Psychiatry was always a field of interest to me, therefore I was particularly excited for this rotation. Throughout the rotation, I encountered a wide variety of patient presentations, including anxiety, depression, mania, schizophrenia, substance-use disorders, and personality disorders. I was able to apply the knowledge I gained during the psychiatry course in didactic year to real-world clinical scenarios. Compared to my previous rotations so far, psychiatry required a very different approach to patient care, with a greater emphasis on communication, observation, and building rapport rather than relying heavily on physical exam findings or diagnostic testing.

Although I was not exposed to procedures during this rotation, I was able to significantly improve my interviewing and communication skills. As I became more comfortable, I was able to independently interview lower acuity patients, including pediatric patients, and participate in interviews of higher acuity patients alongside my preceptor. I learned what pertinent questions to ask, how to navigate sensitive conversations, assess mood and affect, and evaluate thought processes and insight (which is something that I struggled with in the beginning, and something that I can tell takes years of practice to perfect). Another important aspect of this rotation was obtaining collateral information from family members, friends, EMS, and prior medical records. I learned how essential collateral can be in psych, especially when patients are poor historians, acutely psychotic, manic, intoxicated, or unable to provide reliable information themselves.

Going into this rotation, I knew a large portion of psychiatric management would revolve around medications. The experience definitely strengthened my understanding of psychopharmacology. I observed how medication management often required balancing symptom control with side effects, medical comorbidities, and patient adherence. For example, many patients with schizophrenia struggled with adherence to daily oral antipsychotic medications, making long-acting injectable antipsychotics an important alternative, with some administered monthly and others every 3 months. I also had the opportunity to observe several patients with EPS secondary to antipsychotic use. Seeing these side effects firsthand made me realize how clinically significant and relatively common they can be in practice.

Something else I appreciated during this rotation was the team-based approach to patient care. The collaboration between PAs, attendings, nurses, NPs, social workers, case managers, and even security staff demonstrated how important interdisciplinary teamwork is in psychiatry. Each member of the team contributed a unique perspective, and it was rewarding to see everyone working together toward the same goal of patient safety, stabilization, and disposition planning.

Overall, this was a great rotation. It allowed me to gain a greater appreciation for the importance of empathy, patience, and building trust with psychiatric patients. Although a bit intimidating at first, this rotation helped me become more confident in my clinical reasoning and interviewing abilities, as well as my overall approach to caring for patients with mental health conditions.