Psychiatry

Overall Flow

You will be assigned a psychiatrist for the first 2 weeks, another for the following 2 weeks, and typically back to the first psychiatrist for the last 2 weeks. The number of hours and start times will vary between the 3 students on this rotation. There is generally a fair amount of time to read/study on this rotation!

Your Preceptors

Dr. Giede and Dr. DeCessare - mainly adolescent psych., but also outpatient clinics with some focus on personality disorders, and potentially outreach to Vanderhoof.
Dr. Zanozin - Consult Liaison, Early psychosis intervention, Intensive case management with at-risk populations.
Dr. Udumaga - Covers UNBC, Correctional Facility, two outpatient teams - ACT and CAST. Busiest psychiatrist to be paired with, exceptional learning, he and his staff may handpick consults for your learning.
Dr. Jani and Dr. Schlamp: Variety of cases. Dr. Schlamp typically works with a psych resident. Dr. Jani often a shadowing role but feel free to discuss cases.

Your Role

This is very preceptor dependent. They may ask for (or you can offer) help with: note-taking or patient interviews during rounds, performing consults, dictating, and writing admission orders.

Call

During psychiatry you will do home call. This means the preceptor can send you home and call you back into the hospital when there is a case for you to see. Call is until to 11pm and you do not get a post-call day, so you are expected to work the next day.

You will work on 1 weekday call shift/week starting at 5pm and 1 full weekend (both Saturday and Sunday) call/rotation. There is no call for final 2 weeks of rotation!

Call switchboard to determine who is on call, then text or call your preceptor to determine what they want (ie. start time on weekends, where to meet)

Tips and Tricks

This rotation is a great opportunity to hone the thoroughness of your history, spend extra time with patients, and practice your people-watching (mental status exam) skills. There is plenty of time to discuss patient cases and ask for feedback on your assessments, mental status exams etc. with your preceptor, all of whom are quite approachable.

Pro tip: There will be times on this rotation that you may feel like you can NOT get a patient’s story straight. When this happens, realize that you are most likely not as disorganized as you feel. The patient may in fact have a disorganized thought process which could even give you a clue to the diagnosis. Recognize this likely fact and move on to the next section of your interview.

Approach to Psychiatry Consult:

Structure is important in a psych consult, especially when a patient has a disordered thought process. It’s easy to miss important information, at least during the start of your rotation. Use this suggested structure and go one at a time through each of the major HEADINGS. Despite your efforts, patients may try to go off track, but remember:
- - You are the boss and it is your job to know. Simply acknowledge the importance of what they are trying to tell you, let them know that you will discuss it later in the interview, and stress the importance of exploring what you are currently asking them about. Starting off a consult with the identification section is useful in rapport building, be conversational and ask them about their day to day.
  - Sometimes a patient is floridly psychotic and it is impossible to have a conversation with them. They’re either completely detached from reality or so manic that you just can’t get any information. At that point, you can just leave the interview because there’s no point trying to push it farther. You can, however, do a MSE and comment on things like appearance, affect, thought process, cognition...

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