Intern 6 months off Service - Standard?

[postbacpremed87]

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Are the 6 months off service pretty standard or are some programs lighter (cush) in terms of hours? Are there a lot of programs that integrate your Psychiatric future into your medicine months (Ex: Hey you are a Psych resident. Go work up this case that has a Psych spin to it.). I have been told that a lot of off service rotations do not expect as much from Psychiatry residents? Is this the case? For instance if there is a LP that needs to be done - does the Psych resident fight the Neuro resident for it? It would seem as though they need a certain # of those. What has been your experience?

Thanks.

 

[wolfvgang22]

It is pretty standard. However, some programs don't make you do IM call, for example, but do psych call instead.

 

[J ROD]

I am treated no different than any other intern on that service. The one caveat is I can chose not to do procedures like LP if I do not want to it. There is usually someone that needs it for their procedure log or a medical student that wants their first shot. So, I defer and let those that really want it do it. And yeah, I am even doing the 28hr IM call. They asked to be in the pilot, waiver program so as an intern I get worked over good.

 

[Acyl chloride]

6 months is pretty standard in terms of meeting ACGME requirements. Some programs will let you bump a month of neuro to another year to do electives 1st year. It really depends on the program and also the affiliated med/EM/Family/neuro departments as to how stressful the months are and how much they do or don't treat you like a psych/off service intern. This and what site you rotate at and your particular team the month you are there can matter a lot. The folks that started on non psych said they felt like any other ____ intern starting in July while I did psych first for 4 months and then went off service and had built my psych identity more. When on medicine wards we take all comers and tended to divide the admits based on when they walked through the door within reason. That said, my senior if we had two patients coming in would often try to steer ones with more complicated psych histories to me, but again that's very team dependent. On EM I'd heard that they discouraged us from taking all psych patients, however I tended to balance this out and take between 1-3 "psych" patients per shift. I argued that the medical workup that our patients receive when they come to the ED was something I wanted to understand, and also how they are triaged by Social work and so forth had relevance to my training. I didn't get any pushback from this. Still did an LP, and a good number of other procedures, but punted a few central lines to the med student or EM residents. Neuro I very much felt like a non-neuro intern on the team in the sense that they pretty much sent me to see patients first had me me write notes and put in a lot of orders, but then they would redo pretty much the whole exam, but I've heard that the workload varies a lot by site and time of year. Med consults is supposed to be one of our lighter months, but the person who is on this month is staying till 7-8pm because things are so busy. As long as you are flexible with your expectations vs reality and are willing to do the work you will be fine. Still hate 28 hour shifts and have immense gratitude that my program doesn't do them outside of those off service medicine months.

 

[OldPsychDoc]

Varies a lot by program--and a good question to ask on interviews--but choose your program based on psychiatry, not on how strong or how cush the off-service rotations appear to be.

 

[LasVagus]

If I recall correctly from my interviews a few years ago, 6 months of non-psychiatry rotations during intern year was the standard. I think there may have been a program that did 4 months of internal medicine, 1 month of ED, and 2 months of neurology for a total of 7 months. I also seem to remember one residency program that might have done neurology in the second year. So there may be a little bit of variation.

As for what is expected of you during the non-psych rotations, the party line is always going to be "when on this service you are a medicine (or neuro or emergency resident) resident and will be expected to do everything that you would do if you were training to be an internist (or neurologist or emergency physician)". This is what every program will tell you. The reality probably isn't too far off. In my experience, they expected a little bit less of me in terms of medical knowledge. I would be asked to carry all of the same responsibilities, but they didn't seem as annoyed when I didn't know the answers when being pimped. I do think they leaned on me a little bit in terms of helping to verbally de-escalate difficult patients (which shouldn't be a skill exclusive to psychiatry, but we do become better at it than most over time), but I was happy to do this in order to feel useful.

I'm sure there are some psych interns who have experiences of, say, being asked to see most of the psych patients who come into the ED rather than the chest pain/abdominal pain cases, but I don't think I've heard of any egregious examples. In fact, I had several ED attendings who asked me to avoid the psych cases because they knew I would have plenty of opportunities for that later.

As an aside, as a chief resident I am navigating various resident complaints/concerns via text, phone, and e-mail pretty much daily. Interestingly enough, they're almost never about the non-psych rotations. With that in mind, I would echo OldPsychDoc: choose your program based on psychiatry.

 

[Merovinge]

Are the 6 months off service pretty standard or are some programs lighter (cush) in terms of hours? Are there a lot of programs that integrate your Psychiatric future into your medicine months (Ex: Hey you are a Psych resident. Go work up this case that has a Psych spin to it.). I have been told that a lot of off service rotations do not expect as much from Psychiatry residents? Is this the case? For instance if there is a LP that needs to be done - does the Psych resident fight the Neuro resident for it? It would seem as though they need a certain # of those. What has been your experience?

Thanks.

Some places let you substitute in FM in lieu of IM which can be more cush (but certainly not always). You can often do 1 month of EM which is WAY better in terms of hours worked, like usually half, it's almost like have a vacation compared to regular intern hours. Also you should be able to do 1 month of outpatient, which is clearly very cush in terms of hours (and helpful learning!).

Its generally easy to use psychiatry as a get out of jail free card on procedures, but you will perpetuate stereotypes that way. I deferred all abscesses and LPs and wish I hadn't in retrospect. I did take all the bleeding vagina's I could get in the ED though (have a background in ob/gyn), so that gave me enough street creed to pass on butt abscesses.

 

[HarryMTieboutMD]

Are the 6 months off service pretty standard or are some programs lighter (cush) in terms of hours? Are there a lot of programs that integrate your Psychiatric future into your medicine months (Ex: Hey you are a Psych resident. Go work up this case that has a Psych spin to it.). I have been told that a lot of off service rotations do not expect as much from Psychiatry residents? Is this the case? For instance if there is a LP that needs to be done - does the Psych resident fight the Neuro resident for it? It would seem as though they need a certain # of those. What has been your experience?

Thanks.

Most places are 6 months on psych/6 months off. A few have 4 on, 8 off. The requirements vary per institution, but I will say that looking for the "easiest" internal medicine rotations is the WRONG thing to do. And when you are not on psychiatry, DO NOT look for the psych cases- you will have plenty of time for that during the rest of your residency. I personally think psych residents should do a full medicine intern year, purely for character building purposes

At my program, we are treated exactly as other internal medicine interns (at a top 10 IM program/hospital btw), and though it was difficult, it was one of the best experiences I had. Nearly all interns are awful on July 1- the only interns (from any specialty) were those who went to the same medical school because they knew the hospital and EMR... but you learn by exposure to high acuity, high volume cases. Remember, you are still a doctor, and this is your one time to learn basic doctor things. By my 2nd-3rd month of IM I was managing fluids on patients with chaotic volume statuses, responding to RNs paging me about patients having massive bleeds, reading plain films/EKGs, doing art sticks, etc etc etc without even talking to my senior resident, and it felt damn good. I also did as many LPs on neuro as I could and did a para on medicine. In the ED I sutured and learned how to manage DKA, etc.

Do I remember everything from off service rotations intern year? No- but it made me more confident as a physician, and I definitely am not afraid to assert myself when interacting with other services.

 

[clozareal]

6 months off service seemed standard at all the places I interviewed at. Some places though had much tougher requirements in terms of hours and responsibilities, such as ICU or taking frequent overnight call. Others were more lenient and said you didn't have to take call at all off service and had minimal inpatient medicine. Most tried to convey to me that the medicine rotations treated psych residents as medicine interns.

 

[philosophize]

i agree with JROD, i was treated like any other medicine intern while i was on med floors, except for
1) people didn't care if I wasn't interested in doing things like procedures
2) any overnight pts that had psych problems got assigned to my team by nightfloat (I didn't ask, they just did it)
3) I also got a lot of curbside psych consults bc the hospital i was at had a awful CL psych service (run by 1 very incompetent NP supervised by a psychiatrist that never came to the hospital)

 

[philosophize]

before med floors, ppl told me that attendings would expect less of me when it came to differential and assessment/plan during rounds. that was definitely not true. The attendings had the same expectations for me as a medicine intern

 

[lyla]

I think the off-service attendings (particularly inpatient medicine) expected less of me when I was on off-service rotations.

 

[masterofmonkeys]

I am treated no different than any other intern on that service. The one caveat is I can chose not to do procedures like LP if I do not want to it. There is usually someone that needs it for their procedure log or a medical student that wants their first shot. So, I defer and let those that really want it do it. And yeah, I am even doing the 28hr IM call. They asked to be in the pilot, waiver program so as an intern I get worked over good.

Worked over like everyone more than 3 years out who had the same experience?

We did 6 months on med/peds/neuro. Took call and/or night float just like the other medicine/peds people, carried the same patients. The attendings often didn't know who was what. I think it was great and am thankful for the experience. Depending on the program, that doesn't necessarily mean heavier hours (or didn't anyway, before night float pretty much became mandatory). My medicine months were definitely lighter (despite being 'full ward schedule') than my psych months by a substantial margin.

The program I finished up at did not do it that way and did 'medicine-lite' two months of which were extremely light. I think it hurt education and patient care.