I've decided

[LadyJubilee8_18]

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So, I really, really loved pedi, but I just think psych is a better fit. First I enjoyed my psych rotation, then my assessment and plans became mostly about psych, then I met my surgery rotation with complete disdain for the lack of interest in the patients, and finally my teams started getting "me" consults for all the psych issues. I realized the reason I didn't want to do psych was because I was feeling guilty that it seemed more like fun than work. My next thought was, "hey, that's good!" so I'm officially a psychiatrist in the making! .....now what? I'm not really sure what I should be doing as a third year finishing cores to tailor my education to psych. Research? Electives? Interest groups? Step scores? How did you guys swing it once you decided psych?

 

[josehernandez94]

welcome to psychiatry!

one of the nice things about choosing psychiatry is that you don't have to stress TOO much about the whole residency application process. certainly if you're aiming for the top programs, you'll need to have a strong application, but even those places are nowhere near compared to applying in fields like derm or radiology (at least from what i've been able to gather).

so what's important now? there are a couple things. first, get to know a couple of the psych faculty at your program really well. excellent letters of recommendation are something that will really help you stand out when you apply and i think seem perhaps a bit more important in psychiatry than in other fields. find people that you can get to know well and who will be able to offer more than just generic platitudes.

the second important thing is to get involved in some kind of psychiatry project. i don't think it necessarily has to be research (although if you're aiming for a place like mass general, research is probably quite important) but something of an academic nature that is tailored to psychiatry. you can do some kind of volunteering or additional clinical work in psychiatry. i don't think the specifics matter as long as you show that once you found psych was right for you, you pursued some opportunities in it aggressively. anecdotally, i worked on producing a documentary about suicidality in iraq war vets (which unfortunately didn't pan out) and also got involved in a psych research elective (i studied a mental health court program to help treat young adults with mental illness who had become involved in the criminal justice system). really, anything that makes you interesting (and gives programs something to talk with you about on an interview) is great.

great board scores aren't critical, even at the top programs (but obviously they help). i'd say if you broke 220, you'd probably have an excellent shot anywhere and if >230, you'd definitely be set. that said, a marginal or mediocre step score is not a death knell.

in terms of how else you can round out your education, i'd say pursue a lot of non-psych rotations (if you're 100% sure psych is for you). you're going to have the rest of your life to work on psychiatry, so get comfortable with other fields that play a role in psychiatry and could help you for residency. these include: endocrine, neuro (if it's not required at your school), definitely make sure you're comfortable with internal medicine and maybe emergency medicine, and maybe a pain elective wouldn't hurt either.

i hope this is helpful. good luck!

So, I really, really loved pedi, but I just think psych is a better fit. First I enjoyed my psych rotation, then my assessment and plans became mostly about psych, then I met my surgery rotation with complete disdain for the lack of interest in the patients, and finally my teams started getting "me" consults for all the psych issues. I realized the reason I didn't want to do psych was because I was feeling guilty that it seemed more like fun than work. My next thought was, "hey, that's good!" so I'm officially a psychiatrist in the making! .....now what? I'm not really sure what I should be doing as a third year finishing cores to tailor my education to psych. Research? Electives? Interest groups? Step scores? How did you guys swing it once you decided psych?

 

[swanny]

Glad to hear you're interested in psychiatry. Assuming you might still be interested in pediatrics as well, child psychiatry would be a logical consideration🙂. If that is true, I would encourage a child psychiatry rotation in your fourth year, as well as pediatric neurology and/or developmental pediatrics, endocrinology, adult neurology, and cardiology rotations.

 

[howelljolly]

, and maybe a pain elective wouldn't hurt either.

oh the humor...

congrats on your decision, and on finding what works for you.

Im just a med student, but I like the above advice to immerse yourself in non-psych electives now when you have the chance.

To give you an example of something that really caught my attention when I did my psychiatry core rotation.

We had a psych patient who had what was an essentially normal variant in his cardiac rhythm - sinus brady. He had zero, zilch, none, nada, of the other features associated with this finding - making it an isolated normal variant. He was aware he had this

He was on psych medications with sympatholytic properties. He also had every Cluster B disorder in the book.

Every other day, and twice on Thursdays, he'd complain of shortness of breath. He would be atteneded to, and each time, the attending would call a cardiology consult (even after my suggestion to wait it out THIS time). Each time, the cardiology fellow would come to see the patient, and he would be perfectly fine. Each time, the cardiology fellow would write in his note, that the patient had a normal exam, and there was a normal finding of asymptomatic SB. This continued for weeks, until one day the cardiology fellow wrote a PhD dissertation on asymptomatic bradycardia, and its treatment, right in the chart. That was the end of that.

So, the take home point is, know a bit more of the medical management of things. They say that a little learning is a dangerous thing. So learn as much as you can.

I think I feel better now.

 

[LadyJubilee8_18]

welcome to psychiatry!

one of the nice things about choosing psychiatry is that you don't have to stress TOO much about the whole residency application process. certainly if you're aiming for the top programs, you'll need to have a strong application, but even those places are nowhere near compared to applying in fields like derm or radiology (at least from what i've been able to gather).

so what's important now? there are a couple things. first, get to know a couple of the psych faculty at your program really well. excellent letters of recommendation are something that will really help you stand out when you apply and i think seem perhaps a bit more important in psychiatry than in other fields. find people that you can get to know well and who will be able to offer more than just generic platitudes.

the second important thing is to get involved in some kind of psychiatry project. i don't think it necessarily has to be research (although if you're aiming for a place like mass general, research is probably quite important) but something of an academic nature that is tailored to psychiatry. you can do some kind of volunteering or additional clinical work in psychiatry. i don't think the specifics matter as long as you show that once you found psych was right for you, you pursued some opportunities in it aggressively. anecdotally, i worked on producing a documentary about suicidality in iraq war vets (which unfortunately didn't pan out) and also got involved in a psych research elective (i studied a mental health court program to help treat young adults with mental illness who had become involved in the criminal justice system). really, anything that makes you interesting (and gives programs something to talk with you about on an interview) is great.

great board scores aren't critical, even at the top programs (but obviously they help). i'd say if you broke 220, you'd probably have an excellent shot anywhere and if >230, you'd definitely be set. that said, a marginal or mediocre step score is not a death knell.

in terms of how else you can round out your education, i'd say pursue a lot of non-psych rotations (if you're 100% sure psych is for you). you're going to have the rest of your life to work on psychiatry, so get comfortable with other fields that play a role in psychiatry and could help you for residency. these include: endocrine, neuro (if it's not required at your school), definitely make sure you're comfortable with internal medicine and maybe emergency medicine, and maybe a pain elective wouldn't hurt either.

i hope this is helpful. good luck!

Excuse the late response 😳 This is actually really helpful. I talked with my pedi psych preceptor and she invited me to her book club so I can meet some of the faculty on Dec. 10. I also joined the psych interest group and became an officer so we are working on some projects together including a more solid mentor program for our school (two first years committed suicide 😱), and the step is coming up in a few months. So things are moving along nicely.

Thanks for all your advice!

 

[Doc Samson]

(two first years committed suicide 😱)

😱 doesn't even begin to cover it. Good Lord! That class must be in turmoil.

 

[LadyJubilee8_18]

😱 doesn't even begin to cover it. Good Lord! That class must be in turmoil.

Actually one was the year before and one was this year, but still. It is a horrible trend that we all need to work together to break.

 

[masterofmonkeys]

Congrats on your decision. I came into school knowing I wanted to do psych, but like you I absolutely loved peds. The peds docs were and continue to be very supportive of me since I plan on doing child, they of all people know how critical the shortage of child psych is. So don't be afraid to let them know about your decision to go to psych. If your peds dept is like mine, they'll continue to support you and be very excited to see you in 4th year rotations.

On board scores, I tend to agree with what was said above. But just know that you can't write your ticket with a good board score, or a graduate degree, or research, or anything else for that matter. I am becoming a pessimistic, curmudgeonly old man at this stage in the interview but it needs to be said.

And as they said, do something handson, whether research, community outreach, or a mentoring program. Something that shows that you've tried to get a more inside view as to what psych is all about.

From the 10 interviews I've been on this year--whoo--I can say that a few things that are almost always mentioned by them as standing out:
1. letters
2. board scores
3. research

Almost always in that order. Research occasionally doesn't even get mentioned.

Best of luck, this is an awesome profession.