Training as a resident in psychiatry comes with a unique set of challenges not often experienced by trainees in other medical specialties, and we must be versatile in order to get the most out of our training. As a community of psychiatrists, we collectively experience patient aggression, certain traumas, the loss of patients via suicide, the aftermath of disasters, the stories of victims of violence, as well as other stressors in ways that have the potential to impact our training1 – not to mention vicarious trauma.

Each of these factors has been further complicated by an unprecedented global pandemic, highlighting the need to cultivate flexibility and a willingness to adapt as residents in training.  We believe this newly gained versatility will be an asset throughout our professional careers and lives.

Why Versatility in Psychiatric Care Matters

Psychiatry residency accounts for four impactful and formative years at the beginning of a long career in behavioral health – and every day is completely different.

The place where you train in residency will likely affect the way that you practice medicine for the rest of your career. Once that place is chosen, it is important to use one’s time in residency as effectively as possible. This can come in the form of attending conferences, giving lecture presentations, and seeking out a mentor to enhance your educational opportunities.

It is also important for residents to frame their responsibilities and challenges as ones to which they have the ability to adapt, respond, and overcome. This empowered mindset enables us to engage in unique scenarios. For instance, there may be days where we are acting as solo practitioners and cannot rely on the advice of a senior psychiatrist in a key moment. There may be other days where we are given unexpected responsibilities or asked to take on additional students as part of a teaching rotation.

Being able to wear many “hats” at once allows us to clearly assess and respond to situations appropriately. Approaching training with the knowledge and viewpoint that we have the agency to manage difficult and evolving tasks will also allow us to get the most out of our educational opportunities.

Importantly, remaining versatile can help combat the burnout that may come with grueling work schedules.

Versatility During the Pandemic

The pandemic has and continues to affect psychiatric training in unpredictable and profound ways. There have been patients on various services who described how difficult it has been for them not to be able to see their physician’s face under PPE. At the same time, the growth of telepsychiatry over the past year has been exponential.2 fundamentally changing the way we interact with patients, many of whom are still suffering the effects of isolation. Those patients we have treated in the past are experiencing even more mental health repercussions experienced due to the pandemic.3

As a result, we have – and are – training under unusual challenges: higher patient volumes, more complex cases, and higher incidences of comorbidities. But these may be viewed as opportunities for growth as practitioners rather than insurmountable obstacles to overcome. It is incumbent upon us as future psychiatrists to strive to deliver excellent care to our patients and to fulfill our obligations as part of a care team and a larger health system.

Advice for Early Career Psychiatrists

One of the advantages of being a resident is that we are given the opportunity to rotate through different services, each with differing patient populations, environments, and learning opportunities. So what can we do to ensure that we able to adapt to each new situation?

Listed below are a few mantras we have followed that may help others foster a versatile attitude toward tasks and difficult situations:

  1. Approach each new challenge as an opportunity.
  2. Keep an open mind as you enter new learning environments, even if you may have preconceived notions about what to expect.
  3. Be open to constructive criticism: it is a valuable learning tool and expands our clinical toolbox.
  4. If you attempt to adapt to a situation and fail, try looking at the problem in a different way.
  5. Acknowledge that training is not static – how you approach training should be dynamic. An example of this would be, being accustomed to patient interaction in person and then learning how to perform psychiatric evaluations through the computer. A learning curve is needed since the interaction is very different and the physician may need to learn more computer skills in order to rely on technology to perform appointments. In the end, it is helpful to keep the end goal in mind which is the same regardless, to perform excellent patient care.
  6. Know that in residency, as in life, many things are beyond your control; so focus on doing your best at the things you can control.

In the event that you are having trouble adapting to certain situations, it may be best to ask your colleagues or attending for support or advice. If you expect to encounter something unfamiliar, such as patients being put in restraints or even feeling threatened due to a patient’s extreme aggression, it may be best to do some preparation work on your own or with your attending. If this is not possible, consider encountering that event as a treatment team so that you can learn how to handle it properly in the future. As often heard in the medical community, sometimes the best way to learn and adjust is to “see one, do one, teach one.”

Additionally, training in psychiatry inherently comes with a set of unique stressors as compared with other medical specialties and it requires flexibility in trainees to benefit from these events. Learning opportunities may not be apparent at first, but sometimes all it takes is a quick shift in perspective.

Residents’ Corner: Tips from the Authoring Residents

“I think that starting a psychiatry residency during the pandemic has led to a tremendous appreciation of the importance of being versatile when approaching work. I began my year conducting inpatient psychiatric consults via telepsychiatry, which was not how things were initially planned. I approached the situation with the expectation that somehow things would be worse, or less impactful than in-person consults, both in terms of learning and making connections with patients. I quickly learned that having the mindset to be able to pivot to this new format, and whatever other changes were to come about as a result of the pandemic, or other extrinsic factors, would allow me to gain the most from my rotation. Contrary to what I had initially assumed, the rotation ended up preparing me for the rest of my year in ways that I could not have predicted. Additionally, I found that patients who had been isolated due to COVID-19 were appreciative to have a physician take an extended amount of time to speak with them.” –Adam Hirsh, DO (1st year resident)

“I had to learn to adapt to several residency schedule adjustments due to the pandemic, which mainly included remote telepsychiatry. For me, in order to adjust, I tried to keep things as normal as possible as if I was seeing the patient in person. For example, my manner toward patients remained very similar and at times, even improved to try to make up for the lack of personalization that may come without face-to-face communications. I also tried to keep an open mind, understanding that further changes may occur but keeping the end goal in mind, which is good patient care. Outside of clinical work, I tried to maintain all the academic activities that I otherwise would have been involved with so that I could still feel connected to the community at large.” –Danielle Weitzer, DO (4th year resident)

 

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Last Updated: Jun 15, 2021