Rotation Reflections: Child & Adolescent Psychiatry

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Psychiatry, you either love it or you don’t. This rotation made me fall in love the wonderful world of psychiatry. The rotation was not only heavily focused on psychiatric disorders, the evidence behind pharmacotherapy but specialization in child and adolescents. I had the privilege of sharing my rotation with a psychiatry fellow, Kristine, who was also on rotation with Dean. Over the course of the past month, we discussed depression, schizophrenia, bipolar, ADHD, autism, OCD/anxiety. I was able to pick Kristine’s brain, asking multitude of  questions about diagnoses. I even sat in on an ADOS testing! I was happy to be able to share some teachable moments with the fellow, especially about pharmacy practice and community pharmacy.

I learnt a lot about ADHD, something we don’t often see in the adult world. By the end of the rotation, I learn how to dose clonidine in children for ADHD, an important skill, especially with the interchangeability of mcg and mg units. We spend a lengthy amount of time looking at the evidence and trials. By reviewing the evidence and pharmacology, I became more confident weighing the pros and cons of each medication and with my recommendations. I learnt how to switch patients from one antipsychotic to another, a skill I was unfamiliar with. I got plenty of practice during this rotation.

As I got more comfortable, I focused on being more proactive with my patient care plans. I began taking more notes during rounds and also articulating my thoughts around medication management to the team. Another challenge for me was to adjust my level of information for counselling. Some patients were very responsive and asked appropriate questions but others were non-responsive. I had to become adaptive to the situation. This rotation also included a journal club and case presentation. Needless to say, I think I had a lot of practice with my oral communication skills!

During my rotation, I was assigned a few mini-projects. My first project was to create three new questions for Dean’s”Who wants to be a Millionaire?” game. After 10 years of running this game, the challenge was to come up with something not already mentioned! It was a bit of a brain teaser but I came up with four questions.  Another interesting assignment  was to create a loo-learning moment for nurses about drug-induced delirium. This was a fun, creative project. I am not artistic at all but with Dean’s graphic design skills, we pulled off an eye catching informative poster! Delirium Loo Learning poster

Another goal for this rotation to better manage my time. Once I got use to the new computer system, I was able to work up a patient in less than 2 hours (granted these patients have less co-morbidities) and  keep the level of detail required. Its interesting to see how my approach to working patients has evolved since the beginning of residency and no doubtedly at the end.

Overall this rotation has development my reasoning for therapeutic alternatives and how to weigh the benefits of each medication. It was a privilege to work with a wonderful and integrative interdisciplinary team.

 

 

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