So, psychiatrists...how did you survive your internal medicine rotation? Is it possible to fail on this rotation as an intern?

nebuchadnezzarII

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Just wanted to know your experiences on it and any tips you may have. It's been a while since I've been on a medicine service in medical school, and now I'm doing my first month of internal medicine as a psych intern. Did a few months of psych already, but IM feels completely different and overwhelming.

Do you guys have any survival tips, as psych residents on off service rotations?

Also, is it possible to get fired from residency/failed if you are complete garbage during your IM rotation? I ask because I am doing very poorly on this rotation thus far...
 

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I think you need to be worse than garbage to get fired. You'd have to actually go out of your way to do something to get fired.
 
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Taddy Mason

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Also, is it possible to get fired from residency/failed if you are complete garbage during your IM rotation? I ask because I am doing very poorly on this rotation thus far...
Is that your perception or have things been specifically said? Off service rotations and expectations are going to vary considerably between programs and departments. I was generally treated as an MS4/Sub-I except for one medicine month where I functioned more as a true intern. I do personally know people who had to remediate or were placed on some form of probation because of their performance on off service rotations, but those individuals also tended to have issues on their psych rotations as well, suggesting larger problems/deficits.

As far as tips, on day one I asked the chief/senior resident what the explicit expectations were and made sure I was familiar with how they ran the service. Beyond that MGH IM pocket book and Online MedEd were helpful, own your patients, know them well, and always keep the ultimate dispo plan in mind from day one. Read up on topics related to your patients and areas in which your knowledge is weaker but relevant to things you’d likely encounter. And don’t ever be afraid to ask questions or to clarify your plan/thought process. This was never a problem on medicine or in the ED, but was less well received on neuro. But that speaks more to the culture of that department at my program.
 
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nebuchadnezzarII

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Is that your perception or have things been specifically said? Off service rotations and expectations are going to vary considerably between programs and departments. I was generally treated as an MS4/Sub-I except for one medicine month where I functioned more as a true intern. I do personally know people who had to remediate or were placed on some form of probation because of their performance on off service rotations, but those individuals also tended to have issues on their psych rotations as well, suggesting larger problems/deficits.

As far as tips, on day one I asked the chief/senior resident what the explicit expectations were and made sure I was familiar with how they ran the service. Beyond that MGH IM pocket book and Online MedEd were helpful, own your patients, know them well, and always keep the ultimate dispo plan in mind from day one. Read up on topics related to your patients and areas in which your knowledge is weaker but relevant to things you’d likely encounter. And don’t ever be afraid to ask questions or to clarify your plan/thought process. This was never a problem on medicine or in the ED, but was less well received on neuro. But that speaks more to the culture of that department at my program.
Hey, thanks for the tips. And nothing has specifically been said in terms of getting dismissed or put on probation...but I can just feel I am not doing a good job. It's my first week on medicine and it has gone really badly. I'm genuinely trying my best, I always do. But this isn't practice/medical school, this is the real deal. And if I'm not on top of stuff, people will die.

My attending occasionally gets a little pissy or upset if I'm not on top of everything. He realizes I'm off service but one time said "It doesn't matter to me if you're psychiatry, neurology, etc. I have the same expectations of you." He also got mad one time when I saw examined a wound and thought it was improving but it was actually getting worse and the other time when I couldn't hear crackle son a lung exam...My resident said yesterday "You're doing a great job, I know it can be hard coming into this in the middle of the year when everyone is alreayd ahead and you feel really dumb." Etc. etc. Just stuff like that worries me and I take as warning signs. Like when someone tells you you're doing a good job in that context, it usually means the opposite?

In my program, we function as an "extra intern," if that makes any sense. Intern teams are usually 2, and I get thrown in there as a third intern. I take call (always paired with a medicine intern) and follow my own patients, present, place orders, call consults, etc. So pretty much the same as a normal intern but with the understanding that I'm "extra."
 

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Hey, thanks for the tips. And nothing has specifically been said in terms of getting dismissed or put on probation...but I can just feel I am not doing a good job. It's my first week on medicine and it has gone really badly. I'm genuinely trying my best, I always do. But this isn't practice/medical school, this is the real deal. And if I'm not on top of stuff, people will die.

My attending occasionally gets a little pissy or upset if I'm not on top of everything. He realizes I'm off service but one time said "It doesn't matter to me if you're psychiatry, neurology, etc. I have the same expectations of you." He also got mad one time when I saw examined a wound and thought it was improving but it was actually getting worse and the other time when I couldn't hear crackle son a lung exam...My resident said yesterday "You're doing a great job, I know it can be hard coming into this in the middle of the year when everyone is alreayd ahead and you feel really dumb." Etc. etc. Just stuff like that worries me and I take as warning signs. Like when someone tells you you're doing a good job in that context, it usually means the opposite?

In my program, we function as an "extra intern," if that makes any sense. Intern teams are usually 2, and I get thrown in there as a third intern. I take call (always paired with a medicine intern) and follow my own patients, present, place orders, call consults, etc. So pretty much the same as a normal intern but with the understanding that I'm "extra."
Yeah, that’s similar to how my medicine months were set-up and your experience sounds pretty typical. Just be mindful of, and responsive to feedback and do your best. If nothing has been explicitly said re: your performance I wouldn’t be too concerned. Anyone I’ve known who had to remediate or was put on some form of probation royally f-ed up, had professionalism issues adding to the mix, and also raised concerns on their psych rotations. If you’re not checking any of those boxes just keep on keeping on.
 
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Just wanted to know your experiences on it and any tips you may have. It's been a while since I've been on a medicine service in medical school, and now I'm doing my first month of internal medicine as a psych intern. Did a few months of psych already, but IM feels completely different and overwhelming.

Do you guys have any survival tips, as psych residents on off service rotations?

Also, is it possible to get fired from residency/failed if you are complete garbage during your IM rotation? I ask because I am doing very poorly on this rotation thus far...

You'll probably be fine - most programs don't just "fire" an intern/resident without at least a few warnings and a clear heads up. Try and learn as much as you can and be a good team player, that usually gets you farther than book smarts/knowledge.

I found it helpful to have the intern survival guide from onlinemeded.org when I was an intern doing medicine, not sure if they still make that/you have access to it.

Good luck!
 
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calvinhobbes

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Hey, thanks for the tips. And nothing has specifically been said in terms of getting dismissed or put on probation...but I can just feel I am not doing a good job. It's my first week on medicine and it has gone really badly. I'm genuinely trying my best, I always do. But this isn't practice/medical school, this is the real deal. And if I'm not on top of stuff, people will die.

My attending occasionally gets a little pissy or upset if I'm not on top of everything. He realizes I'm off service but one time said "It doesn't matter to me if you're psychiatry, neurology, etc. I have the same expectations of you." He also got mad one time when I saw examined a wound and thought it was improving but it was actually getting worse and the other time when I couldn't hear crackle son a lung exam...My resident said yesterday "You're doing a great job, I know it can be hard coming into this in the middle of the year when everyone is alreayd ahead and you feel really dumb." Etc. etc. Just stuff like that worries me and I take as warning signs. Like when someone tells you you're doing a good job in that context, it usually means the opposite?

In my program, we function as an "extra intern," if that makes any sense. Intern teams are usually 2, and I get thrown in there as a third intern. I take call (always paired with a medicine intern) and follow my own patients, present, place orders, call consults, etc. So pretty much the same as a normal intern but with the understanding that I'm "extra."
Don’t worry. Most attendings don’t care and as long as you’re nice and respectful and show up on time and work well with others, just get through it, everyone does! (Plus, it does help that you’re on psych...in 1 year you’ll pass the attendings in a hallway and they won’t even remember you, promise!—unless you’re a nice, friendly, memorable person :) )
 
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Just wanted to know your experiences on it and any tips you may have. It's been a while since I've been on a medicine service in medical school, and now I'm doing my first month of internal medicine as a psych intern. Did a few months of psych already, but IM feels completely different and overwhelming.

Do you guys have any survival tips, as psych residents on off service rotations?

Also, is it possible to get fired from residency/failed if you are complete garbage during your IM rotation? I ask because I am doing very poorly on this rotation thus far...
Please discuss with your senior resident and attending. Better to get feedback and demonstrate proactiveness than wait until it is too late. In my experience it is usually residents who seem oblivious to their shortcomings who are the ones in danger, so I think it is a good sign you have some healthy degree of awareness of having some difficulty. You should be supervised so you are not going to kill anyone. People don't expect interns to know anything, just be on time, do what you say you are going to do, ask for help, and be keen to learn as much as you can and open to feedback. And of course you are not going to be at the same level right now as interns who have done a lot more medicine than you have.
 
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clozareal

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Just wanted to know your experiences on it and any tips you may have. It's been a while since I've been on a medicine service in medical school, and now I'm doing my first month of internal medicine as a psych intern. Did a few months of psych already, but IM feels completely different and overwhelming.

Do you guys have any survival tips, as psych residents on off service rotations?

Also, is it possible to get fired from residency/failed if you are complete garbage during your IM rotation? I ask because I am doing very poorly on this rotation thus far...
I second following the advice of your senior resident and attending. Be open to not knowing and seeking help/learning for next time. Utilize UpToDate as much as possible. Most of the assessment/plan comes from your resident/attending anyways. You're just there to collect and organize the data during rounds, but they're also doing the same as a redundant step so you won't harm anyone while you're learning.
 
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Please discuss with your senior resident and attending. Better to get feedback and demonstrate proactiveness than wait until it is too late. In my experience it is usually residents who seem oblivious to their shortcomings who are the ones in danger, so I think it is a good sign you have some healthy degree of awareness of having some difficulty. You should be supervised so you are not going to kill anyone. People don't expect interns to know anything, just be on time, do what you say you are going to do, ask for help, and be keen to learn as much as you can and open to feedback. And of course you are not going to be at the same level right now as interns who have done a lot more medicine than you have.

This.

But also to me this is quite revealing:

"My resident said yesterday "You're doing a great job, I know it can be hard coming into this in the middle of the year when everyone is alreayd ahead and you feel really dumb." Etc. etc. Just stuff like that worries me and I take as warning signs. Like when someone tells you you're doing a good job in that context, it usually means the opposite?"

Why would you take that as a warning sign and how does it "usually" mean the opposite? If your senior is telling you you're doing a "great" job, it means they are at the least very much satisfied with your performance.

Seems to me you might have some self-worth issues to ponder on? Just food for thought. In a high stress environment with so many hours like an IM rotation, these sometimes jump to the fore.
 
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We were treated the same as the medicine interns and we're on the same size teams and carried the same amount of patients (and patients in the ICU). Some in our dept struggled and one almost didn't pass her medicine months but she was fairly flagrant in her "I don't give a flying **** about diabetes" attitude. Our program director had to intervene.

Whenever I was on a new service, I'd just read back in the chart and see what was standard or expected from the attending or senior. If you read your patients chart, and even what was done in the ER etc etc you really start to see how formulaic it is. Also remembering all the social work BS and being mindful of how you're going to discharge a patient goes a long way.

Studying for Step 3 could also help. Sometimes if you are (or appear) knowledgeable in theory one can deflect rusty examination skills (which will improve with practice). And even running through the case simulations can be helpful in coming up with a rudimentary plan. Getting put on a team with a weak medicine intern also helps bc everyone might be more focused on their dumpster fire of a census than yours lol.

Staying organized, knowing what's going on with your patient and writing a note is literally more than half the battle on medicine. And hell, some days we'd even cure people...
 
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Every program is different but we had some fail x 2 and released from program due to their rotations on medicine. They were not safe. That aside, personally I would take the social dispo patients on the team. And let the medicine residents do medicine which they like. The team was so grateful I got couple rocks off the service working with CM they thought I was a rockstar. Bc I was always talking with CM and working on options. So, I gave them my most complex medical pts for social dispo. Win, win for everyone!
 
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Every program is different but we had some fail x 2 and released from program due to their rotations on medicine. They were not safe. That aside, personally I would take the social dispo patients on the team. And let the medicine residents do medicine which they like. The team was so grateful I got couple rocks off the service working with CM they thought I was a rockstar. Bc I was always talking with CM and working on options. So, I gave them my most complex medical pts for social dispo. Win, win for everyone!
You had psychiatry residents who were kicked out of psychiatry residency for doing poorly on their off service medicine months? Name your program so everyone can avoid it that’s an absolute joke
 
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You had psychiatry residents who were kicked out of psychiatry residency for doing poorly on their off service medicine months? Name your program so everyone can avoid it that’s an absolute joke
It started the cause for concern as it was like second rotation. Still had cause for concern but passed about a year worth of psych rotations including some second year. Retook medicine. Still deemed inadequate and a risk.

Politics in medicine my friend......they want you gone....you gone. I think it was more a convenient way to do it and set up
 
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It started the cause for concern as it was like second rotation. Still had cause for concern but passed about a year worth of psych rotations including some second year. Retook medicine. Still deemed inadequate and a risk.

Politics in medicine my friend......they want you gone....you gone. I think it was more a convenient way to do it and set up
This makes no sense..you are a psych resident no one should care if you are an adequate medicine resident, in my program everyone goofed off during off service months, we were still professional but nowhere as good as the actual medicine residents...you should really post your program so people can avoid that’s ridiculous...why would a psych PD fire a resident for being bad at internal medicine? Horrible
 
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This makes no sense..you are a psych resident no one should care if you are an adequate medicine resident
I disagree. You don't need to be good or great at your IM rotation, but you should still be adequate. It is a required rotation, so you have to pass. Plus, having at least the basics of IM down makes you a better psychiatrist. Our medications cause too many side effects in too many body systems to not have some general medical knowledge allowing us to do proper workups and initiate treatments for such things.
 
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Requirements are required. Not passing is failing. One could argue that IM rotations are the most likely to get you fired because they are the hardest. I don't see how that means that someone can fail at it and get a free pass.
 
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I disagree. You don't need to be good or great at your IM rotation, but you should still be adequate. It is a required rotation, so you have to pass. Plus, having at least the basics of IM down makes you a better psychiatrist. Our medications cause too many side effects in too many body systems to not have some general medical knowledge allowing us to do proper workups and initiate treatments for such things.

Unless you do something grossly unprofessional, I really don't know how you could 'fail' an IM rotation. By simply getting through med school and passing the boards, you should have enough knowledge to get by. This is why we have tests. That's why this case of TWO fired residents on an IM rotation is definitely a bit of a red flag.
 
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I agree that dismissing someone from residency for inadequate performance on an off service rotation is...a bit more extreme than I have seen, particularly if their on service performance was good. I think as long as your attitude is good, that goes a lot farther than knowledge or abilities for an off service rotation. The residency dismissing people must have a lot of cushioning with scheduling if they are able to just drop people like that. I also agree that if you feel inadequate, you're probably right, but that's okay so far into intern year since you haven't been doing it. I was also treated much like a sub-i as an intern on medicine and it went fine. Pick up the medicine you need to know and move on. Quite honestly, I think inpatient months of medicine are not nearly as helpful as outpatient months would be, but most hospitals are structured to wring as much benefit out of their residents as they can, hence inpatient. Inpatient neuro...I have no idea how to fix that. We do not seem to be exposed to the right stuff there, but I am not sure outpatient would be better. I do find it frustrating that they are only required 1 month of psych whereas we are required 2 months of neuro.
 
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Unless you do something grossly unprofessional, I really don't know how you could 'fail' an IM rotation. By simply getting through med school and passing the boards, you should have enough knowledge to get by. This is why we have tests. That's why this case of TWO fired residents on an IM rotation is definitely a bit of a red flag.
Totally agree. Hell, there are IM residents who do horribly and still get promoted, and they are closely followed by program leadership to correct any incompetencies. But to dismiss a psych resident bc they “failed” an IM rotation? Doesn’t make sense. They must have not shown up, were unprofessional, etc. Can’t be performance based, heck IM residents accidentally kill patients all the time (all part of “learning,” smh) and yet they aren’t dismissed either. Something isn’t right here with this program...or, the resident must have really did something egregious to the point of reaaaaaaally pissing off leadership.
 
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Totally agree. Hell, there are IM residents who do horribly and still get promoted, and they are closely followed by program leadership to correct any incompetencies. But to dismiss a psych resident bc they “failed” an IM rotation? Doesn’t make sense. They must have not shown up, were unprofessional, etc. Can’t be performance based, heck IM residents accidentally kill patients all the time (all part of “learning,” smh) and yet they aren’t dismissed either. Something isn’t right here with this program...or, the resident must have really did something egregious to the point of reaaaaaaally pissing off leadership.
This is exactly why I told that guy to @ his program so people can avoid it moving forward
 
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You had psychiatry residents who were kicked out of psychiatry residency for doing poorly on their off service medicine months? Name your program so everyone can avoid it that’s an absolute joke

This makes no sense..you are a psych resident no one should care if you are an adequate medicine resident, in my program everyone goofed off during off service months, we were still professional but nowhere as good as the actual medicine residents...you should really post your program so people can avoid that’s ridiculous...why would a psych PD fire a resident for being bad at internal medicine? Horrible

I disagree. For one, you're still a medical doctor. A psych intern failing medicine, at most programs, has to be pretty damn awful and if they then fail remediation? Yeah, you're asking for trouble. The thing is, while you're a psychiatrist, you HAVE to be able to function adequately on the inpatient psych units and outpatient psych clinics. That means recognizing when something needs workup, even if you're not the one doing the workup. Say a psych intern on medicine doesn't "get" what a proper acute MI workup is BUT (and this is the big thing) doesn't alert anyone else either, like their senior or even a nurse so the patient dies? There are psych units where patients die of medical causes and I'm sure in the majority of cases, there likely weren't warning signs, but if there are and the attending misses it, that's a problem. Learn your medicine. It sucks now, but you won't regret it later.

And honestly, this is very rare that a program would fail a psych intern on medicine or that the PD would then fire the intern. When I hear stories of any interns being dismissed after failing medicine, it's usually for things like lying about labs or orders or something. There was a psych intern at a hospital across town when I was an intern who was fired after he missed 3 medicine shifts and in two cases didn't even call in. According to my co-intern who was friends with him, he "forgot" he was on call. In one case, he overslept. Rumor has it, he'd done the same thing on his neuro rotation and was caught falsely calling in sick. He ended up having to remediate neuro, but before the remediation, he did this on medicine. I don't know what ever happened to him. I felt really bad for him at the time. Now I just wonder why he couldn't get it together.
 
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As a psych intern who started on medicine floors, I pretty much felt the same as you. I hadn't done medicine since 3rd year. Since you've presumably been working at the hospital on psychiatry rotations, you'll know the EHR and the general function of the hospital. 90% of surviving on medicine is becoming competent at the workflow. The 10% is actual knowledge, and even then, seniors and attendings basically make the plans, you'll just execute them. Have an extremely low-threshold for asking for help, just ask in a semi-intelligible way ("I know we're treating heart failure, but I could really use a bit of review with diuretics, dosing, etc." or even "you said we should give fluids--what kind and how much?" You won't really feel like you're rising to the level of the medicine interns, who are probably teaching medical students, bringing up journal articles (at least I never did), but the plus side of having the rotation later is that the medicine interns also become a resource for help and guidance!
The way you can stand out is helping out with any psych-related issues that don't quite rise to the level of consults, and then with any soft people skills that we are sometimes better at handling (I had a very sick patient who required lots of family updates, which I liked doing). You'll do fine if you can put in orders on time, are decently knowledgable about your patients, and can work with the medicine teams okay. You don't need to be a medicine genius at all.
Never miss mentioning in your introductions to your team members that you're a psychiatry intern just starting out on medicne, it helps tailor the patients you're assigned, as well as gently temper expectations.
 
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I disagree. You don't need to be good or great at your IM rotation, but you should still be adequate. It is a required rotation, so you have to pass. Plus, having at least the basics of IM down makes you a better psychiatrist. Our medications cause too many side effects in too many body systems to not have some general medical knowledge allowing us to do proper workups and initiate treatments for such things.
I could not have said it better myself. I would say an intern should be "adequate" in IM as the bare minimum--not for the fear of being fired, but because we owe our future patients at least that much. We certainly don't have to be rockstars at IM, but I'm having a much better time as a senior who really took my 4 months of medicine seriously when I was an intern. In the grand scheme of things, 4 months is a tiny amount of time to become proficient at something, but I worked hard to at least have the foundation. Now if I have a complex patient with multiple medical comorbidities, I have a good idea of what to do (edit: which includes when to refer out) and can pretty easily look up the rest to jog my memory.
 
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I disagree. For one, you're still a medical doctor. A psych intern failing medicine, at most programs, has to be pretty damn awful and if they then fail remediation? Yeah, you're asking for trouble. The thing is, while you're a psychiatrist, you HAVE to be able to function adequately on the inpatient psych units and outpatient psych clinics. That means recognizing when something needs workup, even if you're not the one doing the workup. Say a psych intern on medicine doesn't "get" what a proper acute MI workup is BUT (and this is the big thing) doesn't alert anyone else either, like their senior or even a nurse so the patient dies? There are psych units where patients die of medical causes and I'm sure in the majority of cases, there likely weren't warning signs, but if there are and the attending misses it, that's a problem. Learn your medicine. It sucks now, but you won't regret it later.
"Learn your medicine. It sucks now, but you won't regret it later." <------ This is the way.

I'm not even an attending yet, but my program pushes us to be independent as seniors (still with appropriate supervision of course; they're just not next to us holding our hands). I've already had a few instances of medical emergencies that I caught when the signs were still more subtle, and as we know, the earlier we intervene, the more likely the patient can have a better outcome. I caught these because I worked really hard during my intern year IM months (which included both inpatient and outpatient medicine).

To OP, I know it can seem like there's no downtime (and there often isn't!) but I found it helpful to do Step 3 questions from Uworld during my medicine months. I didn't do the cases during that time but I think that would also have helped a lot. You got this!
 
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So, psychiatrists...how did you survive your internal medicine rotation​


one day at a time
 
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Contrary to what I'm seeing above I don't recommend you simply survive your IM rotation. Thrive on it. Try to do as well as your IM colleagues. Some of this may not be possible. Many of you enter your IM rotation months into residency with your IM colleagues way ahead of you.

The fact of the matter is starting later in in the year you will know less than your IM colleagues. It's hard to stand toe-to-toe with an IM resident who's done it a dozen times while you've not yet done it once, but that shouldn't excuse psych residents from trying to play the role of village idiot and cower in fear whenever something happens as I see with several psych residents.

Your medical skills will be needed as a psychiatrist and I see several psychiatrist quite lacking in their medical skills that are needed in psychiatry such as not recognizing metabolic problems, understanding the mind-body implications, and treating basic medical problems for their patients who don't have a PCP.

From what I've seen in a lot of psych residents doing their non-psych rotations are treated as the village idiot, but worse the psych resident wants to assume this role so anything serious is not given to that resident.
 
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Contrary to what I'm seeing above I don't recommend you simply survive your IM rotation. Thrive on it. Try to do as well as your IM colleagues. Some of this may not be possible. Many of you enter your IM rotation months into residency with your IM colleagues way ahead of you.

The fact of the matter is starting later in in the year you will know less than your IM colleagues. It's hard to stand toe-to-toe with an IM resident who's done it a dozen times while you've not yet done it once, but that shouldn't excuse psych residents from trying to play the role of village idiot and cower in fear whenever something happens as I see with several psych residents.

Your medical skills will be needed as a psychiatrist and I see several psychiatrist quite lacking in their medical skills that are needed in psychiatry such as not recognizing metabolic problems, understanding the mind-body implications, and treating basic medical problems for their patients who don't have a PCP.

From what I've seen in a lot of psych residents doing their non-psych rotations are treated as the village idiot, but worse the psych resident wants to assume this role so anything serious is not given to that resident.
I’m very much in agreement with you. But it’s quite difficult to escape the role of the village idiot when everyone else, having had several months of experience by now, is way ahead of you. You have to put in a lot more effort at this stage because there’s not really the hand holding you get at the beginning of intern year and senior residents/attendings often seem to forget you’re doing this for the first time. Don’t get me wrong - I’m trying to make the most of it. I just mean that it’s increasingly difficult as the year progresses.
 

FN9

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I’m very much in agreement with you. But it’s quite difficult to escape the role of the village idiot when everyone else, having had several months of experience by now, is way ahead of you. You have to put in a lot more effort at this stage because there’s not really the hand holding you get at the beginning of intern year and senior residents/attendings often seem to forget you’re doing this for the first time. Don’t get me wrong - I’m trying to make the most of it. I just mean that it’s increasingly difficult as the year progresses.
That's why I mentioned making friends with senior IM residents, my experience was positive in that I would ask them any question that I felt like an idiot for not knowing, a couple of them were great and helped where as others had a look on their face "How can you not know this basic stuff you idiot"

Remember, you had the same training in med school, you will catch up in no time, just be eager to learn, show up on time, do your work and a little extra and ask questions when you dont know.

One day at a time.
 
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I think you need to be worse than garbage to get fired. You'd have to actually go out of your way to do something to get fired.
FWIW at our program there were people put on remediation plans with potential for nonrenewal due to honestly pretty egregiously bad performance on their medicine rotations.

As others mentioned, expectations vary. At some programs psychiatry interns are treated almost as sub-I's. At my program, they are treated as medicine interns (with the understanding that a second month of medicine at the end of PGY1 is nothing comparable to actual IM PGY1's at that point.)

Most places I've worked 99% of being an intern is having a very modest modicum of medical knowledge but mostly discussing things with your senior, creating a to-do list, and then efficiently executing that to-do list. It's rare for medical knowledge alone to be the issue and much more common for lack of follow-through, effort, and/or common sense to be the problem. (In extreme cases, the lack of "common sense" is a complete lack of fundamental medical knowledge.)
 
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Northwell (Staten Island Univ Hospital) resident.

I don’t know how patients who get admitted to internal medicine survive here. As a psych intern you have to do several months of internal medicine on the inpatient units. The regular workday is so stressful. You don’t learn you just work. The weekend calls are so stressful. You feel like there is no support. When our residents in psych get together we share our horror stories and learn that everyone has gone through it and nothing has changed from the better. What can we expect? When our psych attendings are treated like garbage, and nurses and social workers are treated like garbage, our residents will be treated like garbage. It is not surprising that SO many of our attendings have said “so long!” in the past couple of years. The head our cl service, and the head of addiction, and the head of outpatient and a bunch of attendings who were there for years have all moved on. It’s probably for the better for them. COVID is widespread on Staten Island. We were seeing patients in person for months when the pandemic started. A few of our residents got it. Attendings too.

Im going to think twice about getting the vaccine since one of our residents was hospitalized after getting it. I wouldn’t want to be a patient at SIUH on the medicine service if it’s the last thing I do!
 
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MacDonaldTriad

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Medicine sucks for psych interns. IM interns are like those hyperthermophillic bacteria who live on the sulfur vents at the bottom of the ocean and somehow adapt. We visit that world for a few months and it is hard. It is also life changing and even the brief exposure has lasting impressions on our ability to be physicians and have some credibility with understanding diseases and mind body interfaces. I hated it, but I have benefited from it for multiple decades now. Reducing this requirement would reinforce the stereotypic ridicule our medical collogues throw in our direction and they would be right. Sure, some places are needlessly worse than others, but the requirement is justified. How the requirement is fulfilled is where the work remains.
 
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nebuchadnezzarII

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Medicine sucks for psych interns. IM interns are like those hyperthermophillic bacteria who live on the sulfur vents at the bottom of the ocean and somehow adapt. We visit that world for a few months and it is hard. It is also life changing and even the brief exposure has lasting impressions on our ability to be physicians and have some credibility with understanding diseases and mind body interfaces. I hated it, but I have benefited from it for multiple decades now. Reducing this requirement would reinforce the stereotypic ridicule our medical collogues throw in our direction and they would be right. Sure, some places are needlessly worse than others, but the requirement is justified. How the requirement is fulfilled is where the work remains.
Well put. Especially that last part. My program is very good for psych but appears to be a workhorse program when it comes to internal medicine. The patient load is unbearable. Like you wrote, the IM interns have adapted. But I always feel like I’m drowning.
 
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Stagg737

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Totally agree. Hell, there are IM residents who do horribly and still get promoted, and they are closely followed by program leadership to correct any incompetencies. But to dismiss a psych resident bc they “failed” an IM rotation? Doesn’t make sense. They must have not shown up, were unprofessional, etc. Can’t be performance based, heck IM residents accidentally kill patients all the time (all part of “learning,” smh) and yet they aren’t dismissed either. Something isn’t right here with this program...or, the resident must have really did something egregious to the point of reaaaaaaally pissing off leadership.

Idk where you did residency, but this certainly isn't the case where I'm at. Sure, there are the few cases where this happens, but oftentimes it's something that the whole team, including the attending, missed that led to the outcome. If we had IM residents actually killing patients d/t lack of medical knowledge or ability to function, they'd be gone asap.

We don't know what the standards for J Rod's programs were or the individual residents. The attendings I talked to on IM said they expected off-service residents to be able to function as solid Sub-i's, learn some things, and help the team be efficient. They weren't expected to be as good as the IM residents, but they better be functioning better than the M3s. Unfortunately, I have encountered one or two residents (while in med school) that made me wonder how they got into residency or even graduated med school. Yes, they exist, and I don't think dismissing ANY resident who couldn't even pass an IM rotation after 2 tries is that outrageous. If anything, it may be a sign that a program expects their residents to at least live up to a minimal standard of care.

I’m very much in agreement with you. But it’s quite difficult to escape the role of the village idiot when everyone else, having had several months of experience by now, is way ahead of you. You have to put in a lot more effort at this stage because there’s not really the hand holding you get at the beginning of intern year and senior residents/attendings often seem to forget you’re doing this for the first time. Don’t get me wrong - I’m trying to make the most of it. I just mean that it’s increasingly difficult as the year progresses.

It is a tough situation, and my advice may not be that great as I was lucky enough to start residency on my IM rotation so the IM interns were just as clueless as I was. It's not that hard to be successful on a reasonable IM rotation though (that means seeing up to 10 patients a day with adequate support). Make sure you're learning how to treat the most basic/common stuff: HTN, COPD, pneumonia, HLD, etc. Learn about the common meds for these issues which you will almost certainly encounter in a large percentage of your psych patients and how they interact with psych meds. You may need your co-residents and senior to cover for you if you get overwhelmed, that's okay. If that happens, help them take care of the menial stuff that takes up their time (ordering labs, placing consults, ordering 1:1, etc). You don't have to be a rockstar, you don't even need to be solid, but you should be able to be helpful to the team and be putting in an effort to learn the basics.

Remember, you're a physician first, and the first step of evaluating any psych patient is ruling out a medical cause for their condition. It would be pretty hard to do this if you're so bad you can't even handle the most basic medical problems. Additionally, you should be able to manage the basic side effects our medications cause. If you're going to put someone on Olanzapine and they get metabolic syndrome, you should be able to at least start them on metformin until they can see their PCP.
 
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