Monthly Archives: July 2014

Post-Psychiatry Rotation Update: On Studying and the Shelf

4 weeks is not a lot of time to study for a shelf exam.  I had been told by my classmates who’d gone through the rotation before that I would have “so much time” to study and would often leave the psych hospital early.  I don’t know what they meant by “early,” but I was definitely leaving around 5pm most of the time and not getting much downtime to study during the day.  This might have been due to the fact that I was a bit slow at writing my notes, or because I the team frequently “put me to work” calling patients or doing other things, or because I always tried to see my patients one-on-one at some point after rounds; honestly, I have no clue.

Thankfully, much of the teaching we received from the house-staff on this rotation was both applicable to our clinical experience and fair game for the test.  We were also given access to multiple online resources such as past lectures from faculty members and clinical skills modules developed specifically for third-year medical students who may or may not see specific diagnoses on their rotations in psych at various institutions.  I feel that the informal lectures and these resources helped us make the best of limited time.

In addition to all of this, I did a bit of studying on my own; I again had grandiose plans of finishing multiple books and doing tons of questions, but I wasn’t as stressed about not getting everything done this time.  I’ve also sort of resigned myself to “not being social until 2015” when my clerkships are over, with the occasional exception–brunch with a few friends today after church, for example–and because of this I’ve been less frustrated about what the rest of my classmates seem to be able to do with their time.  I’m still trying to figure out how to stay on track with my studies while still getting enough sleep to be functional, but I’m trying to walk the line between “figuring it out” and “worrying about it”; I learned in one of my study resources (confirmed, really) that worrying about one’s sleep schedule can contribute to poor sleep.

In any case, here are the books I used or intended to use.  all of them were a bit older, so they still referred to the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which was updated again last year.  However, this wasn’t much of a problem, as there are resources online that tell you what the important changes were between editions.

  • First Aid for Psych: this book was a lot shorter than others in the FA series, but it still took me forever to get through it.  It was a good resource, though.  Bullet point form seems to work well for me.
  • Blueprints for Psych: started this one right after finishing FA.  Got to about chapter 3.  In general, I find the Blueprints series useful, but it seems to take me ages to get through, even though I’ve only completed one book in the series (Peds).  I’m already a slow reader, and prone to sleeping while trying to study, and the prose format just makes things worse.
  • Casefiles for Psych: planned to do it because I liked the Surgery and Peds books in the series…didn’t have time to even crack this one open, though.
  • UWorld QBank: there are only 150 psych questions on UWorld.  I went through them all once and did the incorrect ones after that.
  • Pretest for Psych: I started this 1 or 2 days before the test.  Didn’t get very far because I was still trying to finish the resources provided by the clerkship director, and by that point I also was super distracted and not studying efficiently.
  • Lange Q&A for Psych: heard people liked this book because the questions are quite difficult…but I didn’t have time to see for myself.

I have no idea when I’ll get word back about how I did in this rotation; they did give us mid-rotation feedback, which was fairly positive, but that’s all I have to go on for now.  I haven’t even heard back about Peds yet, so I know it might be a while for this rotation too.

I start my 4-week Neurology rotation tomorrow.  I’m a little nervous about it, because I feel like I don’t have any background in the subject; the “Brain and Behavior” class we took before starting clerkships was difficult for me.  I guess we’ll see what happens!

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Post-Psychiatry Rotation Update: Weeks 1-4

I’m officially halfway done with clinical clerkships! Just took my shelf exam for psychiatry. I thoroughly enjoyed this rotation, from the patient encounters to the cafeteria food.  I was only in psych for 4 weeks, on one of the adult Psychosis treatment teams.  The time flew by. I didn’t see much acute psychosis this month though–actually, I saw quite a few other cases involving mood disorders, drug abuse, and personality disorders.

Our treatment team consisted of an attending physician, a second-year resident, 2 interns, a social worker, a pharmacist, and a pharmacy student.  We rounded in the mornings, asking each patient about their mood, sleep quality, activity during the previous day, etc., and updating them on the current plan.   We also had a separate meeting every morning in which we discussed treatment and discharge planning for our patients.  It was a fantastic opportunity to see interdisciplinary care at work, something that I had not had much exposure to on other rotations thus far.

The timing of this rotation was interesting as well; the five of us medical students (an unusually small group, as the rotation usually sees 12 or more students at a time) started at the same time as the newest interns. For the first few days, we actually taught them some things about how to navigate the electronic medical record and remote access to the clinical workstation. They–as well as the other residents–were always open to teach us about various aspects of psychiatry that would be useful for day-to-day application on the wards and for the shelf exam.

Each of us was exposed to a number of different parts of life at the psych hospital and beyond it.  We participated in morning report, in which we met with the residents, attending physicians, and other staff members and helped report on patients who were admitted the day before and also did presentations for the rest of the residents on topics given to us by the chief resident.  We each attended an AA or NA meeting off-campus to learn about the rich community that is available for people who have abused substances in the past. Some of us were able to see the court proceedings that determine whether a patient who was involuntarily admitted to the hospital should be required to remain there.  I had an afternoon each of addictions clinic and psychosis clinic, where I received a brief glimpse of outpatient psychiatry and how psychiatrists interact with patients that aren’t acutely ill.

In addition to our other requirements, we were each required to be on call from 5-9pm for three nights of the rotation.  I can’t speak for my classmates, but I learned quite a bit from this experience.  I helped admit patients with various complaints and got to accompany the on-call interns and the senior resident for cross-cover issues.  One I will never forget involved one of the interns and I “talking down” a patient on the addictions unit who had become stressed and was experiencing cravings; we talked to him about what happened and led him through a deep breathing exercise, and he told us that he felt better afterward–in fact, every time I was on the unit after that, he always smiled and waved at me and thanked us for helping him.

We also witnessed ECT, or electroconvulsive therapy.   It is used in a number of patient populations, including those with severe, medication-resistant depression.  The patient is anesthetized, electrodes are placed on the head, and then an electric current is administered that induces a seizure.  The patients usually see improvement in their psychiatric conditions after multiple sessions and continued maintenance; sometimes they don’t realize that they are getting better, even if others see a difference.

One thing I loved about the people I worked with on psych (and peds too, come to think of it) is the amount of feedback that I received, almost on a daily basis.  Members of the team frequently told me when they thought I did a good job with a particular patient, thanked me when I found out useful information from family members, and suggested ways I could improve upon my progress notes or my style of interviewing patients during morning rounds or admissions.  A common comment from the people I worked with is that patients seemed to be able to relate to me.  Many of the patients even had feedback for me.  One patient commented to the team on morning rounds that she felt I had listened to her and really helped her throughout her hospital stay.   On my last day at the hospital, a patient who has been struggling with fairly severe depression encouraged me to never stop smiling.

All told, I miss this rotation already.  I hope that all of the patients I followed over the 4 weeks are able to overcome or manage whatever they were admitted to the hospital for.  I want to check up on them via the EMR to see how they’re doing every now and then, but I don’t think I will have access to the psych records in the long-term.  For now, I’ll miss them, and they’re in my thoughts.