Residency looming

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sc1988

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With my pgy1 year right around the corner, I can't help but be excited for the start of a new chapter of my life. I was wondering if anyone has any tips on what I should be doing for the next month and a half. I purchased the Massachusetts handbook for psychiatry (outdated), to get a basic crash course. What can I expect during residency / what might be most challenging for a noobie to the field? I feel as if my psych history taking is abysmal. How can I improve that? One rotation I was in, I asked the patient why she was in the unit, to elicit a history, to which she responded "are you kidding, you tell me." It went downhill from there, lol. Is there a systematic approach I can use that will be universally applicable? Outpatient psych seems easier for me to obtain histories with, not so much in-patient / I'm also more intimidated. Any advice or tips would be appreciated

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With my pgy1 year right around the corner, I can't help but be excited for the start of a new chapter of my life. I was wondering if anyone has any tips on what I should be doing for the next month and a half. I purchased the Massachusetts handbook for psychiatry (outdated), to get a basic crash course. What can I expect during residency / what might be most challenging for a noobie to the field? I feel as if my psych history taking is abysmal. How can I improve that? One rotation I was in, I asked the patient why she was in the unit, to elicit a history, to which she responded "are you kidding, you tell me." It went downhill from there, lol. Is there a systematic approach I can use that will be universally applicable? Outpatient psych seems easier for me to obtain histories with, not so much in-patient / I'm also more intimidated. Any advice or tips would be appreciated
If you must read something, try The Psychiatric Interview by Daniel Carlat. It's a great resource and an easy read. Your interview skills will develop quickly with practice though. I wouldn't worry!
 
I think most of our peers would suggest taking the time to rejuvenate! I am currently reading Edward Shorter's "A History of Psychiatry: From the Era of the Asylum to the Age of Prozac". It was recommended to me by a providing psychiatrist in my region. I feel the historical perspective will enkindle a sense of mission for starting residency.
 
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If you must read something, try The Psychiatric Interview by Daniel Carlat. It's a great resource and an easy read. Your interview skills will develop quickly with practice though. I wouldn't worry!
ive been reading this as well, pretty good. Also provides forms for interviewing, and i very much like forms.
 
With my pgy1 year right around the corner, I can't help but be excited for the start of a new chapter of my life. I was wondering if anyone has any tips on what I should be doing for the next month and a half. I purchased the Massachusetts handbook for psychiatry (outdated), to get a basic crash course. What can I expect during residency / what might be most challenging for a noobie to the field? I feel as if my psych history taking is abysmal. How can I improve that? One rotation I was in, I asked the patient why she was in the unit, to elicit a history, to which she responded "are you kidding, you tell me." It went downhill from there, lol. Is there a systematic approach I can use that will be universally applicable? Outpatient psych seems easier for me to obtain histories with, not so much in-patient / I'm also more intimidated. Any advice or tips would be appreciated
For the problem that you mentioned you can avoid it or rectify it by saying something along the lines of "I reviewed your chart and I know that you've already told some people what is going on with you, but I don't always trust what I read or hear so its better if you tell me what happened to bring you here." Angry and reactive types of patients typically respond well to this as they often feel frustrated with being misunderstood or misrepresented. As you get more experience you will know which patients are already exasperated by how they roll their eyes and/or give a heavy sigh right when you walk in the room. Might even want to address it right off the bat, "I can see you're already frustrated and are tired of answering all these questions so I'll try to make this as quick and painless as possible."
 
Ok I wholeheartedly agree with the "take the time off" suggestion. Intern year is half emergency psychiatry/inpatient craziness and half off service reevaluating your life.

If you're really looking for something to calm your anxiety, I suggest dividing up a large textbook (like MGH or K&S) and Stahl's Psychopharm throughout the year. I divided it over 10 months since one of our inpatient medicine rotations is very busy and I knew I'd probably get no time to read, and another month was for buffer.

It's possible to get through both books in the year. It doesn't necessarily make you better with patients, but it builds a framework to organize your knowledge. I also suggest dividing up Splik's 100 articles (just google it, it's somewhere here on SDN) and planning to read one per week.

Practically speaking, here are some things that helped me, so take em with some salt:
- Get your crew on Slack. It's way better than group texts and you can share files
- Get a journal article organizer. My med school gave Endnote, but there are other cheaper/free programs
- Download the app "Telegram" and find the Sci-hub bot. You can message it doi numbers and it will give you PDF articles
- Figure out your loan stuff (Get on that PSLF if that's your thing)
- Figure out how to manage your money (Like a budget...for real)
- Learn to cook (like Crock Pot stuff + leftovers)
- Get better at organizing your tasks (You'll be tired and have a lot of stupid administrative stuff to handle)
- Go to the dentist

The rest of the stuff comes with experience. Interviewing patients and rolling with the BS is tough, and it's made tougher by having to consciously think about lists of questions. At some point write down all the questions that go on notes in a booklet. Some pencil pusher somewhere cares a lot about your note having the patient's employment status. I would take it out after an interview with a patient and make sure I've covered everything. After a while asking everything became routine. Then you can focus on delivery, empathy, poise, tact, etc.
 
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read the Black and Andreasen Introductory textbook of psychiatry from cover to cover. I m doing this to prepare for MOC exam (along with some other materials). It is helping me to learn DSM 5. It is kind of basic, but will give you a solid foundation and can be read very quickly.

that's the 6 th edition, the link got messed up when I edited
 
Don't sweat the inpatient interviews, really only thing you need to do is avoid the stumbling block you mentioned. In my mind you should completely get rid of the medschool teaching of your first sentence being super open ended. Your first sentence should convey that you know who they are, have reviewed their records and are interested in learning more about their experiences that led them to be hospitalized. It's still open ended but it lets the patient know you care enough about them to "do you homework".
 
Chilling. Living. Relaxing. Styling and profiling.

All that.

No gunning.
 
PGY-1 here nearing end of intern year. Best thing you can do, by far, is relax and enjoy the free time you have!

As others have said, the interview ability will come with practice. If you ever get nervous and blank out, go with the tried and true MSAPE, namely "mood", "sleep", "appetite", "pain", and "energy", followed by asking about suicidal/homicidal ideation and medication side effects. For a progress note, especially, these are the best things to do. If you're just meeting someone new, it really helps to read their chart, it is rare that you'll get someone completely new (and even then, your program will usually have a standard H&P template that you can just read off of until you get enough experience to rattle it off from memory).

Good luck.
 
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