How to do well on Psychiatry
Your time on Psychiatry will likely have both an outpatient and inpatient component where you will encounter a full range of mental disease. Psychiatric disorders, in general, do not have any display any obvious physical signs or stigmata of disease as you would see on a skin examination or auscultation; it is through communication and observation that psychiatrists carry out their evaluation and assessment. As such, encountering, interviewing, and treating psychiatric patients requires sensitive communication skills and continued altruism, as, while it is often all to easy to chalk up patient's problems to "being crazy" or unstable personalities, these patients are suffering from real disease and real pathologic processes. As a medical student, Psychiatry will help you will hone your communicative skills as well provide a deeper understanding how mental illness shapes patients and society.
Tips on doing well on your Psychiatry rotation
Ditch the white coat
Well, don't ditch it right away but, most likely, your residents and attendings will not be wearing a white coat as it automatically creates a power dynamic between physician and patient. For males, don't wear a tie, as, in the off chance a patient becomes aggressive, they have one less item of clothing to latch onto.
Learn the mental status exam
The physical exam in psychiatry is unlike the remainder of your third year. Take some time to look over the different things that are needed for a complete exam here. The nice thing about the mental status exam is that you can derive the whole thing just by having a conversation with the patient with the inclusion of a few directed questions. Remember to ask every patient, however, if they are hearing voices, seeing things that aren't there, or if they have any suicidal ideation or thoughts of hurting themselves or others. Ask these questions in a normalizing, straight forward way.
Learn the drugs
Of course, this is with any rotation or specialty but, because of the more finite number of psychiatric medications, take some time to learn the categories of each drug (i.e. atypical versus typical anti-psychotics) and the side effects and mechanism of action of each drug and drug category. A good proportion of the psychiatry shelf exam, as well as of Step 2 psychiatry questions, relate to side effects of psychiatric medications. In addition, the umbrella of psychiatry questions found on the shelf and Step 1 also include substance-related disorders and poisonings; know the common signs and symptoms of each different recreational drug or poison intoxication and the proper reversal agent, if there is one.
Learn the timelines
Many of the diseases in psychiatry have different names depending on the duration a patient has been suffering. For example, brief psychotic disorder is for more than 1 week but less than a month while schizophreniform disorder lasts for longer than a month but less than 6 months. Post traumatic stress disorder defers from acute stress reaction in that it is diagnosed after a month of symptoms versus less than a month of symptoms.
Be on guard
Psychiatric patients can be difficult to communicate with and can sometimes be unpredictable. Stay safe, listen to your gut, and politely excuse yourself from a patient if you feel tension or emotions rising.
Continue to quiz yourself
Like any rotation, do questions concurrently with the rotation. As your psychiatry block will likely allow you much more time to study and return to some normalcy state of being, ensure that you honor the rotation by running through question banks and reviewing pathology and concepts in your review book of choice.