Psychiatry

Psych at BMC involves working as part of the consult and liaison (C&L) service. Two students will work at HAC and two at ENC. The C&L service receives consults from Medicine, Surgery, OB/GYN, etc. that have patients who seem to be "depressed", are "difficult" or have issues involving psych meds. Students are informed of new consults by the resident or fellow and may generally see the patients on their own or with the resident/fellow, whichever they feel more comfortable with. It was definitely helpful to see patients with the residents for the first few weeks to get an idea of how best to conduct a psych interview and write up the mental status exam (the psych equivalent of a physical exam).

The two students assigned to HAC will also get to follow an adolescent patient in the "IRTP" at the Fuller. This is a long-term, locked facility for patients in the 13-19 year old age range. Generally this is a well-liked part of the rotation, although it requires a long write up at the end. Those assigned to ENC get to see outpatient psych with Dr. Burns, who really is just a wonderful person. He has very interesting patients (who do not always show up) who will tell you everything about themselves. Dr. Burns will teach you a bit and you’ll have the opportunity to see how patients are managed on an outpatient basis. It’s only for two hours a week, though.

There is also a didactic lecture schedule for med students and you get to attend the resident lectures on Fridays at noon, which were generally very good. The BIG downside to the rotation here is that you must write an approximately 10-page research paper that you present to the group on the last Wednesday of the rotation.

This is a very good rotation for those who want to do medicine, as you get to see how psych issues are handled on medicine patients. You will also learn a lot about using antidepressants and anti-psychotics, both of which are frequently used by medicine docs. It is also excellent if you want to do psych as a career, as you get lots of exposure to residents and especially attendings. I suggest if you are really considering a career in psych, make an effort to work with Dr. Berenbaum. He makes himself very available to students, teaches very well and is an excellent psychiatrist. Overall the service isn’t too busy and you’ll find you have time to run errands and do other stuff during the day.

At Bedford we spent 2 weeks on the substance abuse clinic and 4 weeks on the wards. Ward patients were typically long-term chronic schizophrenia cases, although there was quite a variation and some patients had really interesting diagnoses (NPH, Korsakoff's etc.) Given the aging VA population, medical issues were often developing and the floor staff seemed to appreciate our input regarding medical issues. We also spent an afternoon a week in the psych walk in clinic where we did the initial interview and then presented to the attending. There was quite a variation in diagnoses: lots of PTSD, depression, anxiety, bipolar disease, and dementia. Some of the patients were quite symptomatic. Finally, there were several one day "field trips" which were mainly observational: a morning at a jail clinic, a VA outpatient day center in Lowell and a day on home visits with a social worker for the day treatment center.

Dr Frankenburg (inpatient ward) gives some great lectures on the history of psychiatry and the relation of mental illness to creativity in the arts for those who like the literary/historical side to medicine. Dr. Herz gives good lectures and teaches a lot in the day clinic as well.

There is a lecture series of variable quality that addresses the major psych disorders, neuropsych testing, pharmacology and other issues. Some speakers were great, others less so.

Days went from 9-4 or so, shorter on the substance abuse clinic and were not very busy. We wrote up three cases that Dr. Frankenburg critiqued, and we spent three nights at BMC psych ED until 10 PM.

Overall, we saw a good variety of cases (obviously no adolescents with eating disorders, etc.) and had decent teaching. I enjoyed psych there and felt prepared for the exam.

Bournewood Hospital is located in a lovely suburban area in Brookline. It takes about 20 minutes without traffic to get there from BMC. Bournewood Hospital is organized into several units: 2 adult intensive treatment units, 2 substance abuse units and 1 adolescent unit. During the rotation there, you will rotate through at least three of these units. While it could be said that the time on each unit is limited, the benefit is that you will see a wide variety of psychiatric problems in unique populations.

There are also a few extracurricular engagements that come along as part of the experience, including the opportunity to witness electroconvulsive theory. The rotation at Bournewood may warrant a little more of your time than rotations at other sites, but the exposure is good, and a lot can be learned here.

When at the chemical dependency unit, if you work with Dr. Johnson, be prepared to do a huge amount of "psychoanalysis" as well as to lead groups with the patients. Dr. Johnson will often pull you away from your other rotation, but remember that you DO NOT have to go to any of these sessions if you are not on the chemical dependency unit.

Carney has 3 locked wards. One is primarily devoted to substance abusers, one for psychotic/delusional patients and a new ward for adolescent patients. The majority of patients were either substance abusers suffering from depression or patients with bipolar disorder. There was a significant number of schizophrenic patients as well. In addition, students may see patients as consults to other services, or in the emergency room depending on the attending call schedule.

Supervision is by attendings only, with ample time for teaching throughout the day. The social workers are also an excellent resource at Carney and are interested in teaching. Students are expected to follow 4 to 5 patients and write notes on each one daily. You are required to hand in 4 write-ups for the rotation and there is a patient interview examination at the end. Hours are flexible and vary with attendings, but are generally 9 to 5. There is no nighttime call.

HRI was a really great experience. There are three psychiatrists there, and basically, each student gets paired up with one of them for the entire 6 weeks. There are three main units at HRI: The Women's Unit (unlocked-eating disorders, but everything else too), the Addictions Unit (unlocked-basically it's a detox/rehab for EtOH and drugs), and the Admissions Unit (locked-a mishmash of all kinds of patients with all kinds of psych issues). Your experience varies drastically depending on the physician that you work with. Two of the physicians only work part time, so that if you are working with them, you can expect to leave each day by 2-3 PM. The third full-time psychiatrist expects you stay each day until 5 PM. The day usually starts at about 8:30AM. Either way, it's not a stressful rotation, and you have the opportunity for a lot of patient contact and a lot of decision making in your patient's management. I think that the variety of patients that you see is good, and it helped prepare me well for the exam. One thing that is lacking there is any formal teaching sessions. Occasionally the psychiatrists would set aside some time to give us a lecture, but there's no schedule of lectures (which would be nice). We conveyed this need to them when we were there, but I don't know if this has been implemented yet.

The psychiatry rotation at the VA was an outstanding experience and it provided me with a good understanding of the fundamentals of psychiatry. Before starting the rotation, I expected to exclusively see PTSD. However, I found the range of pathology to be extensive. I saw multiple patients with acute mania/bipolar, schizophrenia, anxiety disorders, substance abuse, personality disorders, and even somatoform disorders.

As a student, you will be assigned to 1 of 2 teams: The Dunn/Weichert team or the Trachmann team. I was on the Dunn/Weichert team and this was another highlight of the rotation. Dr. Dunn completed a fellowship in psychopharmacology and he loves teaching about psych medications. He typically gives 2-3 lectures per week on the different classes of psych medications. He is a good lecturer with impressive knowledge. After working with Dr. Dunn, you will have a strong understanding of this difficult class of drugs. Both Dr. Dunn and Dr. Weichert are a lot of fun to work with, given their friendly personalities. They are also easy to get along with. Both are excellent teachers and they enjoy working with students. I was not on Dr. Trachmann's team so I cannot comment on it. If you are on her team, you will still see the same patients and you will work on the same floor.

The typical day began around 9:00AM, when everyone in the psychiatry department would assemble to learn about the newly admitted patients from the previous night. Following this, we would divide into our respective teams to interview the new patients. This was quite enjoyable. We were able to observe Dr. Dunn or one of the residents interview a new patient, who typically had an acute exacerbation of his/her mental illnesses—you will see some wild stuff. After the interviews, we would assemble to discuss diagnosis and management of our patients. Following this, we would write notes and check on patients until 11:00AM, when Dr. Dunn would usually give us a lecture. Some days we would have multiple lectures, but usually all lecturing ended by 1 or 2 PM. Occasionally, Dr. Nadelson, the chief of psychiatry, gave a talk to the students. He is brilliant and he was trained as a psychoanalyst. It is quite entertaining to hear his thoughts on the patients' personalities. The sessions with Dr. Nadelson were unforgettable. Once the lectures were done, you will see some of your patients and possibly admit a patient. Typically, you will finish around 3 to 5 PM. You will rarely be there past 5 PM and there is no call.

I loved this rotation and highly recommend it. If you choose to do it at the VA, relax and have fun; you will learn a lot. If you are not careful, it may even make you consider psychiatry as a career.

Probably the third happiest moment of life so far (the first two being acceptance to medical school and passing the boards, respectively) is finding out that you have your Psychiatry rotation at the Westwood Lodge (known affectionately as "The Lodge".) And it certainly should be! For six (very short) weeks, you will be "studying" in a country-club atmosphere, be absolutely forbidden to write notes on patients, and have the greatest hours known to man. However, beneath the vacation-like exterior lies perhaps the greatest secret of all; Dr. Pappas and Dr. Arkema (the site director) do things that most would say the BUSM Psychiatry department failed at; they actually TEACH you Psychiatry. You will meet with them for one to two hours a day where they will review patient cases and relevant issues in Psychiatry. They will lecture, run journal clubs, and prepare you for practice as well as the exam. You will learn to empathize with some of the sickest patients you will ever see (and you WILL have stories to tell your grandchildren.) They also arrange "special guests" to speak with you; notably a clinical psychologist whose specialty is psychological testing and has YOU do the Rorschach test. I left this rotation having a great understanding of this field of medicine as well as feeling extremely refreshed. In summary, if you are considering a career in Psychiatry, want a relaxing six weeks, and want to see some of the most bizarre cases ever ("One Flew Over the Cuckoo's Nest" did not begin to prepare me) you want to go to Westwood Lodge. I can't imagine medical school without it.