opinion on curriculum change

[sarahjay]

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I was wondering what people's thoughts on the residency programs that are switching their PGY2 and PGY3 year to meet ACGME requirements. One of the programs I interviewed at this year is adopting this model next year.

My mentor thinks it's going to be a terrible plan because he says that there are rotations during PGY2 year that are key to a resident's performance as a PGY3.

Any thoughts?

 

[WhoisJohnGalt]

Maybe I'm missing something... how does switching PGY2 and 3 help?

 

[Fermata]

I'm guessing that the movement of the continuous outpatient year to PGY-II would allow more call coverage and supervision. It seems a bit unorthodox.

 

[Cinnameg]

I'm guessing that the movement of the continuous outpatient year to PGY-II would allow more call coverage and supervision. It seems a bit unorthodox.

This is the curriculum that University of North Carolina (UNC) seems to have implemented already, with the PGY2 year all outpatient. I didn't ask how long they'd been doing it, though, but it seems to have worked out really well for them. It was completely unique among the programs where I interviewed.

 

[Doctor Bagel]

My medical school set the PGY2 year as the primary outpatient year, and apparently it was pretty successful. Residents liked it, and honestly, I'm not really sure where another year of inpatient psych and c/l will help you with the intensive therapy skills you learn in your outpatient year. I think a lot of us are really interested in learning more about outpatient treatment and to start working on therapy skills, but we're stuck admitting drunk people at 3 am in the first two years (admittedly, I'm post call and consequently a little bitter).

What does your mentor think will be lost with a switch like that?

 

[flash]

U Florida also has outpatient year 2. Residents seem to like it.

My opinion is that there are too many damn opinions in this match process 😎.

 

[Chimed]

My medical school set the PGY2 year as the primary outpatient year, and apparently it was pretty successful. Residents liked it, and honestly, I'm not really sure where another year of inpatient psych and c/l will help you with the intensive therapy skills you learn in your outpatient year. I think a lot of us are really interested in learning more about outpatient treatment and to start working on therapy skills, but we're stuck admitting drunk people at 3 am in the first two years (admittedly, I'm post call and consequently a little bitter).

What does your mentor think will be lost with a switch like that?

I think the rationale for doing hospital rotations in the first 2 years are two-fold:
The first is that you become very good at handling acute cases and know when and when not an inpatient admission is warranted. Those are important skills to have under your belt and typically inpatient settings have a lot of supervision for that. By the time you're doing outpatient in 3rd year, you can handle most emergency situations and that fosters more confidence in dealing with issues that inevitably arise in the outpatient setting.

The second issues is continuity of care. It just seems like a smoother transition to start your outpatient work in 3rd year and continue with those patients through the rest of your training rather then having to stop your clinic work and transfer those patients. I suppose if you continued a clinic through your 3rd year inpatient, that would help. But unless your program has a really light case load, I don't know how you could continue a full case load and go back to inpatient without transferring most of them.

 

[Doctor Bagel]

I think the rationale for doing hospital rotations in the first 2 years are two-fold:
The first is that you become very good at handling acute cases and know when and when not an inpatient admission is warranted. Those are important skills to have under your belt and typically inpatient settings have a lot of supervision for that. By the time you're doing outpatient in 3rd year, you can handle most emergency situations and that fosters more confidence in dealing with issues that inevitably arise in the outpatient setting.

The second issues is continuity of care. It just seems like a smoother transition to start your outpatient work in 3rd year and continue with those patients through the rest of your training rather then having to stop your clinic work and transfer those patients. I suppose if you continued a clinic through your 3rd year inpatient, that would help. But unless your program has a really light case load, I don't know how you could continue a full case load and go back to inpatient without transferring most of them.

I can see those points, even though I'm to the point now where I feel like by the end of this year, I'll have a pretty good handle on acute psychiatry. 6 months of inpatient psych at both a VA and a university ward coupled with 40 or so overnight calls feels like pretty good exposure to me. Our only new inpatient experience next year is a state hospital rotation.

As for continuity, sure, you probably can't keep most of your patients, but for those you do keep, you can treat them for 3 years.

 

[sarahjay]

Thanks for all the input people. It was hard to get an unbiased opinion from people at my program since I believe they want me to stay here.

I'm glad to hear that there are programs out there doing well with this curriculum because I was worried of being essentially a 'guinea pig' if I match there.

 

[Chimed]

Thanks for all the input people. It was hard to get an unbiased opinion from people at my program since I believe they want me to stay here.

I'm glad to hear that there are programs out there doing well with this curriculum because I was worried of being essentially a 'guinea pig' if I match there.

Even though I favor the more traditional sequence of doing inpatient primarily in the first 2 years, in the end of the day, it likely makes little difference in your overall training.