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Psychiatry Program Discussion


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I did electives at McMaster, U of T, Western, and Calgary - 

 

I had a really good experience at Western, partly because it was my home program, so I knew who to work with.  My sense is that it's a solid program and the residents are generally happy, and there are some great staff who really want to teach.  On the downside, London is, IMO, a pretty crummy city to live in - not very diverse, not a lot to do.  And you don't have as much access to really specialized stuff as you would in a larger centre.  There is also no dedicated psychiatric emergency unit - there are a couple of (very bleak) "mental health" rooms in the main ED, but the ED where you do call isn't set up very well for psych.  There have also been really bad volume issues lately with just not having enough beds.  If it were in a different city, though, I'd have ranked it much higher.  They tend to undersell themselves on interview day for some reason.

 

McMaster, I enjoyed my elective also - unfortunately there was some shuffling of staff right before I got there so instead of getting an elective with a single preceptor, I got shuffled around between like 4-5 different staff, which made it difficult.  The facilities were very nice (nice new psych hospital) and the residents also seemed happy.  I was super impressed with their interview day and their program director was incredibly friendly and welcoming.  Again would have ranked it higher if it were in a bigger city.

 

Calgary I hear great things about but I didn't have a great elective experience.  They seemed to expect me to kind of sit on the sidelines, and visiting students are only offered general adult inpatient electives, which isn't always the best environment for an elective student to shine.  I think my poor experience was mutual and they didn't offer me an interview.  That said, I know it has a good reputation and the residents I spoke to were happy.

 

U of T I did a 4 week elective, which I enjoyed.  What the residents told me is pretty in line with what I've experienced over the past 6 months as a PGY1.  Toronto is a great city and I absolutely love it (the cost of living is upsettingly high but IMO totally worth it).  The program has every subspecialty and specialized experience that you could ever dream of.  There are lots of great staff who are amazing teachers and the formal didactic program is good from what I've experienced so far.  That said, it can be bureaucratic, it's easy to get lost in the shuffle, and the site lottery can be frustrating, because it's very possible to get assigned to a site that you really don't want to be at, and then you're stuck there for 6 months-1 year.  And moving sites means changing email addresses, using a new EMR, etc.  You don't have that predictability of knowing what hospital you will be working at.  I can't speak much to the core psychiatry 4 years because I am a PGY1.

 

Ottawa really impressed me on interview day - I ended up ranking it second.  Their PD seemed nice, the residents were happy, and the facilities are also really nice.  Ranked it second mainly because of some of the specific interests that I have that are a better fit with U of T.

 

If there are specific questions about U of T from a PGY1 perspective I'm happy to answer them by PM.  Best way to learn about programs is to speak to residents in person, on interview day and on elective, and to get out there and do electives.  If you haven't done your electives yet, I recommend asking if you can attend one of the residents' academic half days during your elective to get a sense of what the formal teaching is like and also to meet more people.

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I did elective an elective at Dal and liked it. I liked the city and province too. The interview was more like an MMI so a little bit unerving, but I felt like they were being objective and trying to rank people fairly. I heard mixed things from the residents- some liked it and some didn't. Many complaints centred around the child and adolescent psychiatry block. They do child specific call for that block and seemed to hate the scheduling and environment. There were also some people that did not like the mandatory Saint John rotation. A plus is that you can moonlight there getting paid as staff in fourth year (and up) in rural communities on weekends, which seemed cool. It is a mid sized program, and I really liked that. The PD seemed awesome and supportive. They had some really cool extracurriculars and Dal has a strong neuroscience undergrad and masters program. Overall out of the 8 programs I applied to for psych I ranked them third.

 

Did not apply to any programs in Alberta.

 

I am at UBC and like it. Inteview was again one of the more unerving ones because of the MMI type format. I liked my elective. The PD has been really great to me. It is a bigger program with a few sites, which has positives and negatives. Positive is lots of opportunity because of bigger school with fellowships and research. Really good incentives to doing a masters while in residency either during or taking time off for it. Possible the only school that will let you go away to do it at another institution. Residents had complaints but nothing came through as a common complaint for the most part is was individual issues. Call schedule seemed like the best.

 

To be honest though like alot of people I just ended up ranking where i felt like living for 5 years. If I was ranking purely on programs and my interests I think it would have been 1. Toronto 2. Ottawa 3. UBC 4. Dal... but because I have a spouse and a dog and have certain interests outside of work my list was 1. UBC x2 3. Ottawa 4. Dal 5. Toronto... i think it changed many times the last day!

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I loved my psychiatry residency in London! Off the top of my head, a few things I loved: the size -- large enough that there's a lot going on and a lot of opportunities, but small enough that you know all the residents and most of the faculty. It's easy to get involved and a friendly, noncompetitive resident group. Call is hard but infrequent (max is about once a week, and it decreases to once a month by your last year, with no call in the 2 months prior to exams), but honestly I found it to be a great learning experience. I liked that you have lots of responsibility and the opportunity to lead a team; by the end of residency you are VERY comfortable handling any acute psychiatric emergency. I felt very prepared for exams, since we do TONS of practice with regular OSCE's (twice a year), monthly OSCE prep sessions, and PRITE/COPE each year for written prep. I liked that there was one hospital system with one EMR and a really great dictation system.

 

London took me a while to get used to compared to Toronto where I grew up and did my education. But ultimately I loved it and decided to stay permanently in London after residency is over. I like that I spend less than 5 minutes commuting to get to work and that there is never any traffic, and that it's a slower more relaxed pace of life. I like that it has a super low cost of living and I can have a great house in a great area for waaay less than I ever thought possible. It's true that my hobbies changed -- I garden instead of shopping, etc. But I'm also not in my 20's any more ;-). It's a great place to raise a family. Interestingly, the vast majority of grads from our program choose to stay in London, which I think speaks to how much people like living here once they get used to it.

 

Anyways, those are a few things just off the top of my head, feel free to ask if you have more questions.

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I'm glad you've gotten good responses!

I don't know if I can add a tonne and very similarly only applied and did electives at Ontario programs.

 

My ranking ended up:

1) Mac - KW 2) Mac 3) Toronto 4) Ottawa 5) Western

 

The KW program came out of no where, as I only applied to it due to geographical location.

I liked all the programs on that list each with pros and cons. Given that most of the other programs have been discussed I'll talk about where I ended up.

 

The KW program had a lot of attractive features if you are interested in community psychiatry.

It is a small residency program of only 2 a year, but serving a large population base relatively in KW/Cambridge/Guelph.

The access to staff is fantastic and generally on a first name basis. Great group of residents that gets along very well.

Access to some surprisingly specialized programs for a small community program through Homewood (Inpatient PTSD, Eating Disorders, Addictions, Integrated Mood and Anxiety)

Call mirrors that of the Hamilton program, but is not overnight. (Until 11 pm) No post call days, but any day of the week I'd choose to maintain my sleep wake cycle.

 

Of course, downsides as well. Being a satellite program and relatively new, there's always trailblazing to do and new scenarios to navigate for the first time, and the videoconferencing can be less than optimal at times which the program is working on. I also have 7-8 hospital badges already haha.

 

As for the rest

 

Mac - Hamilton - Pros - similar to my program in a more tertiary centre, Con - Their Psych Emerge is eternally quite hectic. 

 

Toronto - Amazing access to niche areas of psychiatry/surprisingly friendly vibe on interview day Cons - Lottery system, for me Toronto is more fun to visit than to live in. I enjoy having a backyard and a bbq.

 

Ottawa - Good program, great city, did medical school here, in the end was just a little too far away from family.

 

Western - Better than they get credit for, and glad they're getting lots of credit here. Con - Did undergrad at Western, and as my wife very aptly put it, returning to London years later was like being at the bar after the lights were turned on haha. Nice city with very affordable living, but it represented a different time for me.

 

Hope that helps!

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These are great replies! I too am considering psychiatry. I am currently in 3rd year and am planning electives. Unfortunately my core rotation at my home program has been disappointing so far. To be fair, I'm not even half way through, but I haven't been getting much experience with patients. It is frustrating, but I have heard that the staff here are reluctant to let even residents do too much. What electives would any of you recommend for more experience actually seeing patients? I don't feel like my core rotation is going to provide me with an accurate idea of whether I want to specialize in psych.

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These are great replies! I too am considering psychiatry. I am currently in 3rd year and am planning electives. Unfortunately my core rotation at my home program has been disappointing so far. To be fair, I'm not even half way through, but I haven't been getting much experience with patients. It is frustrating, but I have heard that the staff here are reluctant to let even residents do too much. What electives would any of you recommend for more experience actually seeing patients? I don't feel like my core rotation is going to provide me with an accurate idea of whether I want to specialize in psych.

 

I would think generally, inpatient is easier than outpatient to get access to patients. That said, a lot of outpatient is becoming more consult based and depending on the preceptor it may set up well.

 

Still, inpatients don't have a significant amount of rapport already developed with a certain psychiatrist. With general adult, the turnover is usually a couple weeks and tests your general interview skills for depression and psychosis. If you get caught up in a more specialized program, over a short elective you may not get many new consults if any, or the topic area might be hard to access at your level of training.

 

For me, Psych Emerge and Consult Liaison were also good opportunities to get my feet wet as they have lots of new assessments. 

Depending on the city/program, you may get buried in a team of several residents, or you may get to run the show. A little bit the luck of the draw.

 

Generally if you're interested and speak up, most preceptors and residents will be quite supportive of a medical student interviewing and coming up with plans.

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These are great replies! I too am considering psychiatry. I am currently in 3rd year and am planning electives. Unfortunately my core rotation at my home program has been disappointing so far. To be fair, I'm not even half way through, but I haven't been getting much experience with patients. It is frustrating, but I have heard that the staff here are reluctant to let even residents do too much. What electives would any of you recommend for more experience actually seeing patients? I don't feel like my core rotation is going to provide me with an accurate idea of whether I want to specialize in psych.

 It depends what you want specifically out of psych. I think if you want to see patients and if you are a neuroscience fan as your name suggests (I am as well), then consult liason, geriatric psychiatry, or neuropsychiatry rotations would be good options for you. I would get some feedback from other students on what electives and preceptors are good though because as we all know it varies a lot. I did a consult liason elective at MUN and NOSM and got to see lots of patients, but most specific to psychosomatic medicine, post suicide attempt, and tons of delirium. I did a geriatric psych elective in Victoria and saw less patients (still 4+ per day), but found the teaching/supervision fantastic and the discussions helpful. Geriatric psych inpatient wouldn't be as good for your objective as outpatient where you are diagnosing new presentations of dementia. A combo of outpatient with inpatient consults, or team with geri psych and geriatricians would be a great option. I did a sleep elective at Dal and saw a lot of patients on my own and again learned a lot, but it was very specific to this one area. My electives tended to around things where I would see older adults as I am more into geriatric psych- so I am biased in this way. If you are interested in a broad base that's adult focused you could considered ER psych. As someone what was on the fence about what specialty I chose, doing some bread and butter electives like ER psych, adult inpatient/outpatient can be helpful because even if it isn't the area you see yourself in, you probably shouldn't choose a specialty where you don't like (or can't stand) the bread and butter. For me I realized I will take addiction and mood disorders over stroke, heart disease, and diabetes any day- and that was a helpful thing for me to realize, but also a difficult thing to come to terms with because I saw myself as a family doc/internist/neurologist.... etc for so long... even though I am a total psychiatrist :)

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