Neurology rotation

[Tangerine123]

Hi there,

Psych resident outside the US. One of the residency requirements is to do a 1 year neurology rotation. My hospital provides the following possibilities

1. General inpatient neurology

Pros: Good mix of patients. Top tier research center
Cons: Apparently psych residents get sometimes assigned to a smaller general inpatient unit with no other residents. Just you and the attending. (Not sure if this is a con, might give you more independence)

1. Stroke unit (ER/ICU)

Pros: Psych residents don't do night shifts. 20 minutes away from were I live with public transportation.
Cons: I'm already burned out just thinking about it.

1. Trauma/Neuro/PM&R rehab clinic

Pros: Apparently chill rotation. Let's you work somewhat independently. It's in a nice quaint village.
Cons: It's 1:30hours away from home (I would comute daily with the train). Colleges have said that it's more IM than neurology (not sure if this is a con).

What would make more sense to choose?

My goal is to eventually establish an outpatient practice. The IM component made me consider the rehab clinic at first, but It's extremely unusual here for psychiatrists to prescribe or modify non-psych related treatments. I'm now leaning more towards general inpatient neurology.

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[Bartelby]

I vote general inpatient neurology. Good broad based exposure is helpful, and we don’t get a ton of neurology in our training.

 

[tr]

Second for general inpatient neuro. Stroke won't be very useful for psychiatry.
PM&R/IM could be useful too but not worth 3h/day on the train for a year (!). Ugh.

 

[Celexa]

Agree not stroke. So incredibly boring, high acuity and stress mixed with the absurd (I don't know how any neuro resident gets through a week without smashing the stroke pager in rage), least useful for psych.

A lowlight of my neuro rotations was when a stroke alert went out for a guy who reported a day of numbness in his pinky finger.

 

[annoyedpsychiatrist]

first one sounds nice. I am genuinely surprised with the complex neurology cases ive been seeing. I have patients with extremely rare neuro disorders that i never thought id encounter. I recently had a patient who passed away from suspected Creutzfeldt-Jakob disease. It can be useful to get exposure in neurology thats for sure. Especially movement disorders.

 

[clozareal]

Inpatient neuro > PM&R rehab > stroke

 

[Asklepian]

Dual-boarded neurologist/psychiatrist here. I would echo the intuition of the others here: Inpatient neuro is likely the best bang for your buck.

I disagree with the poster who said that stroke is boring. It's actually incredibly interesting when you learn neuroanatomy and some of the clinical syndromes that result from stroke, and there is a lot of overlap with psych (high post-stroke rates of Depression/OSA, e.g.).

 

[comp1]

Stay the heck away from stroke. It's quite removed from what you deal with in psychiatry RELATIVELY. Yes, people with stroke tend to have depression. It also tends to be managed by their PCP's. The purpose of the neurology rotation is to help you see things that might be in psychiatry's domain, but end up not being. There is more clarity with stroke than other neurologic conditions, particularly once the stroke has been diagnosed as they would be if you were rotating on the unit. You want to be seeing things like Marchiafava Bignami syndrome, NMDA receptor encephalitis and temporal lobe epilepsy.

 

[Candidate2017]

I disagree with the poster who said that stroke is boring. It's actually incredibly interesting when you learn neuroanatomy

I dare say very few budding psychiatrists enjoy playing "Where da lesion at?" or holding the stroke pager. A year long stroke rotation combines both. For a year.

 

[Celexa]

I dare say very few budding psychiatrists enjoy playing "Where da lesion at?" or holding the stroke pager. A year long stroke rotation combines both. For a year.

OP said ED and ICU so you can possibly toss managing intubated patients with devastating neurological injury on top of what you already said.

Ugh come to think of it my three days in the neuro icu in medical school also ranked real high up there in worst memories of medical training. Nothing like torturing an almost-corpse on the daily to see if today they groan in pain and might live long enough to get trach'd and peg'd and sent on a one way trip to the one nursing facility who takes long term vents!

 

[Tangerine123]

Thanks for the responses! So I will definitely go for general inpatient neurology.

The general neurology inpatient unit takes 2 psych residents per year. Some others that applied have priority over me, so I should get a spot in early 2025. This falls really good into my residency time frame.

Just wanted to share a pic of the village were the rehab clinic is. Some colleagues actually find a place there to rent. But I'm in a relationship, and we both will work weekends now and then, making it hard for us to see eachother for a year. That's a no-go for me, hence why I was willing to commute daily.

 

[PsyDr]

Oh no, I just hit my head, and lost my ability to communicate in German! I'll need TBI rehabilitation in that place.