Neurology absolutely necessary for Psych residency?

[chipsych]

Hey SDN!

M4 here at an allopathic school in the midwest in need of some quick advice. So I have 3 months until I'm done, and I'm yet to take my neurology clerkship. Due to scheduling issues it's been put off this long, and it's looking like I'm going to have to do it in May. It's an elective for us, so I would only be taking it for the sake of next year. I'm wondering if the general consensus amongst the future (or current) psychiatrists here on SDN is that this is a must for pgy1. I understand I'll be doing 2 months of neuro next year, but I'm wondering how much 4 weeks of a disjointed mix of inpatient, consult and clinic based neuro will really help me. As far as I can tell, programs do not "required" you to have neurology... I've only seen "strongly recommended".

The only reason I ask is because I started (what I thought would be a BS 4th year) elective in quality improvement that I can get an extra 4 weeks out of in May, and it actually seems like the project I'd be able to complete would be more interesting/useful if I had 8 as opposed to just 4 weeks to work on it.

Just gauging the masses on this one. I also thought about waiting until the match and then emailing my future PD directly. Looking forward to hearing your thoughts on it, and thanks in advance!!

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[peppy]

Nah, it's not necessary to do it in med school. It might make things easier if you've had exposure to neuro before you have to do it as an intern, but you'll likely be fine without it.

 

[splik]

yes do it! I can't believe you can graduate medical school without having done neurology. Doing a really good neurological examination is something most non-neurologists cannot do and thus cannot teach. If you have the opportunity to hone your skills in the neurological examination and get good teaching go for it!

 

[billypilgrim37]

If you enter residency without a significant amount of experience performing a neuro exam, your colleagues are going to be rightly frustrated with you. Do the clerkship, and make mastering that exam your only goal.

 

[notdeadyet]

Please do a neurology elective. You'll spend 2 months on neurology services in your intern year. Or another way to look at it is that you'll be spending about 1/3rd as much time on neurology as you will on psychiatry so at least come nominally prepared.

One trend you'll notice on this forum is lots of people griping about how much some doctors on other services are dismissive of psychiatrists. This stereotype of the medically clueless psychiatrist gets propagated when interns show up on internal medicine rotations and only want to get assigned to easy cases or show up on things like neurology and need to be taught how to do a neuro exam.

Like billypilgrim recommends, do the neurology rotation and focus on a decent neuro exam. During your internship, you'll fine tune it and develop it into something worthwhile. For the rest of residency, you'll need to be able to eek out what is a psych issue from what is a neuro issue.

I sympathize though. My med school didn't make neurology a requirement and I had to use a month of fourth year to do neurology instead of spending my spring doing things like radiology and study electives. It was a bitter pill to swallow at the time, but boy I was grateful when I started internship and had a caseload of my own neurology patients that I had to perform my own neurology exam for unattended.

 

[Bartelby]

I have done a month of neuro mixed outpatient/inpatient and a neurology subinternship, and I think both were tremendously helpful. Not only does it take significant practice to know what "normal" feels like when it comes to reflexes, strength testing, and other parts of the exam, you need to run through the exam probably 30 - 40 times before it starts feeling natural to you and you can complete it in a reasonable timeframe to be useful on a clinical service. Not only that, you don't want to miss multiple sclerosis, a drug effect, encephalitis/meningitis, or something like a stroke because you don't know your neurology well enough.

It's pretty important, I think you should do your best to make time for it.

 

[psychattending]

You will help yourself significantly by getting neurology training as a medical student. Being reasonably competent in other aspects of CNS function is important for any practicing psychiatrist.

 

[nitemagi]

You could get by without it.

But then ask yourself do you want to be someone that just gets by?

Your answer to the latter question should answer your original question.

 

[billypilgrim37]

You could get by without it.

But then ask yourself do you want to be someone that just gets by?

Your answer to the latter question should answer your original question.

I imagine sinister flames flickering behind you while you say this, and lots of good eye brow work.

 

[nitemagi]

I imagine sinister flames flickering behind you while you say this, and lots of good eye brow work.

Indeed...


Muahahahaha!!

 

[sunlioness]

It surprises me that there are schools where neuro isn't a required clerkship. We had it in MS-III in the same block with psych.

 

[notdeadyet]

It surprises me that there are schools where neuro isn't a required clerkship. We had it in MS-III in the same block with psych.

Some of the more psych-emphasized schools do so at the expense of neurology.

My med school had 8 weeks of psych required as a 3rd year clerkship, so neuro was a 4th year elective.

 

[billypilgrim37]

Some of the more psych-emphasized schools do so at the expense of neurology.

My med school had 8 weeks of psych required as a 3rd year clerkship, so neuro was a 4th year elective.

I was the first year that we robbed one month from surgery and gave an extra two weeks to psych and OB. So surgery 8 weeks, OB 6 weeks, psych 6 weeks. The extra OB would have been bad, but they basically spread out the 4 weeks of work over 6 weeks, so the hours went down to about 50 a week, down from like 80 before. The neuro clerkship has always been a required 4 weeks during 3rd year, but my year they also started giving us an option to be on neurosurg for one of the 4 neurology weeks if you were on the inpatient unit (since inpt neurology is the ultimate dead horse beating experience).

 

[digitlnoize]

We didn't have a required neuro month, but a good amount of elective and "selective" time.

I'm still trying to find a neurologist in my town to take me for my "medical selective" month coming up...and it's not looking good. I might not be able to do one either...but I did a month of C-L where I did a decent number of neuro exams, and I did a couple months of IM where I went to a nursing home and did a bunch of neuro exams, MMSE's, etc. I certainly can't say my neuro chops are awesome, but hopefully it'll be enough to get by if I can't get a neuro rotation set up.

 

[chipsych]

Excellent points made by all, definitely makes sense. I think the right choice is pretty clear. Thanks for the input!

Muahahahaha!!

nitermagi: If the medicine thing doesn't work out, I see a bright career in graphic design... just sayin'!

 

[Chimed]

You could get by without it.

But then ask yourself do you want to be someone that just gets by?

Your answer to the latter question should answer your original question.

Not to rub it in any further to the OP, but it's almost like saying "Do I need to go to medical school to prescribe psychotropics? Hey, I could just get a PhD and become a prescribing psychologist." 🙄

 

[sunlioness]

Some of the more psych-emphasized schools do so at the expense of neurology.

My med school had 8 weeks of psych required as a 3rd year clerkship, so neuro was a 4th year elective.

Ours was a bit more psych heavy. 8 week rotation. 5 weeks of psych, 3 weeks of neuro.

 

[st2205]

How about the flip side? I have some serious doubts about having only two months of neuro that's supposed to sustain your career in psych. How much thought should be considered burning up an elective used for something else on a second neuro or sub I?

 

[digitlnoize]

How about the flip side? I have some serious doubts about having only two months of neuro that's supposed to sustain your career in psych. How much thought should be considered burning up an elective used for something else on a second neuro or sub I?

This is what I see wrong with medical education. Due to the academic (classroom) isolation during undergrad and pre-clinical years of med school, most people don't have a clue what they want to do before mid-late 3rd year, and that's too late to really tailor your clinical experiences to your career interests...at least, not to the degree that would be helpful. I'd argue that although all physicians should be well rounded, and it is helpful to have experiences in a variety of specialties, the mix could be altered depending on the specialty and career interests of the student...if the student knew those interests far enough ahead of time, through earlier clinical exposure and reduced studying of "zebra-itis."

For a psychiatrist, I'd like to see one less month of surgery (I think one month is plenty for most of us), and instead an extra month of neuro exposure. I think some extra GI exposure, OB exposure, or Endocrine experience could also be very helpful...but it would require more flexibility in our education.

 

[chipsych]

Thought I'd briefly chime in as to why neuro is an elective. For the class of '11 and '13, it is required. '11 had to take it at some point in fourth year, while '13 has to take it during third. They removed a month each of IM and surgery from 3rd year, moving neuro to that year as well as an elective month, and added EM as a required 4th year rotation. '12 was stuck in the middle of that transition. I have 3 months each surgery and IM under my belt, and am required to take EM, but neuro ended up being elective.

Long way of saying yes, it is required, just not for my class because of changes made to the curriculum.

 

[chipsych]

Thought I'd briefly chime in as to why neuro is an elective. For the class of '11 and '13, it is required. '11 had to take it at some point in fourth year, while '13 has to take it during third. They removed a month each of IM and surgery from 3rd year, moving neuro to that year as well as an elective month, and added EM as a required 4th year rotation. '12 was stuck in the middle of that transition. I have 3 months each surgery and IM under my belt, and am required to take EM, but neuro ended up being elective.

Long way of saying yes, it is required, just not for my class because of changes made to the curriculum.

I know. Exhilarating story.😴

 

[st2205]

This is what I see wrong with medical education. Due to the academic (classroom) isolation during undergrad and pre-clinical years of med school, most people don't have a clue what they want to do before mid-late 3rd year, and that's too late to really tailor your clinical experiences to your career interests...at least, not to the degree that would be helpful. I'd argue that although all physicians should be well rounded, and it is helpful to have experiences in a variety of specialties, the mix could be altered depending on the specialty and career interests of the student...if the student knew those interests far enough ahead of time, through earlier clinical exposure and reduced studying of "zebra-itis."

For a psychiatrist, I'd like to see one less month of surgery (I think one month is plenty for most of us), and instead an extra month of neuro exposure. I think some extra GI exposure, OB exposure, or Endocrine experience could also be very helpful...but it would require more flexibility in our education.

I've been pretty happy with our requirements. Outside of cores, we're required to do ICU, ER, 2 wks rads and 2 wks anesthesia. Then we have selectives (IM selective, surgery [second IM selective], peds selective, then choose between PM&R, orthopedics or neuro). Only one month surgery 3rd year, so there's a lot of time available to do a variety of things. I started a big post on more unique electives for psych (more lengthy post) but my charger did and it's still on my laptop.