2023 Psychiatry Clerkship Guide

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Psychiatrists are physicians who focus on understanding and treating mental health disorders and psychological distress, primarily through the use of talk therapy and medication. The psychiatry clerkship gives medical students the chance to gain first-hand experience with this complex and continuously evolving specialty.

“One day, in retrospect, the years of struggle will strike you as the most beautiful.” – Sigmund Freud

This guide will cover the psychiatry clerkship, including when to place this rotation, how to make the most of your rotation, psychiatry clerkship resources, the shelf exam, and the pros and cons of pursuing this specialty.

 

Intro to the Psychiatry Clerkship

Clinical clerkships (also known as rotations) allow medical students to practice medicine while being supervised by an established physician. Clerkships provide students with direct, first-hand knowledge of what the many different medical specialties are actually like, enabling students to better determine the field of medicine they are most passionate about and want to practice when they eventually become a physician themselves.

Most US medical schools require the following rotations:

Medical School Clerkship icons

Some schools may also require additional rotations, such as emergency medicine, radiology, anesthesiology, and more.

Psychiatry is the field of medicine focused on understanding and treating psychological distress and mental health disorders. Psychiatrists use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) in evaluating a patient’s symptoms and determining if they show signs of a diagnosable disorder.

Psychiatrists can also help patients with conditions that aren’t necessarily classified as DSM illnesses, such as psychological distress that comes from pain, trauma, or other high-stress situations.

While it can sometimes be easy to confuse psychiatrists and psychologists, psychiatrists are medical doctors, which means they have an MD or DO. This means psychiatrists have been through four years of medical school, a residency, and perhaps even a fellowship.

They are able to diagnose and treat mental conditions using medication or non-medication treatments, also known as psychotherapy. Psychiatrists often rely on talk therapy to help patients with mild symptoms or who have issues that won’t necessarily respond to medications.

Psychologists typically have Master’s or PhD-level training. While they can diagnose and treat mental illness, they can only use non-medication treatments.

It should also be noted that psychiatry is about a lot more than simply memorizing DSM criteria and assigning each patient a diagnosis. The DSM is more of a guide. Psychiatrists formulate a more holistic view of their patients by considering the psychological, socioeconomic, and physiological causes of their symptoms, not only the symptoms themselves.

There are a few ways to categorize psychiatry, including  clinical vs. research roles, the setting of one’s practice, such as academic vs. community vs. private practice, and numerous variations depending on your subspecialty and area of focus.

For more information, including how to become a psychiatrist and the many subspecialties within psychiatry, read our comprehensive guide: So You Want to Be a Psychiatrist.

 

When to Place the Psychiatry Rotation

Unlike other rotations, psych is often considered standalone, placed ad hoc with additional priority given to the big rotations, such as Internal Medicine. It stands in stark contrast to the placement strategy of OB/GYN and surgery, where positioning one before the other provides a huge advantage in terms of OR preparation and exposure to surgical culture for the latter rotation.

Even though it can be one of the most mentally taxing, psych is often considered one of the easiest overall rotations. You might choose to place it first as a way to ease into clerkships, and given how some rotation grades may not make it into the MSPE/Dean’s letter, it can be a strategic move to place it earlier than a more difficult rotation. Easier rotation/shelf = higher grades, if it matters at your school.

While psychiatry is unique, it can also be seen as a soft entry into medicine/neurology, especially in the outpatient setting. The psych clerkship allows you to get used to the pace of outpatient clinics and exposes you to writing long notes, which will help with medicine, so you may want to prioritize it early on.

Another option is to place it in the middle as a “break rotation,” such as between medicine and surgery to give yourself some precious time to recharge.

If you are interested in pursuing psychiatry as a specialty, it’s best to place it in the middle of the pack so that you are experienced when you get to it but still have time to pivot if it’s not your true love. This also leaves you time to acquire a letter of recommendation and schedule elective psych rotations if they are available, such as addiction medicine, child psychiatry, psych sub-I, etc.

Keep in mind that you may not have the opportunity to choose your clerkship order, depending on your school’s rotation process.

 

What to Expect From the Psychiatry Rotation

Structure

Depending on your institution’s clinical partnerships, for the 4-6 weeks you spend in psychiatry, you could find yourself in an inpatient facility, outpatient setting, or a combination of both.

For example, you may be able to opt for 2 weeks in an unlocked inpatient psychiatry wing followed by 2 weeks in the adjacent locked unit, or you may select or be placed in a 4-week rotation at a community mental health center that provides low-cost outpatient psychiatry services.

Finally, you may have the opportunity to benefit from a built-in elective component, such as 2 weeks at a child/adolescent program or addiction medicine clinic. Much like neurology, OB/GYN, and surgery, you will find yourself in a variety of settings, each with its own unique patient population.

Inpatient

Unsurprisingly, your daily schedule will vary according to what service you are on. Regarding the inpatient side, rejoice in a more reasonable wake up schedule. You will likely not find yourself waking up at 4 AM to pre-round ahead of the first OR case of the day, nor will you feel like you are on a marathon-long episode of House.

Instead, you will be assigned a couple of patients to pre-round on ahead of morning report and/or rounds. You’ll likely begin around 6:30-7:30 AM or possibly even later if it isn’t a busy service, after which you’ll meet in the team room with your residents before the attending arrives to signal the start of rounds (as late as 10 AM.)

Depending on your attending’s style, rounds will be reminiscent (or a preview) of inpatient medicine. You will discuss all of the patients assigned to your team, either in the team room, which is sometimes called “card flipping,” or utilizing the traditional approach of going door to door, which is sometimes called discovery or learning rounds.

Assuming your patients are relatively stable and your list is not maxed out, expect rounds to take around 2 hours. Next, it is commonplace to break for a 30 minute to one hour lunch before finishing your notes in the early afternoon. Yes, you heard that right—a dedicated lunch period!

Your mid-to-late-afternoon will likely be filled with your weekly medical student or resident didactics. On the other hand, you may find yourself walking or driving home while the sun is still up. While we don’t necessarily want to get your hopes up, of all the required inpatient rotations, psychiatry gives you the best chance to go home early. Moreover, it is unlikely your team will require you to come in on weekends.

As you would expect, the acuity of patients differs greatly between the inpatient and outpatient settings. Furthermore, there is a huge difference between the unlocked and locked units. The type and intensity of psychiatric conditions will vary accordingly, as will the amount of time spent with each patient.

Your patient list may include people with schizophrenia who are actively psychotic, those with bipolar I disorder who are currently manic, and suicidal major depressive patients. If someone is recovering well, you may speak with them for less than 15 minutes. On the other hand, you may devote multiple hours a day to a patient who is trending toward an extension of their psychiatric hold.

If you are part of the locked unit team, do not expect to do too much pre-rounding or visits on your own, as safety and continuity of care take priority. You may also find yourself on a team who takes ED consults, which often results in voluntary or involuntary admissions for acute bouts of psychosis, major depression, or substance abuse.

Finally, given the low priority of mental health in the United States, many of your patients will be unable to afford outpatient services, so expect regular social work and occupational therapy consults to serve as stopgap measures. Less commonly, you will lead consult requests to other medical specialty teams, such as cardiology (usually for psychiatric medication side effects) or addiction medicine.

In the end, expect your patient list to be varied, but within the narrower spectrum of psychiatry.

Outpatient

If you find yourself in the outpatient setting, expect a typical 8-5 ambulatory medicine schedule, albeit with longer (sometimes 1+ hour) patient visits. You will likely be asked to show up earlier than the first patient to preview the day’s schedule, and there will be a predefined lunch period.

Unlike the inpatient side, you may not find yourself with as much responsibility or autonomy in outpatient psychiatry, especially if it is a packed schedule and the attending wants to get home on time. On the other hand, if you are placed in a community health setting, you may have more autonomy than even your inpatient weeks could provide.

Depending on the needs of the patients and frequency of no-shows, expect to stay until 5-6 PM on bad days and 4 PM on good ones.

If your outpatient weeks follow your inpatient ones, expect the same spectrum of conditions, but less emergent presentations of such. For example, you may see a follow-up for major depression in which the patient is well-controlled on their current medication regimen and no major changes are made to the therapeutic regimen followed by a young adult who was referred for workup of generalized anxiety disorder.

In terms of proportions, expect the majority of patients you see to already be well-established with practice, unless you are in the community setting. Again, your participation in these visits may be more limited according to your attending’s preferences, but if there is a new patient, you may have a chance to perform the initial diagnostic workup.

While psychiatry is full of surprises, you can still prepare for your rotation appropriately and effectively. To help you with that, we have expanded upon the most common conditions you will run into during your psychiatry rotation as well as what skills you should expect to acquire and practice.

 

Making the Most of the Psychiatry Rotation

High-Yield Psychiatric Conditions and Topics

While psychiatry is often viewed as an offshoot of medicine or neurology, the topics you will face are as unique as the patient population and practice of psychiatry itself.

To that end, we recommend you view your psychiatry rotation as the self-encapsulated discipline that it is, knowing that while the inpatient and outpatient tasks are, on the whole, similar to other medical specialties, you must become familiar with (quite literally) a different book of knowledge.

Conditions

Major Depressive Disorder (MDD)

  • Clinical Features and DSM-5 Diagnostic Criteria
    • Five or more of the SIGECAPS symptoms for at least 2 weeks causing clinically significant distress or impaired social functioning, with at least one of the symptoms being depressed mood or anhedonia.
      • S – Sleep (insomnia/hypersomnia)
      • I – Interest loss (AKA anhedonia)
      • G – Guilt/Low self-esteem/worthlessness
      • E – Energy changes (fatigue)
      • C – Concentration difficulties (pseudodementia)
      • A – Appetite changes (increased or decreased)
      • P – Psychomotor agitation or retardation
      • S – Suicidality
  • Remember, sadness and anhedonia count as separate symptoms!
  • Remember to exclude disease (hypothyroidism, adrenal insufficiency), drugs (intoxication or withdrawal), and other disorders (bipolar/mania).
  • Treatment: 1st line – Cognitive Behavioral Therapy (CBT) with initial pharmacotherapy (SSRIs).
    • SNRIs are also first-line meds.
  • Additional medications
    • Ensure patient compliance and 4-6 week medication trial before switching.
    • Atypical antidepressants
    • Tricyclic antidepressants (TCAs)
    • Monoamine oxidase inhibitors (MAOIs)
    • Electroconvulsive Therapy (ECT) for treatment resistant depression, depression with psychotic features, or high risk of suicide.

Major Depressive Disorder Subtypes

  • MDD with seasonal pattern (Seasonal Affective Disorder; SAD)
  • Commonly fall or winter seasonal pattern
  • Symptoms need to be present for 2+ consecutive years and majority of years in a patient’s lifetime
  • Treat with bright light therapy
  • Atypical Depression
    • Most common MDD variant
    • Unique clinical features:
      • Hypersomnia
      • Hyperphagia/over-eating
      • Leaden paralysis (feel like lead)
      • Rejection sensitivity
      • Mood reactivity (brightening of mood with good events)
    • 1st line treatment – Same as MDD
  • MDD with psychotic features
    • Psychotic features (delusions, hallucinations, etc.) only occur alongside MDD episode (contrast with schizophreniform disorder)
    • 1st line treatment – Antidepressants with atypical antipsychotics
  • Persistent depressive disorder (dysthymia)
    • Depressed mood plus two or more MDD symptoms (usual not suicidal or psychomotor) that are present for the majority of the day and majority of days for 2 or more years.

Bipolar Disorder

  • Clinical Features
    • Alternating features of MDD (above) and mania
    • Manic episode
      • Present for at least one week
      • 3+ of the features below
      • Significant dysfunction +/- psychotic features
      • Requires hospitalization
    • Hypomanic episode
      • Present for at least 4 days
      • 3+ of the features below
      • No significant dysfunction AND no psychotic features AND no hospitalization.
  • Mania features (DIGFAST)
    • D – Distractibility
    • I – Irresponsibility (risky activities)
    • G – Grandiosity
    • F – Flight of ideas/racing thoughts
    • A – Activity Increase
    • S – Sleep change (no need for sleep)
    • T – Talkativeness
  • DSM-5 Diagnostic Criteria
    • Bipolar I – At least one episode of mania +/- hypomania or MDD episodes
    • Bipolar II – At least one MDD episode AND one episode of hypomania
    • If there is mania, it is not Bipolar II
    • Rule out intoxication
  • Subtypes
    • Rapid Cycling
      • 4+ episodes of mania, depression, or hypomania in one year
    • Cyclothymia
      • Persistent mood instability with numerous depressive and hypomanic periods that aren’t severe enough for bipolar disorder
      • Present for at least half the time of a 2+ year period, never absent for more than 2 months at a time
    • Drug-Induced
      • Can be due to intoxication or withdrawal
      • Alcohol, PCP, amphetamines, cocaine, steroids, etc.
  • Treatment
    • Acute Management
      • Depression – Atypical antipsychotic + mood stabilizer
      • Mild to moderate mania – monotherapy with atypical antipsychotic or mood stabilizer
      • Severe mania – Same as acute depression
      • ECT is okay in pregnancy
      • Screen for suicidal ideation
    • Long-term management
      • Lithium (preferred), valproate, lamotrigine
      • Lithium is the only drug proven to lower the risk of suicide

Schizophrenia

  • Clinical Features and DSM-V Criteria
    • Continuous cognitive disturbances for at least six months, including two symptoms from the following list, with at least one symptom being one of the first three:
      • Delusions (grandiosity, paranoia, etc.)
      • Hallucinations (usually auditory)
      • Disorganized speech (word salad, loose associations, tangential)
      • Disorganized behavior (inappropriate laughing/smiling)
      • Negative symptoms (mutism, flat affect, anhedonia, apathy, avolition)
    • Symptoms must cause significant personal or occupational impairment
    • Rule out substances, schizoaffective disorder, and mood disorder with psychotic features
  • Diagnostics
    • While not necessary, brain imaging may show cortical, hippocampal, and temporal atrophy with enlargement of the cerebral ventricles
  • Subtypes
    • While not true subtypes, it is important to differentiate between schizophrenia and other “schizo” disorders:
      • Brief psychotic disorder has similar features but lasts less than one month and usually arises due to a trigger
      • Schizophreniform disorder is exactly like schizophrenia but lasts between 1-6 months
      • Schizoaffective disorder is a mixture of a mood disorder with schizophrenia, with the dominant symptoms being that of schizophrenia, which also need to be present for at least 2 weeks in the absence of mood symptoms
      • Schizoid and schizotypal disorders are personality disorders and covered more below
    • Catatonia
      • Associated with many mental disorders
      • Characterized by either suppressed movements (immobility, staring, mutism), “excited” movements (restlessness, purposeless movement), or “malignant catatonia” (fever, delirium, rigidity), which resembles neuroleptic malignant syndrome
      • Treat with benzodiazepines such as lorazepam and discontinue any dopamine blocking drugs
      • Can also use ECT for malignant catatonia
  • Treatment
    • Antipsychotics such as risperidone, quetiapine, and aripiprazole are first-line
      • Base your decision on side effects and interactions
      • Clozapine and olanzapine should be held in reserve due to potential agranulocytosis and metabolic effects, respectively
    • Treatment-resistant Schizophrenia
      • Persistent symptoms despite multiple 6-week trials of antipsychotics
      • Start clozapine and monitor the ANC
    • Consider long-acting/depot antipsychotics to those at increased risk of noncompliance
    • Do not stop antipsychotics in pregnancy; try either haloperidol or olanzapine

Overview of Personality Disorders

  • Unlike the above disorders, the features of personality disorders must be present for most of a person’s life and emerged early on, much like your own personality. The below patterns are maladaptive, inflexible, and cause significant impairment.
  • Cluster A (Weird)
    • Characterized by odd or eccentric behavior with inability to form relationships in the absence of psychosis
    • Association with psychotic disorders
    • Types
      • Paranoid Personality Disorder (PD)
      • Schizoid PD
      • Schizotypal PD
  • Cluster B (Wild)
    • Characterized by dramatic or emotional behavior
    • Association with mood disorders and drug abuse
    • Types
      • Antisocial PD
      • Borderline PD
      • Histrionic PD
      • Narcissistic PD
  • Cluster C (Worried)
    • Characterized by fearful, anxious, or avoidant behaviors
    • Association with anxiety disorders
    • Types
      • Avoidant PD
      • Dependent PD
      • Obsessive-Compulsive PD (Not OCD, Ego-syntonic presentation)
  • Remember, people with any of the above PDs have an ego-syntonic presentation in which they view their symptoms as normal
  • Reach for CBT/cognitive therapy first
  • If more symptomatic, consider mood stabilizers like valproate or SSRIs for features of mood disorders

Medication Classes

Antidepressants

  • Selective serotonin reuptake inhibitors (SSRIs)
    • Examples: Fluoxetine, sertraline
    • Used to treat MDD, generalized anxiety disorder (GAD)
    • Common adverse effects
      • Sexual dysfunction
      • GI upset
      • Insomnia
  • Serotonin norepinephrine reuptake inhibitors (SNRIs)
    • Examples: Venlafaxine, duloxetine
    • Used to treat MDD, GAD, neuropathic pain, fibromyalgia
    • Common adverse effects
      • Sexual dysfunction
      • GI upset
      • Insomnia
      • Hypertension
  • Tricyclic antidepressants (TCAs)
    • Examples: Nortriptyline, amitriptyline
    • Use to treat MDD (not first-line), neuropathic pain, migraine prophylaxis
    • Common adverse effects (3 C’s)
      • Anticholinergic effects
      • Cardiotoxicity
      • Coma (sedation)
  • Monoamine Oxidase Inhibitors (MAOIs)
    • Examples: Selegiline, phenelzine
    • Used to treat MDD (atypical depression)
    • Common adverse effects
      • Priapism
      • Sedation
  • High-Yield Atypical Antidepressants
    • Mirtazapine
      • Good for underweight/insomnia individuals due to propensity for sedation, increasing appetite
    • Bupropion
      • Good for smoking cessation alongside varenicline
      • Reduces seizure threshold, causes agitation/tachycardia
    • Vilazodone and Vortioxetine
      • Can cause GI upset, priapism, insomnia

Antipsychotics

  • First-Generation
    • High-potency
      • Haloperidol, fluphenazine, trifluoperazine
      • Used to treat variety of conditions, including schizophrenia, acute psychosis, delirium, and other acute agitated states
      • Can cause extrapyramidal symptoms and neuroleptic malignant syndrome
      • Fewer metabolic/anticholinergic effects
  • Low-potency
    • Chlorpromazine, thioridazine
    • Used to treat acute agitation and delirium
    • More anticholinergic effects/sedation and less extrapyramidal effects than high-potency cousins
  • Second-Generation
    • Risperidone, quetiapine, olanzapine, clozapine, ziprasidone
    • Used to treat variety of conditions, including schizophrenia, bipolar disorder, acute/postpartum psychosis, Tourette syndrome, and MDD with psychotic features
    • Can cause neuroleptic malignant syndrome, metabolic effects, prolonged QT interval, and anticholinergic/sedation effects
      • Extrapyramidal symptoms are less common
      • Clozapine can also cause myocarditis and agranulocytosis

Psychiatry Rotation Skill Acquisition

If you thought neurology was a cerebral specialty, just wait until your first rounds with the psychiatry team. Although the DSM-5 makes everything seem cut and dry, real-life patients are anything but that.

For example, a patient may present with an unknown history of bipolar disorder and require hospitalization for certain features of their condition, but otherwise, they don’t meet the criteria for Bipolar I. Other times, especially in child and adolescent psychiatry, the diagnosis may be uncertain or straddle two similar conditions, such as conduct disorder and antisocial disorder in a 17-year-old.

As such, it is imperative to take a thorough standardized history, incorporating the unique elements of psychiatry. For those hoping to brush up on their suturing skills, look elsewhere. Psychiatry is one of the least hands-on specialties. Nonetheless, your enhanced history-taking skills will be an invaluable addition to your tool set for every other rotation.

History Taking

In addition to your typical history elements (CC, HPI, FH, MH, Social/family history), you will need to incorporate additional elements, including:

  • Psychiatric specific history
    • Hospitalizations (what, where, why)
    • Use of psych medications (as much detail as possible)
    • Suicide attempts (why, when, how)
  • Detailed substance use history (if applicable)
    • For each substance, gather:
      • Age of first use
      • Frequency and quantity
      • Route of use
      • History of withdrawal

Above all, adapt your approach to allow for more time with each patient, thereby allowing compassionate rapport building to come to the forefront. While some of the questions above may be specific, always lead with open-ended questions and utilize reflective listening so the patient doesn’t think you are just completing a checklist.

Once you have completed a few, start tailoring your history taking based on the patient’s presentation to make the encounter more successful.

Mental Status Exam (MSE)

Think of the MSE as the psychiatrist’s (as well as part of the neurologist’s) physical exam. It qualitatively and quantitatively assesses a patient’s mental status. Specifically, use your time with the patient to analyze their:

  • Appearance and behavior
    • Well dressed?
    • Abnormal motor activities?
  • Level of Consciousness and Cognition
    • Delirious? Somnolent?
    • Amnesia?
    • If applicable, this is where the mini-mental state examination (MMSE) would come in. Of note, it is not the same as the MSE.
  • Speech
    • Echolalia?
    • Poverty of or pressured speech?
  • Thought Process
    • Circumstantial thinking?
    • Flight of ideas?
  • Thought Content
    • Delusions?
    • Suicidal/Homicidal ideation?
  • Perceptions
    • Hallucinations?
    • Illusions?

Overall, your pre-rounding, rounding, and note-taking skills are transferable from other medical inpatient specialties. The wrinkle will be the length of each element. While rounding tends to go faster since everyone typically sees the patient on their own and draws similar conclusions, your conversations with the patient are expected to be longer, as will your notes.

Unlike other rotations, the latter will almost feel like writing a narrative in which you include quotes, feelings, and the like. In short, your typical SOAP note format will be augmented by a longer subjective section, while your objective section will consist of the MSE rather than physical exam maneuvers.

While learning how to function as an efficient and effective psychiatry clerk may not have as steep of a learning curve as stepping into the OR for the first time, do not ignore previewing and applying the above skills. Your team and patients depend on you more than you know.

Clerkship Tips Rotation acvice graphic

 

Psychiatry Clerkship Resources

The following resources will aid you throughout your clerkship and help you succeed on your shelf exam.

  • AMBOSS
    • Psych articles
    • Psych shelf QBank
    • Psych rotation overview
  • Anki
    • AnKing Psychiatry Shelf/Step 2 Tagged cards
    • Could consider supplementing Step 1 Psych pharm cards
  • UWorld
    • QBank (unnecessary to do both UWorld and AMBOSS)
  • NBME Psychiatry Practice Exams
    • Do any and all
  • DSM-5
    • Pocket versions available for rounds, otherwise apps and resources like AMBOSS abound
  • First Aid Psychiatry
  • Case Files Psychiatry and Pre-Test Psychiatry
    • Low-yield—okay to use if you don’t have access to or run out of other Qbanks

 

Psychiatry Shelf Exam

While the clerkship itself may feel mutually exclusive to all others, that is far from the truth on the shelf. Be prepared to answer questions regarding organic causes of psychiatric conditions, such as delirium, adverse drug effects, seizures, etc.

In that respect, there are some elements of medicine and neurology on there, but not necessarily surgery or OB/GYN, with the exception being special considerations for pregnant patients. Know first-line medications just like you know your diagnoses. You will be hit again and again with them.

The two biggest types of questions are those related to the diagnosis of a condition and those related to its first or second-line management. Pediatric elements are also incorporated into the exam, including those relating to normal development.

Have the DSM-5 diagnostic criteria for each major condition on lock because you will be diagnosing things like MDD, anxiety, and bipolar over and over again.

On that note, don’t start second guessing yourself if you feel like you are answering with the same diagnosis for multiple vignettes/presentations. The spectrum of diagnoses is narrow.

It may also be helpful to know genetic causes of disability, like Huntington’s and Down syndrome. However, the bulk of the exam, which is similar in length to all other shelf exams, is primarily psych, so you can still easily pass without worrying about more esoteric topics.

Psych is one of the easier shelf exams if you stick to studying with spaced repetition and practice questions. You don’t need to do much outside of that.

Learn more from our How to Prepare for Shelf Exams Guide.

 

Residency Choices: Pursuing the Psychiatry Specialty

Psychiatry currently ranks in the #3 spot of our Least Competitive Specialties ranking based on our MSI index specialty comparison of 24 specialties.

View our comprehensive Specialty Competitiveness Index, which assesses specialties based on USMLE Step 1, Step 2 CK, Top 40 NIH, publications, and more.

Psychiatrists typically enjoy a lifestyle that’s hard to beat, with the average psychiatrist earning around $280,000 and working an average of 47 hours per week. Psychiatry isn’t without its drawbacks though. Treating mental illness and working with people with substance use disorders, severe mental illness, or personality disorders can be incredibly emotionally draining.

Psychiatry has recently increased in competitiveness in recent years due to our society’s increased understanding of the importance of work/life balance and mental health. Psychiatry is no longer the stigmatized medical field it once was, which means there are currently more opportunities than ever.

The specialty really shines when it comes to its wide range of subspecialties, which you can pursue after completing your psychiatry specialty.

Notable Psychiatry Subspecialties:

  • Child Psychiatry
  • Psychosomatic
  • Geriatric
  • Forensic
  • Addiction
  • Public
  • Interventional

Psychiatry is quite a unique specialty in medicine, as it’s the least algorithmic. You will need to think deeply and holistically about each of your patients, as even if two of your patients have the same disorder, you’ll likely still have two different treatment plans.

If you like to spend time with patients, hear their stories, and build longitudinal relationships, psychiatry might be the specialty for you. No other medical field goes as deep when it comes to supporting people through their challenges, and it’s one of the few specialties left where you’ll regularly meet with your patients for 45 minute to one hour appointments.

You must be able to help people work through emotionally heavy situations and listen to many upsetting or tragic stories. Over time, you will get to see your patients improve, which can be highly satisfying.

Psychiatry also offers a lot of flexibility, as you can potentially have multiple jobs or work in multiple clinical settings or with multiple patient populations at once. Theoretically, you could run your entire practice out of your home office. Other specialties demand that you take one job in one setting, whereas psychiatry allows you to tailor your career to your own personal goals.

Plus, of all the required inpatient rotations, you have the best chance of going home early with psychiatry, both during and after residency. For the most part, you’ll face regular business hours. Overnight emergencies or weekend calls do not happen often, though this is highly dependent on the program. Some programs will have none at all.

With that said, psychiatry isn’t for everyone, as it’s a hands-off specialty that does not require physical examinations or procedures. You must also be comfortable with uncertainty, as our understanding of mental illness is still evolving.

It can be difficult to know exactly how to help patients. You may try multiple treatment options with little to no success. You are also more likely to deal with patient populations that require fortitude on your part, such as people with severe mental illness or personality disorders and people with substance use disorders.

Learn more about whether or not the psychiatry specialty is right for you: So You Want to Be a Psychiatrist (video and article).

 

Final Thoughts on the Psychiatry Clerkship

Your psychiatry clerkship will be less taxing on your time than other rotations, but it will also present a challenge, as there is far less overlap between this rotation and the others. If you have the choice, carefully consider where you want to place this rotation, as it could help ease you into your rotations or provide a break in between more draining ones.

If you love the brain and are deciding between psychiatry and neurology, know that while they do have things in common, each has a different primary focus. If you’re interested in how the mind works, how to treat emotional disorders, and are comfortable with ambiguity and holistic formulation, psychiatry could be a good fit. If you prefer more concrete answers and black and white pathophysiology, neurology might fit better.

Psychiatry offers a flexible medical career that’s extremely patient-facing and comes with a reliable work/life balance.

 

Get the Advice and the Resources You Need

Med School Insiders offers a number of Residency Admissions Consulting Services designed around your specific needs. We can help you prepare for residency with application editing, interview prep, and mock interviews.

View our library of resources, including guides on the entire residency application process, how The Match algorithm works, how to choose a specialty, and more.

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