Welcome to your new psychiatry clerkship! To help you thrive during your clinical rotations, we’re sharing practical, hands-on advice from experienced medical professionals to help you make the most of your psychiatry rotation.
We’ve compiled a quick psychiatry clerkship guide to help you seamlessly navigate your psychiatry rotation.
The Fundamentals of a Psychiatry Rotation
While all areas of medicine incorporate a holistic approach to caring for patients, your psychiatry rotation will take it further by helping you recognize how impactful social determinants of health, such as a patient’s upbringing, social history, and current circumstances, can be.
Mastering psychiatric exams starts with the mental status exam (MSE), which helps clinicians evaluate a patient’s mental state (cognition, mood, behavior, and perceptions) and is a standard element of psychiatric clinical evaluations in diagnosing mental health or neurological conditions. They also help you prepare for the psychiatry shelf exam and work with your psychiatry attending.
While it may feel very different from the physical exams you know and love, the mental status exam is a physical exam adapted to the unique requirements of psychiatry. The best way to master the mental status exam is to practice using it and remain consistent. Helpful resources such as standardized patient encounters and simulation labs are excellent ways to practice the mental status exam. If simulation labs are unavailable, another fun exercise is to do a mental status exam on your favorite movie character.
Mastery of the mental status exam also includes knowing the significance of your findings, such as being able to identify symptoms like pressured speech, flight of ideas, thought blocking, mania, and depression. Some students learn best from first understanding the most severe presentations of each finding while working towards mastery of more subtle presentations. For instance, first knowing and understanding pressured speech may make it easier to understand pushed speech.
TIP: Osmosis videos are a great way to learn essential findings and help you get a good grade on your mental status exam findings!
From new interventions like targeted neuromodulation for refractory obsessive-compulsive disorder to recent releases of medications with completely novel mechanisms, psychiatric innovations are exciting to learn about and often intimidating to digest. A good way to learn about cutting-edge research is by asking about the research interests of faculty and residents on your team. Many of us are excited about the new directions research is taking us, and we’ll gladly share our interest and enthusiasm. You can also refer to clinical decision-making tools like UpToDate, which includes ground-breaking and relevant research that’s summarized and regularly updated.
Engaging with your Attending and Team
Work on your teamwork skills to make a great impression on your psychiatry attending. Your psychiatry rotation will likely include collaborating with a diverse care team that includes social workers, psychotherapists, recreational therapists, nursing staff, and other experts.
Remember that time management is crucial when you meet with care team members. Take some time to review the patients your team is working with the night before treatment team meetings to help you identify specific questions to enhance your learning or understanding of complex psychiatric conditions.
Last but not least, consider volunteering to work with a variety of patients. The shelf exam is a mix of complex and routine patient presentations; working with different types of patients is a fantastic way to study while on the job.
Reviewing psychiatric cases before treatment team meetings or rounds can be intimidating, given the number of factors that can contribute to patient care.
To get started, we recommend understanding the following factors:
- The patient’s previous psychiatric history
- Medications that have been effective or ineffective
- Major symptoms leading to the presentation
- The patient’s intended result of pursuing treatment
- Current treatment response
After you’re able to identify these factors, move on to aspects such as substance use history, family history, and more complex social variables like financial status. Understanding these factors helps you understand the myriad of variables that can contribute to symptom occurrence and symptom resolution.
Patient Interaction
Experience and frequent observation are the best methods to develop your approach to psychiatric patient care. When you start your psychiatry rotation, take the time to introduce yourself to each patient and clearly identify your role as a medical student or acting intern.
If you recognize similar personality traits and habits in a member of your team, it’s worth shadowing them as much as possible to learn their approach. Then, with enough experience and exposure, you’ll subconsciously master your style of interacting with patients. Start by being a good listener. Allowing patients to share their experiences and feelings while you’re actively listening to them can be therapeutic for the patient and a rewarding experience as a new clinician. Many students I work with can identify key moments when they were listening to patients as the lynchpin in their decision to specialize in psychiatry.
Knowing how to relay the team’s concerns to patients and their families is a sure way to get a good grade or evaluation regarding patient rapport and communication. The challenge is that psychiatry has a vast amount of complex phrasing and words that may confuse patients, which means that knowing how to simplify complex information and relay it clearly and concisely is an important skill to develop.
There’s an old saying in psychiatry that collateral is king, referring to how speaking to a patient’s friends and family may help their recovery. However, good communication doesn’t start and end with in-person interactions; it’s also essential for making phone calls. So, while speaking to someone on the phone may be an unappealing prospect, it will help you develop an important skill you’ll use regardless of your specialty.
How to Study More Efficiently
We recommend you create a good study plan for your psychiatry rotation, reviewing rotations with satisfactory evaluations and exam performance. Identifying the principles and study methods that best support learning is highly personal, and past success tends to result in future success. Like other third- and fourth-year student rotations, integration of active study methods and reviewing content is crucial to performing well and reaching honors on your shelf exam.
Active study methods include:
- Create and review practice questions
- Study sessions with attendings or medical school professors
- Reading case studies, whether from your rotation or case studies included in review material
Medical students often do well with actively learning new content but may not take the time to review older content as frequently as necessary. Reviewing older material is as important as learning new material. Consider using resources like flashcards, reviewing previous exams, or revisiting practice questions you’ve missed in tools like Osmosis.
While active studying and content review are what most students need to excel in their psychiatry rotations, the shelf exam offers unique challenges. For example, neurology, treatments that reduce suicide risk, diagnostic questions, and treatment questions are the bulk of topics that appear on the shelf exam. A surefire way to get points on the exam is to understand that electroconvulsive therapy, lithium, and clozapine are treatments known to reduce the risk of suicide, as every iteration of the shelf will ask at least one question with this concept in mind. Between 10-15% of the shelf exam questions focus on neurology, so make sure to learn about neurological conditions to diagnose and manage delirium, types of tremors, and neurocognitive disorders.
Questions about diagnosis and treatment benefit from understanding terms often used in psychopathology, and the best way to learn psychopathology is through spaced repetition. An essential resource for studying each mental health disorder is the DSM-5 TR, which is a diagnostic manual that provides insights into differentiating similar conditions as defined by experts. It is particularly beneficial for understanding and diagnosing personality disorders.
Key Takeaways from Your Rotations
Success in your psychiatry rotation requires empathy, thorough preparation, and a genuine interest in understanding the complexities of mental health. By consciously engaging with patients, practicing active listening, and committing to continuous learning, you’ll learn to appreciate the unique challenges and rewards that a career in psychiatry can provide. Make sure to approach each patient and staff interaction with curiosity and compassion, as these traits are the core of effective psychiatric care.
Best of luck on your psychiatry rotation—may it be a fulfilling and enriching experience on your path as a future clinician!
About the Author
Michael Klug, DO, is currently a third-year psychiatry resident working in Eastern North Carolina. He completed medical school in New Jersey after attending college in New Orleans. Outside of mentoring medical students, patient care, and nerding out about new psychiatry and neurology research, he spends his free time playing guitar, trying coffee from all over the world, and lifting weights.
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