What makes a good psychiatry residency program?

[psycheswape111]

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So I'm at a program right now where the attendings do very little teaching. The bulk of supervision for PGY-1's comes from PGY-2's. The PGY-2's are effectively supposed to teach us psychiatry. The problem with that is that they have so much of their own work to do that they can't really teach us anything. They're still trying to figure things out themselves. Also, I'm not aware that our didactics even cover teaching skills. 3 months in I was still trying to figure out basic logistics because if something hadn't come up during a time a PGY-2 was available to ask, I just didn't get any answer on how it was supposed to work. We do a lot of social work-type stuff that takes up a huge amount of time. My hours on gen med have been better than my hours on psychiatry services. Our didactic time is "protected" but it's protected by our PGY-2 residents. (And their didactic time is protected by us.) The upper levels have to do more work so that we can go to didactics. They're supposed to cover our pagers but they often don't. We only have 2-3 hours of didactics a week and I've often had to leave to answer pages. When I come back from didactics, I have a giant pile of work to do from the two-three hours I missed and end up going home two hours later than usual. I never feel like I know what's going on. I don't feel like I'm learning psychiatry. I feel like I'm losing knowledge but gaining the ability to write notes quickly and ignore pages that aren't important. I have no personal life to speak of. My city is new to me. I've been able to meet one person outside my program and hung out with her a grand total of 4 times. I struggle to find time to go to the gym and cook healthy food. When I talk to other residents about how I feel, they say it's normal and "lots of people here need SSRIs/therapy". They tell me that this is just what residency is like.

Meanwhile... At my friend's program, she's supervised directly by an attending and works one on one with them on each patient. She has time to think about each patient's diagnosis and treatment and doesn't feel like she's constantly scrambling to get everything done so she can go home to take care of her basic needs. She doesn't have to worry about any social-work type tasks. She carries just as many patients as I do, but works 2/3 or less of the hours. Her program has 6-7 hours of didactic time each week that's protected by attendings. She has a life and goes out several nights a week. She feels like she's learning a lot about psychiatry and loves her life. Her program also has greater diversity in it's clinical training sites.

Yet my program is "more prestigious" and "more academic" than hers and therefore better? Am I missing something here? I feel like her program is clearly superior to mine in terms of both training and quality of life. The only light at the end of the tunnel is maybe I'll somehow have better fellowship opportunities? But probably not. What is the deal? Why is my seemingly inferior program "more competitive"? (I am not in some desirable metropolitan coastal area). Does this system where I'm relatively miserable and constantly fending for myself somehow lead to me being a better doctor?

 

[witzelsucht]

sounds like you answered your own question there

 

[splik]

Yet my program is "more prestigious" and "more academic" than hers and therefore better? Am I missing something here? I feel like her program is clearly superior to mine in terms of both training and quality of life. The only light at the end of the tunnel is maybe I'll somehow have better fellowship opportunities? But probably not. What is the deal? Why is my seemingly inferior program "more competitive"? (I am not in some desirable metropolitan coastal area). Does this system where I'm relatively miserable and constantly fending for myself somehow lead to me being a better doctor?

well if you're not in some desirable metropolitan coastal area your program is probably not much more competitive in any meaningful sense given than location is the biggest driving force for competitiveness in psychiatry out of proportion to any other medical specialty.

But maybe it's time to plan your exit strategy. It won't get better. The early phase of residency is usually when residents feel most positive about their program...

I wouldn't put too much emphasis on didactics though. I'd rather gouge my eyes out than attend 6-7 hours of didactics a week. And all the didactics in the world aren't any use if they aren't any good, quality matters much more. High quality supervision matters much more than do didactics.

One thing to bear in mind is that you are entitled to 1 hr of supervision from your attending each week. This is an ACGME requirement. You may have to ask for (in fact, insist upon it) but they have to provide you with it. In addition you are supposed to have at least one additional hour a week of supervision.

 

[TexasPhysician]

Prestige means little once you hit the residency level. Some prestigious places are competitive and have great training. Others are not competitive and have relatively poor training despite the name.

Competitive residency programs generally have a mix of quality faculty, reasonable work loads, good variety, and geographically ideal.

Most fellowships in psych are easy to obtain, and even poorly ranked programs can rank well for fellowships.

 

[Monkey House]

Having the flexibility to come in wanting to do X but also being able to do Y is one key factor often overlooked. Many residents come in wanting one career path but many will realize they want to do a different career path in psychiatry instead. A good program will afford you the opportunity to explore all paths and come out well prepared for any of those paths. Come in geri but still able to do child. Come in private practice but still able to do academics. Come in research but able to do outpatient.