How to get the most out of your psychiatry placement
Authored by Anna Taylor, Cohort 2016
I recently finished my psychiatry placement and had a fantastic and varied time! There are lots of things that you can do to make the most of your placement and get as much experience from it as possible.
This is good advice for any placement of course! No matter how long or short your psychiatry block is, it’s worth sitting down in the first few days to look at exactly what your medical school and hospital offers in the way of access to different teams and subspecialties.
If you’re responsible for organizing attendance at ward rounds or clinics, do this as soon as possible so that it’s in your diary and you know you won’t miss out. You can also then do some private study before you work in that subspecialty, to enable you to get as much from it as possible and clarify things you aren’t sure about.
It can be helpful to get a grasp of some of the legal frameworks used within psychiatry, like the commonly used sections of the Mental Health Act, as well as the Mental Capacity Act. Psychiatry is truly biopsychosocial, so gaining an understanding of the various therapies offered to patients – including side effects of pharmacological treatments and the availability of psychological therapies.
What to bring
There are, of course, the standard suggestions of a notebook, several pens, your ID badge and your phone! It’s worth bringing your phone charger if your phone is anything like mine and runs out of battery quickly if you’re using Maps (which you may use a lot if you’re on a community placement and are driving to see patients!).
I’d also recommend bringing a textbook along for reference, or for studying in case there’s a gap between seeing patients. Psychiatry PRN is a great starter, with some helpful advice on history taking and how to do a mental state examination as well as chapters on the main clinical presentations.
The Maudsley Handbook of Practical Psychiatry is a useful pocket-sized book covering all the common areas, and the Oxford Handbook of Psychiatry is also great, albeit possibly more detail than is needed at undergraduate level.
Psychiatry has a wide range of diverse specialties. By experiencing them all, you could discover an area that you hadn’t previously known about or thought you might like. Equally, you might realize that certain subspecialties aren’t for you. For example, you may love the hospital environment and relatively fast pace of liaison psychiatry, but not really like the slightly slower pace of working with older adults in the community.
You might not enjoy forensic psychiatry but love working within perinatal services. You could discover that you like subspecialties such as neuropsychiatry or old age psychiatry that can be similar to medical specialties. The great thing about psychiatry is that there are so many areas to learn about, and if you aren’t happy within a team, try somewhere else!
Observing a Mental Health Act assessment can be a great learning experience in an acute setting, and taking a step back with a Balint group can enable you to reflect on some of the patients you’ve seen in a really supportive environment.
Learn by doing (and talking!)
It can be difficult to learn psychiatry from a book, and you’ll only become proficient at taking psychiatric histories if you do it as much as possible. You can of course learn psychiatry’s definitions, and the constellations of symptoms that lead to diagnoses, but to really understand what it’s like to live with those symptoms you need to hear the patient experience. Don’t forget to cover the patient’s medical history, as they will probably have other illnesses too (independent or related to their mental health).
Get used to asking questions you might initially find uncomfortable, such as about patients’ personal history, forensic history or drug and alcohol history. The ability to do a good mental state examination also takes practice, as some patients may have quite subtle signs. Additionally, always try to present your patient histories to someone you’re with, and discuss their management plans. If you get the chance, ask to write in the patients’ notes on ward rounds, or help to draft letters.
As well as from patients, you can also learn a lot from junior doctors and more senior psychiatrists. Ask them what drew them to psychiatry, what they love about their job, and if there’s anything they don’t like. It’s also good to ask about what it’s like training in psychiatry, so you can get an idea of whether it’s something you might like to do as a career.
Don’t just stick with the psychiatrists, either – you can get valuable experience with psychiatric nurses, OTs, social workers, psychologists and psychotherapists. Even talking to the anaesthetist during an ECT clinic can give you a new perspective and new knowledge!
You may come into contact with a patient or situation that is worrying, triggering or frightening. It’s important that you talk to someone about this if you want to – if you have a psychiatrist mentor then chat to him or her, or speak to the person who saw the patient with you about how it made you feel.
Alternatively you can bring them up in a Balint group or similar setting and discuss the patient with several other people. The important thing is to not bottle up any feelings that may have been evoked; psychiatrists get supervision too!
Read, read, read
And not just textbooks! There are so many fascinating books about mental health, from autobiographies to fiction, from the history of psychiatry to sociology and public health. Some fantastic books to start with include Kay Redfield Jamison’s memoir ‘An Unquiet Mind’, Lisa Genova’s fiction ‘Still Alice’, and Sebastian Faulks’ ‘Human Traces’.