Often, it has been said that medical students should spend more time during their psychiatry clerkships seeing outpatients with mild psychopathology that is typical of what they will most likely encounter in general medical practice. Assigning students to locked inpatient units with chronically ill psychotic patients, however, may risk leaving them with a pessimistic view of the field that will discourage interest in psychiatry. Fortunately, this has not been our experience at New York University (NYU).

As Iyabode’s comments suggest, there is considerable enthusiasm on the part of our students in working with the severely mentally ill and with unmedicated patients seen in an emergency room. The success of a clerkship, I believe, is dependent less on the setting than on the availability of interested, committed faculty and on the requirement that students be fully integrated into the treatment teams and given primary responsibility for their patients’ care. The excitement Iyabode describes in watching her patient recover is partly the satisfaction of knowing her personal role in the patients’ care.

Several years ago, we lost the on-call room designated for students in the psychiatry emergency room. As a result, I have not been requiring overnight calls. We do offer students the option of staying overnight with the understanding that if things are quiet, there will be no place to sleep. The response has been largely enthusiastic, and I believe that the key is active, direct patient care responsibility.

What Iyabode’s essay does not reveal, however, is the amount of reading, research, and reflection that are crammed into the free hours between patients and teaching conferences. I suspect this is true for academic physicians everywhere—that scholarly work is so much a part of the fabric of everyday life that it cannot meaningfully be separated and quantified.

Drs. Agboola and Manley are affiliated with the Department of Psychiatry, NYU School of Medicine, New York, NY.