I became interested in psychiatry during my second year (M2), when I took a clinical neuroscience (CNS) course. I finalized my decision to go into psychiatry during my third year (M3) clerkship at Elgin Mental Health Center, an academically oriented state hospital. Elgin’s patients are intriguing, and learning about them was maximized by many inpatients having long stays.
My main interest within psychiatry is neuropsychiatry which, to me, is looking for behavioral manifestations of general medical and neurological illnesses, doing brain imaging, and elucidating neurotransmitters and brain systems in primary psychiatric disorders. I think this is psychiatry’s future, and that neurology and psychiatry will eventually intertwine. I want superior training in both fields, and to provide a high quality of research, teaching and patient care.
I chose Nutan Atre-Vaidya, M.D. as my adviser during January of my third-year (M3), and I expressed an interest in neuropsychiatry. She designed a fourth-year (M4) neuropsychiatry elective for me, for which I will describe a typical day.
Usually, I awoke around 5:45 a.m. I did not have to be at the North Chicago VA until 8:00, but like most Rosalind Franklin University of Medicine and Science (RFUMS) M3s and M4s, I lived in downtown Chicago, at least an hour’s drive to North Chicago, during which I enjoyed the quiet time and listened to CDs. Students arrived a half-hour before clinic started. I followed either my supervisor or the residency director. On days with my supervisor, I arrived early and looked up my patients in the computer, to prepare to discuss each patient with the residents. When they arrived, we discussed the patients and they made some teaching points. Most RFUMS psychiatry residents are international medical graduates (IMGs). By the fourth year (PGY-4), they are excellent psychiatrists. Knowledge and teaching of psychiatry vary widely among first (PGY-1) and second (PGY-2) residents.
I saw the patients with the residents, and then we discussed the patients with my supervisor. I wanted to see some patients myself, but she felt that the residents needed all the exposure they could get. Mostly, I observed the resident’s interview, after which I could ask questions. I never liked that format. My attending discussed the patient afterward, and I always enjoyed this. She taught well and made great points. If something particularly interesting arose, she asked one of us to search the literature and report back. At the VA, there was plenty of time to interview each patient and to speak at length with my attending. Patients received optimal care.
At noon, the residents had a seminar with the residency director, who had invited me to participate, and who impressed me with his knowledge, teaching style and rapport with patients. The format was great. Usually, a PGY-1 or PGY-2 presented a patient. We worked with the group on how to present and to develop a differential diagnosis, and discussed aspects of the case. He taught the residents to make a primary psychiatric diagnosis only after general medical causes are excluded. Too often, clinicians forget this and make a primary psychiatric diagnosis until proven otherwise. I was able to eat lunch and relax until the afternoon clinics started.
After lunch, I went with the residency director and spent the afternoon at the Kiley Developmental Center in Waukegan, a state facility for adult mentally disabled and autistic individuals. Sometimes this was the most interesting—and frustrating—part of the day. The residency director sees all Kiley patients receiving psychotropic medications. He meets with the patient and a team of caregivers—social workers, psychologists and internists. This was frustrating, because his recommendations had to be approved by a committee not run by physicians, and sometimes this "impinged" on the patients’ care. He did well with the resources he had, and was always open to questions. The Kiley clinic ran until 4:00 or 5:00.
Afterward, I stayed in or near the RFUMS campus in North Chicago and went to the RFUMS gym or ran on a trail. My evenings were usually spent looking up topics that arose during the day, or working on a forthcoming presentation to the students and residents. For this, I spent 2 hours nightly at the library reading journals, and I enjoyed this. M3s were with me throughout, and I taught them whenever I could, which included giving pointers about preparing for the postclerkship shelf examination.
This was a strongly positive experience, one of the best of my third and fourth years.