PA-Port 1

PA-Port 2

PA-Port 3

Psychiatry was my fourth rotation during my clinical year. Similar to our other rotations, we had one mid-site evaluation, and one final site evaluation. Prior to meeting with our site evaluator, we were given instructions on what material to bring and how to prepare it. Although we were tasked with submitting the same usual documents, there were extra factors that we had to keep in mind. For example, our drug cards required an article demonstrating the evidence of efficacy of each drug. Although I was initially a overwhelmed with having to find ten articles, I believe that it helped me develop a deeper understanding for how these drugs work, which allowed me to determine what interventions were better for different psychiatric conditions. Another difference between the psychiatry site evaluations and our other site evaluations is that for our H&Ps, our mental status exam replaced our physical exam. For our first site evaluation, we met with our site evaluator in person. We went in alphabetical order (based on last name) answering questions about our cases and helping each other with questions that were more difficult. We did not necessarily present the case to one another but I believe this method of evaluation is more effective for learning. We basically had an hour-long conversation about our patients and I enjoyed interacting with my classmates in this way as opposed to the usual monotonous reading 5-6 pages worth of an H&P.

For our final site evaluation, the structure was similar but we convened over zoom. We were allowed to submit any journal article of our liking so long as it was within the realm of psychiatry and behavioral health. Usually, we have to submit an article pertaining to one of our H&Ps. Because our site evaluator asked us questions pertaining to our case, I made sure to know my case inside and out so that I would be prepared to answer any questions that came my way. I made sure to review my differentials, medications, and assessment/plan extensively. I think it made a big difference compared to my first evaluation because I was more confident answering questions and I had a better idea of what to focus on for the final evaluation.

My rotation in psychiatry is one of the best experiences I’ve had during my clinical year. I was given the opportunity to work closely with my preceptor, multiple residents, and developed unique relationships with the patients I met in the inpatient unit.  In complete honesty, I wasn’t looking forward to this rotation because psychiatry did not interest me; it felt like a specialty I would never consider. After these five weeks, however, I am considering inpatient psychiatry as a field to practice in.  A typical day during this rotation consisted of me arriving early and following my assigned resident while they rounded on their patients. During my first week, I observed and took notes on the different interview techniques they implemented. Because I needed to conduct some interviews for my procedure log, I wanted to understand which questions were pertinent and why. I was initially worried about interviewing patients because, typically, there is an order in which questions must be asked. If the conversation deviated (and it always did), the interviewer was responsible for redirecting the patient. This was something that I felt required a certain level of skill that I was not yet confident in. Once rounds ended, I talked with my resident about the patient, about questions that were asked, and went over differential diagnosis. This method of teaching was extremely conducive to my learning, and I feel like I have a very strong foundation in inpatient psychiatric conditions because residents were able to dedicate time to answering any questions I had. By the second week, I was able to ask questions during interviews, translate during interviews, and eventually conducted entire interviews by myself.

Patients that were difficult to deal with were those that were acutely psychotic or manic, especially if they were aggressive or sexually preoccupied. These were patients I usually observed from a distance with multiple members of the treatment team. The most important thing I learned about dealing with these patients is to ensure that they are not blocking the entrance to the door, and to never approach them alone while they are experiencing psychosis or mania. Once these patients were medicated, they were more agreeable and conducting interviews was easier. One patient in particular who was labile and aggressive upon admission, became more linear, calm, and able to interact with his peers with appropriate intervention. We were able to converse about jobs he had in his youth and his family by the time I left, and I was extremely proud of his progress. This is a patient that I am certain will stick with me for the remainder of my career. Overall, I believe this rotation helped me understand patients better. Sometimes when patients present with unusual behavior, they may have underlying issues such as psychiatric conditions, personal life challenges, or other factors entirely. I think this perspective is necessary to provide the best possible care, and I am grateful to the team I worked with for providing this perspective that I will carry with me not only during my future rotations, but for the rest of my career.