Category Archive: Psychiatry

Best Books and Resources for the Psychiatry Rotation

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Third Year, Psychiatry, Psychiatry Rotation

July 13, 2015

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This post is part of our series on the best books and resources to help you perform well on your third year rotations and shelf exams. Also check out our lists for clerkships in Internal Medicine, Family Medicine, OB/GYN, General Surgery, Neurology, Psychiatry, Pediatrics, and Emergency Medicine. You can also check out our complete list of "Best Books" lists for medical students here. 

Background: Clerkship Grades

At the beginning of each of these clerkship lists there are a few things I must say. First, your grade on clinical rotations will depend on both your clinical performance and your performance on a shelf exam at the end of the rotation. While it is true that how you work with your teams and patients will play into your evaluation, there is no denying that your knowledge of the subject matter is, by far, the most important part of your final grade because it directly affects both of these two areas of evaluation. As a resident, I currently find myself filling out medical student evaluations every week. There are very few 'incredible' medical students and very few 'terrible' medical students. The vast majority of you (~95%) fit into the "good and easy to work with" group; the only thing you have to set you apart from others is your knowledge base. You have no alternative but to study! First Aid for the Wards is a great resource to understand the dynamics of your clinical rotations, I highly recommend it.

Essential Resources

The resources I will describe in the clerkship lists are books and online question banks. From the onset let me point out two indespesible resources that I will not list for each rotation individually.

  • First, I consider a great online question bank essential. Both Kaplan and USMLE World are very good products. I highly recommend purchasing a one year subscription to one of these USMLE Step 2 question banks. As you complete your third year rotations, these question banks will prepare you for 1- your clinical duties, 2- your rotation shelf exam, and 3- the USMLE Step 2 during your fourth year.  
  • Second, online review materials (e.g. Medscape, UpToDate, etc.) are essential resources to prepare for your patients in the hospital. The books and question banks can never provide the type of in-depth detail about disease processes that you will need to learn how to properly take care of your specific patients. To be a great medical student, you must prepare more profoundly for the diseases you are encountering personally in the hospital.

Book Series for Third Year

Medical students are not all made the same; we are all very different learners. There are a number of companies producing review materials for third year medical students, each with a slightly different focus. Each of these companies produce a different book for each clerkship. Interestingly, some companies' books are rated higher in some clerkships than others. If you find a product that works for you, consider sticking with it during your third year even if that product is not 'rated' as highly for a specific clerkship. Below are a few of the review products and their features.

  1. The Case Files Series: A unique teaching model; the Case Files series introduces a number of important clinical cases and follows them up with clinical pearls and important concepts. For students who need vivid clinical situations to remember factoids and concepts, this is a great series. (Case Files Psychiatry)
  2. The PreTest Series: The PreTest series is a classic question bank format with questions and detailed explanations. As I previously mentioned, I believe there is no substitute for a great question bank. While an online resource (USMLE World or Kaplan) can be more robust and mobile, a good question book is still a great option. The PreTest series produces a couple fantastic question banks. (PreTest Psychiatry).
  3. The BluePrints Series: The BluePrints series has a beautiful format that is very easy to read. The text is laid out in a bulleted lists, but with more details and descriptions than the First Aid series with which most students are familiar. I think very highly of these review books. (Blueprints Psychiatry).
  4. First Aid Clerkship Series: The First Aid series well known to most students also produces review books for third year clerkships. The content is similar to what students are used to, bulleted lists of high yield information. While I highly recommend many of the First Aid review books for USMLE Step preparation, the books are not quite as widely read and recommended for clerkships. (First Aid Psychiatry).

Best Books for Psychiatry Rotation

So, we can agree that books are not sufficient for success on your clerkships, but they are still an incredible resource that you should tap into. Let's review the best books and resources for your Psychiatry rotation. These lists come from both my experience and also from one medical school's annual survey of its 250 graduating medical students who try to detail which resources were the most useful on their rotations.

Psychiatry is one of the very unique clinical clerkships that you will encounter during medical school. There is little overlap of the material you will need to know in psychiatry with the rest of your clinical rotations. The good news is that the material you must master for your psychiatry clerkship is not intellectually demanding. The truth is, the material you need to impress on rounds and on the shelf exam are simple lists of diseases, drugs, and side effects. You must master the psychiatric diagnosis and you must know how the differ from each other, even though the differences are very subtle. You must also master the side effects of the psychotropic medications, this is very high yield information. Luckily, all of this material is easily packed into a single review book.

 

1. First Aid for the Psychiatry Clerkship:

This is, by far, the best volume in the First Aid Clerkship series. First Aid for Psychiatry is truly fantastic. This is my own personal belief and the believe of nearly all medical students, as the book tops all my lists. The bullet-list format of First Aid is perfect for the bullett-list information you need to learn about psychiatry. Rather than reading a second book, I actually read through this book two times and this was my best shelf.  


 

2. Case Files Psychiatry:

Many students belive Case Files Psychiatry is a great book and can be a great companion to the First Aid text. However, nearly all students agree that it should not take the place of the First Aid text. 

3. Lange Q&A Psychiatry:

Both Kaplan and USMLE World have great questions for psychiatry. If you are looking for great questions in print format, the Lange text is a great choice. This book has a wide variety of great questions and is very highly rated by students.


 

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Spotlight Interview: Matching in Psychiatry

Categories:

Choosing a Specialty, How to match in....?, Psychiatry, Psychiatry Rotation, The Match

May 31, 2012

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 A Psychiatry Resident’s Perspective:  From an interview with Dr. Frazier a psychiatry resident at UC Irvine Medical Center in Irvine, California

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • How competitive is the psychiatry match?

Overall, it is not a very competitive specialty.

 

  •  What must a student do to match well in psychiatry?

Mainly, you must show interest in the field. Let people know you’re interested when you’re in your rotation. Doing some research also helps you know if you like the field. Research may also help to get a good letter from someone at your university.

 

  • What are residencies looking for in a psychiatry applicant?
Solid letters of recommendation, a good personality (more important here than in many other specialties), to a lesser extent good board scores (not as important, but they will definitely help you!)

 

  • What should students look for in a psychiatry residency?

Look for a program that trains physicians in what you want to do. Are you interested in research? Choose a program that supports that. Are you interested in clinical work? Choose one that focuses more on that. Also, make sure you get along with the residents. I recommend an away rotation to your top school(s) if you can.

 

  • Do you have any advice on the application, letters of recommendation, personal statements, or how to rank programs?

Identify your letter writers early on. A few from psychiatry, one from medicine, one from family medicine or something else. For ranking, just choose the place that you want the most. Don’t try to game the system!

 

  • What do you wish you knew before application/interview season?  

Interviews are generally very laid back. Still prepare, but don’t stress them too much. Have a few questions for the interviewers.

 

  • What other advice do you have for students applying to psychiatry residency?

Again, identify letter writers early. They mean a lot for residency in general, but maybe even more for psychiatry. Other than that, enjoy your career!

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the Match, The Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

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Spotlight Interview: Why did you choose psychiatry?

Categories:

Choosing a Specialty, Psychiatry, Psychiatry Rotation, Why did you choose....?

May 31, 2012

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A Psychiatry Resident’s Perspective: From an interview with a psychiatry resident at UC Irvine in Irvine, California

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to Psychiatry?

I like the idea of working with the whole person. I feel like in psychiatry you address a person’s social, financial, and relationship concerns, which in my mind are the most important part of life.

 

  • Describe a Psychiatrist’s typical work day?

There are different fields in psychiatry, but what I’m interested in is private practice. I’ll probably end up splitting my days between therapy and medication management appointments. Therapy appointments usually go an hour, med management about 15-20 minutes. In those visits the person already has a therapist but consults a psychiatrist for medications.

You can also work in an inpatient setting in a hospital, work for the prison system, do telemedicine (something else I’m interested in), work with children, geriatrics, forensic, or almost anything else you want. I like the variety of the specialty.

 

  • What type of lifestyle can a Psychiatrist expect?  

Psychiatry has the big advantage of being a less demanding specialty. Depending on your working situation, you might be on call once a week or so. Even the psychiatry residency usually has weekends off! Most private practice psychiatrists work around 30 hours per week.

 

  • What is the average salary of a Psychiatrist?

Again depends on your situation, but you’ll see something like $200,000 as an average. In California, psychiatrists generally take cash only and charge around $300 an hour.

 

  • What is the job market like for Psychiatrist?

There’s a big need for psychiatrists. In particular, child psychiatry needs more people.

 

  • What can you tell us about Psychiatry Sub-specialties?

Child psychiatry: 2 extra years after residency (but you can eliminate your 4th year of adult and make it 5 years total for adult and child). There is more demand for this field. The salary is generally higher. The lifestyle is about the same for this and all the others.

Forensic psychiatry: 1 extra year. Harder to get a footing in this one, but pays very well once you do ($1000 per hour for testifying in court). Custody hearings can be part of this specialty.

Geriatric psychiatry: 1 year. Not too sure about the job market. I imagine it’s in high demand. Probably similar salary to adult.

 

  • What are the potential downsides of Psychiatry that students should be aware of?

It definitely takes a certain personality to do the job and do it well. You need to be able to separate yourself from some of the sad stories you’ll come across. You also need to be able to set boundaries well with people.

 

  • What else would you tell medical students who are considering Psychiatry?

It’s a great job and something to definitely consider. Some people say there’s not much medicine involved, which is as true as you make it. You can definitely go a more therapy-centered route if you prefer. But, if you love the medicine and research side, there’s plenty of opportunity for that as well. The brain isn’t very well understood.

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

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Physician Satisfaction by Specialty

Categories:

Choosing a Specialty, Dermatology, Emergency Medicine, Family Medicine, General Surgery, Internal Medicine, Neurology, Ophthalmology, Pathology, Pediatrics, Psychiatry, Radiology, Urology

April 26, 2012

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The most recent installment of the Medscape Physician Compensation Report was recently published. Along with some of the best information on the web about physician salaries by specialty, the new Medscape report also reports which specialties are the most satisfied with their jobs (click here to view the entire Medscape Report). The results may surprise you. There is no correlation with salary and satisfaction.  The highest paid specialties (orthopedics and anesthesia for example) are found in the middle of the list while pediatrics, ID/HIV, and pathology are all found at the top of the list.  Interestingly, plastic surgery is–by far–the least satisfying specialty. So, the most competitive specialty is by far the least satisfying…that’s odd!

 

From the 2012 Medscape Compensation Report

 

My conclusions from the Physician Satisfaction Survey:

  1. The age old adage is correct: Money does NOT buy happiness.
  2. Just because a specialty is desirable to match into does not mean it is desirable to practice in [plastics].
  3. I can find only one thing that links the most satisfying specialties: LIFESTYLE.  If you look at dermatology, psychiatry, emergency medicine, infectious disease, pathology, and ophthalmology they have a great lifestyle in common. They all have minimal call, good salary (but they are not the big earners), and few emergencies.  They all lend themselves well to family, recreation, and other hobbies outside of medicine.

 

My unsolicited advice:

  • I am sure there are my internists and plastic surgeons who are very satisfied with their jobs. I would bet that they knew exactly what there were getting into before they choose their specialty. Satisfaction in the workplace has lots to do with managing your expectations (and the expectations of your family and friends!)  If you really love some of the specialties that do not have the best lifestyle, that is great, just make sure you know that this will be an issue before you go into he specialty. Once you have made that decision, you will not be shocked (and neither will your family/friends) when you work a lot more than those around you.

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The Most Recruited Medical Specialties

Categories:

Residency, Choosing a Specialty, Dermatology, Emergency Medicine, Family Medicine, General Surgery, Internal Medicine, Neurology, Ophthalmology, Pediatrics, Psychiatry, Radiology, The Match, Urology

April 25, 2012

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Now that I am in the first year of residency I am beginning to think about landing that first real job.  As a Transitional Year resident I am heavily involved with the Internal Medicine residents at my hospital.  I found out very quickly that these internal medicine residents are HIGHLY sought after. In fact, many of them receive job offers on a weekly, or even daily basis.  The jobs that are in highest demand for internists are outpatient primary care and inpatient hospitality.  Many of my senior residents are being offered salaries between $200,000 and $300,000 along with many benefits including loan repayment. There are even some offers higher than $300,000 for less desirable locations! This is in a stark contrast to the ophthalmology job market that I will face, where starting salaries are low and it is terribly difficult to get your foot in the door.

Recently, I came across the Merritt Hawkins database.  Merritt Hawkins obtains information about starting salaries and benefits for newly graduated residents. I speak about their great physician salary database in my Ultimate Guide to Physician Salaries. However, their database also contains a list of the 20 most recruited specialties in medicine. The list may shock you!  The ability to find a well paying job right out of residency is NOT AT ALL correlated with the competitiveness of the specialty.  Case in point: family physicians and general internists are the two most highly recruited specialists in medicine!

From Merritt Hawkins

 

This list represents the Top 20 most ‘requested physician searches by medical specialty.’ The numbers represent the number of times Merritt Hawkins was used to recruit a person from the respective specialties (Merritt Hawkins full PDF including physician compensation data is available here for free). So, when you are deciding on a specialty, don’t forget that competitive does not equal good job placement.  In fact, many of the least competitive specialties are very high on this list (pediatrics, psychiatry, family medicine)

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Conversion Disorder vs Factitious Disorder vs Malingering

Categories:

Psychiatry, Psychiatry Rotation

November 2, 2011

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Conversion disorder, factitious disorder, and malingering have one major characteristic in common: they represent conditions that are not ‘real’.  However, ‘real’ is a vague word and it is important to understand the differences between these conditions.  Properly diagnosing your patient with one of these psychiatric ailments will allow you to create appropriate plans of care for your patients.

1. Conversion Disorder: is a psychiatric condition that results in a neurological complaint or symptom, without any underlying neurological cause.  Patient’s may experience seizures (i.e. ‘pseudoseizures’), weakness, non-responsiveness, numbness, and even vision loss.  The symptoms are not intentional, the patient is not faking or intentionally creating his/her complaints, yet upon further investigation no biological explanation for the symptoms can be found.  The symptoms, therefore, are ‘real’ to the patient but are not caused by any ‘real’ pathology.  The current thought is that the symptoms are somehow caused by an overload of emotional stress in the body. The name “conversion disorder” comes from Sigmund Freud who stated that stress can cause a psychiatric ailment to ‘convert’ to a medical problem.  Do not fall into the trap, however, of many students/doctors/nurses who say the patient is ‘faking’.  While you may know that a patient complaining of sudden vision loss has a completely healthy eye without disease, the patient’s eye and brain are actually NOT processing any sight.  Alternatively, a case that I have seen a number of times, a patient with syncope from conversion disorder whose labs, tests, vital signs, and clinical status are completely normal will actually NOT respond to painful stimuli (sternal rub, nail bed pressure, supraorbital pressure) during an episode.  It is important to remember the unintentional nature of conversion disorder when discussing the condition with a patient.  To them it is REAL, even if to you it seems fake.

Studying for the Psychiatry Rotation?  Check out First Aid for the Psychiatry Clerkship

2. Factitious Disorder (a Somatoform Disorder): is a condition where patients intentionally fake disease, or intentionally cause disease in order to play the ‘patient role’.  The main distinction between this and conversion disorder is the intentional nature of factitious disorder. Often referred to a Munchausen Syndrome, factitious disorder is characterized by patients frequently feigning illness to obtain attention, sympathy, or other emotional feedback.  They achieve this goal through exaggerating symptoms, deliberately faking symptoms, or even intentionally creating real symptoms.  Patients have been known to contaminate their own body fluids, even injecting themselves with dirt, bacteria, or fecal matter in order to create illness that will then lead to primary emotional gain. A related disorder is known as Munchausen by Proxy, which is characterized by a person intentionally faking or causing illness in another (usually a child) in order to obtain the same emotional feedback.  Victims of Munchausen by Proxy are often children who return to the hospital time and time again with infections or other ‘ailments’ that are either fabricated or intentionally created by their caregiver.

3. Malingering: is the intentional faking or creating of illness in order to obtain secondary gain (e.g. workers compensation, disability payments, avoiding work or jail time, pain medication, etc.) Malingering is NOT a psychiatric illness; this is the first major distinction from the other two disorders. Malingering is an intentional abuse of the medical system to obtain personal benefit.  The difference between malingering and factitious disorder is the goal of the patient; malingerers abuse the system to obtain secondary gain while patients with factitious disorder attempt only to obtain emotional, or primary gain.  In simpler terms, the end goal of a malingerer usually involves monetary value, while the goals of patients with factitious disorder have no such value.

QUICK REVIEW:

  • Conversion Disorder: Unintentional, due to emotional stressors, no ‘gain’ to the patient
  • Factitious Disorder (Munchausen): Intentional, primary or ’emotional’ gain
  • Malingering: Intentional, secondary and often monetary gain

 

 

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Which doctors get sued the most?

Categories:

General, Choosing a Specialty, General Surgery, Neurosurgery, Pediatrics, Psychiatry

September 23, 2011

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Have you ever wondered which physician specialties deal with the most malpractice lawsuits? While I was in medical school I often heard physicians discuss the rising costs of malpractice insurance and the lack of tort reform.  I knew that OB/GYN doctors had to deal with a lot of lawsuits, but I had no knowledge of which other specialties faced frequent lawsuits.  The New England Journal of Medicine recently published a great paper identifying which medical specialties are sued the most frequently.  The paper can be freely accessed by anyone (click here to see the full article).

The most interesting results can be summarized by the graph below, which demonstrates the percentage of physicians sued in a calendar year, separated by specialty. As you can see, neurosurgeons and cardio-thoracic surgeons lead the list with nearly 20% of all physicians in these specialties sued each year.  Wow, that seems excessive!  On the other side of the graph, only about 3% of psychiatry and pediatric physicians deal with lawsuits each year.

Taken from NEJM, click the link below to see the full article

See the full article here

The article also presents data that demonstrate the cumulative probability of being sued during your career.  They find that by the time physicians in ‘high risk’ malpractice fields, such as general surgery and neurosurgery, reach 55 years of age nearly every singly physician has been sued at least once (95-99%).

Malpractice lawsuits are an important topic, especially when choosing a medical specialty during medical school.  Students need to know what problems the every-day doctors face so that we can make informed decisions.  If someone went into neurosurgery without knowing that nearly 100% of all neurosurgeons will be sued by the age of 55, this might result in a very unhappy professional life.  On the other hand, if you love neurosurgery and you are informed about this problem, you will be able to weigh all the pros and the cons of the specialty before making your decision.  When you know what you are getting into, you always have a higher chance of success.

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