Medical School Rotation: Psychiatry Clerkship

source- northcoastjournal

What I liked
- Getting to see first hand a patient in a manic, or psychotic, or severely depressed state. As students we read how these cases would present themselves, but experiencing it in real life takes it to another level.
- Having the full role of an intern (we worked directly with attendings, no residents at this site). We would round on our patients in the morning, write progress notes and/or full psychiatric evaluations, and then present to the psychiatrist. She would encourage us to create our own treatment plan with drug dosages and all, which was challenging but a great learning experience.
- Since this is psychiatry, we get to spend a lot of time with patients learning about their life and challenges they've faced (and sometimes continue to face).
- Since this was an inpatient unit, I got to see VERY ILL patients directly from the ER. A few experiences that continue to stick out were 2 schizophrenic patients with severe auditory hallucinations, a bipolar patient with active psychosis, and pt in severe major depressive episode with no response to medication (she was schedule for ECT after my last day on the clerkship). I'm telling you guys, I was so lucky to end up at this site.
- Age and class status do not protect you from 'disease of the brain'. There continues to be this notion that being mentally ill is your fault, and you can think it away. IT IS NOT. I wish some of the more ignorant members of society could get to see what I did.
- I was at a hospital site that really enforced appropriate follow-up care. Okay, so what? Doesn't every medical institute do that? Not exactly. We were right in the middle of Chicago, and many admissions were of homeless men and women. The sad reality of poverty due to mental illness was ever present on the unit, and it was a mad cycle that fed itself. However, there was an amazing team of social workers that found shelters and doctors for their patients, and it allowed me to have a small glimmer of hope for their future.
- Psychiatrists are pretty awesome, chill, and have a good sense of humor. I liked that. Everyone was funny, including the staff!
- I had the opportunity to also see a child psych session, as well as an eating disorder management appointment. Both very eye-opening and something I would've loved to see more of.
- My attending had a meme wall about psychiatry. ITWASAWESOME.
- [Just an aside, I got to be at my apartment for this clerkship, walk to work, and see my roomies everyday! #winning]
- Also.....Psychiatry is totally my jam.

writing progress notes @ the hospital - pretty scarves - an afterwork snack & studying - quirky kids books

What I disliked
- Seeing a patient readmitted only a few weeks after his last discharge; it feels like you've 'failed' the patient, although there's no way to force someone into outpatient substance abuse treatment. Substance abuse is a difficult road to recovery.
- The full reality of mental health within the sphere of society and healthcare. As I mentioned before, there was a strong link between being mentally ill and being in poverty. A lot of these patients did not have access to appropriate medical experts when they first experienced pscyhotic/manic breaks, and they lived this self-destructive life that could have been less overwhelming if they had the right medication & psychiatrists to help them along.

Tips for studying 
Start UWorld early - I finished it in two weeks and had all of my notes written by the third week.
Lange Q&A for Psychiatry - completed one pass, and reviewed a few chapters I was weak on.
Psychiatry section of First Aid for Step 2 - I made little index cards off of this chapter (the first two weeks) and kept them in my pocket throughout the rotation to help me out.
Pocket Psychiatry book (from my medical school's bookstore; I cannot find it online!) - great resource to use while rotating.
UpToDate & AccessMedicine - I used these two sources for my presentations and pre-reading for other student's lunch presentations. Great information!
Notebook - Again, I carried around a notebook with me to track my patients, take notes, and do a little something different. I've started adding in commonly used medications for each rotation, and in this book I pasted in charts of pscyh meds + dosages + sideffects. You can find these charts on AccessMedicine if you look under Tables for Current Diagnosis Psychiatry and some of their Pharmacology textbooks.

My First Aid for Step 2 index cards, plus my BF's annotated Lange. I have a sheet to write notes on concepts not covered in UWorld or FA but may show up on the NBME.

Shelf exam tips
UWorld - reviewed my notes 2 times before the exam, and redid my incorrect questions. (Almost 2 passes)
Lange - reviewed my weak chapters after finishing all the Q's (Almost 2 passes)
Plussss, all the studying I did above throughout the clerkship.

Studying in bed before sleepy time!

That's it for now. Hopefully I will have my family medicine rotation in review post up much earlier! I'm crossing my fingers they will update my grade quickly this time around.

Cheers,
Chantelle