Clinical Year: Psychiatry Rotation for PA Students

I am going to be honest with you: psych was not my favorite rotation. It was actually my least favorite, and the one I most dreaded going to each day. I spent all 4 weeks on the inpatient psych ward at the hospital, and a whole month was too long to be on a locked unit. Patients in the hospital sometimes stay for a very long time, so I followed a few patients the entire rotation without many changes, and I just did not feel like I got the best exposure to psychiatry. I really wish I had some outpatient experience mixed in. Even the med students only spent 2 weeks at a time on inpatient before rotating through outpatient, pediatrics, or the ER.

Walking into a unit with 2 locked doors that require codes was a little nerve-wracking, but it is necessary for patient safety. This was also my first rotation working with med students and residents, and my first using electronic medical records, since my family medicine site still used paper charts. The med students only stayed my first week, but they were so helpful and showed me the ropes.

My attending was great, very patient and a good teacher. One interesting thing about a teaching hospital is that the attending is not around much. We would arrive around 7 to 7:30 am to see our assigned patients, and the doctor would show up to round at 9.

Rounds on psych were different from other services. The whole team, attending, residents, students, and a social worker, would sit in a big conference room and bring patients in one at a time to discuss how they were doing, medication changes, and discharge plans. After rounds, we put those plans into action, which often meant a lot of phone calls. There has to be heavy communication with family members before discharge to make sure the patient will be safe, can continue their medications, and can make it to follow-up. One of the hardest parts of psychiatry is arranging discharge, because the patient has to have somewhere safe to go. If they have no home or anyone to take them in, the social workers work to find a shelter or halfway home.

I saw some extremely interesting, and very sad, cases. For me it was just emotionally draining, and there was one weekend I felt genuinely down, which I think came from the environment. On my second day, a patient died by suicide, which was deeply troubling for everyone, providers, students, and patients alike. There are measures in place to prevent it, but a determined person can find a way, and afterward the unit started a patient limit.

One 18-year-old had been started on antidepressants before college and, 2 weeks in, called her parents with thoughts of harming her roommate, then others, then herself. The new medication and the stress had triggered a psychotic break with intense hallucinations, and she was very sensitive to medications, even developing tardive dyskinesia from one of them. I also saw how patients can work the system, like one who would say he was suicidal so he would be admitted, treating the ward almost like a vacation. The attendings were skilled at recognizing motives like that.

I also got to see strong cases of schizophrenia, bipolar disorder, and drug and alcohol abuse. I learned a lot, and one upside of psych is that the end-of-rotation test felt very straightforward. I think psychiatry is easier to learn than some other areas, with the medications being the hardest part by far. The book I used the most was Blueprints Psychiatry, and I would recommend doing as many practice questions as you can.

My frustrations came from only seeing inpatient and feeling so limited by medications. Many patients were on a lot of medicine, and it was hard for me to see the effectiveness in the short time I was there. At least one person I graduated with works in psychiatry now, and I think it takes a strong personality and someone who can keep their emotions out of it to thrive in this field. If psych speaks to you, that emotional steadiness is something to start building now.

Psychiatry may not be everyone's favorite rotation, but it teaches empathy, communication, and emotional resilience that carry into any field of medicine. Go in with an open mind, study your medications hard, and protect your own well-being along the way. If you want support as you prepare for PA school and your clinical year, we are here to help.