Psychiatry Shelf Exam And Personal Reflection
- Hesham Hassan, M.Sc.
- Jul 19, 2017
- 4 min read
Woohoo! I finished my psychiatry shelf exam today and what a relief. I enjoyed the rotation but it will make you question your own sanity after doing inpatient psychiatry for too long. I wanted to share my thoughts on the exam, resources I think work best, and then I'll give a recap at the end on my overall impression of psychiatry now that it is finished.
THE EXAM
110 NBME questions and 2.5 hours of some of the lengthiest vignettes yet. There were many child psychiatry questions, and I would almost argue they consisted of about half of the questions (which can be difficult for students who do not get much child psychiatry exposure). The other half of the questions could be divided between patients older than 60 and patients younger than 60. There was a diverse mix of pharmacology related questions as well that required you to know specific side effects and contraindications. I would not consider the exam difficult, but I only have Obstetrics and Gynecology for comparison; the two disciplines are very different. Psychiatry does not rely heavily on lab values or diagnostic imaging, so those questions will require you to use your best clinical judgement and maybe take a little more time. I also found myself saying "well, this diagnosis would be more likely" using what I know about overall prevalence of diseases and differences in gender, etc. so I recommend you pay attention to those statistics. Also, I was also very pleasantly surprised by how much I retained from my neuroanatomy in second semester (shout out to Drs. Brett and Welke), and from psychopharmacology in fourth semester. I came across several topics that I had not thought about since Step studying but if you have pediatrics or internal medicine before psychiatry then likely you have already seen this information more recently. Overall, I felt good about the exam when I left the exam center today and I am even more confident about my knowledge base in psychiatry now.
THE RESOURCES
Online MedEd Videos are an amazing overview of all the disorders and I recommend watching the videos your first week of the rotation. They are not difficult to get through and you should have enough study time during this rotation.
UWorld Step 2CK Qbank has 179 Psychiatry questions but to do all of them you will have to select all disciplines and then the psychiatric subsection (Pediatrics, for example has 15 questions). Do not get caught up on legal/ethics questions as there were none on the exam.
First Aid for Step 1 - Neuro and Psychiatry section are more in-depth than the FA Step 2 CK book and the information is high-yield. Some obscure questions I got right were because of reading through these FA Step 1 sections. I have the 2015 edition which isn't updated for DSM-V, but that did not seem to make a difference because the questions were not focused on the changes.
Sketchy Micro for pharm - if you can rewatch the neuro videos you definitely should. I am glad that I rewatched a few choice videos like diphenhydramine (Midsummer's Night themed video) and both anitpsychotics videos, but I wish I would have made time for all of them related to neuropsychiatry and neuropathology.
Lange Psychiatry Q&A
- I had access to an old PDF copy of this book and I did the second practice test two days before the exam. The only reason I am suggesting this one is because you should do this the first week of the rotation so you are exposed to some old terms and ideas, and these answer explanations were the best at explaining what exactly are some of the terms used to describe psychosis like the difference between different organizations of thought or what exactly "magical thinking" means. Other than getting some good background knowledge for a foundation, you can disregard this book.
THE ROTATION
Overall, I had a great experience and am thankful for the patients from which I learned so much. There were specific patients that stood out while I took the exam today so I am grateful for that their stories have made the impressions they have. My background in social work made me particularly useful during this rotation and I was able to do a lot of hands on work. I even had some charge nurses trying to convince me that I was made for this but I honestly cannot do this long term. I love cases of schizophrenia as they were some of the most challenging and fun patients I have helped but I don't think I loved the cases enough to consider trying to match into psychiatry.
Rohinton Mistry said it best when he wrote, “Flirting with madness was one thing; when madness started flirting back, it was time to call the whole thing off.” The illnesses was real and the toll was taxing because of how much of myself I feel like I invest in patients. Seeing one patient struggle with psychosis occasionally is something I can handle, but the daily drain of psychiatry would be too much.
Personally, I could not imagine listening to a voice everyday telling me to kill someone I love or that I believe that the president is trying to make sexual advances on me through the television. I respected my patients, and I treated everyone as though their delusions and hallucinations were real because to the patients they are real. I am not suggestion anyone entertain delusions or hallucinations for sport. There is no room for mockery in healing, nor being condescending or judgmental because you think someone may be "crazy." Unfortunately, you could see this ignorant treatment from some of the people who have chosen mental health as a profession and from the very family members who are supposed to be a source of strength and support.
To make a long story short: mental health has come a long way in our country but still has much more to go. Be genuine and compassionate with your patients because they can tell when you're not and you'll prevent yourself from making a connection that could help them achieve a healthy baseline.
As always, I welcome any feedback or questions! Feel free to reach out to me anytime through whatever platform you know how to get ahold of me through and I am usually pretty quick to answer. Now, to prepare for my upcoming Family Medicine Rotation!
Comments