Teaching medical students?

[serimeri]

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Anyone have any tips for an incoming PGY1 on how best to teach medical students on my team? I did not have a great experience, honestly in terms of teahing/presenting practice as a student... so I'm still working on it to make myself not look like an idiot in front of the attending.

I was thinking about giving them 2 patients each, then having them look up diagnosis on uptodate. Then letting them decide whether they wanted more or wanted to hang out and study for their shelf.

My friends who did not go into Psychiatry looked at Psych as a "Psych-ation" they weren't interested and wanted a month to relax after surgery, and study for Step 2, get away rotation paperwork done etc.

How have you interns been handling this? I'm honestly not the type to draw big old things on whiteboards

 

[Psychotic]

"See one, do one, teach one" still works. Even if it is only writing notes and paperwork.

Have med students learn how to write notes, chase down orders, make phone calls, etc. Stuff that makes your life easier. If you are lucky, you will get good students - I have been very lucky this year, not a bad one in the bunch, and none of them planned to go into psychiatry, but they still worked hard for me.

You will feel like low man/woman on the totem pole, but med students are there to learn and help. Do it right and you can leverage your time. Be explicit - tell them what they need to do to get a good grade, or whatever. They care about that sort of thing...remember?

On a related note, the new interns started this week (I am a rising 2nd year) and my life has already improved, after just a couple of days. I am planning to check out after lunch tomorrow and leave the interns in charge of the unit, before I start a new service next week. First golden weekend for me in about 6 weeks...

 

[nitemagi]

Teach them the basics. I never call surgeons for consults in a hospital without being able to tell them the basics (abdominal exam, etc). They should be able to do that with psych patients no matter what they go into.

Beyond that, remember this might be their only experience with psychiatry (and whether they'll go into it). So tell them why they might consider it.

 

[serimeri]

"See one, do one, teach one" still works. Even if it is only writing notes and paperwork.

Have med students learn how to write notes, chase down orders, make phone calls, etc. Stuff that makes your life easier. If you are lucky, you will get good students - I have been very lucky this year, not a bad one in the bunch, and none of them planned to go into psychiatry, but they still worked hard for me.

You will feel like low man/woman on the totem pole, but med students are there to learn and help. Do it right and you can leverage your time. Be explicit - tell them what they need to do to get a good grade, or whatever. They care about that sort of thing...remember?

On a related note, the new interns started this week (I am a rising 2nd year) and my life has already improved, after just a couple of days. I am planning to check out after lunch tomorrow and leave the interns in charge of the unit, before I start a new service next week. First golden weekend for me in about 6 weeks...

I feel like I'm too passive sometimes with giving orders, but I like your advice about telling them what it takes to get a good grade. I'm the type that likes to keep things laid back and fun. But I will totally let them do the physical exam stuff.

How have the new interns started? Aren't they still in orientation? I though employment for everyone starts on 07/01.

 

[serimeri]

Teach them the basics. I never call surgeons for consults in a hospital without being able to tell them the basics (abdominal exam, etc). They should be able to do that with psych patients no matter what they go into.

Beyond that, remember this might be their only experience with psychiatry (and whether they'll go into it). So tell them why they might consider it.

good idea. Maybe I can convert some of those future surgeons.

 

[psych md jd]

Your attending will likely have a talk with them. Some do, some don't. I did.

You will look good if you ask your attending what he wants you to do with the students.

Basically, newly minted interns will watch the more senior residents for a few days until they fledge.

 

[Psychotic]

I feel like I'm too passive sometimes with giving orders, but I like your advice about telling them what it takes to get a good grade. I'm the type that likes to keep things laid back and fun. But I will totally let them do the physical exam stuff.

How have the new interns started? Aren't they still in orientation? I though employment for everyone starts on 07/01.

July 1 is the historical / traditional start date, but I remember reporting for orientation around June 20 last year, and first day on the job about a week later (got paid for all of it, all that mattered to me at the time).

 

[serimeri]

July 1 is the historical / traditional start date, but I remember reporting for orientation around June 20 last year, and first day on the job about a week later (got paid for all of it, all that mattered to me at the time).

Nice perk! It kind of eases you into the role too.

 

[OldPsychDoc]

Many programs (most that I know of anyway) start the interns around right now, to overlap them for a week before all the seniors move up a level--and to give the finishing G1s a week off!

 

[psych72]

Many programs (most that I know of anyway) start the interns around right now, to overlap them for a week before all the seniors move up a level--and to give the finishing G1s a week off!

This honestly seems like such a fantastic idea. I think every program should do this. I want to get my feet wet a little before taking full control. It'll also give my future PGY2's time to catch a breather before they have to deal with me.

 

[smalltownpsych]

I feel like I'm too passive sometimes with giving orders, but I like your advice about telling them what it takes to get a good grade. I'm the type that likes to keep things laid back and fun. But I will totally let them do the physical exam stuff.

How have the new interns started? Aren't they still in orientation? I though employment for everyone starts on 07/01.

Physical exam stuff in psychiatry? Usually someone else is keeping track of the physical stuff in a psych consult I would think. I'm thinking learning how to do a solid psychiatric interview would be more helpful and that skill would translate to many other areas of medicine.

 

[nitemagi]

Physical exam stuff in psychiatry? Usually someone else is keeping track of the physical stuff in a psych consult I would think. I'm thinking learning how to do a solid psychiatric interview would be more helpful and that skill would translate to many other areas of medicine.

This is important for psychiatrists, and part of what non-medical providers (and non-psychiatrists for that matter) often neglect. There's a lot of psychiatric mimics from medical conditions that few others rule out or look for. Emergency Departments are notorious for neglecting this stuff, for example.

And if you don't look for it, you definitely won't find it.

 

[smalltownpsych]

This is important for psychiatrists, and part of what non-medical providers (and non-psychiatrists for that matter) often neglect. There's a lot of psychiatric mimics from medical conditions that few others rule out or look for. Emergency Departments are notorious for neglecting this stuff, for example.

And if you don't look for it, you definitely won't find it.

I understand the importance of considering medical conditions, but I just didn't picture a psychiatrist doing a physical exam routinely the way that a primary care doc would. I thought they would evaluate the potential medical issues that might mimic psychiatric conditions by reading the other docs reports and examining the lab results. Obviously an advantage a psychiatrist has over non-medical school trained providers such as myself is they have more knowledge, experience, and training about how to interpret those reports and results.

 

[nitemagi]

I understand the importance of considering medical conditions, but I just didn't picture a psychiatrist doing a physical exam routinely the way that a primary care doc would. I thought they would evaluate the potential medical issues that might mimic psychiatric conditions by reading the other docs reports and examining the lab results. Obviously an advantage a psychiatrist has over non-medical school trained providers such as myself is they have more knowledge, experience, and training about how to interpret those reports and results.

Depends on the hospital. Many psych units require the psychiatrist to do a physical exam on admission as well. Though it's a fairly routine exam.

Many private hospitals outsource this to internists, though.

 

[Armadillos]

Private hospitals I'm sure are different because of the lower acuity, but at some academic places if a psych resident doesn't do a good physical on an agitated psych patient admitted through the ED then the patient isn't ever getting an actual physical. EM docs aren't going to risk their safety with agitated psych patient before the 5-2-25, and by the time that kicks in psych can come see them and now EM doesn't want to waste anymore time on that patient when they have traumas/chest pain/etc. keeping their attention

 

[serimeri]

Almost 90% of the places I interviewed at, had residents do the Physical Exam on Psych patients, regardless of whether or not it was done in the ER. Everytime the Psych patient is on the floor, a Physical exam is done. Also, if there is a medical condition, you must do follow up SOAP notes on the patient.

When you are a resident, you are required to do this stuff even on your off service months.

I think part of the reason this occurs is most faculty/PD's feel really pissed when staff calls them Psychologists and disregards their authority as a Physician (just my opinion). It doesn't help when a nurse who has been here 25 years, asks if a Psychiatrist is the person who trains therapy dogs.

 

[smalltownpsych]

Thanks for the info guys, I was extrapolating from a few settings that I have worked where the psychiatrists didn't have anything to do with the physical and I think that actually was problematic at times. I have not had much exposure to resident training programs. That's one reason I frequent the student doctor network even though I am licensed, there is still so much to learn and Gray's Anatomy isn't always the best source of info. I'm even beginning to think that no one is having sex in the supply closet at the hospital. 🙄

 

[Psychobabbling]

Anyone have any tips for an incoming PGY1 on how best to teach medical students on my team? I did not have a great experience, honestly in terms of teahing/presenting practice as a student... so I'm still working on it to make myself not look like an idiot in front of the attending.

I was thinking about giving them 2 patients each, then having them look up diagnosis on uptodate. Then letting them decide whether they wanted more or wanted to hang out and study for their shelf.

My friends who did not go into Psychiatry looked at Psych as a "Psych-ation" they weren't interested and wanted a month to relax after surgery, and study for Step 2, get away rotation paperwork done etc.

How have you interns been handling this? I'm honestly not the type to draw big old things on whiteboards

As a PGY-3, I can say teaching medicine was far easier than teaching psych. I always reflected on teaching of residents/attendings when I was a student, and made mental notes of things I found helpful v. not helpful v. rude, etc. So when it came time to teach, I always started as such, especially in July.

1) Organizing your H&P - as this is our real building block in all of medicine, helping students in organizing this section is actually enjoyable. I also provide examples as I'm teaching, and tie this in as to how I personally would use this in beginning to formulate a differential diagnosis, that being said....

2) Differential diagnoses - with the data they collect, I would allow them to start to formulate THEIR DDx in a non-judgmental fashion. I would help them rank most likely to least likely, focusing on common things being common. I also helped them to think about a DDx in a different light. For example - taking a main symptom (in medicine for example, "Chest Pain" - and from their forming a broad ddx, then, incorporating history and physical exam components, +/- lab, imaging if available, to adjust how we would rank things, etc

3) Presenting - as students became more comfortable with these 2, their presenting skills also would improve. I would speak to them about projecting a sense of confidence in their presentations, going over their presentations before and after rounds, pointing the good, bad and in-between. For those where confidence was a primary issue, I made it a point to help boost that at different points (in rounds if they muttered the right answer to a question, I'd nudge them to speak up, get it right, receive some praise; sometimes I'd ask softer questions to those students, etc)

4) Treatment - not as common in the early part of the year, but I would also gauge their knowledge of this area. Looked to reinforce this either by taking them with me to see additional patients after rounds, encouraging them to go home to look up "what happens if complication X, Y, Z arose and I was the only member of the team and I HAD to do something on my own (even though this obviously would never happen)" - I would do things like when they tagged along to help increase their curiosity to learn, make them a more active member

Remember, you have something to teach, even if you don't realize it. You're not going to get a lot of knowledge type questions, especially early on. Focus on helping them build a foundation. Psych is a little more grey, but you can still focus on the basics. Hope this was a little bit helpful. This is how I did a lot of my medicine months. Adapted of course for psych portion of teaching

 

[serimeri]

As a PGY-3, I can say teaching medicine was far easier than teaching psych. I always reflected on teaching of residents/attendings when I was a student, and made mental notes of things I found helpful v. not helpful v. rude, etc. So when it came time to teach, I always started as such, especially in July.

1) Organizing your H&P - as this is our real building block in all of medicine, helping students in organizing this section is actually enjoyable. I also provide examples as I'm teaching, and tie this in as to how I personally would use this in beginning to formulate a differential diagnosis, that being said....

2) Differential diagnoses - with the data they collect, I would allow them to start to formulate THEIR DDx in a non-judgmental fashion. I would help them rank most likely to least likely, focusing on common things being common. I also helped them to think about a DDx in a different light. For example - taking a main symptom (in medicine for example, "Chest Pain" - and from their forming a broad ddx, then, incorporating history and physical exam components, +/- lab, imaging if available, to adjust how we would rank things, etc

3) Presenting - as students became more comfortable with these 2, their presenting skills also would improve. I would speak to them about projecting a sense of confidence in their presentations, going over their presentations before and after rounds, pointing the good, bad and in-between. For those where confidence was a primary issue, I made it a point to help boost that at different points (in rounds if they muttered the right answer to a question, I'd nudge them to speak up, get it right, receive some praise; sometimes I'd ask softer questions to those students, etc)

4) Treatment - not as common in the early part of the year, but I would also gauge their knowledge of this area. Looked to reinforce this either by taking them with me to see additional patients after rounds, encouraging them to go home to look up "what happens if complication X, Y, Z arose and I was the only member of the team and I HAD to do something on my own (even though this obviously would never happen)" - I would do things like when they tagged along to help increase their curiosity to learn, make them a more active member

Remember, you have something to teach, even if you don't realize it. You're not going to get a lot of knowledge type questions, especially early on. Focus on helping them build a foundation. Psych is a little more grey, but you can still focus on the basics. Hope this was a little bit helpful. This is how I did a lot of my medicine months. Adapted of course for psych portion of teaching

You seem like the type of attending/resident, I would have loved to have had. Confidence is a big thing for me, and I lack in that aspect.

 

[shan564]

As a PGY-3, I can say teaching medicine was far easier than teaching psych. I always reflected on teaching of residents/attendings when I was a student, and made mental notes of things I found helpful v. not helpful v. rude, etc. So when it came time to teach, I always started as such, especially in July.

1) Organizing your H&P - as this is our real building block in all of medicine, helping students in organizing this section is actually enjoyable. I also provide examples as I'm teaching, and tie this in as to how I personally would use this in beginning to formulate a differential diagnosis, that being said....

2) Differential diagnoses - with the data they collect, I would allow them to start to formulate THEIR DDx in a non-judgmental fashion. I would help them rank most likely to least likely, focusing on common things being common. I also helped them to think about a DDx in a different light. For example - taking a main symptom (in medicine for example, "Chest Pain" - and from their forming a broad ddx, then, incorporating history and physical exam components, +/- lab, imaging if available, to adjust how we would rank things, etc

3) Presenting - as students became more comfortable with these 2, their presenting skills also would improve. I would speak to them about projecting a sense of confidence in their presentations, going over their presentations before and after rounds, pointing the good, bad and in-between. For those where confidence was a primary issue, I made it a point to help boost that at different points (in rounds if they muttered the right answer to a question, I'd nudge them to speak up, get it right, receive some praise; sometimes I'd ask softer questions to those students, etc)

4) Treatment - not as common in the early part of the year, but I would also gauge their knowledge of this area. Looked to reinforce this either by taking them with me to see additional patients after rounds, encouraging them to go home to look up "what happens if complication X, Y, Z arose and I was the only member of the team and I HAD to do something on my own (even though this obviously would never happen)" - I would do things like when they tagged along to help increase their curiosity to learn, make them a more active member

Remember, you have something to teach, even if you don't realize it. You're not going to get a lot of knowledge type questions, especially early on. Focus on helping them build a foundation. Psych is a little more grey, but you can still focus on the basics. Hope this was a little bit helpful. This is how I did a lot of my medicine months. Adapted of course for psych portion of teaching

I think this is all great advice.

One thing that I liked to do with students as a PGY1 was to assign them basic topics and ask them to present on it. For instance, when I wanted to teach them about pharmacology, I'd tell each student to pick a class of drugs (given the choice of antipsychotics, antidepressants, mood stabilizers, and drugs of abuse), organize them by subclass (i.e. first-gen vs. second-gen antipsychotics, different types of antidepressants), and make a table to list the mechanisms, indications, common class side effects, common unique/idiosyncratic effects, etc. for each drug. Then I'd have them present those things to the group (other students are welcome to join), and I'd help them fill in gaps in their presentations and/or help them conceptualize it better (i.e. if they say "olanzapine causes weight gain," I'd add which antipsychotics cause more weight problems and why). After that, I'd give each student a different topic for next time. I usually had them do tables about diagnoses for the first week or two and then pharmacology for the next week or two.