The Fourth Year...

[fiatslug]

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So there's been debate on whether or not to continue the 4th year of psychiatry residencies (I can't find any online links to pros/cons of the 4th year; perhaps y'all know of some?). And as I'm deciding whether or not to do a 4th year or go into Child & Adolescent as a 4th year, I'm starting to wonder myself. I was sorta interested in chiefing, but now the thought of diving into Child sooner is quite appealing. (The flipside is, my maternity leave will likely keep me a 3rd year until sometime in mid August, which may effectively hose my chances to start a fellowship as an "off-timed" 4th year anyway 🙁 ). So to those of you who've done it/are doing it/have a strong opinion about it:

What did you/are you getting out of 4th year?
Do you think it should be retained, changed, or dropped?

slug out.

 

[whopper]

Without trying to belittle our own field--I often compared this to Internal Medicine--a field where you got to know a lot more technical information,and I always thought IM had to know more than we do, but their program is 3 years.

So why then is our own program 4 years?
I questioned this, and I am thinking perhaps 3 years is sufficient, but I don't want to sound presumptuous. My own program gives residents a lot of breathing room to have a life and much more free time than the other programs in the medical field. I was wondering perhaps that is why the program's 4 years, but then again, other psychiatry programs have their residents working the brink.

I don't know.
From my own experience-I felt the learning curve plateauing after 4 months of doing inpatient and 3 months of doing ER/psychiatry crisis. My program does 4 months of internal medicine. I felt we should've been doing more internal medicine which my fellow residents DO NOT WANT--IM in my hospital is tough-you work the maximum, but thought I could've been there more before the learning curve peaked.

Bottom line is I felt the first 2 years were worth it when you got inpatient, crisis, neurology & IM all packed in--just a little less psyche and a little more IM (but this is specific for my program).

I've just started 3rd year and I'm doing outpatient for the first time, so I can't make any judgements on how long I'd need for to do this before I "get it" but I doubt it'd be 2 years. Inpatient is much more demanding. I'm speculating right now in 6 months I'd probably get it down right.

 

[outofhere]

I actually think fourth year is very important. This is the year you learn to tolerate the anxiety of being on your own, consolidate the things you have learned, and become more psychodynamically oriented. Sure, how many people does a resident need to see before one becomes a robot about prescribing an SSRI? However, what is a patient really saying when they are asking for more meds, knowing the psychodynamic implications of prescribing, what it means to a patient's psyche...etc, is an art that needs practice. For my program, I get an hour of med supervision, two hours of psychotherapy supervision, and another hour of supervision for the elective. That is FOUR hours weekly, imagine missing out on 4x50 (assuming you go on vacation for 2 weeks), that is TWO HUNDRED hours of supervision! That, in my opinion, is MISSING OUT! I have been doing outpatient since PGY II year and I think 3 years (out pt) is about the right length of time for me to establish good continuity, see patients through various phases of life...etc.

 

[Doc Samson]

I actually think fourth year is very important. This is the year you learn to tolerate the anxiety of being on your own, consolidate the things you have learned, and become more psychodynamically oriented. Sure, how many people does a resident need to see before one becomes a robot about prescribing an SSRI? However, what is a patient really saying when they are asking for more meds, knowing the psychodynamic implications of prescribing, what it means to a patient's psyche...etc, is an art that needs practice. For my program, I get an hour of med supervision, two hours of psychotherapy supervision, and another hour of supervision for the elective. That is FOUR hours weekly, imagine missing out on 4x50 (assuming you go on vacation for 2 weeks), that is TWO HUNDRED hours of supervision! That, in my opinion, is MISSING OUT! I have been doing outpatient since PGY II year and I think 3 years (out pt) is about the right length of time for me to establish good continuity, see patients through various phases of life...etc.

👍 👍 👍
Amen.

 

[OldPsychDoc]

👍 👍 👍
Amen.

While agreeing in principle with what Doc S. and Whopper are saying, as you're thinking of a 2 year fellowship, I don't think you necessarily "miss out" on this stuff. A lot of the mentoring, "finishing", and leadership stuff can happen in the CF-II year as well. I looked at my 1 year addiction fellowship as a chance to do this, as well as learn the sub-specialty stuff.

Especially if you're looking at adding an ankle-biter of your own to the mix, I wouldn't unnecessarily turn your 5 year program into a 6 year program just to do a lot of 4th year electives.

YMMV.