Psychiatry Clerkship: 150 Biggest Mistakes and How to Avoid Them

When beginning their clinical rotations, medical students are faced with a wide variety of books in all specialties. These books range from lengthy and comprehensive to brief and bare bones. This book, one of an evolving series on medical student clerkships, falls squarely in the brief and bare-bones category. The book is structured as a list of 150 mistakes made by medical students in psychiatric clerkships (as determined by the authors from the mistakes “we made on our psychiatry clerkships and continue to see students make”). Each numbered mistake is briefly described and discussed in one to three paragraphs. There are 10 to 15 such mistakes covered in each of nine chapters titled Approaching the Psychiatric Patient, The Psychiatric Interview, Prerounds, On Call, Write-Ups, Presenting New Patients, Daily Progress Notes, Team Rounds, and The Oral Examination. As may be surmised from the chapter titles, many of the mistakes listed are not psychiatry-specific but rather cover areas experienced by medical students on most inpatient clerkships.

Interspersed among the 150 mistakes are 68 “success tips” that summarize previously discussed mistakes and are often repetitive rather than additive to the information already given. The mistakes and tips are covered in 116 pages. There are an additional 60 pages devoted to eight appendices covering ward etiquette, tips (general pearls), DSM-IV descriptions of several “must know” disorders, a brief table of commonly used psychiatric medications, basic procedures in psychiatric emergencies, and templates for an initial interview, global assessment of functioning, and the Mini-Mental State Exam.

The book’s content, partly because of its brevity, tends to be superficial. An additional annoying feature (to me, at least) is an underlying tone that adherence to the authors’ guidance will result in good grades with less emphasis on the medical logic and professionalism underlying the suggestions. Following the authors’ recommendations will “help you ace your oral examination”; “you can review the pertinent chapter…and impress the team during rounds”; “write-ups play a large role in the determination of your overall grade”; and “there are many a number of things about which you must inquire with every patient or you will fail your rotation.”

Some of the book’s advice is good, such as “evaluating a psychiatric patient will require you to listen more and talk less.” Some advice is problematic to be giving to a medical student with no prior exposure to psychiatric patients. Examples include the statement that “your gut reaction to patients will help you determine how ill they are and what treatment is necessary” as well as the claim that “in the case of a psychotic patient, you will need to put on your ‘poker face’ in order to encourage the patient to elaborate on his delusions.” Some of the book’s advice is banal; namely, “if you are turning in your write-up to your attending, be sure it is on time.” Some advice is incorrect, such as the statement that “all patients should have a urine drug screen, and anyone with a history of alcohol use should have an alcohol level.” However, most of the information is sensible although not nuanced.

Bottom line, do I recommend this book to medical students? It does have the virtue of being brief and practical with generally reasonable advice for the novice clinical clerk. However, other books will provide a deeper understanding of the professional and clinical skills medical students are expected to attain in medicine and psychiatry.