Mar 19, 2015
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MD/PhD Student
I'm a US IMG, very interested in doing Psychiatry. I did a core and elective rotation in Psychiatry, but I haven't had luck matching for 2 years. I'm currently doing an observership in Psych. How useful are Psych observerships to residency programs? I'm really trying to show them that I want to pursue Psych as a career interest and that I'm not going to just drop out after 1 year or treating it as a back-up. Please help!
 

splik

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observerships are useless. especially if you have core and elective rotations in psychiatry in the US. why didn't you match? what are you not telling us? do you have strong psychiatry letters? how have you spent your time post-graduation?
 
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MacDonaldTriad

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Mar 13, 2013
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Splik is right. Observerships can get you letters, but no one gets in because they did an observership unless it is at the place observed, and no one doesn’t get in because they lack an observership. (Sorry about the triple negatives).
 
OP
Z
Mar 19, 2015
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MD/PhD Student
really? they're useless? i have read a few program descriptions that state that they welcome applicants who have done observerships. i don't know why i didn't match. the thing is, i feel that there is no algorithm for matching. US grads do get a preference and I understand that. I did my core and elective with the same attending. I waived my rights to see my LOR so I don't know what it looks like. Also, I do have lower scores and come from a low tier caribbean school. I always thought Psychiatry cared about genuine interest because there has been a history of people dropping out after intern year, but I really don't know what they use as a basis to select their candidates anymore.
 

splik

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waiving your right to see your LOR doesn't mean you can't see your LoR only that you've waived your right to see it. It is IMHO a mistake (especially for IMGs) not to ask to you see your LoRs.

also there really has n0t been a huge number of people dropping out after intern year. once you're in psych you're damaged goods and no one else wants you...
 
OP
Z
Mar 19, 2015
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MD/PhD Student
okay, so i'll see if i can go ahead and view my LOR. thank you for letting me know. i appreciate it. okay, if observerships aren't helpful, what would you recommend?
 

splik

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something showing an interest in psychiatry: this could be psychiatric research, this could be volunteering in some significant way with NAMI, doing public education work on mental illness within a particular community (particularly if you're from a minority background), you could write articles in bottom of the barrel rags like current psychiatry or the AJP Residents' Journal, or get involved in educating high school students about mental health or sexuality issues, or work with someone in public office on mental health legislation etc

but given that applications are due in a few weeks it's a bit late this cycle, and if you've already not matched twice things aren't looking good... looks like you tried to match into other fields unsuccessfully and now trying for psych. psych is actually harder to get into than say peds IM or FM as there are far fewer spots where as there are lot more undesirable or low grade programs in those fields...

and yeah... psychiatrists are a tad sensitive about people choosing the field because they couldn't get into anything else. not because they fear you'll jump ship but because it's narcissistically injuring. basically the same reason there are all these people puffing their chests at how psychiatry is going to get more competitive and the like....
 
OP
Z
Mar 19, 2015
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MD/PhD Student
okay. i appreciate the honesty. i should probably just stick to what i was trying to match into originally.
 

pisekar

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I know that people here say psychiatric observerships are useless. In my experience, I had clinical experience as an observer in 2 different teaching hospitals. I was lucky during my observership experiences and I interviewed psych patients (I also practiced writing psych H&P and progress note, but not in the electronic system.) Anyway, I had 2 years of research experience beside this, no externship or clinical rotation during medical school. I don't know the observership helped me during the rank process but I matched to my #1.
 

splik

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it is useless if you have psychiatry electives/clerkships in the US as a medical student. in fact it's probably a bit suspicious. it is entirely different (though still of limited utility) to do an observership as an IMG who has no other exposure to psychiatry in the US. perhaps they had good experience with residents from your medical school in the past?
 

shan564

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I agree 100% with splik's advice, as usual.

A PD wants to see that you had good clinical skills in your US rotations. Your clerkship/elective will do that, and an observership will not. An observership won't show a genuine interest in psych if you've already done an elective and already applied in psych.

Since you don't know why you didn't match yet, I'll tell you. The main things holding you back at this point are:
1. Low step scores.
2. "Low-tier" offshore school (I'm only saying that because you said it yourself)
3. All of your psych experience was with a single attending, which is probably because that's all that most lower-tier offshore schools can offer. That's not your fault, but it's a hindrance. Given that, I'm assuming that it was also not at an academic center and the attending wasn't on faculty anywhere, since that's how it usually works in those cases... LORs from academic doctors tend to look better than LORs from community doctors, since academic doctors are more experienced with teaching and evaluating students.
4. 2-year gap.

Here's how you can try to offset some of those disadvantages (I say "offset" because you won't correct them completely, but you can make some headway):
1. Pass Step 3 (if you haven't done so already). One of a PD's concerns will be that you might have trouble passing Step 3, since your previous scores were lower. You can address that if you've already passed it.
2/3. Get some experience doing something other than observing. You can try to do clinical research or any of the things that splik suggested, especially if you can get an opportunity in which you can demonstrate your clinical skills to an attending who will then write you a good LOR.
Also, some observerships will let you evaluate patients and present cases to an attending. If so, it's essentially like another elective. Try to do that, even if it's not officially part of your observership.
4. Have a very good explanation for what you did to be productive in the 2-year gap, with a focus on how you've prevented your clinical skills from atrophying.
 
OP
Z
Mar 19, 2015
27
4
Status
MD/PhD Student
Thank you so much for the advice! I was wondering what to do to better my situation so I really appreciate it.
 
OP
Z
Mar 19, 2015
27
4
Status
MD/PhD Student
I agree 100% with splik's advice, as usual.

A PD wants to see that you had good clinical skills in your US rotations. Your clerkship/elective will do that, and an observership will not. An observership won't show a genuine interest in psych if you've already done an elective and already applied in psych.

Since you don't know why you didn't match yet, I'll tell you. The main things holding you back at this point are:
1. Low step scores.
2. "Low-tier" offshore school (I'm only saying that because you said it yourself)
3. All of your psych experience was with a single attending, which is probably because that's all that most lower-tier offshore schools can offer. That's not your fault, but it's a hindrance. Given that, I'm assuming that it was also not at an academic center and the attending wasn't on faculty anywhere, since that's how it usually works in those cases... LORs from academic doctors tend to look better than LORs from community doctors, since academic doctors are more experienced with teaching and evaluating students.
4. 2-year gap.

Here's how you can try to offset some of those disadvantages (I say "offset" because you won't correct them completely, but you can make some headway):
1. Pass Step 3 (if you haven't done so already). One of a PD's concerns will be that you might have trouble passing Step 3, since your previous scores were lower. You can address that if you've already passed it.
2/3. Get some experience doing something other than observing. You can try to do clinical research or any of the things that splik suggested, especially if you can get an opportunity in which you can demonstrate your clinical skills to an attending who will then write you a good LOR.
Also, some observerships will let you evaluate patients and present cases to an attending. If so, it's essentially like another elective. Try to do that, even if it's not officially part of your observership.
4. Have a very good explanation for what you did to be productive in the 2-year gap, with a focus on how you've prevented your clinical skills from atrophying.

Hi,

I know it's been a while but I have some progress. I passed my Step 3 and have been doing clinical research in Psychiatry for about 5 months now. I will continue through the application season. I have a few publications (less than 5) however. I will have added 3 LORs dating from 2015 and 2016.

Any advice from here on?
 
May 11, 2016
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0
it is useless if you have psychiatry electives/clerkships in the US as a medical student. in fact it's probably a bit suspicious. it is entirely different (though still of limited utility) to do an observership as an IMG who has no other exposure to psychiatry in the US. perhaps they had good experience with residents from your medical school in the past?
Hi Splik, I read your landmark psychiatry discussion.. really helped! Im an IMG, and I've been looking for psychiatry observerships (I am interested in Psych residency; this is my first time in the US and the whole system) but I cant seem to find any! I have no pre-existing 'contacts' and every hospital I go to, just says 'sorry we dont have any positions'. I might be able to shadow a Psychiatrist in private practice, but I dont know how helpful that is! Iv got decent step scores, and am wondering about my chances.. Could you give me any advice about Psych Observerships.. how to find them maybe.. I know that question is probably stupid and the answer is obvious, but i'm just trying to find any help i can get.. Thanks again