Intensity of Medicine Experience

[nortomaso]

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.

---

Members don't see this ad.

 

[Poety]

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.

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!

 

[nortomaso]

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!

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.

 

[Poety]

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.

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

 

[Manochikitsak]

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!

How would 2-6 months of Medicine in the first year affect the boards... beats me......

 

[Manochikitsak]

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.

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.

 

[OldPsychDoc]

How would 2-6 months of Medicine in the first year affect the boards... beats me......

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.

 

[Poety]

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.

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

 

[MDgonnabe]

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.

 

[Anasazi23]

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.

 

[MDgonnabe]

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

yeah, it's the medical training we get that essentially separates us from the psychologists. i say we embrace the torture.

 

[nortomaso]

yeah, it's the medical training we get that essentially separates us from the psychologists. i say we embrace the torture.

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

 

[MDgonnabe]

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

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!

 

[Anasazi23]

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.

 

[willow212]

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).

 

[Poety]

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).

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!

 

[willow212]

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.

 

[Poety]

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.

Great thanks so much willow!

 

[Sally Jizmitton]

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.

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.

 

[alina_s]

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.

 

[willow212]

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.

Bumping for Poety...

 

[Poety]

Cut, Pasted and saved - thanks willow

 

[willow212]

My pleasure. Happy reading!

 

[MDgonnabe]

is there a consensus on which programs are notoriously med intense? that's pretty much what i'm looking for.

 

[Poety]

Jhu

 

[MDgonnabe]

Jhu

yeah... that seems to be the only one i've encountered thus far. i was totally over the iv's on the inpatient psych floor. it was like at first sight. but surely there must be others!

 

[Poety]

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

Oh yeah, like willow said: Mass General is the be all end all

 

[willow212]

MGH-McLean has a med-psych inpatient unit, and there is a lot of interface with medically complicated patients on the consult service.

 

[atsai3]

Duke Med/Psych combined residency (5 years)