Psych Interns in the ICU

[psymed]

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So I have a question..........I'm hearing that a lot of Psych Interns rotate through the ICU during their medicine rotation.

Not that I have a problem with it. I'll be clueless no matter where you put me on my first day.........but seriously why the ICU? I realize that one has to be a well rounded physician but from an academic stand point wouldn't psych interns benefit more by just being on the floor rather than learning vent parameters?

 

[whopper]

Several CL consults I've had were in the ICU, however I do not think its in the best interests of the psychiatry resident, or the IM program to put a psychiatry resident in the ICU.

My own program used to put psychiatry residents in the ICU, but stopped that thankfully right before I started.

 

[psymed]

Thanks Whopper! I agree.

 

[howelljolly]

As the reluctant psych-hater on this thread, I'll offer a few points.

The ICU is full of end-of-life, and competency issues.... Theres ICU psychosis, and delerium.... Family meetings, a interdsciplinary approach to patient care, berievement...

And, theres a final burst of medicine for the psychiatrist to remind them that the hemodynamically stable patient with a pulse of 55, with every attention-seeking behavior under the sun does not need an urgent cardiology consult every....single....day....

Or maybe it will train the psychiatrist to think that maybe when one of the inpatients, who has been on Deaths door for THREE DAYS... just maybe this is Neuroleptic Malignant Syndrome.

OK, Im done. Sorry.

 

[kugel]

Can't think of any reason a psych resident needs to be in the ICU, besides the esoteric "learn the most about medicine possible" or "learn to work under pressure" arguments.
Personally, I think I learned a LOT of medicine assessment skills in the ED ("What does really sick look like.") I took all the abd pain, diff breathing, N/V pts I could get - avoided trauma and fx's. And I learned a lot about medicine and about patients at a broad spectrum family medicine clinic. Very little of what I needed to know for the rest of my career was learned on the Medicine ward. "Really? This poor schlub needs for ME to learn how to tap a lung? Is that honestly of any benefit to me or to him?"

How many IM or surgery residents are really prepared to handle ICU patients and families?
Hmmm....
What if the hospital had a proficiency test that had to be passed before any resident was allowed to work in the ICU? Wouldn't be perfect, but it would display a basic knowledge of the facts, measurements, treatments, ethics etc.

 

[Tradewind]

The problem with asking this question is that psychiatrists who never rotated in an ICU (the majority of younger psychiatrists) will almost always say that they can't conceive of how rotating in an ICU would help. And may go on to say that that's ridiculous, flagellating, pompous, etc..

Psychiatrists who have rotated in an ICU and who are further from graduating (ie aren't bitter, or as ego-involved, etc.) would probably be the most objective.

This is a good question to ask, but the answers are likely very biased depending on one's personal background. People tend to defend their own backgrounds.

Of course, now that I've said that, maybe there will be all sorts of different responses... perhaps.

 

[whopper]

An ICU rotation will help, but then again, so will a lot of things that aren't in a psychiatric curriculum.

IMHO, the time doing IM is best spent covering the medical floors. You will see problems on the floor that is more compatible with possible problems you will encounter in psychiatric inpatient. ITs better IMHO than outpatient because its higher intensity will have you learn more faster. It'll also teach you the medicine you need in CL psychiatry.

While ICU is more intense than the medical floor, its of an intensity that will hardly if ever (unless there's a code) be encountered in psychiatric practice.

An ICU rotation will help in CL psychiatry, but that type of medical coverage for a patient is way out of the coverage a psychiatrist will provide. Yes it'll help, but the benefit/cost ratio is more effective IMHO on a medical floor.

 

[sunlioness]

The problem with asking this question is that psychiatrists who never rotated in an ICU (the majority of younger psychiatrists) will almost always say that they can't conceive of how rotating in an ICU would help. And may go on to say that that's ridiculous, flagellating, pompous, etc.. .

I did two ICU rotations my intern year (an IM internship). I don't think it's necessary or even all that helpful for psychiatry.

 

[Doc Samson]

Unfamiliarity with the ICU would be significantly limiting in the practice of CL psychiatry. Dealing with vents, rotoprone beds, propofol washout, precedex - they all only happen in the ICU. Walking in there as a psychiatrist, you need to have basic knowledge of the treatments/procedures happening to your patients or you'll lose the potential smidgen of repsect your criticial care colleagues might've had for you.

 

[strangeglove]

It seems that some of the arguments against doing an ICU rotation are rooted in the notion that psych interns are somehow inherently less capable of handling this (e.g. requirements to take tests to do an ICU rotation). Why would this be the case? All US medical school graduates, even those who have not done an ICU rotation in medical school, should be equipped to handle an ICU rotation. If not, then there is something wrong with that medical school.

As far as what good an ICU rotation does: It teaches you how to handle very sick patients, which makes handling the not so sick ones much easier. I really started to feel like a doctor after I did my ICU rotation late in my intern year. Did I ever use half the skills I learned there as a PGY-2? Probably not. But I feel pretty confident about the initial workup and management of patients who become septic, or hypotensive or go into a-fib with RVR (all of which have occurred on my calls on the psych units). Also, as Doc Samson intimated, I don't want to be that C-L psychiatrist who doesn't know why a patient is still on a vent. And the family work in the ICU is really important, so it's good to see it from the side of the primary team.

 

[Faebinder]

We as psychiatrists would benefit 10 times as much from doing a neurology rotation over an ICU rotation.

 

[Doc Samson]

We as psychiatrists would benefit 10 times as much from doing a neurology rotation over an ICU rotation.

I did 2 months of ICU and 2 months of neurology as an intern. I use my ICU experience far more than anything I learned on my neurology rotation. This is not to say that I don't use an awful lot of neurology in my day to day practice (I work at a major neurological subspecialty hospital), i just didn't learn any of what I use during my intern neuro months.

 

[DrFraud]

if I had the choice i would prefer to do a residency that either required or gave me the opportunity to rotate through an ICU. The docs in ICU are usually fantastic and the traing I received in med school at my hospital's ICU is 2nd to none.

 

[CaMD]

I loved my ICU sub-I and would rather work in the ICU than the medicine floors any day. Unfortunately the program I chose doesn't have this option.

 

[whopper]

Some of the differences in opinion may be due to way ICU was handled at their specific residency, and the length of time in the residency.

E.g. I wouldn't be against ICU in my own program if the residents spent 6 months, (vs 4) doing IM.