So I just started one of my internal medicine ward months as a psychiatry intern. While I'm doing fine on it, I do feel a little disappointed at the service>learning. I feel like I spend most of my day doing notes, calling consults, other busy work... I don't feel like I've actually learned that much medicine. Obviously we never have to know as much as the internal medicine residents, but definitely enough to handle basic floor issues on our psych wards. Have other people felt this way?
I'm not familiar with your rotation so I could be way off, but keep in mind that in residency often times service is education. Let's say a pneumonia case comes in. You evaluate the person and do a physical exam, then present to the attending who follows with her own exam and points out the relevant findings so you can confirm your exam's accuracy, then she agrees or disagrees with your evaluation and management plan. That's great learning! You then admit the person and have to painstakingly order each and every thing, thinking through (and asking about) whether this person needs heparin v lovenox, clarifying all of their meds and doses, sweating out whether they accurately remember what they've been taking and if/how you should thus adjust what you start, thinking about what diet is appropriate, how often they need to be checked on, what as-needed medications can save you future trouble, what as-needed meds/orders might get you into trouble, on and on. Then you see what problems come up afterwards. More frustrating but invaluable learning!
Then you write the note. You are crunched for time but you learn how to quickly hammer out all of the relevant medicolegal facts, your diagnosis, and enough reasoning to prove that you aren't negligent, all the while handling multiple distractions that could easily let errors or sloppiness slip through. That's more learning! Maybe while you are writing (and holding the pager) you find you have to break off and address acute pain, an abnormal EKG, some dyspepsia, a difficult family member, all of which you think through and then (as needed) run by your senior resident. Again, excellent learning!
By the end of the day you are fried, and maybe you didn't sit through a single lecture or even a chalk talk, and no one sat you down for a formal "this is all of my feedback" talk. But that could be fine. You learned a lot via didactics in medical school, but now it's about real problem solving and then getting feedback from senior residents, attendings, and the real-world consequences of your choices in a controlled environment. It's also about reading under time pressure and with the frantic search for the immediately needed right answer rather than as an academic exercise. As the months pass by you realize how much easier it is to handle the chest pain page, or to do a med rec, or to write an admit note while juggling three other semi-urgent issues. In all likelihood you will look back and realize you've learned a ton through the year and that you needed all of it to function autonomously.
All that said, I get that some programs are bad. Yours might be, obviously I have no familiarity with it. Realize, though, that you should grade it on different metrics than you did your medical school.
