If you could change the 6 core clerkships...

[PL198]

Everyone saying psych is unnecessary is being totally dumb. Psych is just as important as IM is. Even if you're some generalist IM/FM doc, what are you going to do? Refer everyone with uncomplicated anxiety or major depression to a psychiatrist? Really? Not to mention communicating with patients with schizophrenia, bipolar, personality disorders, etc. who have medical issues that need treatment. Are you just going to refuse to treat these people?

Psych is an incredibly important rotation—one of the most important, actually. Just because you don't like psych doesn't mean it's not important.

Even if you don't believe it's necessary, what about fairness? Why do people think it makes substantially more sense to have psych folks sit through surgery than it does to have surgeon folk sit through psych? It seems obvious to me that psych is far more applicable to the field of surgery than the reverse . . .

yeah because one clearly has absolutely no skill in dealing with psych patients for their entire life if they don't spend 1 month on a psych clerkship as a 3rd year med student.

holy false dichotomies

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[sloop]

Everyone consuls everyone anyway. It's not that they can't handle the problem but for medicolegal issues.

People do not necessarily consult for uncomplicated major depression. Primary care docs start people on SSRIs and SNRIs all the time.

Go ahead and place a psychiatry consult from the medicine or family med service because of an obvious case of uncomplicated depression and see how the psychiatrists respond after seeing the patient. Even if you think they're fine with it, try eavesdropping on their resident lounge afterwards to see what they really think.

Or take my previous example of the psychotic patient with medical problems that need treatment. A psych consult might be appropriate, but so what? What are they going to do for you? Tell you the patient is psychotic and put in orders for haldol? Fine, but what if the patient has chest pain? Do you just twittle your thumbs until psych arrives?

Similarly, see what happens if you consult endocrine from family because your patient has impaired fasting glucose.

Or see what happens when you consult hematology from OB to work up a macrocytic anemia.

Yeah, sometimes legal concerns generate unnecessary consults, but doctors do need to be able to handle the common bread and butter stuff of most disciplines as it relates to their patients.

The argument has been made that a short third year rotation doesn't necessarily help with this. I disagree. You may not remember from rote how to handle this stuff years down the line and into practice, but you should be able to recognize certain things as issues you can manage without a consult and look it up.

People shouldn't be consulting specialists for clear cut, obvious **** that can be managed by anyone with a medical degree. Sorry, but if you're a doctor, you should act like a doctor. Just because you don't like someone's medical problem doesn't make it a specialist issue.

yeah because one clearly has absolutely no skill in dealing with psych patients for their entire life if they don't spend 1 month on a psych clerkship as a 3rd year med student.

holy false dichotomies

Fine, then can we just graduate everyone after they pass step 1?

 

[PL198]

People do not necessarily consult for uncomplicated major depression. Primary care docs start people on SSRIs and SNRIs all the time.

Go ahead and place a psychiatry consult from the medicine or family med service because of an obvious case of uncomplicated depression and see how the psychiatrists respond after seeing the patient. Even if you think they're fine with it, try eavesdropping on their resident lounge afterwards to see what they really think.

Or take my previous example of the psychotic patient with medical problems that need treatment. A psych consult might be appropriate, but so what? What are they going to do for you? Tell you the patient is psychotic and put in orders for haldol? Fine, but what if the patient has chest pain? Do you just twittle your thumbs until psych arrives?

Similarly, see what happens if you consult endocrine from family because your patient has impaired fasting glucose.

Or see what happens when you consult hematology from OB to work up a macrocytic anemia.

Yeah, sometimes legal concerns generate unnecessary consults, but doctors do need to be able to handle the common bread and butter stuff of most disciplines as it relates to their patients.

The argument has been made that a short third year rotation doesn't necessarily help with this. I disagree. You may not remember from rote how to handle this stuff years down the line and into practice, but you should be able to recognize certain things as issues you can manage without a consult and look it up.

People shouldn't be consulting specialists for clear cut, obvious **** that can be managed by anyone with a medical degree. Sorry, but if you're a doctor, you should act like a doctor. Just because you don't like someone's medical problem doesn't make it a specialist issue.



Fine, then can we just graduate everyone after they pass step 1?

Yeah Cuz that's what I said

 

[PL198]

Its just hilarious you think 1 month in the 3rd year of med school is what makes or breaks someone being able to treat basic psychiatric conditions.

 

[sloop]

Its just hilarious you think 1 month in the 3rd year of med school is what makes or breaks someone being able to treat basic psychiatric conditions.

I don't think it makes or breaks it. I think it's helpful. If you're prepared to say people should be allowed to graduate without stepping foot in a hospital at all, fine. But for the rest of the people in this thread operating under the assumption that clinical rotations serve some purpose and should exist, my point is that psych is at least as relevant as the other rotations, if not more.

 

[BigRedBeta]

Its just hilarious you think 1 month in the 3rd year of med school is what makes or breaks someone being able to treat basic psychiatric conditions.

Okay, fair enough. I'll backtrack a touch because of your argument even. Perhaps it's more accurate to say that these exposures are a matter of vocabulary. There is utility in speaking people's language to them. Obviously a third year clerkship is neither necessary or sufficient to be a successful psych resident. But it may be the basis for an IM resident getting an efficient consult from the psych service because they were able to triage the psych concern appropriately.

 

[PL198]

I don't think it makes or breaks it. I think it's helpful. If you're prepared to say people should be allowed to graduate without stepping foot in a hospital at all, fine. But for the rest of the people in this thread operating under the assumption that clinical rotations serve some purpose and should exist, my point is that psych is at least as relevant as the other rotations, if not more.

When did I say that? You have a reading comprehension problem.

 

[VA Hopeful Dr]

it's not kicking it down the road, it's just about realizing that you're going to deal with imaging 10x the amount of times you will see a pregnant patient in any field other than OB

Spoken like someone who has never left the academic hospital.

In real life, most of us non-surgeon outpatient doctors don't look at our own films or, if we do, we still rely on the radiology read before making the final decision.

Besides that, you get PLENTY of exposure to imaging in residency (to use your argument). 1 month of radiology in med school isn't going to make you any better at reading CTs or MRIs.

 

[mimelim]

MS3/MS4 is about getting a basic clinical foundation on which a residency education can be built. I'm in vascular surgery, about as far from peds/ob as you can get. They are still important from an exposure standpoint. Also, the concept of shortening clinicals during medical school is just plain laughable. I'm sorry that some of you have had bad experiences in your clinical years. It is a travesty, but the solution is NOT to cut them out. The solution is to improve them (or don't go to a school with poor clinicals).

This isn't about learning how to treat things. This is about learning how specialties function. What the realities of their expertise and care are. If you don't know what inpatient or outpatient psych looks like or the care that they offer, how can you effectively consult/utilize them? You can always say, "but I will always consult psych to deal with it." I'm at a quaternary care facility. We have maybe 2 psychiatrists that see in patients and that is only Tuesday-Friday 10am-3pm. (I'm making up the times, but I'm pretty sure it is close to that). That basic foundation lay by a simple 1 month rotation is usually sufficient for non-psych residents to learn what they have to in residency to handle the things that they need to on the wards within their specialty. And I think that it does make a difference having a dedicated 1 month foundation than learning everything on the fly and while focusing on a million and one other things.