Necessary 4th-year rotations for the psychiatry-bound student

[Oceanview]

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I'm an MS-4 going in to psych.

Was just wondering if people had any takes on helpful 4th-year electives?

Any courses you found essential?

Any courses, in retrospect, you wish you had taken?

Thanks.

 

[Adam_K]

I'm an MS-4 going in to psych.

Was just wondering if people had any takes on helpful 4th-year electives?

Any courses you found essential?

Any courses, in retrospect, you wish you had taken?

Thanks.

I did electives in as many aspects of psych as I could (C/L, PES, inpatient, geriatric) and did a child neurology rotation (couldn't swing child psych as there wasn't a spot to be had). In psych, the one rotation that I wish I had done was a first episode psychosis, but I couldn't schedule one either.

Outside of psych, I wish I had done an endocrinology elective, with an emphasis on neuroendocrinology. Hopefully, I'll be able to do one during residency.

Apart from that, additional neurology or neuroradiology experience would be a plus, I think. All this, of course, if you can arrange it.

 

[OldPsychDoc]

I did electives in as many aspects of psych as I could (C/L, PES, inpatient, geriatric) and did a child neurology rotation (couldn't swing child psych as there wasn't a spot to be had). In psych, the one rotation that I wish I had done was a first episode psychosis, but I couldn't schedule one either.

Outside of psych, I wish I had done an endocrinology elective, with an emphasis on neuroendocrinology. Hopefully, I'll be able to do one during residency.

Apart from that, additional neurology or neuroradiology experience would be a plus, I think. All this, of course, if you can arrange it.

I took an endocrine elective, but is was essentially all diabetic re-checks. Important, but pretty boring. I enjoyed my community cardiology elective--ekgs, echos, htn...useful stuff.

Overall, it doesn't really matter--you'll feel just as incompetent as an intern whatever you take!

 

[atsai3]

I'm an MS-4 going in to psych.

Was just wondering if people had any takes on helpful 4th-year electives?

Any courses you found essential?

Any courses, in retrospect, you wish you had taken?

Thanks.

Take only as much psych as you need to help you decide on applying for psych residency. Otherwise, you might find the following helpful:

neurology consult
endocrine consult
ER

-AT.

 

[MBK2003]

I second the Endocrine inpatient consults recommendation - so much of what I do in the ER and the inpatient unit is think about how to manage diabetes and thyroid disease.

I also did an outpatient cards elective, but I did peds outpatient cardiology and while I didn't get familiar with adult HTN management, I got really, really good at detecting murmurs (because kids are almost always less obese than adults at the cardiologist office and they can have some pretty impressive murmurs) which improved my ability to detect murmurs in my adult populations.

I would also recommend a medicine or ICU sub-I where you can get procedures. I'm not saying every psychiatry resident should be completely proficient at ABGs and central lines, but it certainly made a VERY stressful intern year somewhat less stressful when I could reliably count on my ability to get blood from my patients and to do the abdominal paracentesis.

MBK2003

 

[Anasazi23]

Great suggestions above.

I agree with them, and would also like to throw my hat into the ring for:

Neurology
Pediatric Neurology
Outpatient cards
Endocrine
Family practice or outpatient clinic
Derm (differentials between drug rashes and non-drug, psychoderm, etc)

You'll get enough psychiatry in residency. This might be your last chance to get hands-on clinical medicine training without having to sacrifice a lot. So take advantage.

 

[sga430]

i am not a psych resident yet and i am an img but i did do rotations here. however i felt memory disorders (behavioral neurology) is good in that it is the interface between psych and neuro.

 

[Hurricane]

I second the ICU rec. I didn't realize it at the time, but I think that's the month I learned the most about medicine. Having that experience under my belt really boosted my confidence on the IM wards.

 

[Oceanview]

Thanks for all of the suggestions.

I think the consensus is to:

1) focus on topics outside of psychiatry that are not covered formally but frequently seen in caring for psych patients.

2) take courses to prepare for being a medical intern.

Along these lines, I'm thinking of adding a neurology month (possibly child), endocrinology consults month and perhaps an ICU month. I've already done cardiology.

Any other ideas?

 

[latte]

Found this thread very interesting and relevant to a question that I had in mind. I'm keen on psychiatry as an option in future, and only have enough time to do 2 electives in the US (IMG here). My initial plan was to do one in Psych, but now thinking that if I will be fulfilling a month of Psych clinic mornings with my medical school already, would it be a better idea to not to Psych in the US again - repetitive? And if so, which 2 other specialties would you recommend that I give highest priority to? Thanks!

 

[whopper]

This is merely just my opinion.

You're going to get about 3.5 years of psyche as a resident. Several attendings I know forgot several of the medical aspects of practice and do not think outside the psychiatric box.

For that reason, only get as much psyche as you need to make your CV & resume' look good. 2 letters of rec from psyche attendings and maybe an extra few weeks tops. The rest should be spent on medical areas where psyche has good correlation.

E.g. Neurology, Endocrinology, GI & Family Practice.

 

[latte]

This is merely just my opinion.

You're going to get about 3.5 years of psyche as a resident. Several attendings I know forgot several of the medical aspects of practice and do not think outside the psychiatric box.

For that reason, only get as much psyche as you need to make your CV & resume' look good. 2 letters of rec from psyche attendings and maybe an extra few weeks tops. The rest should be spent on medical areas where psyche has good correlation.

E.g. Neurology, Endocrinology, GI & Family Practice.

That's great thank you for the advice! 🙂 There's one thing I don't really understand though...could you kindly enlighten me on how endocrinology correlates with psychiatry?

 

[whopper]

Man, I guess I really am a 4th year because now this stuff which was once new & mysterious to me is now becoming regular.

Endocrinology has several correlations with the emotional state, and several psyche meds & pathologies have direct correlations.

Thyroid function has strong correlation with depression, memory & concentration & anxiety. Hypothyroidism can cause depression, hyper can cause anxiety or sx similar to mania--which is why all inpatient psyche patients need a TSH taken.

Reproductive psychiatry-the area focused on how female reproductive tract affects mental pathology--has a lot to do with hormones. E.g. putting a female on the right type of birth control can help emotional states, post partum depression or psychosis etc.

Several endocrine disorders can cause psychiatric sx: pheochromocytoma can cause anxiety, Wilson's disease can cause psychosis, hypercalcemia can cause psychosis.

Sexual & Gender ID DOs have strong roots in endocrine etiologies.

If you do an endocrine rotation, you will not see much psychiatric
sx correlated with endocrine disorders. You will probably see some, but not much. However, any psychiatrists should have a solid foundation on endocrine disorders, as well as neurological, primary care, management of metabolic diseases (several psyche patients have metabolic disorders) and IMHO some GI--since several psyche pathologies have some correlating GI sx: e.g. irritable bowel syndrome, anxiety can often cause GI sx, etc.

Once you do psychiatry as a resident, except for IM & Neurology which are required, you will probably get little if any specific training in GI & Endocrine. The only times you will probably be offered these are during electives and during elective time you will probably want to do specialized psychiatry electives instead of endocrine or GI.

So I say do them now, before you enter residency. Besides, psyche residents who know their medicine and catch medical problems their attendings pretty much have now forgotten are seen as the "better" residents.

Once you do psychitary as a resident--by the end of your 2nd year you will know psychiatry very very well. So loading up on psychiatry as a medical student will only accomplish the inevitable sooner, and that really won't matter much because psyche is 4 years.

During my 3.3 years as a psyche resident I've probably caught about 10 cases in the psyche inpatient which were completely of medical etiology that about 2-5 attendings missed per case. Had I not caught it, the patient never would've gotten better since their attendings never thought outside the psychiatric box. (e.g. had a patient labelled as psychotic--but had hypercalcemia 2ndary to hyperparathyroidism causing her psychotic sx-had I not caught this--she would've been shipped to long term care where she would've only been seen once a month and probably would've been there till the day she died. After the endocrine problem was detected & treated she got better--no psyche meds were needed at that point.)

 

[DrRazberrySwirl]

when i was a 4th year, i only got a chance to do one psych elective (child). due to scheduling and other issues, etc., i wasn't able to do any others. i was worried that i would be totally unprepared to be a psych intern. but frankly, i've realized that you'll have time during your residency to learn all the things you need to know for psych, and you dont have to know it all the moment you start. the nice thing about psych residency is it is a little bit more laid back- you have more time to talk to your attendings/supervisors, and to consult with your co-interns/residents, more time to read, ect. therefore, i wholeheartedly second doing rotations that will make you a stronger intern in general, especially on your medicine months, which depending on where you go, can potentially be extremely difficult months, albeit important ones. i am on medicine now, and its just so rushed, hectic, and you dont always have time to sit down and really think. and i'm definitely too tired at night to read. i so wish that i had done a medicine sub-i (not required at my school unless you were planning on going into medicine) and an micu month (something also not required at my school, that i think should be). my neuro consult elective was awesome, and extremely helpful, and i think once i get to my neuro consult months later this year, i'll be very prepared. dont worry so much about psych electives (unless, of course, you are unsure that it is the field for you). if you are sure, i definitely agree with doing rotations that will make you a stronger intern/physician/psychiatrist in the general sense. medicine sub-i, micu, neuro consult, cardiology, etc.

 

[latte]

A big thank you to the both of you for the very comprehensive replies! 🙂 your advice has been tremendously helpful, I do feel that I now have a better insight into the state of things! I do have some queries though if you could kindly bear with me...


To whopper: You mentioned "2 letters of rec from psyche attendings and maybe an extra few weeks tops" - the system for our school is such that we only have a psychiatry rotation which consists of mornings spent in hopsitals every day for one month, substantiated by relevant tutorials. As far as I know this might be the only exposure to Psychiatry that we will have, period. So I'm not sure if it this is deemed as sufficient...? I also spoke to the prof and he advised that if Psych was my main interest, that I should pursue an elective in it. I see the perfect sense in what you're saying and love the idea of being able to broaden my experience, but feel like I'm torn in between different medical school systems at the same time...

To DrRazberrySwirl: Please correct me if I'm wrong, but I do believe you're pointing me in the direction of picking up as much clinical experience in general medicine as I can? 🙂 I'd like to brush up on my clinical skills as best as I can, and gain more competence and confidence in them - but at the same time I'm wondering about how important it is to show that I have done an additional elective in Psychiatry (to reinforce the interest and enthusiasm factor). Referring to what I wrote above, we might only have one month's rotation of Psychiatry overall.

 

[whopper]

Your situation unfortunately happens to several medical students. I did my psyche rotation in a hospital that had several aspects to see: an involuntary unit, a voluntary unit, a crisis center, outpatient and lecture days once a week rolled into 1 rotation.

In your situation you may need to do that extra elective to get that extra perspective. Definitely get at least 1 letter of rec from a psyche attending. I hear 2 is preferable, but since I'm not a program director, they'd be a better person to ask just in case.

 

[latte]

Your situation unfortunately happens to several medical students. I did my psyche rotation in a hospital that had several aspects to see: an involuntary unit, a voluntary unit, a crisis center, outpatient and lecture days once a week rolled into 1 rotation.

In your situation you may need to do that extra elective to get that extra perspective. Definitely get at least 1 letter of rec from a psyche attending. I hear 2 is preferable, but since I'm not a program director, they'd be a better person to ask just in case.

That's great thank you so much for getting back to me about this. You've been incredible with the much-needed advice! 🙂