidenced by the closing of inpatient wards all over NYC in recent years.

Regardless, I'm of the camp where a fourth year psych sub-I is essential for your application, but this is what I was taught last year when I was applying.[/QUOTE]
 
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rkaz said:
"Let's just get married now, and then we can date and learn if we are compatible afterwards"?
Click to expand...

OldPsychDoc said:
To quote the Beach Boys: Those Midwest farmers' daughters really make you feel alright. And the Northern girls with the way they kiss, they keep their boyfriends warm at night...

Love the northern midwest! 😉
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I love the Midwest too! (Originally from there- I bet you can tell from my screen name which state), but same-sex marriage isn't legal in most Midwest states, so I'll just go ahead and date date date those Midwestern boys!:naughty:
 
OldPsychDoc said:
To quote the Beach Boys: Those Midwest farmers' daughters really make you feel alright. And the Northern girls with the way they kiss, they keep their boyfriends warm at night...

Love the northern midwest! 😉
Click to expand...
but they wish they all could be California girls.
 
Haha. Midwestern girls definitely have a certain cuteness coupled with that Midwestern friendliness you don't find elsewhere.

Also I think a distinction in degree of latitude needs to be made when considering California girls. The toxic mix of craven attention seeking, failed, bitter dreams of stardom, and commitment to superficiality of LA women is pretty much the worst. Although you have to give them points for a rainbow palate of pure hotness.
 
WolverineDoc13 said:
I love the Midwest too! (Originally from there- I bet you can tell from my screen name which state), but same-sex marriage isn't legal in most Midwest states, so I'll just go ahead and date date date those Midwestern boys!:naughty:
Click to expand...

This is a bit of a tangent, but my understanding was that you can get married in a different state and still be considered "married" in your home state. I know at least one couple that has done that.
 
shan564 said:
This is a bit of a tangent, but my understanding was that you can get married in a different state and still be considered "married" in your home state. I know at least one couple that has done that.
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Yes, this is a tangent (that I started), but that option depends on the state. Some states still only define marriage between a man and a woman (though that's quickly changing). And either way, I don't think it's acceptable for a couple to have to get married in a different state for any reason. However, I have faith that it will all change in a few years-- even in my beloved midwest.

Woth that said, my initial comment was honestly just a joke that I made in response to rkaz's statement (about comparing not taking a 4th year sub-i to marrying a girl too soon). Nothing more. (Clearly, it wasn't a very good joke)
 
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