AMEN
IMHO, residents should do 6 months of medicine (we do 4 in my program).
I've actually thought a few times that psyche residencies were too long but we don't learn enough medicine. That's a reason why I've been telling medstudents wanting to go into psyche to do electives like endocrinology, neurology & GI--3 areas that I feel interface with psyche quite a bit, and to not go too heavy into doing a psyche elective.
I don't want Chrismander to feel alienated by our opinions. I can't judge him and he may have his own valid reasons.
Thanks whopper. A couple of clarifications.
There's different environments to learn medicine in. One way (the most common) is to do 100% ward medicine, maybe offering some peds for those interested. For other programs, I've seen those 4 months split up differently, to include some time in the ER or various clinics. Myself, I'd like the variety of different environments. Some things can only be learned on the ward, and some skills you can develop in the ER more easily. For example, taking a vague set of presenting complaints from someone who looks otherwise healthy and figuring out how extensive a workup is justified, and how quickly--that's something you pick up in the ER more than the wards. That's a skill I imagine would be useful down the road when I need to know whether to refer one of my outpatients to his internist, or whether to call a consult on my inpatient or just wait and see. I'm in the middle of my sub-i right now (probably why i started whining the first place), and I'm learning a ton. Some of it's very practical and useful, and some is just arcana that I can use to justify the MD after my name and the $100,000 degree. Also, the patients tend to come into the ward pre-digested--by the time I get called for their admission, the diagnosis or general direction of the workup is already there, and my job consists of implementing consultant's recommendations and making sure patients get their tests done. That's all well and good, but a month or so of ER time would give the opportunity to see some virgin patients, and hone my decision making skills. I haven't done my ambulatory month yet, so I can't really say if a month of that in lieu of medicine wards would be useful to me as a psychiatrist. My sense is that it could go either way--I might get more exposure to things that are neglected on the wards (chronic diabetes management, and other health care maintenance things for instance), or it might be a low yield waste of time.
As for the issue of capping psych interns--contentious, but I see y'all's point of view. I'm in the middle of a 12 day stretch and feeling less than enthused about the field of internal medicine at the moment, and I see that my flippant tone may have been somewhat inappropriate. To the posters who jumped on me, you're right: it is somewhat insulting to insinuate that psych inerns need to be treated "like med students", and we do need to learn our medicine. I'd like you to ponder one point though--one of the psych interns on another team is doing her "sub-i month" right now. It's october. The medicine interns have been slogging through nothing but medicine for almost 4 months now. When they started in July, the chief resident was there on the wards with them 7 days a week along with their resident, the entire system was geared towards helping them make a smooth transition to being fully-functioning interns. In July, she was over in the psych ward learning psych interviewing and how to dose psychotropics. I don't think it's demeaning to our profession to suggest that she's not going to be performing as well as her cointerns right at first--she's out of practice, she hasn't done medicine in at least 4 months, maybe longer. Some Psych interns are going to end up not doing medicine until the end of their PGY-1. Under the system at this hospital, for the first month they get a lower cap than the medicine interns--in no other way are they "infantilized" or "treated like med students". They manage their patients just like anyone else. In the second and third months they're on ward medicine they cap just like any other intern. By then they're back in the swing of things. Then in their fourth month they work in the ER, instead of on the wards. Maybe a month is too long a time to be broken in (after a rough start, i'm pretty efficient again after about two weeks on the wards), but we shouldn't let the perpetual chip on our profession's shoulders stand in the way of appropriate orientation to an intern's job, and patient safety.
Also, "non-malignant off-service rotations" doesn't equate with "easy for the psych residents at the expense of education". There's a HUGE range of ward environments for educational value and malignancy. I don't think it's demeaning to inquire about the medicine ward environment of the different programs--if I was going for a medicine residency, I'd be looking for nonmalignant, educational programs as well. For instance, at one (public) hospital at my school, patients tend to not be very sick (physically), patient panels tend to be mostly ROMI's, stay forever while placement is obtained, but interns have to do everything--draw every blood, wheel patients to every single xray or test. At two other (private) hospitals at our school, there are phlebotomy teams who take care of routine labs, there's a transport service, and there's decent social workers to arrange dispo--and patients tend to actually be sick, and there's good opportunities to learn. One of those two private hospitals (where I'm now) isn't in compliance with work hours, and everyone's a little frazzled. But you're right, at least I'm learning. At the other private hospital (where I rotated as a 3rd year) the hours are more manageable (you get one day off a week), you have an excellent ancillary staff, noneducational patients (i.e. ROMIs with no EKG changes and one set of negative enzymes) get shunted to the PA service leaving the interns with more complicated, interesting patients, there's a daily, protected (PA's take the beepers) case conference for interns and residents to hone their diagnostic skills, and the environment is overall just more pleasant to work in.
Personally, if my ward medicine consisted largely of doing the work of a phlebotomist or patient transporter (hospital #1) for 4 months while not getting much education, I'd feel a bit used. If I was at hospital #2 (where I am now) I'd be stressed & bitter, but at least learning something. If I could get hospital #3, I'd be happiest--learning the most, not doing excessive scut, and being kept within the 80 hour week. So, that's what my original post was about. I know the tone was off--this sub-I has me grumpy, and I didn't come across well.
So I'll ask it again and try to be more precise--What program out there has the best medicine rotations in terms of having good support staff and having reasonable work hours and pace, without sacrificing education, with a good patient population? What programs offer alternatives to the 4 months of wards that you guys feel are interesting and educational? What programs have a good "feel" or "culture"? Lauraaa answered this a bit by mentioning that her program tends to have approachable, friendly attendings who like to teach.
Yeah all things being equal I'd take a hospital with good ancillary support, happy medicine interns, and attendings who are down to earth and like to teach. Strange, I know.
😀
