The shift from 2nd to 3rd-year medical school is a significant change from the classroom setting to the hospital and clinic. This transition was even more challenging for my class because we were used to virtual lectures during the COVID pandemic.
Psychiatry was my first clinical clerkship in medical school. I did well on the shelf exam (COMAT) and honored the rotation. In this post, I want to share my top 4 tips.
1. Have the right mindset on day 1
Psychiatry patients are people. They are just like you. They have interests, hobbies, families, childhood memories, quirks, and talents like anyone else. They also often have a history of trauma, stressors, and a biochemical imbalance that led them to where they are now (e.g., inpatient psychiatric hospitalization or an office visit to an outpatient psychiatrist).
Being a part of the care team for psychiatric patients is tremendously fulfilling when you open yourself up to the experience. The best way to do this is to practice curiosity. Generally, much of mental health seems taboo, but many psychiatric patients can be very open about their experiences and thoughts. For the most part, they want to talk to you. Other patients may be more guarded, some even paranoid, but it can be gratifying to spend time with them and build rapport until they open up. You may even identify with patients if you struggle with your mental health. Notice when you start to have these personal feelings come up, and make sure you have someone to talk to. The psychiatry rotation can be very draining for some students because some elements of working in that space can be triggering.
Be conscious of the terminology you use. Patients are not "schizophrenics.". They are "patients with schizophrenia." There is also no such thing as "crazy" in psychiatry. You may, unfortunately, hear derogatory terms used by doctors or support staff, but you never have to participate. You can even ask whoever is using these terms to clarify what they mean, and they will often realize the harm in what they said and correct themselves.
2. Read the DSM-5
When you see a patient, look up their diagnosis in the DSM and read the related section. This practice is vital for learning the diagnostic criteria of common psychiatric diagnoses (and this is tested heavily on shelf exams, COMATs, COMLEX, and USMLE).
In the first half of your psychiatry block, I recommend reading about topics related to the patients you see during the day to solidify your clinical learning (in addition to any obligations you have for school, like patient case writeups). In the second half of the rotation, you can start incorporating more randomized practice questions and cover topics you may not see during your block.
3. Continue using your preferred question bank
I highly recommend TrueLearn (First Line's sponsor). COMBANK was the best COMLEX Level 1 prep, so I also used their subscriptions for COMLEX Level 2 and COMAT prep. Additionally, they have excellent SmartBanks for the USMLE and shelf exams. Check out my post here for a discount.
With whatever question bank you use, I recommend finding questions specific to the patients you see in the first half of the rotation. (TrueLearn has a question search function that makes this super easy. You can search "bipolar disorder" and create a question set with just questions about bipolar disorder.) In the second half of the rotation, I recommend doing some math; take the number of questions you have left and divide by the number of days until your shelf exam/COMAT. Round up to the nearest five questions (in case you fall behind a day or two). I used this process for all my rotations and finished all practice questions for every block before my COMAT exam. I like TrueLearn because it keeps track of your percentile compared to your peers as you go (overall percentile and percentile for each question set).
4. Embrace learning (no matter what specialty you are interested in)
Have an open mind as much as you can. I did well on all my rotations and can credit that to my attitude starting each clerkship. I would always think and act as if each was the specialty I would be going into. This way, you start with curiosity, a strong work ethic, and an interest in learning and asking questions. Of course, it helps to have a good idea of what specialties you are interested in before starting rotations, but many students have their minds changed in 3rd year. Give each discipline a chance.
Psychiatry is often misunderstood. It is common for students to be interested in another specialty but then switch to psychiatry after their rotation. Even if you realize during your rotation that psychiatry is not suitable for you, know that psychiatry is involved in every specialty in medicine. You can never escape it. Learn during your clerkship so that you can take better care of your patients with psychiatric comorbidities in whatever field you eventually select.
To hear about my experience, listen to the First Line episode on this topic: https://open.spotify.com/episode/1y7OCGI0wIoqkETWqmbn49