My day usually starts around 9 a.m. when I get to the Psychiatric Residency office where I sign
into the Research Volunteer logbook. After signing in, I head to the research room where I sit
down at my desk and work on the project I have been assigned. For the past couple of weeks, I
have been working with Dr. Khan on a research project regarding the use of antipsychotics in
pregnancy. Dr. Khan will then use this information to decide how to treat a patient. I generally
meet with the residents I am working under a couple of times a week to check in on my
progress. I spend an average of five hours a day researching and writing at my desk. While at
times this can be tedious, I understand that it is necessary to move the research we are doing
forward. And I do enjoy having something tangible to present to the residents and Dr. Hossain,
the Chief of Geriatric Behavioral Health Services, at research meetings. I also get to use this
time to get input from the other research volunteers who have more medical and/or psychiatric
experience than I do.
Every other Friday at noon, I attend a Journal Club meeting, where a resident is assigned to
present and discuss a journal article. These meetings are an interesting way to get a feel of how
reading a journal article on clinical research in humans is different from that in earlier stages of
drug trials (i.e., mouse trials as opposed to trials in humans). I’ve learned a lot about what kinds
of metrics are used to determine the efficacy of antidepressants and other psychotropic drugs.
My favorite part of my internship is attending biweekly research meetings. These meetings are
an opportunity for each of the research teams to present their progress in whatever they are
investigating, as well as for research volunteers and residents to join the teams to work on
proposed projects. These meetings show just how busy a psychiatric resident can be. When a
resident reports that (s)he has submitted an article for publication or presented a poster at a
recent conference, the Research Chief and Chief Resident will tell him/her to immediately get
started on something new as soon as possible. It is kind of terrifying to picture myself on the
resident end of this, and I am pretty happy that I am not currently a resident here. I can see
myself being more capable of handling this within a couple of years, but right now, it is daunting.
The best part of these meetings is hearing about how everyone is progressing in their projects
and being able to share how I am doing as well.
So far, this internship has really developed my research “consumption” skills and I find myself
better able to pick out the most important aspects of journal articles, especially the strengths
and weaknesses of different studies. I also have a much better understanding of different
psychiatric disorders, how different medications work, and what kinds of things to look for when
reading articles about these topics, especially the strengths and weaknesses of how particular
studies were conducted. I think this internship is helping me improve my communication skills
as well. When I present my findings at research meetings and talk to the different residents
about my progress, I find that sharing my thoughts about these topics is becoming easier to do
as I gain familiarity with the material discussed. When I started out, I was struck by the amount
of new terminology and drugs that I had not heard of. Over the course of the past several
weeks, I have learned a lot more about topics in psychiatry. I hope to bring this ease of
communication into other settings. For the most part, these skills can be applied in just about
any other setting. I am also looking forward to using my knowledge of psychiatry as an EMT.
I’ve been on a fair number of psychiatric calls, and I look forward to applying what I have
learned from this internship to how I care for patients.
My three specific expectations that I mentioned in my last blog post have been progressing at
different speeds:
1. How the Affordable Care Act has affected the BRMC population:
While I haven’t really been able to gain a whole lot of knowledge about how the BRMC
population itself is affected by the ACA, I have learned more about Charity Care in NJ
and how it works alongside the ACA to provide some level healthcare coverage to the
otherwise uninsured. While it is not an insurance plan in the traditional sense, Charity
Care offsets the cost of ‘necessary hospital care’ at acute care hospitals. Unlike most
insurance plans, there isn’t a network of care providers. I hope to gain a more in-depth
understanding about the gaps in coverage that Charity Care and the ACA don’t meet.
2. Different aspects of psychiatric care and different decisions that must go into it:
I have seen that when providers are considering different treatment options, the daily
lives of patients are definitely considered, especially in terms of how an intervention
would change their day-to-day life and how well they would be able to function without it.
The research meetings give me the most insight into this topic. In my previous post, I
mentioned a patient with severe OCD who the residents are struggling to treat. This
patient has come up again and again as the residents and Dr. Hossain throw around
different treatment options. One of the major barriers to treatment is cost, as well as the
ability of the patient to travel to get treatment that is unavailable at BRMC. It is
interesting to see how they take these aspects of the patient’s life into consideration
when determining treatment. As I have only attended two of these meetings, I think I
have a lot more to learn.
3. Interplay between health policy and hospital operations:
One of the topics we touched upon in HS104b: American Health Care is how the cap on
Medicare “direct” residency funding has severely constricted residency positions
available for foreign medical graduates (FMGs) who comprise a significant chunk of the
physician workforce within the less glamorous medical specialties (psychiatry being one
of those specialties). I’ve seen a lot of the effects of this through this internship because
many of my fellow research volunteers are FMGs who have been struggling for many
years to gain acceptance into a residency program. They engage in activities like
volunteer research with the hope of strengthening their residency applications, but with
no guarantee of getting in anywhere. One of the research volunteers I work with finished
medical school over a decade ago in India and is still trying to gain acceptance into a
residency program. Many of the residents I work with are FMGs as well. A fair amount
come from India and Pakistan, while a significant portion come from medical schools in
the Caribbean.
What I have learned about how policy affects hospital operations comes less from my
experiences as a research volunteer and more from my current job at BRMC as a
Clinical Systems Instructor, which involves electronic medical record (EMR)
implementation. In this role, one of my primary responsibilities is to teach physicians and
incoming residents how to use the EMR program that BRMC has recently implemented.
So, many of the residents I see at meetings are familiar faces. While in theory EMR use
seems like the optimal way to ensure continuity of care and positive outcomes, it
becomes more difficult when some of the older physicians are unwilling to use a
computer and insist on sticking to paper documentation. There are also physicians who
refuse to use EMR because it will slow them down and they work much faster on paper.
I don’t blame them though. If you did not grow up in an age where computer skills are
part of the elementary school curriculum, learning how to use EMR is a difficult
endeavor. Hopefully, getting rid of paper documentation will get everyone on the same
page, but until then, getting physicians to come to training remains a struggle.