Psych residents.. how much do you study?

[Hunjan5]

Hello everyone. I'm a MS3 considering psychiatry. I want to get a sense of how much daily studying should we expect if choosing this field. Of course,
pysch is well known to be a narrower knowledge base than other specialties in medicine.
After internalizing DSM, how much extra studying does it this speciality require, especially when learning psychotherapy techniques. When compared with IM residents, who need to study every night to build a broad foundation knowledge base, how much do you study after work? Thanks!


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[philosophize]

it honestly depends on your prerogative, so YMMV given other obligations like family, kids, etc. I know some people who don't read unless forced to and some that read 2hrs a day.

Personally, I try to read minimum of 30mins per day aiming for 1hr a day. I can usually get this done during down time in the day so I don't have to read when I'm at home. Most of my reading has been papers so far, but I'm trying to add in some books now (see prev thread about books for med students to read).

 

[J ROD]

Not as much as I would like.....have been off service mostly....less time. Hope to get in more as I have more time.

 

[JustAGuy]

I used to read somewhat frequently as a junior resident but not that much as Ive built a solid base. I read now if I need to refresh on something or if something new comes up. And I try to at least read the abstracts and editorials in the major journals each month. so maybe 2 hours a month.

 

[SmallBird]

Hello everyone. I'm a MS3 considering psychiatry. I want to get a sense of how much daily studying should we expect if choosing this field. Of course,
pysch is well known to be a narrower knowledge base than other specialties in medicine.
After internalizing DSM, how much extra studying does it this speciality require, especially when learning psychotherapy techniques. When compared with IM residents, who need to study every night to build a broad foundation knowledge base, how much do you study after work? Thanks!


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Like for internal medicine, the priority is to develop clinical skills, and the main source of learning in both residency programs will overwhelmingly be from caring for diverse patients in multiple settings. In each case, if you have good supervision, just this process will get you the knowledge you require. I think most of us will do >1000 psychiatric evaluations by the end of residency and this adds up to a very solid base.

In terms of what's needed to pass boards, there is actually a need for a very broad, if superficial, knowledge base. You will get questions ranging from the differences between Kohlberg and Kohuts formulation of narcissism, to the functional connectivity patterns which characterize PTSD. However if you have high quality didactics to build on the base of knowledge you derive from clinical encounters, you can be a good clinical psychiatrist without digesting too many additional pages over residency.

 

[Nasrudin]

Psychiatry is a more narrow field of knowledge?! .... get your head out of your ass! Are you seriously thinking that the mechanisms of disease in medicine to be broader than the questions that have plagued human individuals, societies, cultures, and civilizations since we starting cooperating as primates from time immemorial?

Reset. Think about what your asking. Think again. If you still have the same question you're either an incurious, concrete individual or you've been reared by them as a swan amongst amongst ducks.

 

[Nasrudin]

I study all the time. But it's not "studying" as in "how much homework will i have in this course?"

It's I can't believe I'm tasked with interacting with another consciousness and trying to help it flourish in variable systems of relations with other consciousnesses.

These questions fascinate and enthrall me. If I don't study it's because I'm overwhelmed by them, and need a a timeout to just be an idiot for a minute.

Until I realize the lack of pursuit and engagement with these questions yields the type of concrete approach of thinking about relative amounts of homework.... and I get back to work.

So..Thanks, I guess.

 

[DetectiveAlonzo]

OP.

In medicine you have to study in every field. Stop trying to find an "easy" field.

If you don't like the population, you're gonna be a ****ty mental health provider.

 

[Merovinge]

When compared with IM residents, who need to study every night to build a broad foundation knowledge base, how much do you study after work? Thanks!
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That's a joke right? Unless by study you mean hit up the club . If you actually think most IM residents go home and study every night after work...

 

[Monocles]

None for psych. Then again I'm a terrible resident (although I've gotten good evals) and when I'm done with work I do life stuff like grocery shopping, hanging out with my family and friends, and playing video games. Haven't read a single article during last 7 months of residency. If I need to know something I'll look it up on uptodate.

Medicine, on the other hand, a lot unfortunately because I haven't touched a stethoscope in the last 2.5 years and need to pass Step 3...

 

[Nasrudin]

Interesting range of opinions.

Psych is very difficult to practice well. Evaluations are often a game of slick appearances.

One of the difficulties is bench marks of progress and development are difficult to ascertain or recognize. By bosses and residents alike.

Part of my reaction is an abiding recognition of this. And the potential for psych to both recruit and produce half-@ssed practitioners.

If that makes me sound like I'm munching locusts and honey, proclaiming fire and brimstone revelations, and that I'm into dunking pilgrims' heads into the river against their will then.... so be it. I'm a believer.

Because that's the only measure. Sincerity and commitment.

The alternative is just so easy and seductive it scares me.

I could propagate scripts, leave early every day, coast, and master the politics of impressing supervisors too. If I was only just built differently.

But I'm not. So... then. Onward.

 

[Gavanshir]

Psychiatry is a more narrow field of knowledge?! .... get your head out of your ass! Are you seriously thinking that the mechanisms of disease in medicine to be broader than the questions that have plagued human individuals, societies, cultures, and civilizations since we starting cooperating as primates from time immemorial?

Reset. Think about what your asking. Think again. If you still have the same question you're either an incurious, concrete individual or you've been reared by them as a swan amongst amongst ducks.

I take your post to be mostly facetious. Psychiatry is indeed a more narrow field of knowledge.. relative to other fields of medicine. An easy measure is to compare the girth of the psychiatry board review book with that of other fields. The questions that plagued us since the dawn of humanity are mostly philosophical and not exclusive to the field of psychiatry, whereas the anatomy, pathophysiology, pharmacology, diagnostic imaging, physical examination and tools like the EKG in cardiology are very much exclusive to cardiology.

The "facts" that you have to learn to built a foundational knowledge in the field are limited and you will realize that you can get by in residency without doing as much studying as residents in other fields. Having said that, that is the recipe for a lousy psychiatrist and the field doesn't need any more of those. In reality, pondering the philosophical, ethical, scientific and psychological questions as they relate to humans and the human sciences will indeed make you a better psychiatrist, but they are not requirements for practice.

 

[675015]

I like residency cause its not so much "studying" but reading. I can read what is either relevant to what I'm doing with patients or I can read things I just find interesting, anywhere from journal articles to textbooks to novels with some psychiatric relevance. And if something is boring or stupid, I just stop reading it and move on.

 

[splik]

I take your post to be mostly facetious. Psychiatry is indeed a more narrow field of knowledge.. relative to other fields of medicine. An easy measure is to compare the girth of the psychiatry board review book with that of other fields..

No. This tells you that what is required for the boards is much less for psychiatry, not that the field is more narrow. We are expected to master a much slimmer knowledge based (most of which is pseudoscience) than other fields, but that is an indictment of our field being a race to bottom, not the actual state of the diversity of approaches or broad range of problems that psychiatrists can and do treat.

For example general psychiatrists are mostly useless at evaluating and managing brain injury, conversion disorder, sexual addiction, pedophilia, dissociative disorders, anorexia nervosa, bvFTD, body dysmorphia, autism, family systems problems, enmeshment, grief, demoralization, vaginismus, anorgasmia, psychopathy, stalking, morbid jealousy, narcolepsy, rapidly progressive dementias, parasomnias... I could go on!

There are wide range of treatments in psychiatry too: psychoanalysis, mentalization-based treatment, CBT, family therapy (of which their are systemic, structural, narrative, behavioral and other approaches), group therapist, existential psychotherapy, sex therapy, motivational enhancement therapy, nutritional approaches, hypnosis, psychedelics, brain stimulation approaches... I would hazard that the breadth of my knowledge is greater than 99% of psychiatrists and there is so much I don't know and so much I will never be able to learn even though I would like to!

even with psychopharm - how many psychiatrists feel comfortable rxing a TCA and MAOI together (totally legit - can be done one way but deadly the other) or an MAOI and a stimulant? There is a lot of depth as well as breadth.

The problem is the field is the refuge of the lazy and the incompetent and the state of affairs so dire we cannot afford to exact high standards from practitioners otherwise no one would pass the exam!

 

[3lefts]

No. This tells you that what is required for the boards is much less for psychiatry, not that the field is more narrow. We are expected to master a much slimmer knowledge based (most of which is pseudoscience) than other fields, but that is an indictment of our field being a race to bottom, not the actual state of the diversity of approaches or broad range of problems that psychiatrists can and do treat.

For example general psychiatrists are mostly useless at evaluating and managing brain injury, conversion disorder, sexual addiction, pedophilia, dissociative disorders, anorexia nervosa, bvFTD, body dysmorphia, autism, family systems problems, enmeshment, grief, demoralization, vaginismus, anorgasmia, psychopathy, stalking, morbid jealousy, narcolepsy, rapidly progressive dementias, parasomnias... I could go on!

There are wide range of treatments in psychiatry too: psychoanalysis, mentalization-based treatment, CBT, family therapy (of which their are systemic, structural, narrative, behavioral and other approaches), group therapist, existential psychotherapy, sex therapy, motivational enhancement therapy, nutritional approaches, hypnosis, psychedelics, brain stimulation approaches... I would hazard that the breadth of my knowledge is greater than 99% of psychiatrists and there is so much I don't know and so much I will never be able to learn even though I would like to!

even with psychopharm - how many psychiatrists feel comfortable rxing a TCA and MAOI together (totally legit - can be done one way but deadly the other) or an MAOI and a stimulant? There is a lot of depth as well as breadth.

The problem is the field is the refuge of the lazy and the incompetent and the state of affairs so dire we cannot afford to exact high standards from practitioners otherwise no one would pass the exam!

Splik, I really want my residency time to be worthwhile in terms of gaining expertise in the field of psychiatry. Taking egos out of it, if NPs do have similar outcomes and knowledge base as most psychiatrists, without residency or board exams, it makes me think we are not using that training time wisely. Do you have any thoughts on this? In your opinion, are there any general psych programs that do a good job teaching how to evaluate and treat the range of conditions you mentioned, or is it by necessity a self- or fellowship-taught skill set at this point?? I like reading on my own, and do a fair bit of it. However, from my perspective as a medical student, it seems like four years of regular didactics and access to experienced attendings should have the potential to impart a decently broad knowledge base to build on.


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[DetectiveAlonzo]

No. This tells you that what is required for the boards is much less for psychiatry, not that the field is more narrow. We are expected to master a much slimmer knowledge based (most of which is pseudoscience) than other fields, but that is an indictment of our field being a race to bottom, not the actual state of the diversity of approaches or broad range of problems that psychiatrists can and do treat.

For example general psychiatrists are mostly useless at evaluating and managing brain injury, conversion disorder, sexual addiction, pedophilia, dissociative disorders, anorexia nervosa, bvFTD, body dysmorphia, autism, family systems problems, enmeshment, grief, demoralization, vaginismus, anorgasmia, psychopathy, stalking, morbid jealousy, narcolepsy, rapidly progressive dementias, parasomnias... I could go on!

There are wide range of treatments in psychiatry too: psychoanalysis, mentalization-based treatment, CBT, family therapy (of which their are systemic, structural, narrative, behavioral and other approaches), group therapist, existential psychotherapy, sex therapy, motivational enhancement therapy, nutritional approaches, hypnosis, psychedelics, brain stimulation approaches... I would hazard that the breadth of my knowledge is greater than 99% of psychiatrists and there is so much I don't know and so much I will never be able to learn even though I would like to!

even with psychopharm - how many psychiatrists feel comfortable rxing a TCA and MAOI together (totally legit - can be done one way but deadly the other) or an MAOI and a stimulant? There is a lot of depth as well as breadth.

The problem is the field is the refuge of the lazy and the incompetent and the state of affairs so dire we cannot afford to exact high standards from practitioners otherwise no one would pass the exam!

What does it take to make a superstar psychiatrist?

 

[splik]

good psychiatrists exist in spite of their training not because of it. reading is great but it's from patients where you will get the real learning. Back in the day, the now defunct Mass Mental program was the most prestigious psych residency training in the country. They banned their residents from reading at all. I'm not sure I would advocate for that, but they wanted their residents to really listen to their patients rather than abstracting to theory. There weren't check boxes back then, but now the danger is trying to fit people into our bogus pseudomedical diagnoses rather than seeing the person in front of you.

Before I started training this was the best advice I received from a psychiatrist:
Luckily training is short and you'll have your whole career to unlearn your training

BTW if you search the forum Ive written my thoughts before. I cant remember exactly what I said so I won't repeat myself but there might be some wisdom in there somewhere

 

[DetectiveAlonzo]

good psychiatrists exist in spite of their training not because of it. reading is great but it's from patients where you will get the real learning. Back in the day, the now defunct Mass Mental program was the most prestigious psych residency training in the country. They banned their residents from reading at all. I'm not sure I would advocate for that, but they wanted their residents to really listen to their patients rather than abstracting to theory. There weren't check boxes back then, but now the danger is trying to fit people into our bogus pseudomedical diagnoses rather than seeing the person in front of you.

Before I started training this was the best advice I received from a psychiatrist:
Luckily training is short and you'll have your whole career to unlearn your training

BTW if you search the forum Ive written my thoughts before. I cant remember exactly what I said so I won't repeat myself but there might be some wisdom in there somewhere

With my fine detective skills...


I will be sure to get to the bottom of this Splik!

 

[Dharma]

None for psych. Then again I'm a terrible resident (although I've gotten good evals) and when I'm done with work I do life stuff like grocery shopping, hanging out with my family and friends, and playing video games. Haven't read a single article during last 7 months of residency. If I need to know something I'll look it up on uptodate.

Medicine, on the other hand, a lot unfortunately because I haven't touched a stethoscope in the last 2.5 years and need to pass Step 3...

Uptodate may not be the best source. Attending of ours recently stated how he knows that many of the psychiatry articles are written by folks who aren't the experts (and apparently knows a few who as well). A good source for those outside of the field but not those of us within. That was his take. I still use it. That said, can't top journal articles. 'Read daily' is my motto.

 

[Dharma]

I take your post to be mostly facetious. Psychiatry is indeed a more narrow field of knowledge.. relative to other fields of medicine. An easy measure is to compare the girth of the psychiatry board review book with that of other fields.

Narrow, maybe... deep indeed. Quite possibly deceiving does the surface appear.

Girth. Hmm. Interesting choice of words. (Joking).

It will be interesting to see how much this will change as the neurobiological understanding of psychiatric pathophysiology is refined and becomes more common vernacular, and at that, expected knowledge of the average psychiatrist. I currently find the study (or mere thought) of neuroanatomy and physiology in relation (and addition) to the so-called foundations of psychiatry to be a daunting task, to say the least. External expectations are not there at this point, yet.

The questions that plagued us since the dawn of humanity are mostly philosophical and not exclusive to the field of psychiatry, whereas the anatomy, pathophysiology, pharmacology, diagnostic imaging, physical examination and tools like the EKG in cardiology are very much exclusive to cardiology.

How often does the existential affect the diagnosis, therapeutic approach and interaction, and treatment in other fields?

Anatomy is not exclusive to any field in medicine. Sure one may home in on the organ of choice but to miss the whole for its parts is surely narrowing one's perspective and will eventually lead to misunderstanding and lost opportunities and this is certainly the case in psychiatry. I'm not saying they do this (although it is evident that some do, including within psychiatry), but only to point out the lack of the exclusivity in regards to anatomy. (Plus... the brain... I'm not sure many outside of psychiatry are considering the dopaminergic projections of the VTA in regards to potential treatment).

Also, as an example, the refined methods of the psychiatric interview and mental status exam- "tools" of the trade- coupled with an understanding of the potential organic causes of psychiatric presentations could be said to be quite exclusive to psychiatry. Such tools may prove to be more challenging to wield and yield results more difficult to interpret than a cross sectional reading of electrical conductivity at times.

As for pathophysiology and pharmacology, I challenge one to have a true grasp on the proposed mechanisms of pathophysiology and subsequent competent application of pharmacology in regards to psychiatric presentations and somehow find how this is not exclusive to the field.

So, one can say that the neuroanatomy, pathophysiology, pharmacology, examination and tools like the MSA in psychiatry are very much exclusive to psychiatry.

The "facts" that you have to learn to built a foundational knowledge in the field are limited and you will realize that you can get by in residency without doing as much studying as residents in other fields. Having said that, that is the recipe for a lousy psychiatrist and the field doesn't need any more of those. In reality, pondering the philosophical, ethical, scientific and psychological questions as they relate to humans and the human sciences will indeed make you a better psychiatrist, but they are not requirements for practice.

Spot on. Once in residency, one can probably fly low, put in the minimal effort and introspection, never dive deep while floating at the surface, and continue the transformation from being a lazy student towards becoming a half-assed shrink. But the times are a-changing.

OP stay away from psychiatry if you're looking for something easier.

 

[Nasrudin]

Ok. I cede that the number of pharmacological agents we use for the number of conditions is smaller. But I am not facetious.

Because using that as a target and a benchmark of how to approach our work is no way to prepare for the range of interactions we will encounter. The sheer range of human experience that sits across from us, begging questions of enormous import, simply cannot be approached concretely.

If approached concretely with a keen sense of "what's going to be on this test?", you will not just render yourself unimpressive, useless, incompetent-although-perhaps-impressive-to-concrete-supervisors. It renders you dangerous. You send the questions toward an illusion of an exploration you've scarcely considered the costs of. And preferred to return affably to your comfortable sleep. Allowing the innocent to inhabit your ineffectual illusions in the waiting room for meaninglessness.

If that is you. I don't just have a passing dismissive regard for you. I wish I could commit you, give you a nice label, pump you full of a symphonic arrangement of chemical agents, algorithmically targeted at all of your unreasonable responses, and arrange for your roommate to be the same guy you mindlesslessly committed. Or something Dostoevsky would think up.

 

[Gavanshir]

Ok. I cede that the number of pharmacological agents we use for the number of conditions is smaller. But I am not facetious.

Because using that as a target and a benchmark of how to approach our work is no way to prepare for the range of interactions we will encounter. The sheer range of human experience that sits across from us, begging questions of enormous import, simply cannot be approached concretely.

If approached concretely with a keen sense of "what's going to be on this test?", you will not just render yourself unimpressive, useless, incompetent-although-perhaps-impressive-to-concrete-supervisors. It renders you dangerous. You send the questions toward an illusion of an exploration you've scarcely considered the costs of. And preferred to return affably to your comfortable sleep. Allowing the innocent to inhabit your ineffectual illusions in the waiting room for meaninglessness.

If that is you. I don't just have a passing dismissive regard for you. I wish I could commit you, give you a nice label, pump you full of a symphonic arrangement of chemical agents, algorithmically targeted at all of your unreasonable responses, and arrange for your roommate to be the same guy you mindlesslessly committed. Or something Dostoevsky would think up.

You are ever the expansive thinker, but I think we may just be talking along different planes. In reality, by your criteria, there is no adequate preparation for our field. Preparation is life itself. But I also think we have different definitions of what the practice of psychiatry entails. Yours more of a philosophical endeavor, partly an idealistic view, which I suspect comes from an international perspective, definitely not American. I'm curious how does prescribing medication fit into your view of psychiatry?

 

[Nasrudin]

You are ever the expansive thinker, but I think we may just be talking along different planes. In reality, by your criteria, there is no adequate preparation for our field. Preparation is life itself. But I also think we have different definitions of what the practice of psychiatry entails. Yours more of a philosophical endeavor, partly an idealistic view, which I suspect comes from an international perspective, definitely not American. I'm curious how does prescribing medication fit into your view of psychiatry?

We walk through the shadow of the valley of death. Beset on all sides by the tyranny and banality of evil men. We find our patients there asking questions.

This is not idealism. This is hyper-illustrative-realism.

If we shrink from that, then we are not worthy of the title of shrink. Shrinking from it makes you ripe for placement as a cog in the machine. The very same machine that is pulverizing our field. And making the true shrinks extinct.

If we abide this, and let them, piece by piece, make us into psychopharmacologists or "prescribers," then we fail to stand on the shoulders of our greats. We fail to stand at all. For anything. And the sad part is.... if you do that...you take you're flock to the slaughter with you.



How do I approach it...?.... like it f'n means something. Like it's a matter of life and death. Without the sound and the fury, but facing it with humor, courage, and strength to shelter my flock with the hope of making shepherds and not invalids out of them. (just off the top of my head. maybe I can think of something better. But i dig the question)

 

[Nasrudin]

dbl post

 

[MacDonaldTriad]

I’m convinced that no amount of knowledge can make some people good psychiatrists. I’m also convinced that there is no such thing as a person with so much innate ability that their natural skills can make up for not knowing things. The sad truth is that there is a subset of people who will never make good psychiatrists, and no matter how wonderful your interpersonal skills are, you will do dumb things if you don’t know what you are doing. Being good with people is a necessary but insufficient attribute and you have to study. I don’t know that internists have more to learn, I just think psych is so much easier to read about. Both fields are probably more infinite than anyone can handle. At least I have never gotten to the point where I sit back and say; “nailed it, now I am done”.

 

[Nasrudin]

I’m convinced that no amount of knowledge can make some people good psychiatrists. I’m also convinced that there is no such thing as a person with so much innate ability that their natural skills can make up for not knowing things. The sad truth is that there is a subset of people who will never make good psychiatrists, and no matter how wonderful your interpersonal skills are, you will do dumb things if you don’t know what you are doing. Being good with people is a necessary but insufficient attribute and you have to study. I don’t know that internists have more to learn, I just think psych is so much easier to read about. Both fields are probably more infinite than anyone can handle. At least I have never gotten to the point where I sit back and say; “nailed it, now I am done”.

Hahaha. Thanks for that. I think you point to the deeper insight.

There's something about the person who pursues excellence in any field which opens it up to continual process rather than a particular end point.

There's some natural abilities in play. And with anything there's effort and concentration and commitment and dedication.

I'm focusing myself on effort and hard work with the technical, intention/purpose/meaning with the less technical, and then a balance with regard to process for my health, vitality and sustainment of the above, over the course of my professional life and the duration of stay in this particular body. Which will probably coeincide exactly. Unless I become senile.

I guess. I don't fault people for varying degrees of natural ability. And I don't see myself as naturally good at this.

But, for better or worse, I can't help being hostile towards people who don't really care about being good at this.

I don't know if it's because I'm frightened by how easily one could just coast or .... succumb to overwhelming bureaucratic/economic systemic corruption of the field or...what exactly.... but I don't like that one of the most creative and fascinating and potentially most impactful fields is a magnet for jerkoffs and slouches.

I also hate that our field is being bled out by the processes of modern health care delivery. And the corrosive effect that has had on our professional identity.

I can't believe people accept being a "psychopharmacologist." I can't believe people think it's possible to reduce phenomenon of human consciousness to discreet targets of psychotropic agents alone. I can't believe how widespread this is.

So that... I don't want to sound absurd.... but hyperbolic and prophetic and archetypal language seems like the only expressions that capture what's happening to us.

I starting to think if you're not crazy with your rebelliousness towards the direction of modern psychiatry then you're....dead inside.

But I can't be confident in the reality testing of this, because it seems like reality is perverse.

 

[Salpingo]

Like for internal medicine, the priority is to develop clinical skills, and the main source of learning in both residency programs will overwhelmingly be from caring for diverse patients in multiple settings. In each case, if you have good supervision, just this process will get you the knowledge you require. I think most of us will do >1000 psychiatric evaluations by the end of residency and this adds up to a very solid base.

In terms of what's needed to pass boards, there is actually a need for a very broad, if superficial, knowledge base. You will get questions ranging from the differences between Kohlberg and Kohuts formulation of narcissism, to the functional connectivity patterns which characterize PTSD. However if you have high quality didactics to build on the base of knowledge you derive from clinical encounters, you can be a good clinical psychiatrist without digesting too many additional pages over residency.

This! (with the pedantic correction that I think you mean Kernberg and not Kohlberg). If you take an interest in at least one patient on your census at any given time and read up about whatever is ailing them (and assuming you have a good amount of diversity in your program), then you will be way ahead of the game. I believe that's true for pretty much any field of medicine.

You are ever the expansive thinker, but I think we may just be talking along different planes. In reality, by your criteria, there is no adequate preparation for our field. Preparation is life itself. But I also think we have different definitions of what the practice of psychiatry entails. Yours more of a philosophical endeavor, partly an idealistic view, which I suspect comes from an international perspective, definitely not American. I'm curious how does prescribing medication fit into your view of psychiatry?

I think this thread is evolving into whats the breadth of knowledge that makes someone a competent psychiatrist vs. the breadth necessary to make them exceptional. I do feel that a fairly wide array of knowledge is helpful, but not necessary or sufficient, to becoming a great clinician. Learning a lot of esoteric trivia, eponymous syndromes, and neuropsych zebras doesn't necessarily make you a good clinician. Similarly, you could read the manuals on every form of therapy in the world, but most of your efficacy is going to come from seeing a lot of patients, learning how to develop rapport, and tolerate your limitations -- and the most profound knowledge of obscure medications and neurotransmitters won't get you far if your patient isn't taking their meds.

Yes, a medicine intern is going to need a much wider range of knowledge to survive and become a good doctor (at which point, they'll train to become an interventional cardiologist specializing in drug-eluting stents of the right circumflex artery, occasionally doing left ones when on call). But a psychiatry resident needs a different skill set and knowledge base that comes with high frequency and in-depth patient contact.

 

[bashir]

This seems like as good an opportunity as any to thank you, Nasrudin, for your contributions to this forum. Your writing style strikes me as the textual equivalent of a surrealist painting. I often find your posts somewhere on the spectrum from bemusing to impenetrable, but almost always thought-provoking and containing some wisdom worth the trouble to decipher. Thank you for inspiring me to be a better psychistrist.

 

[HarryMTieboutMD]

Just from my observations- the better quality residents tend to read more and pay attention to the literature. In other words, "innate abilities" and being proactive about reading, pushing yourself, etc are not mutually exclusive; they are inextricably linked.

True, your primary learning does come from your patients, but Osler's aphorism is 100% true "to study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all."

This is why I like former and current athletes (which psychiatry lacks, but we are getting better at stealing these people from ortho, etc... I make it a point to recruit these people)- we have an innate ability to push ourselves and compete, always striving for higher levels. Our department chair (internationally recognized, in national academy/institute of medicine) was an NCAA champion D1 goalie and played for the US national team and credits his athletic background to his drive and success.

 

[Shikima]

What's a book?

 

[enoughsaid12]

One does not go into psychiatry to study...