so I’m on week 7 of my psych rotation. and though i’m definitely ready for it to be over, i feel like i’ve learned a lot of useful skills, especially for my medicine rotation. [our pt needs a psych consult? quick, check his ammonia, TSH, LFTs, B12, folate, RPR, and head CT and give him Zydis!]
i haven’t written too much about my experiences partly because i try to avoid talking about patients and mostly because the amount of craziness out there is so crazy, that it feels like crazy is the norm and rather unremarkable. “Your patient wants to hang himself? Well mine cut off his arm because the voices told him to.” “Your patient calls you retarded? Today is the first day mine didn’t threaten to kill me.”
however, last week, i had the most interesting [i.e. upsetting] real-life experience in psychiatry, mostly because it involved not a patient, who i expect to have poor coping skills, but our very own IOR (instructor of record).
you see, we have these logbooks for each rotation that theoretically provide some semblance of standardization of each student’s highly variable learning experience. this is rotation #4 and we’re pretty used to the logbooks.
but psych is a little different.
in psych, one of our skills to get signed off on is “Assess the role of one’s own feelings as one is assessing a mental illness.” probably in my own passive-aggressive rebellion against the lameness of that “skill,” I had chosen not to ask my resident to sign it.
still, i had 43/56 signed by week 6, and technically we only need 45 by the end of the rotation. it seemed that most of my classmates were similarly finished/almost finished with their logbooks. so it was quite the surprise when our IOR walked into class last week expressing his disappointment with our logbook progress. it seems that he was perturbed that among other things, many of us had not assessed the role of our feelings in assessing patients’ mental illnesses, to which i wanted to scream “hello, i think we do this with every patient!?” also, many of us had not seen patients with delirium, which you really only see if you’re on the consult service at the hospital. and down the list he went, naming each particular skill we were lacking as a group.
the best part about this ONE HOUR
discussion admonishment session was his passive-aggressive, anxiety-inducing tone. in his own words, “i’m not saying it’s your fault, but this isn’t right.” whoa.
naturally, most of us became defensive, and tried to point out that some of us simply had not gotten signatures for skills already accomplished or that some of us hesitated to sign off a skill for which we felt we hadn’t quite met the expectations. and so the IOR “tried to help” by clarifying what qualified as a clinical encounter.
per the IOR, a clinical encounter was one in which “the student has a potentially affectively arousing experience in a relational context.” there he went again, using that same unwieldy abstract phrase – AFFECTIVELY AROUSING – that he’d tried to use the first day of the rotation. for the next hour, he repeated “affectively arousing” another 5 times maybe, and each time i wanted to scream, but instead tried my best not to roll my eyes. if that’s not countertransference, i don’t know what is.
several of my classmates were not as successful in hiding their feelings, and voiced their frustration with the meaninglessness of this 1 hour
discussion admonishment session, but to no avail. he just kept going on and on about affective arousal and the logbook.
the next day, we discovered e-mails addressed to each of us and our current attendings.
Dear Dr. ATTENDING and MED STUDENT,
I believe MED STUDENT’s work on the psychiatry clerkship is at least adequate. However, I am concerned because she is still missing important clinical experiences. Although she is not alone in this, I would like her and her current attending and resident to work together to ensure that she has the following clinical experiences:
1) MISSING LOGBOOK EXPERIENCE
2) MISSING LOGBOOK EXPERIENCE
I would appreciate the student and resident or attending discussing these experiences in order further consolidate their educational value.
Here is my latest attempt to briefly define the following key term: “being involved in clinical care” means that the student has a potentially affectively arousing experience in a relational context. The ideal “relational context” is a student interacting with a real patient. A student watching someone else is adequate. In some instances, an in-depth discussion between attending and student will suffice. “In depth” suggests that the relational context (attending and student) includes affective and relationship-based learning in addition to facts and concepts.
Thank you for your ongoing effort and time in working to ensure that clerkship students get adequate clinical experience so that they can master the clerkship’s learning objectives and become competent UCDSOM graduates.
OCPD INSTRUCTOR, MD
P.S. MED STUDENT will also be participating in Seminar Case Discussions to address experience deficits in BLAH BLAH and BLAH BLAH BLAH.
and this… this… there’s not much to say about the above email except that he is seriously OCPD and thankfully the attendings and residents on our team seemed to realize the same thing.
and so from this real-life lession in psych i learned
- OCPD people are not fun to be around
- although you might feel like you’re always being watched by the psych residents/attending, at least you can count on them to understand the personality issues of other faculty.
- there is NO WAY i’m going into psychiatry
p.s. yes, i too am a little OCPD, but hopefully nowhere near as bad as our IOR.