I wrapped up my first clerkship last week – a combination of psych and neuro. I had four weeks of each, a combined OSCE in the 7th week, and then both shelf exams at the very end. I’m going to try to do a quick wrap up after each clerkship for anyone that may find it helpful!
Psychiatry was an interesting first rotation to have, because we rarely even touched a patient! It is all about conversations and very minimal, if any, hands on contact. There aren’t even soap dispensers outside the patient rooms on the inpatient psych unit!
I spent my first two weeks on the adult inpatient psychiatry team, where I was exposed to all kinds of mental illness and addiction. Since the hospital is in the city, we see a lot of the homeless population and many are frequent visitors. The social workers on that unit are complete saints – they work so hard! I was curious how I’d handle it, and found that I absolutely loved it. The changes you can see in people once they are on the right medications, or are detoxed, is incredible. I worked 7am to 2-3pm most days. Not bad!
The next two weeks were on the psych consult team. It is a much busier service and I really enjoyed having to consider all kinds of different medical conditions and how they may contribute to the current psychiatric state. Any time someone in the hospital or ER need a psych evaluation, we were paged. We used the DSM-5 really regularly and I learned so much. I worked 7:15am to between 3-5pm each day.
Over all, I loved psychiatry even more than I expected to. I’ve always been passionate about mental health, and I’m very much considering a career in psychiatry (or a combined residency perhaps) now.
Neurology was totally different than psychiatry! It was actually shocking to jump right into the very physical neuro exam after coming off of a month with no patient contact. Neurology is very complicated and localizing lesions is the crux of it all.
My first two weeks were on the general adult neurology team, which was a bit hectic to be honest. Everyone spoke very quickly and I felt like we were always running around! I learned so much about seizures, multiple sclerosis, encephalopathy and reading CTs and MRIs. I got to help with multiple lumbar punctures and code strokes. I worked 7am – 5pm most days.
The second two weeks were on pediatric neurology, which was a totally different experience than adult. The children’s hospital feels like a different world in general, though. We all joke about how happy it is and how nice all the people are, but it’s really not a joke! My team was incredible, we were taught so much, and things were much calmer. We saw very, very sad conditions – brain tumors, gunshot wounds, brain malformations, and tons of seizures – and I even got to watch brain surgery! We also got to do some outpatient clinic work where there were more headaches and general development questions. Our patients ranged from 2 days old to 20 years old. Days were usually 7:30ish to 4ish, but we had a few much shorter days as well.
The study materials I used were based on recommendations from older classes, so I can’t really say if they are actually the best. For psychiatry I used First Aid for Psychiatry and the UWorld questions. For Neurology I used Blueprints, Pretest, Step One First Aid for some review, and the UWorld questions. I watched the Online Med Ed videos and I took two of the NBME practice tests for neurology.
Our OSCE had five 25 minute stations and combined both neuro and psych. Two of the stations were just a full neuro exam and a full mental status exam, and the other three were cases. We were given the patient name, age, and chief complaint and then had to go in and talk to the patient to figure out the rest. Afterward we had to write a note, including three differential diagnoses and plans for any testing going forward.
The two basic exams were fine and flew by, but the cases were definitely rushed! I felt like I didn’t stay and do quite as much with my patients because I was worried about having enough time to write my note. I think that’s pretty normal, especially for the first one. Overall I felt like they went pretty well though – I guess I’ll know more after I get my scores.
We took the neurology shelf (the subject tests that most medical schools use as exams) first, and it felt pretty hard! All of us used basically the same study materials, and we definitely felt like the content of the test was different than them. I’m not sure if using different materials would have helped more. I do think that having done some outpatient neurology clinic would have exposed us to more of the conditions we were tested on, but there just isn’t time for everything.
The psychiatry shelf is not known to be too difficult, but I think they are trying to make it harder. You need to know your drugs and side effects backwards and forwards, as well as the criteria for diagnosis of all the psychiatric conditions. And even though we didn’t work with any kids on our psychiatry rotation, you have to know the child psych issues too! Once again, the study materials I used didn’t cover everything on the test, but I suppose that may always be the case.
So that’s it! I think it was pretty great for my first clerkship experience, and I cannot wait to keep learning and working with patients this year. It’s way better than being in the classroom. Next up is two weeks of emergency medicine, and then my family medicine clerkship for the rest of the summer.