What are some things that I must know/do to be somewhat competent during my first week as an inpatient psych intern?

[nebuchadnezzarII]

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The anxiety is kicking in! Starting residency in just a couple of weeks; starting on inpatient psychiatry. I'm planning on looking over some psych meds and diagnoses, but it's been over a year since I've been on an inpatient psych floor.

Do you guys have any recommendations for "must-knows" or "must-dos" for before and during my first week? I'm a little bit terrified, but as many have assured me before, that's to be expected. Any recommendations would help - you were all immensely helpful with your advice for internal medicine as a psychiatry resident. Thank you.

 

[thepoopologist]

Knowledge aside.
1. Never act out of emotion, act on what you observe.
2. Avoid labeling as a way of dismissing concerns. i.e. borderline, drug-seeker
3. You can learn from bad attendings too because they generate the adverse outcomes for you.
4. Office politics is real and good relationships with the people above you will save you a lot of headaches

 

[nebuchadnezzarII]

Knowledge aside.
1. Never act out of emotion, act on what you observe.
2. Avoid labeling as a way of dismissing concerns. i.e. borderline, drug-seeker
3. You can learn from bad attendings too because they generate the adverse outcomes for you.
4. Office politics is real and good relationships with the people above you will save you a lot of headaches

Anything specifically you recommend in terms of knowledge, during these next 2 weeks? And of course, everything else you mentioned is important (probably more so). But I feel like after 2 years of clinical during MS3-MS4, you kind of start to understand that stuff.

 

[oldiebutgoodie1211]

Nah as an intern you’re not expected to know anything, just be willing to learn and have a good attitude

 

[thepoopologist]

I mean, there's all kinds of resources for knowledge. Stahl and Maudsley for pharm, dsm criteria and structured interview. ABPN board prep material. reading journal articles. Its not really that, its just having a regimented approach to each case (i.e. read the chart, perform the interview, deterimining whats truth, lie, or absence of information, ddx/case formulation that evolves, treatment plan) and using the books and attendings you have to fill in the blanks. Tons of docs/residents are super smart and can spout off all kinds of knowledge and the difference between the good and bad clinicians is the way they approach cases.

 

[OldPsychDoc]

Focus on building your interview skills--be curious about your patients, practice getting the information without blunt force checklisting, learn their story. Ask lots of questions whenever you're with an attending--learn why they do the things they do. The knowledge will come.

 

[J ROD]

Don't be so anxious you make your anxious patients worse................

 

[Bartelby]

Show up with a good attitude and willing to learn. You will get up to speed fast, and you will probably find pre-reading did little for you. If you want to review something here are some relatively high-yield options:

-Commitment laws / procedures in your state (overview, not the full civil code)
-How to evaluate decision making capacity (https://www.nejm.org/doi/full/10.1056/NEJMcp074045)
-Pros / cons of different chemical restraints (better to think through this before you need it, but your inpatient culture will also guide you; such as for healthy non-geriatric patients haldol 5 / Ativan 2 / Cogentin 1mg; Olanzapine 10 mg IM (never with benzos); Prolixin; NOT Thorazine; using iv haldol for consult patients with IV acces; using PO options when the patient will cooperate for it)
-start familiarizing yourself with resources your program offers; UpToDate, other reference sources, free software, etc etc
-if it's been a while remind yourself of all the elements of a full H&P, you will want to get up to speed / efficient quickly
-consider reading up on or playing around with the Electronic Medical Records System you will work with (make this system your friend!)
-read through any orientation material, policies and procedures etc. (especially if starting on night float or taking call early)

Good luck! Try to have some fun now, you be doing an immense amount of learning very soon!

 

[nebuchadnezzarII]

Show up with a good attitude and willing to learn. You will get up to speed fast, and you will probably find pre-reading did little for you. If you want to review something here are some relatively high-yield options:

-Commitment laws / procedures in your state (overview, not the full civil code)
-How to evaluate decision making capacity (https://www.nejm.org/doi/full/10.1056/NEJMcp074045)
-Pros / cons of different chemical restraints (better to think through this before you need it, but your inpatient culture will also guide you; such as for healthy non-geriatric patients haldol 5 / Ativan 2 / Cogentin 1mg; Olanzapine 10 mg IM (never with benzos); Prolixin; NOT Thorazine; using iv haldol for consult patients with IV acces; using PO options when the patient will cooperate for it)
-start familiarizing yourself with resources your program offers; UpToDate, other reference sources, free software, etc etc
-if it's been a while remind yourself of all the elements of a full H&P, you will want to get up to speed / efficient quickly
-consider reading up on or playing around with the Electronic Medical Records System you will work with (make this system your friend!)
-read through any orientation material, policies and procedures etc. (especially if starting on night float or taking call early)

Good luck! Try to have some fun now, you be doing an immense amount of learning very soon!

Thank you!!! Very helpful!

 

[kaysisiel]

Practice your mental status exams.

Make EMR smartphrases/templates containing bread and butter DSM5 diagnostic criteria. This is super helpful for learning the diagnostic criteria. Note that while people may argue the utility of relying solely on DSM5 diagnostic criteria, you should still know them.

 

[Taddy Mason]

The Mental Status Exam by Trzepacz and Baker is the one book worth going through and should only take a few hours. A good MSE a still has its place. The preponderance of sloppy and inaccurate ones with improper use of terminology baffles me. Beyond that quickly learning logistical things and familiarizing yourself with your state’s hold and commitment processes would be most beneficial, and the latter is the only one you can kind of do in advance.

 

[Nudexta]

Be a team player and be nice to everyone around you. Don’t complain

 

[nebuchadnezzarII]

The Mental Status Exam by Trzepacz and Baker is the one book worth going through and should only take a few hours. A good MSE a still has its place. The preponderance of sloppy and inaccurate ones with improper use of terminology baffles me. Beyond that quickly learning logistical things and familiarizing yourself with your state’s hold and commitment processes would be most beneficial, and the latter is the only one you can kind of do in advance.

Thank you for the specific advice! Will do.

Be a team player and be nice to everyone around you. Don’t complain

Haha, of course. I only complain on here.

 

[comp1]

Suicide risk and protective factors.

 

[box8psych]

I would recommend buying Stahl's Prescriber's Guide to use a quick-reference. It's a wonderful and easy to digest distillation of the need-to-know info for trainees. I built a good foundation of basic knowledge just by using it every time I prescribed a medication. You won't get much regarding the "art" of psychopharmacy, but it's a great place to start. Good luck (you'll be fine)!

 

[deleted1012620]

Look up some mental status exam templates and get familiar with the format and what various terms mean (tangential, constricted, loose, etc)

Be able to generate a basic H&P mental outline from scratch. It's helpful when you're interviewing a patient to let them meander but still be able to remember to get information such as family psychiatric history and what not.

I would read a chapter on emergency psychiatry from any textbook or google for a review article. It gives you peace of mind to know prn medication options and dosing off the top of your head, as this is the most likely area where you'll be put on the spot to make a decision.

 

[NickNaylor]

Goodwin and Guze's Psychiatric Diagnosis (less than $50) is a nice, easy read that would probably be worthwhile as an intern if you're just looking for something to read.

As far as actually functioning as an intern, I would echo much of what is said above: be open to feedback, be engaged and interested in what you're doing, do the absolute best that you can (and recognize areas of weakness and work to improve them), and don't be a pain to those you're working with. You're not expected to know much of anything as a new intern because your psychiatry exposure is almost certainly very limited. I would argue that, especially early on, what is more important is how you approach your work rather than what you know. The latter will come with time, assuming you're driven to learn. The former is much more difficult to teach and develop but influences - positively or negatively - all other aspects of your identity as a physician.

 

[Candidate2017]

In addition to the above, always remember you are treating at least 2 patients: the patient and the attending. Sometimes family members/vested third parties and sometimes yourself.

 

[Desired Member]

Show up with a good attitude and willing to learn. You will get up to speed fast, and you will probably find pre-reading did little for you. If you want to review something here are some relatively high-yield options:

-Commitment laws / procedures in your state (overview, not the full civil code)
-How to evaluate decision making capacity (https://www.nejm.org/doi/full/10.1056/NEJMcp074045)
-Pros / cons of different chemical restraints (better to think through this before you need it, but your inpatient culture will also guide you; such as for healthy non-geriatric patients haldol 5 / Ativan 2 / Cogentin 1mg; Olanzapine 10 mg IM (never with benzos); Prolixin; NOT Thorazine; using iv haldol for consult patients with IV acces; using PO options when the patient will cooperate for it)
-start familiarizing yourself with resources your program offers; UpToDate, other reference sources, free software, etc etc
-if it's been a while remind yourself of all the elements of a full H&P, you will want to get up to speed / efficient quickly
-consider reading up on or playing around with the Electronic Medical Records System you will work with (make this system your friend!)
-read through any orientation material, policies and procedures etc. (especially if starting on night float or taking call early)

Good luck! Try to have some fun now, you be doing an immense amount of learning very soon!

whats wrong with thorazine

 

[oldiebutgoodie1211]

whats wrong with thorazine

hypotension