Written by: McMaster Medical School c2023 Student 1. Where and how long was your placement? What specialty was it in?
This was a 4 week long psychiatry core at Cambridge Memorial Hospital. It was in the inpatient mental health unit there. 2. How did you get to Cambridge? I commuted to this elective. I live in Dundas so it was a 35 min drive for me, however from Downtown Hamilton it would be about a 40-45 min drive. You would probably need a car for this location especially if coming from Hamilton, there's not really any public transit that goes there. 3. What were your accommodations like? Did you get any funding from the school (MacCare etc?) I was commuting and I was able to get some MacCare funding for the commute! 4. Describe a typical day at your core. Start around 8:30am to do rounds in the nursing station until about 9am. Then head over to the acute unit, round on patients there, and then I would see any new patients for consult with my preceptor. I also reassessed patients in the acute sidewith my preceptor, if needed. From about 10-12pm it would be variable. It was often a combination of family meetings with patients, discharges, seeing patients for reassessment, or consult on the mental health inpatient side. Sometimes we would also be calling families for collateral information. After a break for lunch, my preceptor would leave to go either to the emerg or her outpatient clinic. She would leave me a list of patients to see by myself along with the nurses. My afternoon from about 1-4pm would consist of seeing patients for reassessment or consult with a nurse, then writing their notes and dictating any discharges or consults. Sometimes I would call families to update them or get collateral histories. Sometimes I would go down to the ER as well in the afternoon to do consults. Most days I was done around 4pm, sometimes even earlier around 3 or 3:30pm. 5. What level of responsibility/exposure did you have as a medical student? The first week I mostly watched my supervisor do her interviews in the morning, and then I would do my own in the afternoon. By the second week I was doing most of the interviews in the morning with my preceptor's supervision and then doing interviews alone with the nurse in the afternoon. My staff let me do discharge and consult dictations. I was responsible for writing all of the notes and occasionally writing orders to be cosigned. I always had support and was able to watch everything be done first. However, my preceptor gave me a lot of independence and exposure, which was great. 6. What is your most memorable experience? In general, what was most memorable for me is seeing patients improve so much. Previously I had never been able to do psychiatry for long enough to see large improvements in patients. Since it's a 4-week rotation on an inpatient unit, you get to see people come in, improve, and then leave. This was very rewarding and also very eye opening to how different people can present vs their baseline. Especially in the context of acute psychosis and mania, getting to see people change, improve, and return back to their baseline was very memorable for me and changed the way I see psychiatry. 7. What was one thing you didn’t like? It was a very busy hospital, probably exacerbated by COVID. With nursing shortages and other COVID issues, as well as my preceptor being personally quite busy with her various areas of work, I often was feeling like patients were not getting as much care and attention as they deserved. This is true about medicine in general especially during COVID. However, in the mental health inpatient unit you come to know your patients quite well and care for them, and a lot of them are going through a very vulnerable time in their lives. So it was quite hard for me to watch patients not get the care they deserved, or to wish I could do more for them but was limited by my role as a medical learner and not having more say in their final management. 8. Do you have any recommendations for things to do/explore/eat around the local area? I wasn't able to explore much because of lockdown, but the Grand River goes right through Cambridge and there's apparently a lot of trails by the water which look really nice! I've also heard good things about Four Father's Brewing, especially if you're there in the summer! 9. What’s one thing you wish you knew before doing this elective and any future advice for students? If you want to see a lot of variety in psychiatry this is a great location! It's inpatient, but not for long stays. The average patient stay there is about 5-10 days, so it's great to see many different presentations and outcomes. You will definitely see a lot depression and SI, as well as a lot of psychosis. You will also almost certainly see a lot of substance induced mood disorders and mania. One this I wish I knew before doing this core is that psychiatry can be an emotionally draining specialty especially in Covid and in a busy Hospital. It's important to manage expectations about patient care and realize everyone is doing the best they can, and try not to become too hung up on what's not being done for the patients and focus on what is being done for them. 10. Would you recommend this elective/core to current students? Yes!!
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Grand River in Cambridge, Background Credit: wikipedia
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