This was the one rotation I was most apprehensive about going into.
Women’s In-patient Unit
anxiety disorders · mood disorders · post-traumatic stress disorder · borderline personality disorder · substance use disorders · adjustment disorder · complex post-traumatic stress disorder
I spent the first three weeks on the women’s in-patient unit and I’m so glad I got to start here. This unit is dedicated to women with mental illness who may have experienced trauma and/or addiction. This means trauma-informed care is at the core of the care provided. In theory, this is a concept I’m familiar with but being immersed in a clinical environment where this was the cornerstone was a game-changer.
I didn’t find this out until later, but my preceptor was actually instrumental in creating this unit 9 years ago!
Morning rounds started at 9 am and usually lasted for an hour. The whole team usually attended these – staff psychiatrists, residents, nurses, pharmacists, social workers, psychologists, recreational therapists, unit clerks, and medical students. The nurses usually gave a report on what happened overnight and updated the team on new admissions, this was usually followed by a short (ish) discussion on the best management plan for each patient. My favourite part of rounds was how welcomed everyone’s input was, this really helped me gain a better understanding of the unique role of each member of the team and their unique contributions to patient care.
Even though this was an in-patient unit, it had an outpatient feel to it. There were group sessions every day, usually facilitated by the social worker or recreational therapist – sessions ranged from dialectical behavioural therapy to journaling. The actual physical space also gave the impression that you weren’t in a hospital: artwork on the walls, musical instruments, puzzle sets, etc.
After rounds, my preceptor and I came up with a schedule for seeing patients that day. Initially, I started by seeing patients with her but by the second week I was seeing patients alone, except for intake admissions which we saw together. I also had a 2-week Christmas break after my first week so took some time to get used to things. The highlight of my day was often when I just got to sit and talk with our patients without a specific agenda at hand. I really enjoyed the continuity of care I developed with one particular patient who was admitted on my first day and discharged on my last.
General Acute In-patient Unit
mood disorders · schizophrenia · psychosis · bipolar disorder · avoidant personality disorder · antisocial personality disorder · narcissistic personality disorder · Capacity Assessment · Montreal Cognitive Assessment (MoCA)
I spent the next three weeks on an acute general in-patient unit.
This was a different pace from the women’s in-patient unit. Patients presented more acutely and on average, were discharged earlier. Rounds usually started at 9 am as well but only lasted 15 mins. Although, each staff sat down with their patient’s care team – nurse, unit clerk, and social worker – one day/week for a more thorough discussion on the status and management plan for each patient. After morning rounds, we went to see all our patients, some of whom were incarcerated. Because this ward was more acute, I never saw patients on my own. I also learned a lot about how to formally assess capacity and actually attended a few court sessions for patients who appealed their involuntary admission status. There were quite a few code whites on this ward as well, never a dull moment!
Emergency Department
psychosis · suicide risk assessment · substance use disorders · mood disorders
I had three shifts in the emergency department in total, none of which were overnight and I was always paired with one resident.
All patients who are admitted to any of the units (i.e., women’s in-patient unit, general acute in-patient unit) came through the ED and the staff/resident usually had to decide which unit was most appropriate or whether the patient could be discharged home safely. I saw a few patients with psychosis, acute depressive episodes, substance use disorders (i.e., delirium tremens).
Staff always bought dinner and I cannot express how much joy this brought me.
I came away from this rotation feeling more confident in how to take a psychiatric history, perform a Mental Status Exam (MSE), and perform a suicide risk assessment.
Went from being clueless and apprehensive to really embracing all that psychiatry had to offer. Again, all of the staff, residents and allied health team were ridiculously nice and all-around amazing.
~ GoldRimMD