How should I prepare for internship?

[neurofan22]

I'm about to graduate from med school and enter psychiatry residency, and I'm feeling the typical excitement and anxiety. I've heard people at various stages of training say that there's really no preparing for internship, and I definitely appreciate the view that fourth-year med students should just enjoy their free time.

Still, I'd like to hear from anyone who does have recommendations for a finite set of high-yield topics or skills that would help me perform well and take good care of my patients. I enjoy (re-)learning, and I'll feel less anxious if I feel like I'm doing at least a bit of useful review. I also consider it a duty to my future patients that I not start internship unprepared. As an aside, by "skills" I'm referring more to procedures such as venipuncture and ABGs -- I feel confident with my H&Ps.

Thanks!

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[shan564]

Different places sometimes have different approaches/expectations regarding an intern's role. You should probably ask your PD.

 

[MacDonaldTriad]

Get one of the two major text books and read (in this order):

1. The Clinical Psychiatric examination
2. Signs and Symptoms in Psychiatry
3. Psychotic disorders
4. Mood disorders
5. Substance Related disorders
6. Delirium, Dementia and organic stuff.

You probably will only get halfway through this at best, but that is OK.
You probably will not be able to sharpen ABGs, but you can learn the vocabulary of psychiatry.

 

[rkaz]

Different places sometimes have different approaches/expectations regarding an intern's role. You should probably ask your PD.

I have had no communication with my PD, though I've had plenty of communication back and forth with the chief residents and program coordinator. Do you think I should reach out to my PD to initiate communication? I just perceive PDs to be very busy, and thus don't feel like troubling them unless necessary.

 

[OldPsychDoc]

I have had no communication with my PD, though I've had plenty of communication back and forth with the chief residents and program coordinator. Do you think I should reach out to my PD to initiate communication? I just perceive PDs to be very busy, and thus don't feel like troubling them unless necessary.

PDs are FAR less important than the Coordinators and the Chief(s)--in that order!

I'm very happy right now if they replied to my "Welcome" email after Match Day and confirmed that they were happy to be coming here...and that they're getting all the needed paperwork back to the Coordinators. There'll be plenty of time for learning in June.

 

[TheMan21]

Get one of the two major text books and read (in this order):

1. The Clinical Psychiatric examination
2. Signs and Symptoms in Psychiatry
3. Psychotic disorders
4. Mood disorders
5. Substance Related disorders
6. Delirium, Dementia and organic stuff.

You probably will only get halfway through this at best, but that is OK.
You probably will not be able to sharpen ABGs, but you can learn the vocabulary of psychiatry.

what are the two major text books?

 

[MacDonaldTriad]

Most people would say:
1. Kaplan & Sadock's comprehensive textbook of psychiatry (monster 2 volume) or their synopsis of psychiatry (about 1,500 pages),
2. The American Psychiatric Publishing Textbook of Psychiatry, edited by Hales, Yudofsky and Gabbard (about 1,700 pages)

Your program may use one or the other to structure curriculum, but either works. The APA text is more multiauthored so it can be a little more redundant and variable in writing quality. Kaplan and Sadock's chapters tends to reflect the PRITE subjects more, but these are changing now anyway. I don't have much insight into the real boards anymore.

 

[notdeadyet]

I've heard people at various stages of training say that there's really no preparing for internship, and I definitely appreciate the view that fourth-year med students should just enjoy their free time.

These people are right.

Any residency worth its weight is going to assume you know almost nothing. This is necessary, as a residency class is made up of people from a great variety of different places, which all have different techniques, styles, and systems. When you get to residency, they will teach you what you need to know and you can use their curriculum and resources to help shape you then.

There is more of a problem with interns getting flustered and burned out during the course of their year than not knowing enough when they arrive. I'd be with the folks who have been telling you to do what you enjoy and come to your residency ready and eager to get started. Yoga, hiking, cuddling, travel... doesn't matter. If reading K&S is what restores/recharges you, hab at it, but I would hope there is something else that does that better.

 

[Shikima]

These people are right.

Any residency worth its weight is going to assume you know almost nothing. This is necessary, as a residency class is made up of people from a great variety of different places, which all have different techniques, styles, and systems. When you get to residency, they will teach you what you need to know and you can use their curriculum and resources to help shape you then.

There is more of a problem with interns getting flustered and burned out during the course of their year than not knowing enough when they arrive. I'd be with the folks who have been telling you to do what you enjoy and come to your residency ready and eager to get started. Yoga, hiking, cuddling, travel... doesn't matter. If reading K&S is what restores/recharges you, hab at it, but I would hope there is something else that does that better.

Speaking personally, this happened to me.

 

[neurofan22]

Thanks everyone for your replies!

There is more of a problem with interns getting flustered and burned out during the course of their year than not knowing enough when they arrive. I'd be with the folks who have been telling you to do what you enjoy and come to your residency ready and eager to get started. Yoga, hiking, cuddling, travel... doesn't matter. If reading K&S is what restores/recharges you, hab at it, but I would hope there is something else that does that better.

The one thing that I'm not sure I understand about this is that I would think that confidence in one's knowledge would be really helpful in avoiding feeling flustered. Leads me to wonder -- any thoughts on how psychiatry interns become "the flustered/burnt out intern", besides not attending to basic burnout prevention like getting enough sleep and maintaining outside relationships and interests? Are there certain attitudes, personality characteristics, or coping strategies that tend to get psych interns in trouble?

 

[PsychOut83]

Most people would say:
1. Kaplan & Sadock's comprehensive textbook of psychiatry (monster 2 volume) or their synopsis of psychiatry (about 1,500 pages),
2. The American Psychiatric Publishing Textbook of Psychiatry, edited by Hales, Yudofsky and Gabbard (about 1,700 pages)

Your program may use one or the other to structure curriculum, but either works. The APA text is more multiauthored so it can be a little more redundant and variable in writing quality. Kaplan and Sadock's chapters tends to reflect the PRITE subjects more, but these are changing now anyway. I don't have much insight into the real boards anymore.

thanks

 

[Nasrudin]

Just as I was feeling a little guilty for being a goofball. ahhhhhh. thanks. well....back to it then.

 

[notdeadyet]

The one thing that I'm not sure I understand about this is that I would think that confidence in one's knowledge would be really helpful in avoiding feeling flustered.

Unlike a lot of specialties, psych is not a very pimp-heavy specialty. You may see that more on medicine, but if you know your basic DSM criteria, you'll be set. If you were to do a quick review of First Aid for Psychiatry, you'd be doing way more preparation than most of your incoming class. The fluster-effect of intern year in psychiatry is likely to be stuff that you can not prepare for. You become more comfortable with experience.

Leads me to wonder -- any thoughts on how psychiatry interns become "the flustered/burnt out intern", besides not attending to basic burnout prevention like getting enough sleep and maintaining outside relationships and interests? Are there certain attitudes, personality characteristics, or coping strategies that tend to get psych interns in trouble?

I think you hit the nail on the head with your "besides." Outside of the lifestyle/priorities/work-life balance stuff, I think the interns that tend to get more flustered is more personality-driven. E.g.: the folks always flustered and worried on the wards tend to repeat this pattern in intern year. And I never saw any correlation between flustered MS3's and the amount of study they did. Similarly, I don't think you'll find any with interns.

If reading psych stuff calms you down and gets your head out of the game, that's great. But I'd personally spend more time on activities that give you peace, presence, and pleasure now that you may find you won't have as much time for next year. You'll likely do a fair bit of reading next year whether you want to or not.

 

[myPsychAlt]

I generally advise to do as much non-medical, non-psych stuff as possible while you can, but if you really want a suggestion to be a good psychiatrist...

...move early to your city of residency. Read the local (and hyper-local, think DNAinfo in NYC and Chicago) news. Get a feel for the neighborhoods of your city... ALL of them. The place where you practice in residency is going to have it's own series of unique cultural contexts. The more you understand these, the more you will understand the sociocultural factors that are going to play a HUGE part in the mental health of your patients. Like it or not, no matter the program, there is going to be a social work aspect to your job, and the more you know the communities that your patients exist in, the more you can guide their treatment. Proper dosing of Risperdal isn't going to fix everything.

 

[OldPsychDoc]

I generally advise to do as much non-medical, non-psych stuff as possible while you can, but if you really want a suggestion to be a good psychiatrist...

...move early to your city of residency. Read the local (and hyper-local, think DNAinfo in NYC and Chicago) news. Get a feel for the neighborhoods of your city... ALL of them. The place where you practice in residency is going to have it's own series of unique cultural contexts. The more you understand these, the more you will understand the sociocultural factors that are going to play a HUGE part in the mental health of your patients. Like it or not, no matter the program, there is going to be a social work aspect to your job, and the more you know the communities that your patients exist in, the more you can guide their treatment. Proper dosing of Risperdal isn't going to fix everything.

 

[Nasrudin]

I generally advise to do as much non-medical, non-psych stuff as possible while you can, but if you really want a suggestion to be a good psychiatrist...

...move early to your city of residency. Read the local (and hyper-local, think DNAinfo in NYC and Chicago) news. Get a feel for the neighborhoods of your city... ALL of them. The place where you practice in residency is going to have it's own series of unique cultural contexts. The more you understand these, the more you will understand the sociocultural factors that are going to play a HUGE part in the mental health of your patients. Like it or not, no matter the program, there is going to be a social work aspect to your job, and the more you know the communities that your patients exist in, the more you can guide their treatment. Proper dosing of Risperdal isn't going to fix everything.

Cool post, thx. Studying the history and geography of cities is one of my favorite things to do.

 

[hungrycat]

I've decided that I am going to Hawaii to visit my grandma for a few weeks before residency begins. I haven't seen her in a while.