1. Dismiss Notice
  2. Download free Tapatalk for iPhone or Tapatalk for Android for your phone and follow the SDN forums with push notifications.
    Dismiss Notice
  3. Hey Texans—join us for a DFW meetup! Click here to learn more.
    Dismiss Notice

Intensity of Medicine Experience

Discussion in 'Psychiatry' started by nortomaso, Dec 3, 2005.

  1. nortomaso

    nortomaso Senior Member
    7+ Year Member

    Joined:
    Feb 13, 2005
    Messages:
    194
    Likes Received:
    1
    The range of how seriously programs take medicine training during a psych internship vary widely from 4 months of family outpatient to six months of inpt med with 2 months ICU. I was wondering how important this was on competency in the long run. So for those who've already undergone most of their training and my be lingering on here, I'd love to hear your input.
     
  2. Note: SDN Members do not see this ad.

  3. Poety

    5+ Year Member

    Joined:
    Dec 22, 2004
    Messages:
    2,227
    Likes Received:
    1
    Status:
    Resident [Any Field]

    Hi Norto,

    I actually (as you know) haven't had the experience myself but I raised this exact question to many different residents with regard to taking the boards - the response I generally got from programs that offered the family practice rotation was that family practice prepared them extensively for the boards, but that inpatient medicine did not. Now this just may be those programs.

    I've also spoken to some residents that said they were worked so hard during medicine that they barely had time to study so they suffered when taking the boards -

    Just some food for thought for you - sorry I couldn't help more!
     
  4. nortomaso

    nortomaso Senior Member
    7+ Year Member

    Joined:
    Feb 13, 2005
    Messages:
    194
    Likes Received:
    1
    Thanks Poety, actually the boards were furthest from my mind. I'd like to know how much really solid medicine training is an asset to pt care in the long run and whether the lighter medicine training leaves you lacking in confidence when issues overlapping psych and medicne arise.
     
  5. Poety

    5+ Year Member

    Joined:
    Dec 22, 2004
    Messages:
    2,227
    Likes Received:
    1
    Status:
    Resident [Any Field]

    Oh sorry Norto, thats a great question, we should summon Sazi and OPD I'd love to know that too!

    :)
     
  6. Manochikitsak

    Manochikitsak Member
    5+ Year Member

    Joined:
    Nov 3, 2005
    Messages:
    30
    Likes Received:
    0
    Status:
    Resident [Any Field]
    How would 2-6 months of Medicine in the first year affect the boards... beats me...... :confused:
     
  7. Manochikitsak

    Manochikitsak Member
    5+ Year Member

    Joined:
    Nov 3, 2005
    Messages:
    30
    Likes Received:
    0
    Status:
    Resident [Any Field]
    I think at least 2-4 months of Internal Medicine rotations are imporant...anything more than that is overkill and anything less than that would be insufficient. It also helps for Step 3.
     
  8. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
    Physician Moderator Emeritus SDN Advisor 10+ Year Member

    Joined:
    Dec 2, 2004
    Messages:
    6,120
    Likes Received:
    3,502
    Status:
    Attending Physician
    For USMLE 3 it matters...
    I did 4 months straight of IM, and I was appalled at how much Peds and OB/Gyn showed up on step 3. :scared:
     
  9. Poety

    5+ Year Member

    Joined:
    Dec 22, 2004
    Messages:
    2,227
    Likes Received:
    1
    Status:
    Resident [Any Field]

    Wonder if thats what the residents meant by family practice being good?
     
  10. MDgonnabe

    MDgonnabe your royal travesty
    7+ Year Member

    Joined:
    May 26, 2001
    Messages:
    492
    Likes Received:
    4
    what's the better choice for those of us who learn better by doing rather than reading? i was also thinking that, esp since i'm interested in c-l psych, 6 months of a strong im rotation would be a huge plus for me.
     
  11. Anasazi23

    Anasazi23 Your Digital Ruler
    Moderator Emeritus 10+ Year Member

    Joined:
    Feb 19, 2003
    Messages:
    3,504
    Likes Received:
    20
    Status:
    Attending Physician
    The IM months are miserable, but invaluable. The transition from medical student to resident, acutally managing these problems, and just as importantly, learning to direct patient care to a degree and make medical decisions is very, very valuable.

    Granted, you'll wonder about the usefulness of it all after you admit your 14th cellulitis patient, but all the exposure to the myriad medical problems you see from every organ system will make you a much better overall doctor.

    Old school psychiatry training had one year of medical internship, as I'm told. So things could be worse.
     
  12. MDgonnabe

    MDgonnabe your royal travesty
    7+ Year Member

    Joined:
    May 26, 2001
    Messages:
    492
    Likes Received:
    4
    yeah, it's the medical training we get that essentially separates us from the psychologists. i say we embrace the torture. :D
     
  13. nortomaso

    nortomaso Senior Member
    7+ Year Member

    Joined:
    Feb 13, 2005
    Messages:
    194
    Likes Received:
    1

    Now any thorughts on the ICU experience which is required at several programs. Overkill or Mastery?
     
  14. MDgonnabe

    MDgonnabe your royal travesty
    7+ Year Member

    Joined:
    May 26, 2001
    Messages:
    492
    Likes Received:
    4
    to me, personally, it's mastery. heck, i've voluntarily scheduled an icu elective as a 4th year. but this is all because i want to go into c-l psych and love my neuroscience in general. i could totally understand how others here who're more outpatient psychotherapy oriented would abhor putting themselves through that. but hey, that's why there are so many different residencies out there! :)
     
  15. Anasazi23

    Anasazi23 Your Digital Ruler
    Moderator Emeritus 10+ Year Member

    Joined:
    Feb 19, 2003
    Messages:
    3,504
    Likes Received:
    20
    Status:
    Attending Physician
    Overkill.

    Then again, some people actually prefer it. Knowing a few very sick patients very well rather than a higher medicine caseload with less intimate knowledge of their conditions.
     
  16. willow212

    willow212 Senior Member
    7+ Year Member

    Joined:
    Mar 26, 2003
    Messages:
    132
    Likes Received:
    1
    I think it depends on what you want to do. If you want to do C-L work or geriatrics, then you probably want to get exposed to as much medicine as possible (and there, ICU experience IS helpful). If you want to do all pyschotherapy, it's less important.

    You definitely want to feel comfortable with medicine, because you will want to be able to advocate for your patients who may not be getting the medical care they need and deserve because they are "psych patients" (as viewed by many people in the medical establishment). In addition, you also will want to feel comfortable enough to make sure you can determine when you should be worried about an underlying medical illness in the differential diagnosis of your patients.

    A broad range of exposure is what is most helpful (doesn't do you much good to spend all your time on the cancer ward and be clueless about CHF, DM, etc.) Personally, I wish that I had more outpatient medicine exposure (all my time was inpatient on the wards).
     
  17. Poety

    5+ Year Member

    Joined:
    Dec 22, 2004
    Messages:
    2,227
    Likes Received:
    1
    Status:
    Resident [Any Field]
    Speaking of medicine - Before we all start in July, would you recommend any books to review so that we can freshen up? For me, I've been out this year (doing intermittant 4th year clerkships but spending most of my time with new baby) and I'd really like a nice solid review that would prepare me for internship. Any thoughts or ideas from any residents now would be GREAT!

    Thanks so much all!
     
  18. willow212

    willow212 Senior Member
    7+ Year Member

    Joined:
    Mar 26, 2003
    Messages:
    132
    Likes Received:
    1
    To prepare for internship, my best advice would be to spend as much time getting rest and having fun as possible!

    For a general review, you might try a Step 3 Review book (like Crush the Boards by Brochert or Strong Medicine by Costanzo). I also liked the small red pocketbook The Washington Manual Internship Survival Guide.
     
  19. Poety

    5+ Year Member

    Joined:
    Dec 22, 2004
    Messages:
    2,227
    Likes Received:
    1
    Status:
    Resident [Any Field]
    Great thanks so much willow! :)
     
  20. Sally Jizmitton

    Sally Jizmitton Junior Member

    Joined:
    Dec 10, 2005
    Messages:
    6
    Likes Received:
    0
    Status:
    Medical Student
    Hi Nortomaso-

    I was interested in what programs you know of that require 4 months of family outpatient as opposed to the six months of inpatient med. I would prefer the former if possible.
     
  21. alina_s

    alina_s Senior Member
    10+ Year Member

    Joined:
    Sep 24, 2001
    Messages:
    249
    Likes Received:
    23
    Status:
    Attending Physician
    I think that psych residencies have to include at least 1 month of inpatient medicine (I assume IM, but maybe they allow FM?) and a total of 4 months of a combination of medicine/family medicine/pediatrics. From what I've heard from family medicine residents, I wouldn't assume that a program that assigns residents to all family medicine is gentler; I know residents in a few programs who have told me that their inpatient family medicine months were the most grueling. Maybe family medicine departments feel they have something to prove or maybe the programs just don't have enough staff to make as many adjustments to the 80 hour work week? One of my friends in family medicine was relieved with the cush hours on her CCU rotation. It's also dangerous to assume that faculty in the "touchy feely" field of family medicine are any less brutal than faculty from internal medicine.
     
  22. willow212

    willow212 Senior Member
    7+ Year Member

    Joined:
    Mar 26, 2003
    Messages:
    132
    Likes Received:
    1
    Bumping for Poety... :)
     
  23. Poety

    5+ Year Member

    Joined:
    Dec 22, 2004
    Messages:
    2,227
    Likes Received:
    1
    Status:
    Resident [Any Field]
    Cut, Pasted and saved - thanks willow :)
     
  24. willow212

    willow212 Senior Member
    7+ Year Member

    Joined:
    Mar 26, 2003
    Messages:
    132
    Likes Received:
    1
    ;) My pleasure. Happy reading!
     
  25. MDgonnabe

    MDgonnabe your royal travesty
    7+ Year Member

    Joined:
    May 26, 2001
    Messages:
    492
    Likes Received:
    4
    is there a consensus on which programs are notoriously med intense? that's pretty much what i'm looking for.
     
  26. Poety

    5+ Year Member

    Joined:
    Dec 22, 2004
    Messages:
    2,227
    Likes Received:
    1
    Status:
    Resident [Any Field]
  27. MDgonnabe

    MDgonnabe your royal travesty
    7+ Year Member

    Joined:
    May 26, 2001
    Messages:
    492
    Likes Received:
    4
    yeah... that seems to be the only one i've encountered thus far. i was totally :wow: over the iv's on the inpatient psych floor. it was like :love: at first sight. but surely there must be others!
     
  28. Poety

    5+ Year Member

    Joined:
    Dec 22, 2004
    Messages:
    2,227
    Likes Received:
    1
    Status:
    Resident [Any Field]
    Jefferson?
    UNC?
    And maybe any place with a big hospital that has huge turnover- the bigger and more malignant - the better off you are for medicine :laugh:

    Oh yeah, like willow said: Mass General is the be all end all :D
     
  29. willow212

    willow212 Senior Member
    7+ Year Member

    Joined:
    Mar 26, 2003
    Messages:
    132
    Likes Received:
    1
    MGH-McLean has a med-psych inpatient unit, and there is a lot of interface with medically complicated patients on the consult service.
     
  30. atsai3

    10+ Year Member

    Joined:
    May 15, 2002
    Messages:
    1,283
    Likes Received:
    9
    Status:
    Fellow [Any Field]
    Duke Med/Psych combined residency (5 years)
     

Share This Page