Psychiatry rotation at BronxCare is located at BronxCare Fulton. Many students take the shuttle from the main hospital to Fulton which takes about 15 minutes. I know some students can take the M35 bus from the 167th St Subway stop if you are commuting which can take less time. I personally found it just as fast to take the BronxCare shuttle. The shuttle runs on the hour from 7am-5pm and picks up at the ½ hour 6:30am-4:30pm with last stop at Fulton at 5:15 pm.
Psychiatry rotation at BronxCare Fulton consists of 3 weeks Inpatient Adult Psychiatry and 3 weeks Inpatient Child Psychiatry (with Tuesday and Friday half days in outpatient child clinic).
Business casual WITHOUT stethoscope, pen light, tie, dangling earring, lanyards (or anything a patient can pull/hurt you with).
If this is your first day of the rotation, you will be asked to go to the wellness center (located directly in front of the hospital with a green awning) at 8:00am for your titers to be drawn and other paperwork needed before starting in the hospital. Then you will meet Al (or AUC coordinator) on the 10th floor of the building directly behind the main hospital. Here you will have a quick 10-minute orientation (like all the other rotations). You will sign a quick piece of paper and then take the shuttle to the Fulton location. At the Fulton location, the coordinators of the psychiatry department (currently Dr. Schoolcraft) will take you to the conference room where they will go over all the rules and expectations of students of the rotation. During this time, they will also give you a folder with a complete schedule and layout that you will follow while you are at the site. When we were doing this rotation, we happen to have 3 holidays land during the weekday and were told we wouldn’t have any sick days due to this holiday schedule.
You will be placed in a group of 3 students who are placed on either Inpatient Adult or Inpatient Child Psychiatry. You will be required to attend M-F 8am-5pm daily to these floors. On the calendar you are assigned you will see lectures highlighted in green which are mandatory for all students. Highlighted in black on Fridays you will notice case conferences, these are only required by students on Inpatient Adult Psychiatry. During inpatient adult, there are case conferences every Friday with social workers at 2pm to discuss discharge information for your patients. Students on inpatient child are not required to attend. Finally, Grand Rounds occurs every 12-2pm Tuesday in the conference room on the 2nd Floor. All students are required to attend. Lastly, you will notice highlighted in yellow there are 2 write ups due during this rotation. These are to be submitted to Dr. Schoolcraft during your rotation by the end of the day. These actually are not too hard to write on inpatient adult since you are going to be doing your own write ups for your patients and gather much needed information. You can use one of your charts you are writing for both of the write ups.
Duration: 3 weeks
Location: 8th Floor Fulton BronxCare
Typically, I would leave the main hospital on the 8am shuttle and arrive at the clinic at 8:15am. At this time, we would go up to the 8th floor and meet with Dr. Shengelia. At 9am we would have a sign out meeting with all the PA’s/nurses/staff and talk about each patient’s progress throughout the previous day and night. Dr. Shengelia is usually in charge of around 8-10 patients daily. PA’s also work with Dr. Shengelia on the floor and are also see around 8-10 patients. Sign out typically occurs from 9am-10am. Afterwards, students will round with Dr. Shengelia and go talk to each patient. During rounds, patients can be combative and not want to speak with providers, in which case we still document their actions and progress. Dr. Shengelia will assign you a patient and new admission to follow and each medical student typically holds 2-3 patients and follow them throughout their time of admission. During your first day, she will not have you take on brand new patients. She will first let you follow and observe and then when you feel comfortable she will have you start asking questions with her next to you. If a patient is a new admission, Dr. Shengelia will have the entire team sit down with the patient in the cafeteria and ask questions based on their admission information which usually lasts around one hour. She will give you a format paperwork and will show you how she likes to conduct her formal new admission process including what questions are important to ask the patient.
When I first started inpatient adult, I was a little intimidated. At first walking in makes you feel like you are walking into a jail. The nursing station is covered in glass, each room has a lock with key. Patients are not allowed to have certain objects in fear they will harm themselves or others so nurses will ask you not to give any items to the patients. Although some patients can be odd or eccentric, but they are mostly very pleasant and kind. A small percentage of patients can be aggressive, so you have to make sure to take the proper precautions to not put yourself in that situation. Since these patients are mentally ill, you have to protect yourself from harm first. Never go into a patient room alone. Never turn your back on a patient. Never approach a patient face on. Always interview patients in a room with cameras. Don’t interview a patient alone. Never open a door with a patient close. At first these rules were a little scary to me, but after my time on the floor it really wasn’t a worry.
Overall, my experience in inpatient adult psychiatry was incredible. Dr. Shengelia is an amazing teacher who is very kind, patient, and understanding. She was very good at teaching the students in a way that made them feel like residents. She allows you to ask questions to patients and come up with your own differential and diagnosis. She explains if your thought process is right or wrong. Then she expects you to talk to write your own progress note on your patient. It truly gave us responsibility, but ultimately made us feel like a valuable part of the team. I believe the skills she taught me, and other students will continue to our career no matter what field we go into.
Inpatient adult medication room
Duration: 3 weeks
Location: 5th Floor, Child Inpatient Psychiatry
Let me start off by saying the start time is 8am which makes it very hard for students to get there on time based on the shuttle leaving every hour (7am/8am). They emphasize being there 8am sharp, but there is no way to do this with the shuttle times unless you get there an hour before hand. I started the rotation leaving at the 7am shuttle from BronxCare main hospital. I would arrive at 7:15am at the hospital and go up to the student room. The best part about inpatient child, hands down, is they have a medical student room with 2 computers and 3 desks for the students. During the downtime from 7:15-8am I would do some UWorld questions to help the time pass. At 8am, I would try to find the residents and attending and round in the morning. Most times, they would pass right by the student room and we could follow them onto the floor. Try to keep the student room door open so you can catch them as they pass by. From 8am-9am most of the residents and attending would visit the new admission from the night before. This would consist of the attending, 3 residents, and 3 medical students sitting in a room with one child/adolescent. It is clearly very overwhelming to the child/adolescent patients. After new admission rounds, there are social rounds similar to adult psychiatry which consists of nurses/social worker/residents/attendings that talk about all patient progress throughout the morning. Medical students sit in the chairs on the outside of the table and listen as they discuss patient progress. Social rounds usually occur from 9am-11pm. At the end of social rounds, students are expected to go to the medical student room and wait for residents or attending to come get them when they interview other patients. During this time, we would get lunch or catch up on UWorld questions until we were needed. Often time we would walk in and ask the residents if there was anything that we could do to help, without luck and told to continue to wait. Often, we would sit in the room from 11am-5pm without a word from the residents or attendings. We often would have lecture in the evenings to look forward to.
The best part of inpatient child psychiatry was being able to go to outpatient child on Tuesdays and Fridays. Outpatient psychiatry is from 9am-12pm Tuesdays and Fridays. I often took the 8am shuttle and did a few questions in the medical student room before clinic started. You aren’t required to round with the residents and attendings during these days you have outpatient clinic. When you go to outpatient clinic you must go down to the basement floor and exit out the outside of Fulton Hospital. Make a right and follow the green awning. This is approximately 20 feet from the exit of the back entrance of the Fulton Hospital. Your first day in outpatient clinic they will assign you a resident to follow during your 3 weeks in child psychiatry. Let me just say that the RESIDENTS/FELLOWS ARE AMAZING in outpatient psychiatry. They truly were such incredible teachers and were so pleasant to work with.
Overall, I didn’t enjoy child/adolescent psychiatry mostly because you are such an integral part of the team on inpatient adult but often you feel ignored/burden during inpatient child. Most days consisted of trying to get one of the residents or attendings to notice you or try to get a little bit of interview skills down. I was truly looking forward to adolescent psychiatry but was rather disappointed. The most learning I had during this time was hands down in outpatient clinic on Tuesday and Friday. The residents/fellows were absolutely incredible and taught throughout their time in clinic.
Child Psych Floor
Med Student Room
HOW TO STUDY
During this rotation you will get the most out of it if you do inpatient adult FIRST. This way you can get a lot of hands on experience and use the last 3 weeks to study during your down time in inpatient child/adolescent. I honestly didn’t study much the first 3 weeks of this rotation. During the last 3 weeks, I studied UWorld in the medical student room on the computers during the time we were not rounding with residents/attendings. I made UWorld incorrect questions into Anki flashcards and used these to study on my way home from clinicals (Shuttle bus/Subway). I truly think that if you make flashcards daily of your incorrect answers and do these daily on Anki these is no way you can do poorly on this exam. Once it came time for my shelf exam, I had finished all of my UWorld questions and NBME examination x 3 (only 3 exams). I felt fully prepared with how I had prepared. I ended up scoring in the high 80’s which has been my best exam this far. I also ended up honoring the rotation. I wouldn’t change anything about how I studied for this rotation.
OVERALL OF THIS ROTATION
Overall, my review of this rotation was split right down the middle. I truly loved Inpatient Adult. It was 100% were I learned the most during my rotation. I didn’t enjoy inpatient child/adolescent. I felt like it wasn’t a positive learning environment for students and all of inpatient was shadowing (when we were allowed). The best part of child/adolescent was by far outpatient clinic due to the positive work and learning environment set by the fellows and attendings.
I recommend trying to impress Dr. Shengelia who you will be working with during inpatient adult. This should be a good evaluation during your most valuable learning time. She will expect you to do your part and write your notes. She can dismiss you early if you get all of your work done and you have already rounded on your patients. Make sure to always communicate with her and tell her when you are leaving the floor for lunch ect. Dr. Shengelia is very understanding and wants you to learn during your rotation. Make sure to get the most out of your time during inpatient because it will be the most valuable time you have during your psychiatry rotation.
Make sure you are on time for rounds in the morning at 8am. Sometimes they round at 8am SHARP other times they don’t round until 8:30am. It can be rather frustrating to students because it can be difficult to track down the residents and attendings. I recommend when you get to the floor to try to see if they are ALREADY on the floor interviewing a patient. We usually went in a group to the floor of child and adolescent looking in the group rooms to see if they had already started rounding. Often, they have not. GO BACK TO THE STUDENT ROOM AND LEAVE THE DOOR OPEN. When residents walk by hop out and follow them. A lot of times they won’t acknowledge you are there, but they will comment if you aren’t there. After social rounds in the morning, go back to the student room and continue to leave the door open so they know you are there. Try to check in with the residents every couple hour if there is anything you can help with. Often times they will tell you to continue to wait in the student room. Sometimes they will ask you to write a note for them. They will look it over, but they won’t add it into their chart. They will end up writing their own note. Don’t take it personally they did it to every student during out rotation. Try to get much of your study time down during this time in the rotation.
Make sure to impress your outpatient child resident/fellow to also give an evaluation. Since you are required to give 2 evaluations (1 inpatient adult/1 child) during your time in Psychiatry, this is going to be your best evaluation in child. It is much harder to give out evaluations during inpatient child/adolescent due to the many residents and attendings that change daily.
Make sure to use all the rules to protect yourself during your time in this rotation. Go into it with an open mind and I promise you, you will take away tools and skills that will help you no matter what specialty you decide.