Should I do extra psych elective as MS3?

[Armadillos]

So my medschool allows us to do two or three electives third year in addition to all the required rotations. Im pretty interested in psych because of some research projects Ive worked on, but obviously I wont know until after third year what I really want to do. I was wondering if you all think that that standard 3rd year rotation should be enough time to decide if I want to do psych, or if you would suggest doing another psych sub-specialty elective as well to get a broader view of the field?

There are a few other fields I have considered such as doing a peds sub-specialty of some sort, so just trying to plan how to use my electives.

 

[NYCMS2]

So my medschool allows us to do two or three electives third year in addition to all the required rotations. Im pretty interested in psych because of some research projects Ive worked on, but obviously I wont know until after third year what I really want to do. I was wondering if you all think that that standard 3rd year rotation should be enough time to decide if I want to do psych, or if you would suggest doing another psych sub-specialty elective as well to get a broader view of the field?

There are a few other fields I have considered such as doing a peds sub-specialty of some sort, so just trying to plan how to use my electives.

Won't it count against the number of Psych electives you are allowed to take in the 4th year? I say go for it, but really that is what 4th year is for.

At my med school we are limited to 4 electives in any single discipline, say psych, or surgery, etc.

 

[m1345]

So my medschool allows us to do two or three electives third year in addition to all the required rotations. Im pretty interested in psych because of some research projects Ive worked on, but obviously I wont know until after third year what I really want to do. I was wondering if you all think that that standard 3rd year rotation should be enough time to decide if I want to do psych, or if you would suggest doing another psych sub-specialty elective as well to get a broader view of the field?

There are a few other fields I have considered such as doing a peds sub-specialty of some sort, so just trying to plan how to use my electives.

Do you know when your psych rotation is? You might know what you want to do earlier than you think...I knew at the end of the first day of my psych rotation (which obviously isn't always the case). Do you have to schhedule your electives now, or can you wait and see what you'd like to explore further throughout your clerkship year?

I think your main priority in scheduling third year electives should be to explore fields that you would not otherwise be exposed to in 3rd year if you have any interest in them (path, rads, anesthesia, derm, etc). You may love one of those specialties and if you figure this out before the beginning of 4th year (when most med students finally get time to do an elective), you'll save yourself the stress of trying to pull together an application, personal statement, etc last minute.

 

[Armadillos]

Do you know when your psych rotation is? You might know what you want to do earlier than you think...I knew at the end of the first day of my psych rotation (which obviously isn't always the case). Do you have to schhedule your electives now, or can you wait and see what you'd like to explore further throughout your clerkship year?

I think your main priority in scheduling third year electives should be to explore fields that you would not otherwise be exposed to in 3rd year if you have any interest in them (path, rads, anesthesia, derm, etc). You may love one of those specialties and if you figure this out before the beginning of 4th year (when most med students finally get time to do an elective), you'll save yourself the stress of trying to pull together an application, personal statement, etc last minute.

I think you can switch some of your electives as the year goes on, but it depends on availability.

I think I will definitely do an elective in anesthesia/pain to see if I might be interested in that and was also thinking neurology seeing as that isn't one of our required electives. Then I would probably have 1 or 2 more to use and was wondering if it was worth it to do another psych or wasn't sure if it would be a "waste" seeing as the core rotation would be enough for me to decide by.

If i had to guess I would say im 60% to do psych, 20% something in peds, 20% other.

 

[Superpsych]

So my medschool allows us to do two or three electives third year in addition to all the required rotations. Im pretty interested in psych because of some research projects Ive worked on, but obviously I wont know until after third year what I really want to do. I was wondering if you all think that that standard 3rd year rotation should be enough time to decide if I want to do psych, or if you would suggest doing another psych sub-specialty elective as well to get a broader view of the field?

There are a few other fields I have considered such as doing a peds sub-specialty of some sort, so just trying to plan how to use my electives.

If you like peds you may want to look at child psych

Another question to ask: How much do I enjoy IM.... or court cases/criminals.....or substance patients... or the elderly

That would be: CL psych, Forensic psych, Substance, Geri psych

and to answer your question: yes if you want to match in that area and get LORs

 

[notdeadyet]

Armadillos- The answer to your question will depend heavily on what your 3rd year core rotation in psychiatry is like. If you have a mix of, say, inpatient unit and consult psychiatry, that's a pretty good exposure. If you're all one or the other, not so much.

If you decide you like psychiatry and want to pursue it, having a second rotation would be helpful for getting LORs. Depending on your scheduling, you could possibly better accommodate this doing a sub-I rather than another 3rd year elective. I would count on doing a core plus one more psych elective, just for interests sake. I wouldn't bother with doing more than that, as you can then use 4th year to really do rotations with other medical skills that will help you as a psychiatrist, as you'll get precious little exposure in residency.

 

[Armadillos]

Armadillos- The answer to your question will depend heavily on what your 3rd year core rotation in psychiatry is like. If you have a mix of, say, inpatient unit and consult psychiatry, that's a pretty good exposure. If you're all one or the other, not so much.

If you decide you like psychiatry and want to pursue it, having a second rotation would be helpful for getting LORs. Depending on your scheduling, you could possibly better accommodate this doing a sub-I rather than another 3rd year elective. I would count on doing a core plus one more psych elective, just for interests sake. I wouldn't bother with doing more than that, as you can then use 4th year to really do rotations with other medical skills that will help you as a psychiatrist, as you'll get precious little exposure in residency.

Thanks for the advice, this is what I was thinking would probably be best

 

[NYCMS2]

Armadillos- The answer to your question will depend heavily on what your 3rd year core rotation in psychiatry is like. If you have a mix of, say, inpatient unit and consult psychiatry, that's a pretty good exposure. If you're all one or the other, not so much.

If you decide you like psychiatry and want to pursue it, having a second rotation would be helpful for getting LORs. Depending on your scheduling, you could possibly better accommodate this doing a sub-I rather than another 3rd year elective. I would count on doing a core plus one more psych elective, just for interests sake. I wouldn't bother with doing more than that, as you can then use 4th year to really do rotations with other medical skills that will help you as a psychiatrist, as you'll get precious little exposure in residency.

Can you expand on these ideas a bit?

As I am soon to enter 4th year, and will soon start scheduling electives, what do you recommend in terms of the kinds of electives I should take? And are you suggesting that only one additional psych elective is necessary, assuming the core psych rotation was good (and mine was)?

I guess I assumed I would take the max number of psych electives (4) but if I am reading you correctly, that may be a waste of electives.

Thanks

 

[splik]

There can be legitimate reasons for doing a number of psychiatry electives. These include (a) really hating everything else (b) wanting to do away/audition rotations but in general doing all psych electives is discouraged because you are going to be spending the next 4 years doing psychiatry and this is your last opportunity to explore other areas of medicine. I was surprised to learn that many medical schools do not have a neurology clerkship. If this the case at your medical school you really ought to do a neurology rotation (outpatient rather than inpatient) as you should probably learn how to do a neuro exam and have some experience with some common neurological problems. we get precious little of this during residency. if you don't have to do a medicine sub-i, would recommend doing this as it will be helpful for intern year. are there some random areas that you would like to explore you will never get the opportunity to again? is it possible to international electives (I highly recommend)? random things like nutritional or integrative medicine? are you able to take various classes or do some random 'scholarly' project for an elective? think what might be useful, interesting, different, creative, and a valuable experience. if you're interested in child psych doing peds neuro or peds GI is quite interesting as lots of psych.

 

[notdeadyet]

As I am soon to enter 4th year, and will soon start scheduling electives, what do you recommend in terms of the kinds of electives I should take?

It depends on your medical school. I would recommend taking a psych elective that first and foremost interests you and one that is challenging enough to be meaningful. A sub-I is a good idea. I would try to choose one that expands your knowledge of psychiatry. In other words, if you did a core of nothing but inpatient acute, consider doing consult liaison or another area.

And are you suggesting that only one additional psych elective is necessary, assuming the core psych rotation was good (and mine was)?

Definitely. Some folks don't even do a second rotation, though I think it's a good idea to expand your knowledge and give you more to talk about.

Conventional wisdom (though debatable) is to not take more than two psych rotations beyond your core rotation. You have limited time in 4th year to take courses that will improve your abilities as a doctor; any rotations that will make you a more rounded clinician would be worth your while. The temptation is to load 4th year with psych rotations, but you won't really learn anything you won't have to relearn in residency, so I would take other rotations instead.

 

[notdeadyet]

you really ought to do a neurology rotation (outpatient rather than inpatient) as you should probably learn how to do a neuro exam and have some experience with some common neurological problems. we get precious little of this during residency. if you don't have to do a medicine sub-i, would recommend doing this as it will be helpful for intern year.

I'd definitely recommend doing a sub-I in medicine or inpatient family. And neuro is a biggie too (starting a neuro service as an intern not knowing how to do a basic neuro exam is a bit of an embarrassment).

Beyond that, I would also recommend services that have a strong relationship with mental illness. I liked chronic pain, hospice, pm&r, etc.

Lastly, Dr. Toaster's idea of taking more psych electives if you need to convince yourself that psych is right for you is fine.

 

[NYCMS2]

I'd definitely recommend doing a sub-I in medicine or inpatient family. And neuro is a biggie too (starting a neuro service as an intern not knowing how to do a basic neuro exam is a bit of an embarrassment).

Beyond that, I would also recommend services that have a strong relationship with mental illness. I liked chronic pain, hospice, pm&r, etc.

Lastly, Dr. Toaster's idea of taking more psych electives if you need to convince yourself that psych is right for you is fine.

Some very helpful responses - I am glad I asked, because nobody at my school had advised me otherwise, and I assumed I would take 3 or 4 psych electives.

I had a good neurology clerkship, but will look for more in the way of outpatient. And I will do a medicine sub-i (required). I have my eye on an elective in palliative care that interests me, and also an elective in addictions. One called "psychosocial medicine" has caught my eye, too.

 

[digitlnoize]

So my medschool allows us to do two or three electives third year in addition to all the required rotations. Im pretty interested in psych because of some research projects Ive worked on, but obviously I wont know until after third year what I really want to do. I was wondering if you all think that that standard 3rd year rotation should be enough time to decide if I want to do psych, or if you would suggest doing another psych sub-specialty elective as well to get a broader view of the field?

There are a few other fields I have considered such as doing a peds sub-specialty of some sort, so just trying to plan how to use my electives.

A lot of people here will probably say to do something besides psych...but I think, especially if you are considering psych but haven't decided yet, that a second psych month third year can be VERY helpful. It was what sealed the deal for me.

I'd seriously consider doing child. A good backup would be Psych Consults (if you haven't done that) or another sub-specialty (addictions, etc).

There's plenty of time for other stuff. Now is the time to make the right decision on your career.

Oh, and pick psych. It rocks.

 

[Armadillos]

A lot of people here will probably say to do something besides psych...but I think, especially if you are considering psych but haven't decided yet, that a second psych month third year can be VERY helpful. It was what sealed the deal for me.

I'd seriously consider doing child. A good backup would be Psych Consults (if you haven't done that) or another sub-specialty (addictions, etc).

There's plenty of time for other stuff. Now is the time to make the right decision on your career.

Oh, and pick psych. It rocks.

Thanks for the input, after doing a little more research it looks like during our psych rotation we spend 80% of the time with a specific psych service such as VA inpatient, "general" psych floors at the university hospital, consults, addiction, child, geriatric,etc. So I think I will schedule an elective for 1 psych sub-specialty (probably child) and then if I happen to be on that service during my main rotation ill get it switched to addictions.

Also I know it sounds weird asking here, but seeing as I'm obviously not 100% on psych yet, anyone have any suggestions for another field that would be good to do in an elective in that I might not get to see if I would like otherwise? I have spent most my extracurricular time doing stuff related to psych so I dont really know much at all about what other fields I might like. Based on my preclinical grades so far, my boards will probably be good enough for anything except derm/plastic/Uro/NS, but also I've promised myself (and my wife!) that I wouldn't do anything with a surgery residency/lifestyle so that helps narrow things from the start.

 

[st2205]

Thanks for the input, after doing a little more research it looks like during our psych rotation we spend 80% of the time with a specific psych service such as VA inpatient, "general" psych floors at the university hospital, consults, addiction, child, geriatric,etc. So I think I will schedule an elective for 1 psych sub-specialty (probably child) and then if I happen to be on that service during my main rotation ill get it switched to addictions.

Also I know it sounds weird asking here, but seeing as I'm obviously not 100% on psych yet, anyone have any suggestions for another field that would be good to do in an elective in that I might not get to see if I would like otherwise? I have spent most my extracurricular time doing stuff related to psych so I dont really know much at all about what other fields I might like. Based on my preclinical grades so far, my boards will probably be good enough for anything except derm/plastic/Uro/NS, but also I've promised myself (and my wife!) that I wouldn't do anything with a surgery residency/lifestyle so that helps narrow things from the start.

Pathology. Sleep med.

 

[vistaril]

There can be legitimate reasons for doing a number of psychiatry electives. These include (a) really hating everything else .

this is what I see that is common.

It's great and common to say "you should definately spend most of your 4th year getting exposure in medicine, er, palliative care, peds, gyn, whatever because you won't get to do them much anymore and they will help you"......this all sounds fine, but the reason the person isn't doing gyn or em is because they DONT LIKE them. so obviously, if you don't like something, you're not all that jazzed up to sign up for a bunch of electives doing things you DON'T LIKE.

 

[notdeadyet]

It's great and common to say "you should definately spend most of your 4th year getting exposure in medicine, er, palliative care, peds, gyn, whatever because you won't get to do them much anymore and they will help you"......this all sounds fine, but the reason the person isn't doing gyn or em is because they DONT LIKE them. so obviously, if you don't like something, you're not all that jazzed up to sign up for a bunch of electives doing things you DON'T LIKE.

Totally accurate if you pretty much hate all that medicine type stuff and fled to psychiatry in fear because it was the least painful option.

Not so accurate if you liked many fields of medicine and psychiatry just happened to be your favorite.

Psych wasn't an island of last resort for everyone, V...

 

[st2205]

this is what I see that is common.

It's great and common to say "you should definately spend most of your 4th year getting exposure in medicine, er, palliative care, peds, gyn, whatever because you won't get to do them much anymore and they will help you"......this all sounds fine, but the reason the person isn't doing gyn or em is because they DONT LIKE them. so obviously, if you don't like something, you're not all that jazzed up to sign up for a bunch of electives doing things you DON'T LIKE.

I think one of the biggest problems facing medical students and choosing rotations is not having a proper understanding or appreciation for just how broad medicine is and what opportunities are available to them if you look around a little. I have a hard time believing there aren't at least a good handful of good rotations available that they'd enjoy. Medicine is much, much more broad than the six core specialties. Too many people walk away thinking that's medicine.

 

[vistaril]

Totally accurate if you pretty much hate all that medicine type stuff and fled to psychiatry in fear because it was the least painful option.

Not so accurate if you liked many fields of medicine and psychiatry just happened to be your favorite.

Psych wasn't an island of last resort for everyone, V...

no, that's true....but it is definately the case that for a lot of people(we probably disagree on the percentages somewhat) non-psych fields ranged from total repulsion/fear to mild disinterest but tolerability.

 

[Daedra22]

I would like to add to the people on here who recommended PM&R/pain management as a rotation (and even as a potential career option). I did a pain management rotation earlier this year, and it has been by far the most useful rotation I've done - you see a lot of psych, addiction, and if you have a good preceptor you should learn a good bit about pharmacology. If it weren't for the musculoskeletal/procedural component, I might have chosen to go into pain management. Definitely a lot of overlap between psych and pain.

 

[vistaril]

I would like to add to the people on here who recommended PM&R/pain management as a rotation (and even as a potential career option). I did a pain management rotation earlier this year, and it has been by far the most useful rotation I've done - you see a lot of psych, addiction, and if you have a good preceptor you should learn a good bit about pharmacology. If it weren't for the musculoskeletal/procedural component, I might have chosen to go into pain management. Definitely a lot of overlap between psych and pain.

pain management in the real world is mostly procedures....joint injections, various US guided injections, even going up to 'bigger' procedures like kyphoplasty....there is also a decent component of opiate writing of course in pain medicine, and this is often relegated to np's in the same practice while the pain doc is lining up procedures.

Many pain medicine clinics do employ psychologists, but other than that I wouldnt say there is a lot of overlap.

 

[Daedra22]

pain management in the real world is mostly procedures....joint injections, various US guided injections, even going up to 'bigger' procedures like kyphoplasty....there is also a decent component of opiate writing of course in pain medicine, and this is often relegated to np's in the same practice while the pain doc is lining up procedures.

Many pain medicine clinics do employ psychologists, but other than that I wouldnt say there is a lot of overlap.

I was in a private practice, so I'm pretty sure it was in the "real world," but maybe this doctor was an exception. I can only speak from my experience.

 

[vistaril]

I was in a private practice, so I'm pretty sure it was in the "real world," but maybe this doctor was an exception. I can only speak from my experience.

well was the pm&r/pain doc in this example doing injections and procedures or doing psych?

 

[Armadillos]

I would like to add to the people on here who recommended PM&R/pain management as a rotation (and even as a potential career option). I did a pain management rotation earlier this year, and it has been by far the most useful rotation I've done - you see a lot of psych, addiction, and if you have a good preceptor you should learn a good bit about pharmacology. If it weren't for the musculoskeletal/procedural component, I might have chosen to go into pain management. Definitely a lot of overlap between psych and pain.

Yeah I'm definitely considering doing a PM&R elective, although Im afraid I'll get skewered for not knowing anything about MSK anatomy seeing as that was like the first thing we did in medschool and I forgot it all.

Given that pain and psychiatric illness are often "invisible" conditions that a lot of the general public (and even physicians sadly) tend to kind of brush off as not real or not a big deal, I would enjoy the opportunity to work with either population seeing as so many other people are so willing to brush them off.

 

[notdeadyet]

well was the pm&r/pain doc in this example doing injections and procedures or doing psych?

The point isn't to do electives in which you'll be exposed to practicing psychiatry (you get plenty of that in residency), it's expanding your clinical knowledge beyond psychiatry so you'll be a better psychiatrist. PM&R is helpful because there's a high comorbidity with psych complaints and chronic pain and debilitating injury. The point of a PM&R rotation is to work with these patients in this context, which is experience you'll be able to leverage when you see them as a psychiatrist.

 

[Daedra22]

The point isn't to do electives in which you'll be exposed to practicing psychiatry (you get plenty of that in residency), it's expanding your clinical knowledge beyond psychiatry so you'll be a better psychiatrist. PM&R is helpful because there's a high comorbidity with psych complaints and chronic pain and debilitating injury. The point of a PM&R rotation is to work with these patients in this context, which is experience you'll be able to leverage when you see them as a psychiatrist.

Exactly.

The doc I worked with did do injections and procedures once a week. He also did management of pain medications on the other days and spoke with his patients about their psychological and physical functioning as it related to their pain. A lot of them had comorbid psychiatric diagnoses or addictions which showed up on our drug screen. My preceptor was very good about referring out to psychiatrists where necessary.

I really liked the experience and I think it was very beneficial for my education as a future psychiatrist, so I would recommend it to others.

 

[vistaril]

The point isn't to do electives in which you'll be exposed to practicing psychiatry (you get plenty of that in residency), it's expanding your clinical knowledge beyond psychiatry so you'll be a better psychiatrist. PM&R is helpful because there's a high comorbidity with psych complaints and chronic pain and debilitating injury. The point of a PM&R rotation is to work with these patients in this context, which is experience you'll be able to leverage when you see them as a psychiatrist.

this sounds good(almost like something out of a pamphlet), but where your connection fails is 'work with these patients in this context'.....the pain medicine physician is helping them(or usually failing to help them and possibly hurting them) by doing procedures, doing injections, and doling out opiates. And possibly referring to PT and the psychologist in thier practice. Me watching them doing those things isn't going to help in any meaningful way.

 

[notdeadyet]

this sounds good(almost like something out of a pamphlet), but where your connection fails is 'work with these patients in this context'.....the pain medicine physician is helping them(or usually failing to help them and possibly hurting them) by doing procedures, doing injections, and doling out opiates. And possibly referring to PT and the psychologist in thier practice. Me watching them doing those things isn't going to help in any meaningful way.

If your style (or your med school's style) is for you to be a wallflower and just shadow docs, it doesn't really what your electives are because osmosis doesn't teach much. But by MS4, most students take on some responsibilities and duties. If you aren't doing this, then any rotation (including psych rotations) aren't really going to do much for you.

 

[mkeguy]

The point isn't to do electives in which you'll be exposed to practicing psychiatry (you get plenty of that in residency), it's expanding your clinical knowledge beyond psychiatry so you'll be a better psychiatrist. PM&R is helpful because there's a high comorbidity with psych complaints and chronic pain and debilitating injury. The point of a PM&R rotation is to work with these patients in this context, which is experience you'll be able to leverage when you see them as a psychiatrist.

agreed. you'll have 40 years of education in psych. do something else and broaden your horizons. you'll be better able to speak the language of other specialties when you work with them (or go out for drinks)

 

[vistaril]

If your style (or your med school's style) is for you to be a wallflower and just shadow docs, it doesn't really what your electives are because osmosis doesn't teach much. But by MS4, most students take on some responsibilities and duties. If you aren't doing this, then any rotation (including psych rotations) aren't really going to do much for you.

there generally isn't going to be a lot of opportunities for a student to 'do things' on a pain medicine outpt elective. You aren't going to get to do any procedures(maybe the simplest of all the joint injections), and you aren't going to have any real input in the opiate management.

furthermore, even if you did, none of that is really educational from the perspective of what a psychiatrist needs to know.