Psychiatry needs a new marketing campaign to improve its credibility and appeal as an interesting and respectable career option for medical students. Also, exposing those who may be going into primary care to “bread and butter” psychiatry would enhance patient care since a large percentage of psychotropic medications are actually prescribed by primary care doctors.
During the third year of medical school, students rotate through several required clinical clerkships, one of which is psychiatry. Since I started medical school 20 years ago, I have spoken with very few students and doctors who have had positive experiences with their psychiatry rotations.
Why?
In my opinion there are several reasons, but one significant one is that most rotations offer a skewed view of the specialty because they do not typically reflect the real world practice conditions of most psychiatrists.
Most practicing psychiatrists do not spend the bulk of their time on inpatient psychiatric units, but that is precisely where most students spend their time. They get exposed only to the most severely ill patients. They miss out on the outpatient setting where most psychiatrists practice.
It may be surprising to many to hear that I went into psychiatry despite having had a mediocre med school psychiatry experience.
I spent most of it on an inpatient unit filled primarily with patients suffering from schizophrenia. I had had no previous experience or instruction on how to interact with a psychotic person, and I distinctly remember my feeble attempts to elicit a history from a man who became acutely agitated and nearly violent every time I tried to interact with him.
I wish I had had an opportunity to see outpatients and spend time on the consultation-liaison service, but I didn’t.
I do believe schools could most easily improve psychiatry rotations by exposing medical students to a greater variety of practice arenas.
I suppose that the primary reason most academic psychiatry departments do not include medical students in the outpatient arena is due to two factors.
First, providing a positive, balanced student rotation is probably a relatively low priority for many psychiatry departments. Second, it goes against the cultural grain of psychiatry to allow students to “intrude” into the private office-based sessions.
But why?
Of course psychiatric appointments are very personal, private affairs. But aren’t many other patient medical encounters as equally personal in their own ways?
As a medical student I performed many breast and pelvic exams during a family practice rotation. I witnessed numerous urological procedures. I assisted in the labor and delivery process.
Why is it okay for medical students to be involved in these other, very personal, medical events but not in psychiatric sessions?
In an academic setting, are psychiatric interactions with patients really any more deserving of privacy than the above examples?
I don’t think so.
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