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Don't think this has been done for several years now, not sure, and there's been an uptick in medical student interest in the field. Anybody out there?
Why all the sudden interest in putting old people on depakote? Is there new literature? How do you treat delusional parasitosis in an ED setting when you can't admit to psych and can't get someone rapidly into derm? Are you prescribing naltrexone for masturbation addiction? What exactly makes IM thorazine better for people who have inadequate releif of agitation with droperidol? It seems like there's been an uptick in what I deem to be subclinical thc induced psychosis with the legally available high test concentrates, has this been described? Have you ever seen an old lady who's been on high dose benzos their whole life, and they just have this chronic high level of anxiety and fear and incapablity to deal with change even if they have a therapeutic amount of benzos on board? What do you call that?
What other specialties were you considering in med school? If you had to choose something else, what would it be?Don't think this has been done for several years now, not sure, and there's been an uptick in medical student interest in the field. Anybody out there?
What other specialties were you considering in med school? If you had to choose something else, what would it be?
How many of your peers would you consider introverted versus extroverted?
What do you mean exactly?Do you every take primary on surgery patients with really bad delirium? Like..really bad
How has the more recent emphasis on mental health changed residency (competition, interprofessional or scope challenges with PsyD/similar, reimbursements and work load)? Especially post pandemic.
Speaking from my general experience, psychiatry programs first do look at all of the basics, including performance/ranking in medical school, performance on Step 2, extracurricular activities/research, writing skill as evidenced by personal statement, and letters of recommendation a certain number of which really ought to be from psychiatrists (specifics probably vary by program). Interviews are the next step. Interviews are very important. Psychiatry programs place a great emphasis on interest in and dedication to psychiatry. This can be demonstrated in a number of ways during the interviews, like memorable patient cases, how an applicant speaks about psychiatry generally, etc. We also may be quite attuned to quirks in communication, personality factors, and verbal communication abilities, all of which may affect a person's potential as a psychiatrist. Each interview would rate who they interview, in any number of ways, and report back to the PD who ultimately will create a final rank list. Often, applicants are discussed in an open forum committee meeting, as well, after interviews. The process, of course, will vary by program. But that is a general outline. If there are elements of an application that hint at a lack of genuine interest in the field, it may become a negative. If anything like this is glaring, like only having dermatology research all through medical school, applicants ought to bring it up.any insight into how your program/other psych programs rank applicants?
1) The competitiveness of applying to psychiatry residency has definitely increased. I have friends from a few years ago with incredible applications and great personalities who matched way down on their rank lists. Twenty years ago, 260+ Step scores, numerous publications, etc, would probably match higher on rank order. Don't have numbers to back it up--just personal experience seeing friends and acquaintances match here or there over the years. And where I am, the number of psychiatry applicants from our medical school has skyrocketed from about 4-6 per class to as many as 17, which has been surprising but also delightful.How has the more recent emphasis on mental health changed residency (competition, interprofessional or scope challenges with PsyD/similar, reimbursements and work load)? Especially post pandemic.
The core skills learned during clinical rotations in medical school are also very important for psychiatry, so always focus on those.Currently a 3rd year student that will be applying psychiatry this upcoming cycle.
Is there a specific, reasonable, skill-set(s) that you wish you could’ve started honing in on earlier as a medical student on clinical rotations that would’ve set you up for success as a psychiatry resident?
Delirium should not be given to psych as primary. There's an underlying medical issue causing the delirium. Treat that, and give haldol if needed for agitationDo you every take primary on surgery patients with really bad delirium? Like..really bad
I can now infer what was meant by the original question. Yes, delirium is medical 99.99% of the time. There are ultra-rare psychiatric, albeit heterogeneous, versions of delirium (malignant catatonia, delirious mania), but these often require medical care, as well. If delirium is causing agitation that poses an immediate safety risk or interferes with medical care, then treatment with Haldol the specifics of which vary by case. If it is hypoactive delirium, treating with Haldol can prolong delirium and worsen delirium. If too much sedative is given to a hyperactively delirious patient, they may convert to hypoactive delirium, which has a worse prognosis. Our idea now is that there is no psychopharmacologic treatment for delirium, per se, so other factors ought to be addressed, first being treating the underlying medical condition and/or searching for as yet to be discovered medical causes.Delirium should not be given to psych as primary. There's an underlying medical issue causing the delirium. Treat that, and give haldol if needed for agitation
Can't speak to how it's impacted residency since I graduated in 2019 before the pandemic. But man for sure the pandemic and the rise of social media has everyone and their dog/mother thinking they're autistic and have adhd because they watched a tik tok video that they identify withHow has the more recent emphasis on mental health changed residency (competition, interprofessional or scope challenges with PsyD/similar, reimbursements and work load)? Especially post pandemic.
I didn't get to child psychiatry in my response. But yes, it's so out of control. At one point, our child unit was filled with preteens convinced they had Tourette syndrome and homicidal command verbal hallucinations.Can't speak to how it's impacted residency since I graduated in 2019 before the pandemic. But man for sure the pandemic and the rise of social media has everyone and their dog/mother thinking they're autistic and have adhd because they watched a tik tok video that they identify with
It’s for sure out of control. The number of people who self diagnose “neurodivergent” and think they’re autistic is astounding. Huge increase since I completed residency in 2019. I was military for 4 years after and just finished my commitment this last summer and started full civ practice (which I love). But multiple patients a day think they have adhd because they “can’t focus” but were straight A students with zero impairment all the way through their 3rd master’s program but suddenly had “adult adhd”.I didn't get to child psychiatry in my response. But yes, it's so out of control. At one point, our child unit was filled with preteens convinced they had Tourette syndrome and homicidal command verbal hallucinations.
Edit: Even worse if they saw an unknowledgeable NP. I saw one 14 year old who was already on max dose Zyprexa, Lexapro, and Klonopin through an NP.
Agree with this 100%. I typically start with new patients by opening with a welcome and then giving them the floor to just tell me what’s going on. Sometimes it’s brief and then I start asking more clarifying questions, sometimes they talk for a while. Either way I feel like this gives them the chance to express their concerns while also letting them know I’m listening. So far it’s been a pretty successful approach to making patients feel more comfortable so I can ask later some more personal questions regarding things like past trauma and suicidal thoughts. Typically don’t push too much with traumatic experiences on the first visit but can go more into later. I do vast majority med management and not so much therapy though so this may be a different approach from others who plan to engage in more therapy in subsequent appointments.The core skills learned during clinical rotations in medical school are also very important for psychiatry, so always focus on those.
THE important psychiatry-specific skill is the psychiatric interview. In a way it is like other specialties, but mostly not. Get as much experience doing that as possible. Ideally, the psychiatric interview can be conducted as a friendly, supportive conversation during which the patient is put at ease, the therapeutic alliance is created, and all of the pertinent information is collected. The key components are HPI, psychiatric review of symptoms, psych history, social history, substance history, family history, medical history, mental state exam, impression and plan. Knowing the psychiatry-specific things that go in each of these sections should be mastered but will be a work in progress for years. Innumerable resources exist. Briefly, HPI as the patient story about recent events, psych review of symptoms covering present and past symptoms of the major symptom domains (depression, mania, psychosis, anxiety, suicidality, aggressive/violence), psychiatric history as a narrative of the patient experience/engagement with psychiatric treatment (first hospitalization, number of hospitalizations, medications tried and effectiveness vs adverse effects, any suicide history, etc), and so forth. If you can get through all of those, even if only basically, and in a timely manner (20-30 minutes), while establishing a therapeutic alliance with the patient, you will be functioning at a level above many psychiatry interns at the start of residency. Invariably, medical students start off well but then freeze after five minutes. Let the patient speak for a bit and then gather the histories! Ask permission to inquire about sensitive topics. Be open-ended and inquisitive. Ask about suicidal/homicidal thoughts, don't be shy. Have a calm and reassuring demeanor. I can go on and on...
Best of luck to you during the application process!
The more perspectives, the better. Thanks for all your input. It's been a nice thread so far.Sorry I didn’t mean to derail the thread from asking a resident (since I’m not a resident lol), just wanted to provide some post residency perspective as well. Carry on and your responses are spot on to the questions above.
2) I have not run into scope of practice issues directly during residency (at least not face to face). However, the number of psychiatric NPs has seemingly ballooned. There hasn't been a notable effect in patient volumes on our end, but we do see many, many patients in the emergency room, inpatient unit, med/surg hospital, and outpatient clinic who present in the context of sometimes severe mismanagement as the result of seeing a nurse practitioner. Some NPs are fantastic, others are reprehensible knowingly or not. The PNP degree is low hanging fruit. Everyone wants to do it now.
I have worked with a couple of really good NP’s that recognized they didn’t go to med school and would frequently consult me and another psychiatrist on things. But unfortunately there are quite a few out there that fit this description very well. I’ve inherited some patients from NP’s and I’m wondering wth they were doing with patients.While I haven't experience NP competition, as mentioned above, it's a pain to deal with NPs' former outpatients who were inappropriately prescribed and/or inappropriately diagnosed.
From the inpatient side, there is pressure from The Man to manage their NPs, as NPs are proxies for admin. They cost less and do whatever the hospital tells them. As a rule, NPs behave like nurses, meaning they don't adhere to the medical model. In addition to knowledge deficits (i.e., when I was a MS-3, I could read a NP's psych plan and tell they didn't know wtf they were doing), NPs respond to gentle teaching and recommendations like insults to their character and get passive aggressive. Whereas med students and residents crave feedback because they want to BE good doctors, not someone who PLAYS doctor 9-5 and passes the buck to a doctor. It's usually pointless to correct NPs unless you personally employ them (which is how it was meant to be).
In general, hospital gigs that utilize psychiatrists only, or use NPs in limited roles such as overnight call, are preferable to hospitals that have lots of NPs.