Post by Eileen on Sept 25, 2005 19:45:24 GMT -5
My hind-sighted advice for the child and adolescent rotation:
#1 You have lots of extra time. The shelf exam does not cover a huge amount of material… and you will have more than enough time to prepare for it. If you find psych interesting, or find children interesting, use some of this extra time to learn how to properly offer supportive counseling. In child and adolescent psych, you are encouraged to counsel the children. Many of these children are emotionally, physically, or sexually abused. When you meet these kids, you will want to know what you are doing. Example: Imagine an 8 year old is telling you how he was molested by a teenage neighbor…imagine a 12 year telling you how he survived a brutal beating from his father…imagine a 17 year old telling you how she tried to commit suicide…do you know how to respond? Prepare.
#2 Adolescents these days aren’t what they used to be.
Learn about ‘cutting’ and drugs they are abusing (such as coricidin). Read what is online because this is what they are reading. Ask them what they know about their dangerous behaviors (their answers amazed me…and when I informed them of the medical truths, they were often surprised). I found the most therapeutic relationship was formed by treating them like young adults. They sense respect from you…and it builds trust…and helps to obtain information and therefore help them.
#3 Attend your patient’s “family sessions”. The social worker is the most amazing counselor on the floor—learn from her!!! Also, group counseling is done on Monday and Thursday mornings—on a day when the resident is willing to present your patient, skip rounds and go watch group therapy (conducted by a talented psychologist)!
#4 After learning how to do the mental status exam, learn the drugs at the beginning of the rotation and try to anticipate what your patient will be put on. (This means reading the end of First Aid first.) The unit is mostly geared towards pharmacotherapy (more so than psychotherapy). This is good review also for the shelf exam. Also, the attending expects you to know your patients medications (with dosages) in rounds.
#5 Send the collaterals right away (first thing in the morning) when you pick up a new patient. The quicker you send them, the quicker you get them back…and sometimes they are very helpful. Also, do not hesitate to call the patient’s guidance counselor, psychologist, or psychiatrist. Often these people have invested in the patient and they really want to talk to you! (Make sure you have the proper consent forms.)
#6 Schedule proper follow-up care for you patient and provide discharge instructions to parents/caregivers/case workers. Notice how many patients are re-admits…ask yourself…’What outpatient or community resources are available to this patient? What follow-up care did they receive (or not receive) at the last discharge?’. Learn about the resources at the beginning of the rotation. Learn what the CARE program is (see psych webpage), etc.
#7 This is an awesome rotation for personal growth/discovery. It is also much, much more emotional than I thought it would be.
You will find just as much pathology in these patient’s hearts as their brains. 
Recognize and analyze countertransference. 
#8 You will spend one week on adult psych. When you are moving from pediatric to adult, and from adult back to pediatric, make sure you transfer information about your patient to the next medical student taking the patient. Also, sometimes residents are starting/finishing rotations and patients get passed to someone who doesn’t know the whole story. COMMUNICATE!
#9 Shut the door when you enter and leave...you don't want to be responsible for a CODE PINK. (and you want to keep the nurses happy)
#10 The attending likes when you ask questions.
#1 You have lots of extra time. The shelf exam does not cover a huge amount of material… and you will have more than enough time to prepare for it. If you find psych interesting, or find children interesting, use some of this extra time to learn how to properly offer supportive counseling. In child and adolescent psych, you are encouraged to counsel the children. Many of these children are emotionally, physically, or sexually abused. When you meet these kids, you will want to know what you are doing. Example: Imagine an 8 year old is telling you how he was molested by a teenage neighbor…imagine a 12 year telling you how he survived a brutal beating from his father…imagine a 17 year old telling you how she tried to commit suicide…do you know how to respond? Prepare.
#2 Adolescents these days aren’t what they used to be.
Learn about ‘cutting’ and drugs they are abusing (such as coricidin). Read what is online because this is what they are reading. Ask them what they know about their dangerous behaviors (their answers amazed me…and when I informed them of the medical truths, they were often surprised). I found the most therapeutic relationship was formed by treating them like young adults. They sense respect from you…and it builds trust…and helps to obtain information and therefore help them. #3 Attend your patient’s “family sessions”. The social worker is the most amazing counselor on the floor—learn from her!!! Also, group counseling is done on Monday and Thursday mornings—on a day when the resident is willing to present your patient, skip rounds and go watch group therapy (conducted by a talented psychologist)!
#4 After learning how to do the mental status exam, learn the drugs at the beginning of the rotation and try to anticipate what your patient will be put on. (This means reading the end of First Aid first.) The unit is mostly geared towards pharmacotherapy (more so than psychotherapy). This is good review also for the shelf exam. Also, the attending expects you to know your patients medications (with dosages) in rounds.
#5 Send the collaterals right away (first thing in the morning) when you pick up a new patient. The quicker you send them, the quicker you get them back…and sometimes they are very helpful. Also, do not hesitate to call the patient’s guidance counselor, psychologist, or psychiatrist. Often these people have invested in the patient and they really want to talk to you! (Make sure you have the proper consent forms.)
#6 Schedule proper follow-up care for you patient and provide discharge instructions to parents/caregivers/case workers. Notice how many patients are re-admits…ask yourself…’What outpatient or community resources are available to this patient? What follow-up care did they receive (or not receive) at the last discharge?’. Learn about the resources at the beginning of the rotation. Learn what the CARE program is (see psych webpage), etc.
#7 This is an awesome rotation for personal growth/discovery. It is also much, much more emotional than I thought it would be.
You will find just as much pathology in these patient’s hearts as their brains. 
Recognize and analyze countertransference. 
#8 You will spend one week on adult psych. When you are moving from pediatric to adult, and from adult back to pediatric, make sure you transfer information about your patient to the next medical student taking the patient. Also, sometimes residents are starting/finishing rotations and patients get passed to someone who doesn’t know the whole story. COMMUNICATE!
#9 Shut the door when you enter and leave...you don't want to be responsible for a CODE PINK. (and you want to keep the nurses happy)
#10 The attending likes when you ask questions.