Role of non-psych rotations on program selection

[Salpingo]

I was just wondering to what degree the medicine and neurology departments influenced people on the interview trail. Did a malignant medicine program give you pause? Did an exceptional neurology department bump up a program's ranking? I realize its a little short-sighted, but I believe these rotations have the potential to be incredibly traumatic/educational. They're also the people giving/requesting consults.

Thoughts?

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[Doctor Bagel]

Not hugely, but I was a little less excited about matching places that required residents to do 4 full months (or even 6 months) of inpatient medicine. Also, I interviewed at one place that required their residents to work 6 12 hour shifts weekly on their ED rotation, which seemed a bit ridiculous since ED residents can't work more than 60 hours a week in the ED. While that was only a month of intern year, it reinforced my notion that that program was a workhorse program.

 

[Salpingo]

Not hugely, but I was a little less excited about matching places that required residents to do 4 full months (or even 6 months) of inpatient medicine. Also, I interviewed at one place that required their residents to work 6 12 hour shifts weekly on their ED rotation, which seemed a bit ridiculous since ED residents can't work more than 60 hours a week in the ED. While that was only a month of intern year, it reinforced my notion that that program was a workhorse program.

Wow. Was that CPEP or regular ER?

I guess what I'm wondering if these non-psych rotations are just like the majority of med school (something you suffer through to get to the good stuff) or are significant enough that you'd pay attention to them on the interview trail.

 

[digitlnoize]

As I'm looking at programs, I'm considering the non-psych rotations, but it's a relatively minor issue. A few months of hard IM isn't the end of the world, but I doubt it's anyone's preference...but it won't knock a good program off my list.

 

[Daedra22]

This is semi-related, I'm just curious... when you're on IM months as a psych intern, do you function exactly the same as the IM interns?

 

[pingouin]

This is semi-related, I'm just curious... when you're on IM months as a psych intern, do you function exactly the same as the IM interns?

During my M3 IM clerkship, I had 2 psych interns on my team over the course of 8 weeks. They had the exact same roles and responsibilities as the med interns.

 

[Manicsleep]

This is semi-related, I'm just curious... when you're on IM months as a psych intern, do you function exactly the same as the IM interns?

Yes. You are both interns. Its a residency, you are supposed to know medicine and neurology.

Although I would be wary of programs that make you work more than the host residents (72 hours in the ER vs 60 for ER interns). That shows that the psychiatry administration doesn't really care about protecting its own.

 

[Doctor Bagel]

This is semi-related, I'm just curious... when you're on IM months as a psych intern, do you function exactly the same as the IM interns?

Normally, yes. You carry the same numbers of patients and have the same call responsibilities. Not to say the people you're rotating with shouldn't be mindful of the fact that you are a psych resident, especially later in the year when you're not going to be performing at the same level as a IM intern. For example, I felt pretty close to equal with the IM intern when I did IM wards in October and felt a little behind when I did it again in April.

Editing to say that this is not an excuse for not doing your job, but it's obvious you're not going to be on the same level as an IM intern who has done IM all year when you've mainly been doing psych.

 

[peppy]

Yes. You are both interns. Its a residency, you are supposed to know medicine and neurology.

Although I would be wary of programs that make you work more than the host residents (72 hours in the ER vs 60 for ER interns). That shows that the psychiatry administration doesn't really care about protecting its own.

I agree that I would be wary of that sort of situation. If the psychiatry program is unable or unwilling to stand up for its residents when they're basically being taken advantage of on their off-service rotations, then I would not want to go there. It probably translates into other areas too.
If it's just a situation where everyone on IM or Neuro works hard, but you don't get the impression that it's a malignant situation, then I'd say go ahead and go there. Those few months of internship go by fast. I tried my best to avoid any whiff of malignancy though.

 

[whopper]

At the residency program where I did my training, the psychiatry residents that started with the medical residents were on par with them.

The psychiatry residents that started rotation months down the road were behind, and as a result, they were expected to do less because they couldn't be counted on.

When no one knows how to do a procedure, everyone is taught, including the psychiatry resident who knows just as much as the IM residents.

When all the IM residents know how to do it, and the psychiatry resident doesn't know, the senior resident will just make the ones that know how to do it do it.

Normally, for the IM residents, if they are behind, they get their ass kicked. The senior residents will make them learn things they are behind on, or they will get kicked out if the program has some self-respect. The psychiatry residents are an exception because the senior IM residents will go figure it's not their field, so let them pass even if they are not up to par.

While IMHO the above phenomenon is not a good thing, I know plenty of lazier psychiatry residents that embraced not having to do as much.

And these same psychiatry residents were the same ones months and years down the road beeping me, while they were in the ER, not knowing what to do with a patient that was medically cleared but they doubted the validity of the clearance. The better trained psychiatry residents would've been able to handle it on their own.

While I was a chief resident, as much as I would've liked to kick the butts of these lazier residents, the attendings were far worse. Some of the attendings didn't know that a BP of 129/86 was not hypertension. So I was trapped in a situation where I felt doing so would've been just too much of an ironic hypocrisy. Besides the program I was in didn't want to be getting on the backs of the lazier residents. That was a good thing if you actually wanted to learn on your own because you could do so at a more relaxed pace without someone making you do it, but if you blew, you could get away with it.

 

[cleareyedguy]

Programs differ. Some treat all interns the same. Some give psych interns less work or less challenging work. And some, at least according to the above post about ER schedules, over-work them.

Should you make a decision based on these realities? I don't know. I have a bias in favor of training that builds up the resident's sense of responsibility, but I'm not sure how that is optimally done.

Oh, and, yes, there is ongoing negotiating with the other departments about what the psych resident should do on these non-psych rotations.

 

[whopper]

All-in-all, the quality of the nonpsychiatric training should be a lower priority. Besides, you'll probably not even know what the quality is from the programs you're applying.

Most applicants don't even really know the quality of the actual psychiatry program and rely on factors such as the namebrand or proximity to where they want to live.

Not that medical training isn't important. It is. Just that there's plenty of other factors you have to use.