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  1. peachy

    Psychiatry Program Discussion

    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.
  2. I agree with the comment above that it doesn't matter. You won't be penalized for being a strong applicant who was accepted earlier than someone else. This is different from having a grad degree (which is definitely considered in CaRMS), looking at grades (which some programs will do), caring about your research experience, etc. Nobody cares if you spent 3 years or 4 years in undergrad. Having reviewed CaRMS applications in the past, it wasn't even obvious who had completed undergrad and who hadn't. Don't worry about it.
  3. peachy

    What To Wear

    Something you feel comfortable in is the most important. We hold our social on the evening after the interviews, and most people don't change and just wear their interview suit.
  4. peachy

    Psychiatry Competitiveness?

    It depends what you are looking for. Size of program, city, etc. Do you want to be a big fish in a small pond, or a small fish in a big pond? Do you have an interest in Child, Forensic, or Geriatric subspecialties? Do you have a lot of debt/need to be somewhere where the cost of living is reasonable? If you want a large program, as stated above, Toronto is Toronto. If you want a midsized program, Western, Ottawa, Dalhousie have good reputations. Queens is generally considered one of the worst programs.
  5. Hi all -- here is a very short list of key ways to succeed at a CaRMS interview. I have been an interviewer for the past 5 years and am consistently shocked by the fact that almost nobody does all 4 of these: 1. Answer the question asked. At least half the time, when an applicant is asked for an example, they list the qualities that an example would show, but forget to give an example itself. 2. Be specific. Don't ramble on with vague platitudes. If you are going to describe character attributes about yourself, be ready with a (brief) story about it to make it concrete. If you are going to describe how residency will change you, give specifics about how that will happen. 3. Be humble. Don't talk about how you made a diagnosis that the entire rest of the team missed because you are so brilliant or connected to a patient that nobody else could get through to because you are so empathic. This makes you sound naive and conceited. If you give an example like that, at the very least qualify it with "As a med student, I have the privilege of having way more time to listen to a patient than the rest of the team" or whatever. It's way better to honestly describe a mistake you made, how you learned from it, and how you did it differently the next time (or will do it differently the next time). Residency programs don't need you to be brilliant; they need to be sure that you can learn from your mistakes. 4. Say something about the school you are interviewing at. Unless this really is ENTIRELY a backup interview and you don't care about bombing it, try to work in at least one line about how X school is appealing to you because of their great Y. It's flattering to the interviewers and makes you look like you want to be there.
  6. peachy

    Matching To Psych

    1. Psych alternates in its level of competitiveness. Some years spots go unmatched everywhere except Toronto/McGill/UBC, and some years just about every English spot in Canada is filled in the first round. There doesn't seem to be any rhyme or reason to it as far as I can tell. Psych is still consistently a relatively uncompetitive program, even in competitive years. 2. Sounds good. I think that Psych programs will care about (1) that you've done enough psych to show that you have a genuine interest, and (2) schools will like it if you have done a local elective. Neither will make or break you, though. I don't think 2 vs 3 week electives makes a difference, except if it gives you better or worse reference letters.
  7. Except Psychiatry! It's the only specialty expected to continue to have a shortage for the forseeable future...
  8. peachy

    Psychiatry Competitiveness?

    There is no problem matching to Psych, but definitely a good number of people end up at their second choice. It largely depends on the year, as there tend to be some very competitive years alternating with years where many spots go unmatched outside of the large centres. I would guess that research is part of the scoring rubric at every school; not necessary, but helpful in increasing the likelihood of ending up at your preferred location.
  9. peachy

    learning for clerkship

    I think Toronto Notes and Case Files are both good suggestions. But I'd more strongly echo the suggestions not to get too worked up about being well prepared. Take your vacation, have a good time, and start clerkship well rested and excited! Attitude and being willing to learn matters more than the knowledge you start with.
  10. Fracture clinic can be quite high yield though, and is usually run by the orthos. Certainly, weeks on end of being in the OR is not helpful to a family doc. But part of electives is to see and do the part that you WON'T do in the rest of your practice, so that you can really know what's happening when you send your patients to the ortho and they get that knee replacement. So when they are scared of surgery you can explain what the process will be like. So you can understand how the orthos decide who is a good surgical candidate and then give the best advice to your patients and refer them at the appropriate time. Overall, for any field, I think there can be a lot of benefit in taking time to do things that you WON'T do in your primary career -- you will eventually learn to be good at doing MSK exams as a family doc, no matter what electives you do. Choose electives that give you something that complements your eventual practice, not duplicates it. Not that I know anything about ortho or MSK, I'm mostly glad that I'll never have to examine a joint ever again in my career! So I'll also suggest some things I actually do know about... I highly recommend that future family docs do an elective in sleep medicine. For the most part, it's not something you'll get good training on otherwise, and will affect a huge proportion of your patients. Some things you'll learn in a good sleep medicine elective: - spend a night seeing what goes on in the sleep clinic - see lots of obstructive sleep apnea patients - learn techniques to improve compliance with CPAP - learn the difference between being tired and being sleepy - get exposure to the many other sleep disorders - learn the basics of CBT for sleep - learn when and how to use pharmacotherapy for sleep PROPERLY - etc, etc, etc! If you have a good grip on sleep medicine you can do brief interventions with folks that can make a HUGE difference in their lives. If you haven't done any inpatient psychiatry during your core medical school training, please, PLEASE try to get some exposure to this during even a brief elective. It is so important to have even a minimal exposure to SEVERE mental illness so that you can see the difference between a mild depression and a severe depression, for example, or what psychosis really looks like. You will do TONS of psychiatry in primary care but if you don't have a good perspective on what severe mental illness looks like then you can get a skewed perspective that will cause you to overdiagnose mild cases and underdiagnose severe cases, imho. Also, do some general child psychiatry if you can! Mood and anxiety disorders are so often missed in this population and if you don't know what it looks like in children you can't find it. These kids are in SUCH distress and early diagnosis and intervention makes a huge difference, and as a primary care provider you are in the ideal position to be identifying these kids early. If you can get a rotation that gives you even basic exposure to attachment theory and disorders, you can make a HUGE difference in the life of moms and kids. You can learn basic ways to identify attachment problems, and there are just as basic skills you can teach parents to bond better with their children. It's easy, obvious stuff once you learn it, but not at all obvious until then.
  11. peachy

    driving in residency?

    If you can afford it, "Young Drivers" in-car lessons are best for this situation, imho. Do the test with them -- they register it for you, take you to it in the same car you've been doing your lessons in, and review the route with you beforehand.
  12. peachy

    driving in residency?

    I didn't have a car for my first year of residency, and I survived fine. I took a lot of cabs (pretty much daily, often multiple times a day), which still turned out to be cheaper than owning a car (when you take into account lease, insurance, parking, gas, maintenance...). On the other hand, I'm much happier having a car now, with the increased convenience and being able to run out to shop, visit other cities, etc, whenever I want. It's more convenient to have a car in most cities, with the exception of big cities (like Toronto) where there are good public transit systems. But you'll survive anywhere without a car. If you had a seizure on your first day of residency, and couldn't drive for the next six months, you'd manage somehow. It may be nice to have a car, but you can always manage without it.
  13. You probably saw a psychologist not a psychiatrist. Physicians are covered by OHIP, and it's actually illegal for them to charge you out of pocket, so it's not possible that you saw a psychiatrist and had to pay. A psychologist is someone who has a PhD in psychology, so they are called "Dr." as well, which is where the confusion usually arises.
  14. There are lots of opportunities for working with marginalized populations in pretty much all areas of medicine. In psychiatry, you can't really avoid it, even if you want to! Our patients, especially if they have serious mental illness, have trouble maintaining relationships and jobs, which is a recipe for becoming a marginalized person. As to what you can do, it really depends what you're interested in. There are unlimited options. I'm not sure where to even start listing because you can do anything that you want! There are patients in need of psychiatric care everywhere, you just show up and work, basically. An ACT team, an intensive case management service, or an inpatient ward would be common places to work with folks with severe psychotic illness. Shelters are often a place to work directly with people who are homeless, and they'll typically have docs come in for 1-2 days a week to see their clients. If you're interested in trauma or personality disorders, psychotherapy ranging from group programs in hospitals to individual private practice in the community would be some typical options. I don't know what you mean when you talk about prices -- psychiatry, like other areas of medicine, is covered by provincial health insurance such as OHIP, so patients do not pay out of pocket.
  15. Just to expand/clarify this a little: Yes, first year is basically a rotating internship, although depending on the school it can be up to four months of psych plus another couple electives that can be very psych-related. Typically nothing off-service once you get to second year. After that, the next few years are very structured as the Royal College recently tightened up the requirements: PGY2-PGY4 MUST consist of 6 months of general adult inpatient, 6 months of general adult outpatient, 6 months of geriatric psychiatry, 6 months of child psychiatry, 12 months of consultation/liaison, shared care, and serious mental illness. That leaves one final year for electives. There's also psychotherapy training that takes place longitudinally, where you see patients, typically weekly, for specific types of psychotherapy, such as psychodynamic or CBT.