Psychiatry Clerkship

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Psychiatry is taken in the Medicine/Neurology/Psychiatry block of your third year. Just like other rotations, your grade is calculated from a combination of your clinical performance and shelf grade. The class average for the Psych shelf has been one of the highest in comparison to other junior clerkship shelf exams. Depending on where you rotate, this elective can be challenging or easy.

The Test.

The psychiatry test is a shelf board exam purchased by the department. This guarantees that the content of the test will change from section to section. What remains constant is a heavy emphasis on such topics as mood disorders, anxiety disorders, and schizophrenia, and their treatments. The majority of questions were case-based, similar to the questions in these pearls. Be prepared for long vignettes, and manage your time accordingly. Those who have been assigned to Riley Hospital will need to study a review book, as they will have limited experience with adult psych. Those who are on adult psych will need to study some child psych, which is also covered on the exam, but is not as heavily emphasized. The exam also includes a few developmental and chromosomal childhood abnormalities, so if you have some extra time, you might quickly review those. Some questions will be testing your ability to identify psychiatric symptoms as the manifestation of a medical condition (eg. anxiety seen in a hyperthyroid patient) or as a result of substance intoxication or withdrawal, so give “psychosis/anxiety/depression due to a medical condition” consideration if it is an answer option. If normal behavior is an answer option, also give it serious consideration (eg. it is often normal for a child to experience separation anxiety until 2-3yo, so this would not be separation anxiety disorder). Although defense mechanisms are commonly cited as something important to study, several different blocks of students said there were no questions on defense mechanisms on the test last year.


As far as pharmacology goes, the emphasis is on the first-line class used to treat a condition and its most common side effects. There are few to no questions about differences in medications in the same class. Know into which class drugs fall, which diseases they treat, and their major side effects. You do not need to know dosages for the exam, but may be asked the dosages on the rotation. The psychopharmacology lecture will provide you with a good base from which to build your knowledge of these drugs, but is very long and detailed. Skim the packet for the major side effects, especially effects that are unique to one specific drug (the main points will be covered in lecture, so try to take notes). It is imperative to remember that although the wards and clinics may use trade names, the exam is exclusively generic names! Also know when first-line treatment is psychotherapy rather than medication, and what type of therapy is recommended for different disorders (the handout given by one of the lecturers on psychotherapy is helpful here).


Dr. Butler or another faculty member should offer a review session prior to the exam. I would recommend going, even if it is just for the pizza (but bring your own drink). You will get tips on “classic presentations” and help with focusing on “high yield” topics to study.

Books

Because of the nature of the test, the best way to do well is to study a board review book. The recommended text (by Kaplan and Sadock) is long to read in its entirety during four weeks, but can be done, though very few people attempt it.

  • First Aid: Psychiatry is a good book for those who like quick, bullet point reviews, and the amount of time spent on each topic is relative to its weight on the exam.
  • Case Files: Psychiatry is 60 cases with a concise review of the diagnosis from each vignette, along with review questions. The review questions are shorter and more straight-forward than those on the shelf exam, but the information about the cases is useful and a little more in-depth than First Aid.
  • Psychiatry Blueprints provides a good, concise review of almost everything on the exam; it does not contain a good review of medications, however, so use another source for those.
  • NMS Psychiatry is shorter than NMS Medicine text, is easy to get through and has questions.
  • The BRS (Board Review Series) is in its usual outline form, concise and with questions.
  • Appleton and Lange’s Psychiatry and Pretest Psychiatry are good question and answer style texts, although Pretest contains a fair amount of material that is not covered on the exam. Both books contain detailed explanations of the answers.

Any of these review books are sufficient for the exam, but it is helpful to have a review and questions to test your knowledge base and prepare for the style of questions on the exam.

Clinical Pearls

This pearls section is not as complete as others due to the fact that a board review book will be your best bet for success. It is worth noting that while on some shelf exams you may benefit from information learned in other clerkships (medicine, family medicine, etc.), psychiatry stands alone to some extent, and a thorough review is valuable. Concentrate on the signs and symptoms of the disease, treatment as a second focus, and all other items (etiology, etc.) as bonus info. The questions at the end of this section will give you an idea of the depth needed. For the topics not covered by handouts, the pearls will briefly summarize the signs and symptoms, treatment, and any other pertinent information of each psychiatric disorder

Subjects we Recommended reading about

Read with an emphasis on these topics:

  • Schizophrenia, Schizophreniform, Schizoaffective disorders
  • Anxiety disorders
  • Substance use
  • Personality disorders
  • Mood disorders
  • Delirium and dementia
  • Somatoform disorders, factitious disorder, malingering

Psych Medications

The best way to cover psychiatric meds is to learn their applications while on the wards treating patients, and then go over the finer details in a review book. Cover the general use of the drug, its side effects, and how it differs from others outside its class. Differentiation between drugs within a class is not as crucial (sometimes useful on wards, very infrequently tested on the shelf), unless there is a characteristic that makes a specific drug unique. The lecture handout is a great up-to-date resource and will emphasize the more common and widely used medications. Learn the generic names for the test; dosages are not necessary to know