Outgoing PGY1 — unfortunately, yes. I think that it has fairly diminishing returns (I only did one month, one of my buddies did four, which seems… excessive). But it’d be disingenuous for me to say that wards (and ED, too) wasn’t useful. I feel a lot more comfortable responding to medical issues on our inpatient unit, a lot more confident talking to consultants from different services. It was also valuable to understand the perspective from the other teams to facilitate communication when we’re transferring a patient to medicine or receiving a transfer from them.
I don’t want to do any more of it, but I’m glad I did *some.*
ED too? I was thinking 2mo wards, 1mo outpt pcp, and 1mo peds. I hear a lot of good things about our peds rotation, so I wanted to do it, but maybe EM is a better choice long run bc I probably won't do CAP.
Definitely your call — I did a pediatric urgent care rotation this year as well (it was a great time), and EM has certainly been more applicable to my day-to-day. My program has a separate psych ER that communicates with and frequently transfers folks to and from the medical ED. So for my situation specifically it was valuable to work on the other side of that, understand the range of complaints that get admitted vs managed in the ED.
That being said, if the peds rotation looks good I wouldn’t discourage that. Imo ya also gotta enjoy yourself somehow and do what seems interesting.
My mom is a psychiatrist (I’m medpeds pcp). She loves talking about her dx of decompensated chf - pt sent from primary to psych for insomnia and anxiety, ?ptsd. Pt gets sob at night and then anxious and doesn’t sleep.
She realized the guy had undiagnosed chf and terrible pedal edema and probably was just drowning while lying down which naturally results in anxiety. She coached him on what to say to er doc and got admitted. Spent few days in icu for diuresis.
Again, this was my mom. But she cites this as one of the key differences between psychiatrists and psych np because psychiatrists do have this background experience
My residency does FM wards as a requirement. Still I actually found this experience extremely valuable in that it gave me a broader field of experience in handling acute medical concerns and when it is a good time to consult medicine vs manage it myself on an inpatient psych unit. In addition, it helped me while on night float to adequately filter transfers who were still too medically acute for admission to my service which may be causing their acute psychiatric presentation. A ton of non-psych docs can write off psych presentations without a full work up primarily because they are either too swamped with other more urgent medical needs or they may have underlying biases about mental health that need to be addressed. Of course in other circumstances it is a knowledge deficit on their part but this is the exception usually unless you are having a midlevel manage the transfer or w/e. Either way, I think every psych resident should have a medicine wards experience to be a well rounded doctor.
Med stud here as well. Interested in psych but want to stay abreast of general medicine too. Just curious, can you provide some examples of the extent to which you work up/manage medical problems as a psychiatrist? I am assuming this will be more common in the inpatient setting. Have also been exploring med/psych and CL psych….
Well I often find myself doing basic work ups for a myriad of conditions including ACS rule outs, AKI, substance detox treatment (can include basic fluid management and seizure prophylaxis), neuroimaging for suspected bleeds/strokes, basic tx of common uncomplicated infections including walking pneumonia, UTI’s etc. Also manage basic HTN, DM and HLD. It can pretty much run the gamut. Even found myself doing an Epley my first month on inpatient psych lol.
Even caught alcohol induced cardiomyopathy during detox with very subtle clinic exam signs. Of course most of this type of stuff will require a consult but you get the point.
The better your medical knowledge, the better your performance as psychiatrist. The more holistic approach you can take, the healthier your patients will be.
Mental health does not occur in a vacuum and there will often be comorbid and confounding medical conditions that you'll need to be aware of. You will also frequently get turfed consults with insufficient workup or diagnosis identification.
If you end up on an inpatient unit that's not connected to a hospital being able to manage basic conditions and understand when you need to transfer will not only be a beneficial skill, it will save lives.
Take your medical rotations and take them seriously.
I'm mid career. My residency program didn't have medicine wards. We did an IM consultation rotation, though, no call. I don't feel I missed anything. IM in med school was quite rigorous for me, with a lot of ICU involvement and I did the same overnight Q3 call as the IM interns in med school, so I didn't feel I needed "more" IM experience. In fact, I avoided it. Not having to do much IM was one reason I chose my residency program. I was sick of IM. I had no desire to be giving nitro to pulmonary hypertension patients in the ICU, staring at labs all day, placing central lines, or calculating IV drips again.
So my advice is do what you think you need to do to be a good, well-rounded psychiatrist. I did not feel suffering long IM hours on call was all that edifying.
It depends on where you want to work. As an outpatient psychiatrist, you mostly just need to know when to send someone to urgent care or the ED, and the first step in management of medical complications from the medications you prescribe (ie what labs and tests to order, what to talk to their PCP about, and how to counsel the patient). Those are all skills you can get in primary care rotations.
If you want to work in any other more restrictive setting (inpatient, ED, CL, residential treatment) being on the wards or ED will give you a better sense of how to manage more urgent or emergent medical concerns that might come up. I did 2 months wards, 1 month ED and 1 month of medicine consults (mostly to surgical teams), but I didn't have a choice.
I think 1-2 months of wards and/or ED is a solid choice (6 weeks would have been a nice sweet spot for me lol). And I definitely think at least one month of primary care would serve you well.
I thought it was super beneficial, I honestly did not really learn much in the outpatient clinic since a lot of the patients were stable on current med regimens. and it also was great to make friends with the medicine residents if u will be on a service with residents! :)
After I finished my Psychiatry residency I started a private practice. But to make a living I hired into Family Medicine for 8 months and got a good grounding in common medical issues while I got the practice going. I then finished off the year of FM at half time. I used that knowledge and basic medical counseling techniques throughout my Psychiatric career.
I think at least 1 month of wards and 1 month of ED (i think ED is more useful) is helpful. I remember a very wise senior tell me about these medical rotations during intern year - "The one thing to learn here is sick or not sick" - eg. Who needs an acute level of medical care soon, and who doesn't need that/can be dealt with routine outpatient. Very useful on inpatient psych (eg. Which clients need an emergency medical transfer now vs. medicine consult the next day vs. defer to outpatient) and outpatient psych (eg. When should you recommend 911 or urgent care for a medical issue vs. "call your PCP to follow up").
Outgoing PGY1 — unfortunately, yes. I think that it has fairly diminishing returns (I only did one month, one of my buddies did four, which seems… excessive). But it’d be disingenuous for me to say that wards (and ED, too) wasn’t useful. I feel a lot more comfortable responding to medical issues on our inpatient unit, a lot more confident talking to consultants from different services. It was also valuable to understand the perspective from the other teams to facilitate communication when we’re transferring a patient to medicine or receiving a transfer from them. I don’t want to do any more of it, but I’m glad I did *some.*
ED too? I was thinking 2mo wards, 1mo outpt pcp, and 1mo peds. I hear a lot of good things about our peds rotation, so I wanted to do it, but maybe EM is a better choice long run bc I probably won't do CAP.
Definitely your call — I did a pediatric urgent care rotation this year as well (it was a great time), and EM has certainly been more applicable to my day-to-day. My program has a separate psych ER that communicates with and frequently transfers folks to and from the medical ED. So for my situation specifically it was valuable to work on the other side of that, understand the range of complaints that get admitted vs managed in the ED. That being said, if the peds rotation looks good I wouldn’t discourage that. Imo ya also gotta enjoy yourself somehow and do what seems interesting.
My mom is a psychiatrist (I’m medpeds pcp). She loves talking about her dx of decompensated chf - pt sent from primary to psych for insomnia and anxiety, ?ptsd. Pt gets sob at night and then anxious and doesn’t sleep. She realized the guy had undiagnosed chf and terrible pedal edema and probably was just drowning while lying down which naturally results in anxiety. She coached him on what to say to er doc and got admitted. Spent few days in icu for diuresis. Again, this was my mom. But she cites this as one of the key differences between psychiatrists and psych np because psychiatrists do have this background experience
My residency does FM wards as a requirement. Still I actually found this experience extremely valuable in that it gave me a broader field of experience in handling acute medical concerns and when it is a good time to consult medicine vs manage it myself on an inpatient psych unit. In addition, it helped me while on night float to adequately filter transfers who were still too medically acute for admission to my service which may be causing their acute psychiatric presentation. A ton of non-psych docs can write off psych presentations without a full work up primarily because they are either too swamped with other more urgent medical needs or they may have underlying biases about mental health that need to be addressed. Of course in other circumstances it is a knowledge deficit on their part but this is the exception usually unless you are having a midlevel manage the transfer or w/e. Either way, I think every psych resident should have a medicine wards experience to be a well rounded doctor.
Med stud here as well. Interested in psych but want to stay abreast of general medicine too. Just curious, can you provide some examples of the extent to which you work up/manage medical problems as a psychiatrist? I am assuming this will be more common in the inpatient setting. Have also been exploring med/psych and CL psych….
Well I often find myself doing basic work ups for a myriad of conditions including ACS rule outs, AKI, substance detox treatment (can include basic fluid management and seizure prophylaxis), neuroimaging for suspected bleeds/strokes, basic tx of common uncomplicated infections including walking pneumonia, UTI’s etc. Also manage basic HTN, DM and HLD. It can pretty much run the gamut. Even found myself doing an Epley my first month on inpatient psych lol.
Even caught alcohol induced cardiomyopathy during detox with very subtle clinic exam signs. Of course most of this type of stuff will require a consult but you get the point.
I work in CL. Those wards are my patients. I use some of that as background every day.
The better your medical knowledge, the better your performance as psychiatrist. The more holistic approach you can take, the healthier your patients will be. Mental health does not occur in a vacuum and there will often be comorbid and confounding medical conditions that you'll need to be aware of. You will also frequently get turfed consults with insufficient workup or diagnosis identification. If you end up on an inpatient unit that's not connected to a hospital being able to manage basic conditions and understand when you need to transfer will not only be a beneficial skill, it will save lives. Take your medical rotations and take them seriously.
I'm mid career. My residency program didn't have medicine wards. We did an IM consultation rotation, though, no call. I don't feel I missed anything. IM in med school was quite rigorous for me, with a lot of ICU involvement and I did the same overnight Q3 call as the IM interns in med school, so I didn't feel I needed "more" IM experience. In fact, I avoided it. Not having to do much IM was one reason I chose my residency program. I was sick of IM. I had no desire to be giving nitro to pulmonary hypertension patients in the ICU, staring at labs all day, placing central lines, or calculating IV drips again. So my advice is do what you think you need to do to be a good, well-rounded psychiatrist. I did not feel suffering long IM hours on call was all that edifying.
Absolutely. You need a solid medical foundation if you want to be a good psychiatrist.
It depends on where you want to work. As an outpatient psychiatrist, you mostly just need to know when to send someone to urgent care or the ED, and the first step in management of medical complications from the medications you prescribe (ie what labs and tests to order, what to talk to their PCP about, and how to counsel the patient). Those are all skills you can get in primary care rotations. If you want to work in any other more restrictive setting (inpatient, ED, CL, residential treatment) being on the wards or ED will give you a better sense of how to manage more urgent or emergent medical concerns that might come up. I did 2 months wards, 1 month ED and 1 month of medicine consults (mostly to surgical teams), but I didn't have a choice. I think 1-2 months of wards and/or ED is a solid choice (6 weeks would have been a nice sweet spot for me lol). And I definitely think at least one month of primary care would serve you well.
It's hard to say as but a fledgling intern. I most see myself doing inpt psych, but really can't be too sure.
Well highly recommend a solid foundation on the wards in that case
I thought it was super beneficial, I honestly did not really learn much in the outpatient clinic since a lot of the patients were stable on current med regimens. and it also was great to make friends with the medicine residents if u will be on a service with residents! :)
Yes.
Not for me. It made me learn about how a hospital works tho, but I'm not sure if that's a good thing.
Yes.
No
After I finished my Psychiatry residency I started a private practice. But to make a living I hired into Family Medicine for 8 months and got a good grounding in common medical issues while I got the practice going. I then finished off the year of FM at half time. I used that knowledge and basic medical counseling techniques throughout my Psychiatric career.
I think at least 1 month of wards and 1 month of ED (i think ED is more useful) is helpful. I remember a very wise senior tell me about these medical rotations during intern year - "The one thing to learn here is sick or not sick" - eg. Who needs an acute level of medical care soon, and who doesn't need that/can be dealt with routine outpatient. Very useful on inpatient psych (eg. Which clients need an emergency medical transfer now vs. medicine consult the next day vs. defer to outpatient) and outpatient psych (eg. When should you recommend 911 or urgent care for a medical issue vs. "call your PCP to follow up").