neolandrover

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Jun 7, 2011
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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?
 

Roy3333

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Feb 22, 2009
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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?
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?
Welcome to residency. It is about the hospital making money and making your attending's life easy first. You learning anything is a distant second.
 
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Dharma

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Aug 12, 2010
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I try to find the lessons amongst the scut... sometimes it is the lesson.

BTW Uncle Iro is the shiznit.
 

postbacpremed87

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Jan 26, 2011
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What are the expectations for Psych interns at your program while they are on IM months (compared to the IM residents)?
 
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neolandrover

neolandrover

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Jun 7, 2011
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We have the same responsibilities as the medicine interns, but as it's the beginning of the year anyway, people have been pretty understanding that we don't know a whole lot. Most of the upper levels seemed to be pretty understanding that this is off-service for me. But it sounds like my experience is not that different from other's here. I was just wondering if I I was missing something, but I guess not.
 
Oct 13, 2008
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I've probably forgotten more than I've learned while I've been on medicine. That's because of how this particular location is set up. I know that I would be learning a lot at some of the other places I could have been assigned.

So I'd say your experience probably isn't outside of the range of normal, but I wish that wasn't the case.

Learning IMO is most dependent on the quality of your residents and attendings.
 
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Bartelby

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Mar 15, 2007
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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.
 

nancysinatra

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Sep 27, 2007
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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!
I want to echo this - while I too don't know your specifics, I have some recent perspective on this. I just started a fellowship/second residency (it's a mix and I won't go into details) in a field outside psychiatry where I have to see internal medicine patients and it's expected that I already mostly know what I'm doing (which I don't currently, because I spent the last 7 years in psychiatry), and I would kill for some really basic "service learning" to bolster my knowledge right now. Forget lectures - what I wish I could be doing right now is repeat physical exams, discussions with upper levels (moreso than with attendings even), lab ordering, and note writing. Why? Because those things give you education on the job. When you call a consult, that is not busy work. You have to summarize the case and give a rationale for the consult, which makes you think about it. Of course didactics are indispensable, but don't discount the amount of medicine you will learn by just doing patient care.
 
H

HarryMTieboutMD

This sounds like typical intern work. You are learning a ton just by being there and actually doing things (albeit under direction from your senior/attending). Didactics during your medicine months are hit or miss (though case conferences are very useful)- 99% of the learning is done on the wards
 

milesed

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Jun 25, 2011
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Are you carrying a regular patient load like the other IM intern? Do they not have M&M, grand rounds, morning attending teaching before or after rounds?

I mostly learned from the patients I had, reading about the management issues and asking questions of the attendings as we rounded and IM upper level residents supervising us. We did 2 mos inpatient, 1 month of IM consults (to the psyc hospital) and 1 month of IM clinic.
 

jettavr6

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Feb 24, 2008
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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?
Try to learn as much IM as you can. It will help you later in your career when you least expect.