A Resident’s Guide To Surviving Psychiatric Training 2nd Edition Edited by: Tonya Foreman, M.D. Leah J. Dickstein, M.D., M.A. Amir Garakani, M.D. American Psychiatric Association 1000 Wilson Boulevard, Suite 1825 Arlington, Virginia 22209 www.psych.org American Psychiatric Association 1000 Wilson Boulevard, Suite 1825 Arlington, VA 22209 703-907-7300 NOTE: Support for this project was provided by an unrestricted education grant to the American Psychiatric Foundation from Astra Zeneca. The views and opinions presented here are those of the authors and do not necessarily represent the policies and opinions of the American Psychiatric Association and the funding agencies. Copies of this book are available through [email protected]. For information about the American Psychiatric Association, visit the APA homepage at www.psych.org. Copyright 2007. All rights reserved. Printed in the United States of America. A resident’s guide to surviving psychiatric training / [edited by] Tonya Foreman, Leah J. Dickstein, Amir Garakani. American Psychiatric Association; 2nd edition (2007) CONTENTS Acknowledgements……………………..……………………….1 Preface to the second edition…….……………………...……...2 Part I: Learning Curves: How to Maximize Your Educational Experience Psychiatrists are “Real Doctors” Too: Finding Your Place in the World of Medicine ………………………………..…..5 How to Maintain Your Basic Medical Skills ………………….….....8 A Resident’s Guide to Keeping up with the Literature…….….…...11 List of Psychiatric and Related Journals …………………….…….14 A Reading List and Reference Guide for Psychiatric Residents …...19 Sleepless in Psychiatry: How to Survive On Call ………………......26 How To Get The Most Out Of Your Psychotherapy Supervision ....................................................30 Finding and Developing a Relationship with a Mentor …………....32 Doing Research as a Resident …………………………………......35 Getting Published During Residency.…………………………..…38 Residents and the Pharmaceutical Industry ………………….……41 Part II: Standing OUT in the Crowd: How to Become a Psychiatric Leader Your Role as a Team Leader …………………………………..….48 See One, Do One, Teach One: Your Role as a Teacher ………..…51 How to be a Chief Resident……………………………………….53 Getting Involved: Participating in Professional Organizations.….....56 Directory of Organizations..…..………………………………..….58 Being Assertive in Your Professional Roles ………………...……..63 Awards and Fellowships for Psychiatric Residents …………..……65 Part III : Taking Care of Yourself During Psychiatric Residency Charting Your Course: Balance In Your Personal and Professional Life …………………..…………………………75 Benefits (and Pitfalls) of Getting Your Own Psychotherapy ……...78 Parenthood and Residency: Negotiating Parental Leave ………………………...…………………………..82 Spirituality and the Psychiatric Resident …..………………………85 Coming to America: International Physicians as Psychiatric Residents …………………………………...……………………..89 Romance, Relationships, and Residency ……..……………………91 Opening the Closet Door: Residency and Sexual Preference …..…95 i Your Personal Mental Health: The Foundation of your Career …...97 Part IV: And Justice for All: Legal Issues in Psychiatric Training Sexual Harassment: You Don’t Have to be a Victim! ……………..99 Gender Bias Issues …………………………………….……...…102 When Attending Physicians Appear Impaired ………………...…105 Part V: Entrusted to Your Care: Special Issues in Caring for Patients Understanding the Diverse Cultures of All Patients ………..……108 Boundary Issues in Psychiatry ……………………………..…….112 Looking the Part: Professional Attire …………………..………..116 When It’s Time to Say Goodbye: Terminating With Patients When You Leave ……………………………………….118 When Disaster Strikes …………………………………….….….122 Advocating For Psychiatric Patients …………………………..…125 Part VI: Personal Finances During and After Residency Training Moonlighting for Residents ……………………………………...128 Debt Management: Avoidance Equals Interest Accrual………..... 131 How to Make Your University Work for You ………………..….134 Coping with the Changes in Medicine that Affect Residency Training ……………………………………….138 Dealing with Managed Care in the Outpatient Setting …………...140 Part VII: A Look Toward Your Future as a Psychiatrist Couch Time: Psychoanalytic Training …………………………...144 Subspecialty Training in Psychiatry ……………………………...147 Sample Resident Admission Note ……………………………… 153 Sample Hospital Progress Note …………………………………164 About the Authors …………………………………………….166 ii ACKNOWLEDGEMENTS The American Psychiatric Association would like to acknowledge the following organizations and individuals for their contribution to the development of A Resident’s Guide to Surviving Psychiatric Training: American Psychiatric Foundation The Group for the Advancement of Psychiatry APA Committee on Women APA Committee on Residents and Fellows Nancy Delanoche, M.S. Deborah Hales, M.D. Marla Mitnick Carol Nadelson, M.D. Donna Stewart, M.D. Mount Sinai School of Medicine Department of Psychiatry Residents, Graduates, and Faculty Very Special Thanks to: Astra Zeneca For its support of this publication Dedication To our families… For giving us minds hungry for knowledge and hearts eager to share. Thank you for your love and support. and To future psychiatry residents… May you find as much satisfaction in your careers as psychiatrists as we have found in ours. Tonya Foreman, M.D. Leah J. Dickstein, M.D., M.A. Amir Garakani, M.D. April 2007 1 PREFACE TO THE SECOND EDITION Tonya Foreman, M.D. In the spring of 1999, twenty-five psychiatry residents met in White Plains, New York, to begin a two-year term as Sol Ginsburg Fellows with the Group for the Advancement of Psychiatry (GAP). As Ginsburg Fellows, we were invited to attend biannual meetings of the GAP and serve on standing GAP committees with distinguished psychiatrists from around the United States. In addition, we were asked to develop a Ginsburg Fellows’ project. We spent several hours scratching our heads and wondering what we, as psychiatry residents, could contribute to an organization filled with the nation’s psychiatric leaders. “We’re not experts at anything yet,” we told each other. “We don’t have anything to contribute.” Then it dawned on us – we were experts at being psychiatric residents! We represented training programs from Hawaii to Kansas to Canada. Collectively, we formed a rich tapestry of experiences as psychiatric residents and as individuals. During the evolution of this project, members of our group completed a variety of fellowships, discovered the challenges of parenthood, struggled through divorces, and graduated from residency to take "real jobs!” And yes, we are even paying back our student loans. As this book progressed, we collaborated with members of the American Psychiatric Association’s Committee on Women in order to insure that our project addressed the needs of women and minorities. We are grateful for their assistance and for their sensitivity to issues that affect many residents. In 2006, Amir Garakani, M.D., an APA/GlaxoSmithKline fellow, approached staff at the APA about producing a second edition of the book. He believed strongly that in addition to using excellent on-line resources, psychiatric residents wanted a handbook that they could actually hold in their hands, drop in their pockets, and read at their leisure. His tireless pursuit of the project led to the publication of this, the second edition of The Resident’s Guide to Surviving Psychiatric Training. Dr. Garakani’s thoughtful appraisal of the first edition prompted the creation of several chapters that make this edition more timely and complete. The authors who contributed to this book realize from firsthand experience that the vicissitudes of everyday life do not stop because you are a struggling resident. Even though you are emotionally, intellectually, and physically exhausted by the demands of training, your dog will still have to go to the vet, your car will break down, and the dirty laundry will inexplicably multiply in your hamper. As a 2 resident, you will be asked to spend much of your time and energy tending to the needs of others. As some of your own needs go unmet, you may become disillusioned or cynical. In order to complete residency and become the physician you envisioned when you filled out your medical school application, you will have to develop skills and coping mechanisms that allow you to manage your own life as you take care of others. This book was written by psychiatric residents for psychiatric residents. We tried to pool our collective experiences to produce a handbook that would help you with the day-to-day challenges of psychiatric residency. This is not a clinical handbook – many excellent clinical handbooks already exist. This book contains the kind of advice we’d give to you if we could sit together over a cup of coffee and a stale donut in the hospital cafeteria. We have traveled the path you are now taking. We hope that we can provide some encouragement and advice to make your trip a bit easier. Tonya Foreman, M.D. April 2007 3 PART I: LEARNING CURVES: HOW TO MAXIMIZE YOUR EDUCATIONAL EXPERIENCE • Psychiatrists are “Real Doctors” Too: Finding Your Place in the World of Medicine • How to Maintain Your Basic Medical Skills • A Resident’s Guide to Keeping up with the Literature • List of Psychiatric and Related Journals • A Reading List and Reference Guide for Psychiatric Residents • Sleepless in Psychiatry: How to Survive on Call • How to Get the Most Out of Your Psychotherapy Supervision • Finding and Developing a Relationship with a Mentor • Doing Research as a Resident • Getting Published