Shadowing/Observation Opportunities for med students

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rpkall

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I was wondering if anyone can tell me whether MS1's and MS2's typically have any opportunities to observe clinical sessions with actual patients at most medical schools. Is this usually done? Or are there strict confidentiality issues / behavioral regulations for the student that make it necessary to wait until the 3rd year psych rotation?

Obviously, I will ask the department at my particular med school when I matriculate in the fall, but I thought I might get some info from you all so I could figure out how best to ask/con them into letting me watch, etc. I'm extremely interested in the psychiatric interview and how physicians deal with different people, problems, and personality types.

Thanks for any info you could provide; much appreciated!

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rpkall said:
I was wondering if anyone can tell me whether MS1's and MS2's typically have any opportunities to observe clinical sessions with actual patients at most medical schools. Is this usually done? Or are there strict confidentiality issues / behavioral regulations for the student that make it necessary to wait until the 3rd year psych rotation?

Obviously, I will ask the department at my particular med school when I matriculate in the fall, but I thought I might get some info from you all so I could figure out how best to ask/con them into letting me watch, etc. I'm extremely interested in the psychiatric interview and how physicians deal with different people, problems, and personality types.

Thanks for any info you could provide; much appreciated!

Your best bet might be in a psych ER/crisis program. You'll see a high volume and astounding acuity, and most patients (that I've encountered) are OK with having one more listener in the room. Depending on how the institution is set up, you might end up shadowing a social worker instead of a doc, but you could get some idea of how to talk to the patients, how to assess issues, etc.

Believe me, if you let the psych rotation director at your school know that you're interested in this stuff a year or two ahead of when you're "supposed to be", it's in their best interests to get you some exposure!
 
A lot of my med students (especially in the ER) get kicked out when I introduce them and ask if they can stay. Generally, I find that the sicker the patient, the less they mind if the student is there. Inpatient units are more forgiving.

Generally, MS I's and MS II's don't see much clinical exposure or action in that respect. Depending on the med school, however, you do get some exposure...with H&Ps, etc. It doesn't hurt to ask.
 
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I'll be starting out as a first year resident in a month and would certainly yield to the collective wisdom of the previous posts from experienced psychiatrists. As a senior medical student I rotated in a psych ER for a month and found no difficulty in shadowing or being shadowed.... I think that's a great suggestion. I was never asked to leave by a patient, although the option was rarely presented to the patient. I'd also suggest looking outside the hospital as well for some experience. I went into medical school with a similar hope of shadowing, but found most psychiatrists mildly uncomfortable with having a very junior medical student with them. Instead, I ran across a remarkable child psychiatrist who was the director of a residential treatment facility for kids and stayed on for two years as a counselor. I loved it as well as learned a tremendous amount about psychiatry. He also became familiar with my clinical skills as a counselor and became more comfortable with me shadowing in his office. Just something to think about.
 
I wonder if there is a regional difference in patients' attitudes toward medical student shadowing. I would bet there is. I noticed that when I rotated in PA for neuropsychiatry (compared to NYC), the patients generally yield to the "you're the doctor, I'll listen to whatever you say" mentality than in Manhattan. Here, the patients are (often wrongfully) much more empowered and demanding, and have absolutely no problem in forcefully challenging your thinking or decision making.
 
Interesting points from you all. I appreciate the input.

I'm sure some opportunities will surface as I go along in the process, maybe doing some research or chatting with various psychiatrists/psychologists in the dept.

Do any of you think it would help to get a medical text on the psychiatric interview? Is that something that's even necessary for the MSI-IV years (i.e., learned when you go to residency) or would it realistically help me jump-start my knowledge base before shadowing?

Thanks again!
 
rpkall said:
Do any of you think it would help to get a medical text on the psychiatric interview? Is that something that's even necessary for the MSI-IV years (i.e., learned when you go to residency) or would it realistically help me jump-start my knowledge base before shadowing?

Thanks again!

Depends on what you want. There's a good book by Carlat with lots of questions and mnemonics for DSM criteria, that would not be too heavy a read, and might also be practical and generalizable to all your rotations. There's also a tiny white pocket book called "Interviewing for the DSM-IV" or some such thing, that might have a higher benefit/cost ratio.

What's more important, in my opinion, is just to be really interested in your patients, and to be curious about what is going on in their lives, what symptoms they experience, etc. The "what question to ask" issue flows pretty naturally out of that curiosity, I think.
 
When I did my 3rd-year psych rotation, the attending had a college senior that was interested in psychiatry (headed to med school next fall) that shadowed her and I for a couple days on the inpatient service. The patients never minded, I think they were used to having med students, residents, different attendings, social workers, etc. and they don't really differentiate a 1st year student from a 3rd or 4th year.

I would think that outpatients or ER patients might be a little bit more private, though.
 
Thanks again for all the input, folks. I'll try asking the dept when I get up to school and get settled in. I'm sure if I get involved in some aspect of the research they're doing, someone on the payroll will let me hang out in the inpt wards once a week or something.

I looked on Amazon for Carlat's book, and I wound up finding the DSM-IV "white-book" too. Score! Thanks for the tips, OldPsychDoc.
 
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