Transfer into Psych

[hkneuro]

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Hey,

Im currently a transitional year already have matched into Neurology. I realized I actually want to do Psych. I noticed though that a lot of psych programs have a significant amount of psych or even neuro during their PGY-1 Year and currently i have NEITHER of those rotations scheduled in my transitional year. I have like 6 months of internal medicine general in my TY as I had it set up for Neuro....

Would I still be eligible to transfer into a Psych program with a PGY2 opening?

Also, I've only done one Psych rotation as a medical student. I just know I want to do Psych beacuse even going into neurology I wanted to go into Behavioral neurology anyways but then I realized Behavioral Neurology is really just dementia and I am more interested in the neurophysiological basis of behavior and that is basically Psychiatry......

What should I do?

Thanks

 

[BS81]

Yes, you can transfer in to psych as a PGY-2. You just won't get any elective time in Year 4 and won't be able to fast-track in to child. 4 months of medicine will count towards the Psych residency and the other 8 months will just be considered your "electives".

 

[splik]

Yes, get your waiver from your neurology program and apply for psych! Actually the above post is incorrect, 4th year is 4th year at programs that typically take PGY-2s (i.e. you won't forfeit elective time) and you could fasttrack into child psychiatry if you were crazy enough to want to do child psych. Yale, Hopkins, UW, Stanford, and UNM always have PGY-2 spots, there are others out there too and many programs have unexpected openings. You will have to 2 months of neuro at some point usually 3rd or 4th year. You are a bit late in the game, but get cracking and apply now! If you are interested in neuropsychiatry hopkins is probably a good bet, they have a neuropsychiatry/behavioral neurology fellowship too.

 

[splik]

It looks like you don't know wtf you want to do, anything but neuro. Apparently you have also said in the past few weeks you want to do EM or PM&R. I have no idea if psych will be a good fit for you, but it's got nothing to do with Oliver Sacks, and neither what constitutes most of neuropsychiatry. Basically, lots of schizophrenia with large smatterings of character disorder, and substance abuse.

 

[psychattending]

With the new all-in policy, you will need to go through the Match in order to get a PGY-2 slot in a program that takes other residents through the Match.

 

[MrJiggles]

So what is neuropsych anyway? I have seen this question answered before and still dont understand. I see that there are fellowships in specifically neuropsych, does this refer to alot of psych issues post TBI, Alzheimer's, etc?

I doubt even any neurologists have seen the vast array of rare d/o's that Oliver Sacks describes. Brilliant stuff though!

 

[watto]

So what is neuropsych anyway? I have seen this question answered before and still dont understand. I see that there are fellowships in specifically neuropsych, does this refer to alot of psych issues post TBI, Alzheimer's, etc?

I doubt even any neurologists have seen the vast array of rare d/o's that Oliver Sacks describes. Brilliant stuff though!

I did a neurobehavior rotation my entire last year of residency, it was great. Tons of dementia, TBI, localization of everything. Know your lemmas. The fellows knew their neurophys COLD. Like, "you are speaking in odd phonemes so let's review the anomic aphasias and localize the lesion to Brodmann's area X" cold. Good rotation right before boards--neuro was a snap. Career-wise, the fellows were mostly neurologists, going into academic positions.

 

[imp3tigo]

Would I still be eligible to transfer into a Psych program with a PGY2 opening?

Sure. People in surgery have transfered to psych and had their surgery prelim years count towards the 4 year psych residency, so it's not a rigid requirement in terms of rotations during your non-psych year.

 

[hkneuro]

Im so scared to get my waiver from my neurology program....Its just scary leaving a gauranteed spot but I really think Ill be unhappy.... :-/

Don't know what to do. Psych seems like everything Ive ever wanted. I was just scared about reputation and income levels but at this point I dont even care.

Yeah I was thinkgin about PMR and ER but honestly its all about psych. Even doing neurology I used to say in my interviews the most interesting thing about neurology for me was the neurophysiological basis of behavior and honestly thats just basically psychiatry, not neurology. I don't care about peripheral neurology or vascular.... I just want to know about the brain in and out.. But i supposed I want to know and treat from a more structure, or organic, or physiological perspective.

 

[PikminOC]

did you do any neuro months? they may be able to transfer too.

 

[splik]

I Even doing neurology I used to say in my interviews the most interesting thing about neurology for me was the neurophysiological basis of behavior and honestly thats just basically psychiatry, not neurology. I don't care about peripheral neurology or vascular.... I just want to know about the brain in and out.. But i supposed I want to know and treat from a more structure, or organic, or physiological perspective.

mosts psychiatrists dont know **** about the neurophysiological basis of behavior, and it has nothing to do with the practice of psychiatry, and is not all that helpful in trying to understand our patients or guide management. This sounds like neuropsychology to me. Should psychiatric practice be influenced by cognitive neuropsychological models of mind? Probably. Is it? No absolutely not, with some rare exceptions.

 

[Leo Aquarius]

mosts psychiatrists dont know **** about the neurophysiological basis of behavior, and it has nothing to do with the practice of psychiatry, and is not all that helpful in trying to understand our patients or guide management. This sounds like neuropsychology to me. Should psychiatric practice be influenced by cognitive neuropsychological models of mind? Probably. Is it? No absolutely not, with some rare exceptions.

Mankind has, at best, an embryonic understanding of the neurophysiologic basis of behavior. The leaders in this area of research are psychiatrists (just pick up the major research journals in this field), and yet we are still at the tip of the proverbial iceberg.

Even doing neurology I used to say in my interviews the most interesting thing about neurology for me was the neurophysiological basis of behavior and honestly thats just basically psychiatry, not neurology.

If you are truly interested in this area, then you will find many rewarding research projects at big name academic centers headed by big name psychiatrists. It can truly be rewarding.

 

[splik]

The leaders in this area of research are psychiatrists (just pick up the major research journals in this field), and yet we are still at the tip of the proverbial iceberg.

No the leaders in this area of research are psychologists. Given that psychiatry is concerned with morbid mental states, rather than the whole range of emotion and behavior, this is understandable.

 

[Leo Aquarius]

No the leaders in this area of research are psychologists. Given that psychiatry is concerned with morbid mental states, rather than the whole range of emotion and behavior, this is understandable.

Indeed. I think our definitions of neurophysiological differ here. You probably mean cognitive behavioral concepts, of which psychology plays a huge role. I'm thinking of actual physiology of the brain that can help explain behavior, of which psychiatrists and neurologists are pioneering. Just glance at the research at Harvard Longwood and MGH and UCLA Neurophysiology. Fields include Neuroimaging, Neurochemistry, Electroencephalography and Electromyography research, etc.

 

[imp3tigo]

I just want to know about the brain in and out.. But i supposed I want to know and treat from a more structure, or organic, or physiological perspective.

You should probably stay in neuro. Psychiatrists don't know the brain in and out. Besides it sounds like you can do a lot of what you're interested in from within neuro, and make a whole lot more money at the same time.

 

[Leo Aquarius]

... I used to say in my interviews the most interesting thing about neurology for me was the neurophysiological basis of behavior and honestly thats just basically psychiatry, not neurology. I don't care about peripheral neurology or vascular.... I just want to know about the brain in and out.. But i supposed I want to know and treat from a more structure, or organic, or physiological perspective.

Psychiatry focuses on behavior and thought, not organic structures of the brain. Look to neurology for that.

It comes down to what you want to do day in and day out. Seriously. Do stroke workups and "locate the lesion" every day, and then offer very little to fix them? Or analyze thought disorders, mood disorders, acute psychoses, and offer medication and therapy that can totally cure someone? I'm biased of course, but I've seen completely hebephrenic patients arrive to our unit and walk away normal a week later and the nurses saying you did a miracle doc. It's deeply satisfying.

 

[BS81]

Psychiatry focuses on behavior and thought, not organic structures of the brain. Look to neurology for that.

It comes down to what you want to do day in and day out. Seriously. Do stroke workups and "locate the lesion" every day, and then offer very little to fix them? Or analyze thought disorders, mood disorders, acute psychoses, and offer medication and therapy that can totally cure someone? I'm biased of course, but I've seen completely hebephrenic patients arrive to our unit and walk away normal a week later and the nurses saying you did a miracle doc. It's deeply satisfying.

Totally cure someone? How often does that happen?

Sent from my DROID RAZR using SDN Mobile

 

[Leo Aquarius]

Totally cure someone? How often does that happen?

Hardly ever, in any branch of medicine. I guess enthusiasm got the best of me, but they appear cured 🙂

 

[Enkidu]

I just want to know about the brain in and out

Did you consider neuropathology?

 

[nancysinatra]

Psychiatry focuses on behavior and thought, not organic structures of the brain. Look to neurology for that.

It comes down to what you want to do day in and day out. Seriously. Do stroke workups and "locate the lesion" every day, and then offer very little to fix them? Or analyze thought disorders, mood disorders, acute psychoses, and offer medication and therapy that can totally cure someone? I'm biased of course, but I've seen completely hebephrenic patients arrive to our unit and walk away normal a week later and the nurses saying you did a miracle doc. It's deeply satisfying.

Umm, this is more than just a little biased.

Here's my take (ok not to cause mass outrage on this forum--I am playing devil's advocate. I'm also on a really boring rotation this month): Do you want to be analytical and exacting and familiar with a wide range of pathology, including common and rare conditions--OR do you want to give Seroquel all day to people who you are probably misdiagnosing as "bipolar"? An exciting day might be one where instead of PO Seroquel, you get to use PO Depakote.

Or--do you enjoy solving complex problems that often ends up saving lives, or do you enjoy lecturing people about the evils of alcohol, drugs, tobacco, and poor sleep hygiene?

 

[Leo Aquarius]

Umm, this is more than just a little biased.

Here's my take (ok not to cause mass outrage on this forum--I am playing devil's advocate. I'm also on a really boring rotation this month): Do you want to be analytical and exacting and familiar with a wide range of pathology, including common and rare conditions--OR do you want to give Seroquel all day to people who you are probably misdiagnosing as "bipolar"? An exciting day might be one where instead of PO Seroquel, you get to use PO Depakote.

Or--do you enjoy solving complex problems that often ends up saving lives, or do you enjoy lecturing people about the evils of alcohol, drugs, tobacco, and poor sleep hygiene?

It's humorous to point out all the silly annoying aspects of a specialty. Could you do DREs every day, with every male patient? Hell no. So goodbye urology. One patient asked our urologist "Why do you guys do this (digital rectal exams) for a living?" Exactly! What the hell happened to those med students?

 

[PETRAN]

Indeed. I think our definitions of neurophysiological differ here. You probably mean cognitive behavioral concepts, of which psychology plays a huge role. I'm thinking of actual physiology of the brain that can help explain behavior, of which psychiatrists and neurologists are pioneering. Just glance at the research at Harvard Longwood and MGH and UCLA Neurophysiology. Fields include Neuroimaging, Neurochemistry, Electroencephalography and Electromyography research, etc.

Most of functional neuroimaging and EEG/cognitive ERPs research is done by psychologists as well. We are talking cognitive neuroscience here (which is the "modern offspring" of traditional experimental cognitive psychology), like researching the neural corellates of working memory (and e.g. whether is due to a global resource limitation or modality-specific), attention (visuo-spatial, symbolic, cross-modal etc.), consciousness, perception of all modalities, thinking and reasoning, long-term memory (semantic, episodic, procedural etc.), language, and even more social-affective concepts like interpersonal perception, causal attributions, stereotypes, physiological basis of emotions. etc.


Hell, nowadays even a large number of molecular-cellular studies in rats about LTP, stress and the amygdala, neurodegeneration and neuroplasticity etc. is done by psychologists (although, true, here academic medical doctors have a large role to play due to the applicability of these studies in disease and treatments).

But the research of "on-line" mental functions is traditionaly done by psychologists of the experimental-positivistic-"psychophysical" (as it was used to be called) kind (rather than the clinical/counselling one).


From an applied side of view, the closer you'll get to "tap" the workings of the brain would be clinical neuropsychology ,e.g. performing assessments on cognitive functions and correlating them with brain-damage, hence making suggestions about one's mental abilities and about further rehabilitations plans or forensic procedures. From what i've seen some fellowships in behavioral neurology overlap with these areas as well (and these are almost always the only medical doctors that do cog neuroscience research).


Academic psychiatry seems to dwell in cognitive neuropsych/neuroscientific models of various abnormal mental states these days, but the field is still kinda obscure and ofcourse, no practicing psychiatrist would ever need to use these models in his/her day-to-day practice. When you turn to real life, everyday severe parental abuse, serious social ostracism combined with a good amount of lysergic acid and other hallucinogens seem to be of greater importance to a teenager's psychotic delusions in comparison to a model of Bayesian causal reasoning that relies in lateral dorso-frontal circuits. Although such cognitive (and computational) models may gain importance in the future due to their ever-increasing explanatory power.