Psychiatry

Updated June 2014. Because of your M2 class in psychopathology, you will be well prepared for this clerkship in M2, making this Shelf much easier. In the past, people who do psychiatry first found their first shelf to be much easier than their colleagues in other clerkships. You will encounter a fair number of questions that have “medicine” answers (I had one on mine which the patient was delirious because she was hyponatremic and the answer was clearly give saline). In general, if there is a laboratory abnormality, the answer is likely something medical. Students taking psychiatry first might find the exam “medicine-y” while more advanced students will not. This rotation has a reputation of being less academically demanding, but can be extremely rewarding.

The clerkship is organized in two blocks, A and B; you will rotate with a different preceptor for each. You will receive a little form by e-mail about a month in advance that requests you to rank your sites (Carle, Provena, Pavilion, and VA) and specialties (Adult Inpatient, Child Inpatient, Addiction, Consultation-Liason, In-Home Counseling) in order of preference. Your preferences will be used by the clerkship director to assign you to preceptors. Just because you're assigned to one site, however, doesn't mean that you'll have no interaction with other sites; most people assigned to Pavilion will see outpatient clinic at Carle on Kirby, and rarely, a consult at Carle Foundation. This also means that even if you're on Child Inpatient, you'll still see some adults in outpatient clinic. Addiction psych is reportedly just adult psych with a bit of a spin.

One new thing to come down the pike from Chicago are the "Mini-CEX" evaluation instruments, which are just a 1-4 ranking in a few competency areas (professionalism, MSE, etc) that are to be filled out by your preceptor after observing you talk with a patient. You'll need to have four of these completed by the end of the clerkship. At the moment, they mean precisely nothing to your grade; however, if your preceptor marks you poorly, be certain to ask them why - if you don't fix whatever problem there is, there's nothing stopping them from doing the same thing on your real evaluation. You will receive two evaluations, one from each preceptor. If they aren't congruent, your performance on the oral exam will determine if your grade will be based on the higher evaluation or if the two will just be averaged. The oral exam is interviewing a patient and coming up with an assessment and plan. The examiners will ask you to clarify certain aspects of your plan, ask some tangential questions about theory, but it's pretty much painless.

If you haven't heard this already, bring your enthusiasm and engagement A-game. Nobody expects you to act like a 3rd-year psychiatry resident, or profess a deep desire to go into the field, but everyone will be very quick to recognize a student just going through the motions. The most efficient way to ensure getting hammered on your evaluations is to disrespect the discipline, the staff, the patients, or anything else. Be proactive about pursuing experiences; if you've never seen ECT, Dr. Roberts and Dr. Su are the only game in town, and Dr. Roberts does the most. Even if you're not on his service, you can still ask to observe. If you've never been on a consult, ask to go on one if your preceptor takes them. Be engaged and ask pertinent questions (when not with a patient, of course).

Go in expecting to work, and you'll find it a rewarding and non-stressful clerkship.

Note (2012, but still true in 2014): most of the lectures in psych are NOT very informative. The only good ones are Dr. Hawley's lectures (very structured, medications focused) and perhaps Dr.Welch's (unstructured and too long but shares practical tips). Bring some flashcards or print out questions if you are someone who can't stand slow-paced therapy sessions that takes 2 hrs and go no-where.