SPECIALTY REPORT. In this issue Psychiatry. Featured Interviews Dr. Amelia Gallitano Dr. James B. McLoone. Dr. Arielle Rubin Dr.

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1 SPECIALTY REPORT In this issue Psychitry Fetured Interviews Dr. Ameli Gllitno Dr. Jmes B. McLoone Psychitry Deprtment Chir t the University of Arizon College of Medicine Phoenix PAGE 02 Physicin-Scientist Perspective 08 Dr. Arielle Rubin Dr. Nte Jones Recent Grdutes Future Psychitrists 13 1

2 From the Chir: Jmes B. McLoone, MD Dr. Jmes B. McLoone is the Chir of the Deprtment of Psychitry t the University of Arizon College of Medicine Phoenix. He is bord-certified in Psychitry nd Geritric Psychitry, Distinguished Life Fellow in the Americn Psychitric Assocition, nd is recipient of the Howrd E. Wulsin Excellence in Teching Awrd by the Arizon Psychitric Society. How hs your journey through medicine led you to this point in your creer? I come from fmily of physicins; both my fther nd grndfther were Er Nose nd Throt physicins in Phoenix. I knew from young ge I hd n interest in medicine, so I went to the University of Arizon for my undergrdute pre-medicl studies nd mjored in Zoology nd Psychology before ttending George Wshington University School of Medicine nd Helth Sciences. I went into medicl school without hving much exposure to Psychitry, but it ws field I felt drwn to. In the summer of my first yer of medicl school, I hd the opportunity to prticipte in some Psychitry clinicl reserch, which furthered tht interest. Even so, I kept n open mind through my clerkships nd loved mny of them. I ultimtely chose to commit to Psychitry nd pursued residency t the University of Cliforni t Los Angeles, which ws considered the premiere trining progrm in Psychitry t the time. After finishing my residency, I cme bck to Phoenix nd soon jumped into the role of Residency Director t Good Smritn now Bnner University Hospitl nd hd the plesure of serving in tht position for nerly 35 yers. I found tht I very much enjoyed medicl eduction, so when the University of Arizon College of Medicine pproched me to help tilor clinicl experiences for their medicl students in Phoenix, I ws more thn hppy to prticipte. Especilly now tht the College of Medicine Phoenix hs chieved seprte ccredittion, I m very fortunte to be involved in both our clerkship nd residency progrms. Wht do your responsibilities s Chir entil? There re the overrching responsibilities of high qulity clinicl cre, eduction, nd scholrship. I ve lwys been believer tht if the qulity of clinicl cre is top-notch, residents nd medicl students exposed to tht culture will certinly benefit. Excellent medicl eduction goes hnd-in-hnd with excellent clinicl cre, nd my min gol is to provide tht experience to our students, residents, nd ptients. As Chir, nother primry tsk is to help orchestrte the concerted effort mong our clinicl nd bsic science fculty, our hospitls nd clinics, dministrtion nd our students nd residents. We hve been very fortunte in fostering n lignment of the College of Medicine with our clinicl prtners in metropolitn Phoenix nd beyond. We re lso developing subspecilty fellowships nd grdute degree trnsltionl neuroscience reserch progrms. These types of efforts will help solidify our identity s contemporry cdemic deprtment. 2

3 Do you prctice s clinicin in ddition to your Chir responsibilities? Yes, I m still ctively involved in clinicl prctice. I ws drwn to Adult Psychitry nd Psychophrmcology erly on, nd I begn my creer working in inptient settings. There, I sw the most cutely ill ptients, s is often the cse in medicine. As I becme more involved with dministrtive responsibilities s Residency Director nd Clerkship Director nd now Chir, I trnsitioned to outptient prctice becuse it is esier to mnge my schedule. Now I see mny similr illnesses s in the inptient setting, but the cuity of symptoms is different nd I get to help in the lifelong mngement of ptients symptoms. tretment options for our ptients. Though mediction side effects re still concern, they re much less so thn few decdes go. There re lso better nd more refined psychotherpy tretments in ddition to or insted of phrmcologicl ones. In the future, I d like to see true biologicl understnding of wht cuses psychitric disorders. Current medictions re very helpful, but I strongly believe tht there is something more t work underneth the illnesses thn just neurotrnsmitters. We hve some understnding of the biologicl bsis of psychitric illnesses, but we need to get to the core of the disese process to better tret our ptients nd give them better qulity of life. Cn you comment on psychotherpy tretment versus phrmcologicl tretment? The trining of Psychitry includes in-depth trining in both psychotherpy nd phrmcologicl tretments, nd most clinicins will use combintion. There re those who grvitte towrds one or the other, nd this lrgely depends on the ptient s symptoms. Ptients with more severe symptoms will likel y require phrmcologicl tretments to stbilize them, while ptients who do not hve such severe symptoms my respond just s well to psychotherpy. All in ll, I ve found tht ptients do better with combintion of the two methods. It is lso not unusul to hve tem pproch to tretment; nursing cre, fmily counseling, support groups, nd therpy sessions cn ll ssist ptients on the rod to recovery. How do you believe the field of Psychitry hs progressed since you begn your creer, nd how wi! it continue to chnge in the future? There is better clssifiction of dignosing ptients with psychitric syndromes thn ever before, which is incredibly importnt in their mngement. There re newer, sfer, nd more effective I believe ptients will be better served if you hve nturl inclintion to be genuinely interested in people. Wht qulities do you believe re importnt in those who hope to pursue Psychitry? I think tht the next genertion of physicins re very bright, energized, nd hrd-working qulities importnt for ll of medicine. They re willing to sk questions, consider lterntives, nd be cretive in their pproches to medicl cre. Specificlly for Psychitry, I believe tht ptients will be better served if you hve nturl inclintion to be genuinely interested in people nd re willing to sk the next sometimes uncomfortble question. So much of the tretment process is built upon trust, so being comfortble being with people, especilly when they re not lwys t their best, is lso importnt. And lstly, be mindful of personl wellness. Medicine is n intimte field often wrought with stressful humn dilemms, so sometimes it s esy to lose tht personl blnce. I think tht ech genertion gets better with this, but don t forget to blnce tking cre of ptients with your own personl wellbeing. Mggie Xiong, MS1 3

4 Progrm Director: Andre Wxmn, MD Dr. Andre Wxmn is the University of Arizon College of Medicine Phoenix Psychitry Residency Progrm Director nd Director of the Consulttion-Liison service t Bnner- University Medicl Center, Phoenix. Dr. Wxmn ttended Ohio Stte University for her undergrdute eduction in Biology (mjor) nd English (minor) nd received her Medicl Degree from Ohio Stte University. Dr. Wxmn completed her residency in Psychitry t Bnner University Medicl Center, Phoenix Wht drew you to medicine nd the field of psychitry in specific? When I decided to go to medicl school I hd no ide wht I wnted to do. I lso hd no previous exposure to psychitry, so it wsn t even field I hd considered initilly. When I looked bck t my experiences with psychitry in my first two yers of medicl school nd my clinicl rottions, it becme very obvious to me tht this ws the right field for me just bsed on my personlity nd interests. I think tht my ultimte decision to pursue psychitry ties bck to me being n English minor. I lwys enjoyed reding nd listening to stories nd the field of psychitry llows me to explore who my ptients re nd how their del with their illnesses on much deeper level. This ws the distinguishing fctor between psychitry nd other specilties which ultimtely drew me to the field. Wht trits do you believe contributed to your over! success? Overll, I think you relly hve to wnt to do this type of work in order to be successful in the long-term. A lot of people underestimte how hrd the work is becuse psychitry isn t s physiclly demnding in comprison to fields such s surgery; however, deling with the emotionl side of ptient cre cn be very difficult. To be successful, you hve to be curious bout people nd you hve to possess the desire to spend more time with your ptients. The more chllenging spects of the field include finding the right therpies for ptients nd oftentimes we hve to try out certin therpies for months to determine whether they re effective. So, being incredibly ptient nd supportive s physicin is very importnt in this field becuse successful therpies in psychitry usully tke long time nd ptients cn get very frustrted during the process. Wht recommendtions do you hve for current/ future third-yer medicl students to succeed in their rottions? I lwys tell students to tke dvntge whenever they re given the opportunity to see ptients independently. Ptients will usully tech student bout the symptomtic presenttion of their illness, so the more time student spends with them the better ide they cn develop bout the wy certin illnesses present. Textbook descriptions of n illness often do no justice to the rel-life experiences of ptient. Ultimtely, we look for students who re engged with their ptients nd we try to incorporte them s prt of our tem to the best of our bilities. 4

5 Wht future ch!enges do you believe wi! the field of Psychitry fce? We don t relly know how the field is going to be ffected by the continued helthcre reforms. When our previous helthcre system ws reformed yers go, it ws ctully very beneficil for the field of psychitry becuse of the recognition tht ccess to psychitric services should be promoted. However, no one cn predict whether future reforms will led to the sme benefits or possible set-bcks. Additionlly, there is continued growth for the need of psychitric services tht is currently not being met due to smll numbers of psychitrists vilble to fill tht void. Phoenix hs lwys been underserved when it comes to psychitric services nd we ren t grduting sufficient number of people to fill tht need. Rnd Hnn, MS1 Clerkship Director: Devn Rstogi, MD Dr. Devn Rstogi completed her medicl school nd residency in Psychitry t Wshington University in St. Louis. Upon completion of her residency, Dr. Rstogi took on fculty position t Wshington University s Associte Professor of Psychitry. Dr. Rstogi now currently enjoys the position of Clinicl Site Director for our Psychitry Clerkship t MIHS. Wht ws your bckground going into medicl school nd where did you do your trining for medicl school nd residency? During the sme time I ws in high school in Little Rock, Arknss, my brother nd sister were in college t Wshington University in St. Louis. They told me bout medicl progrm t Wsh U clled the Scholrs Progrm in Medicine (SPIM). SPIM ws n 8 yer progrm where you re dmitted to Wshington University s n undergrdute nd then utomticlly dmitted to the medicl school. I pplied nd ws ccepted in to tht progrm. So I went to Wshington University for my undergrdute nd medicl school nd lso styed on for my residency in Psychitry. Upon completion of my residency, I styed on s fculty for the next 15 yers nd worked up to the position of Associte Professor of Psychitry, until I moved to Arizon 7 yers go. Did you know erly on tht you wnted to go in to Psychitry? Were you considering ny other specilties? I didn t know in first nd second yer of medicl school wht specilty I would go into, but psychitry ws my first rottion of third yer clerkships nd I just immeditely knew it ws wht I wnted to do. It bsiclly clicked for me in tht I knew it ws something I could do nd enjoy doing every dy. I ws so excited, I went nd tlked to the residency progrm director nd he sid Oh, everybody loves their first rottion of third yer if you re still interested, come bck nd tlk to me. I ws interested in my other rottions, but nothing spoke to me quite like psychitry did. A lot of it ws just me feeling very rewrded by the prctice of it nd noticing tht the residents nd ttendings were similr-minded people. 5

6 Did you hve mentor s medicl student or resident? If so, wht sort of dvice did you receive #om your mentor tht you found most helpful? In residency you lwys find those professors tht you work with tht you re in we of. You respect them in terms of their intelligence nd clinicl cumen nd then you try nd model yourself fter them. I hd few of those who helped guide me. Which spects of psychitry influenced you the most when it cme time to decide upon specilty? Psychitric ptients get such poor cre in generl becuse their psychitric illness is seen s the primry issue, s if they hve no other medicl problems. I relly sw myself s being their dvocte nd functioning s their primry cre doctor nd chmpion for their issues. When you tke cre of psychitric ptient, you tke cre of ll of their issues their medicl, psychitric nd socil issues. During your very first ssessment, you re trying to sort out the medicl issues they hve tht ren t being ddressed nd wht their psychitric issues re. Dischrge plnning needs to begin on tht very first encounter. You consider whether they hve plce to go. If they don t, while you re trying to stbilize your ptient mediclly nd psychitriclly, you re lso working on mking sure they hve sfe plce to go when they leve. Sometimes, tht is lmost the only chnge you re mking. You my only be tweking medictions or getting them bck on their medictions. But you re mking difference in their disposition nd putting together dischrge pln. It cn mke ll the difference for the ptient nd for their fmily. Wht do you enjoy most bout psychitry? There is never dull moment! There is nothing more fscinting thn people nd how their brin works. How they think ffects their I stress [to students] tht if they cn interview psychitric ptient, they cn interview nyone nd honing those skills is importnt. behvior. People re lwys interesting nd, more often thn not, surprise you. Often ptients hve gotten off trck nd we re ble to help them get bck on trck so they cn chieve their best in ll relms of their life. There is nothing more rewrding thn tht. When ptients suffer, so do their fmilies. So relieving our ptients suffering is helpful to mny people t once. At Desert Vist we do court ordered tretment. So, I m used to deling with the popultion tht relly doesn t hve insight into their illness. They don t relize how sick they re. They come in very ill nd re often forced to tke medictions they don t think they need. You cn probbly imgine tht s not the best reltionship t the very beginning, but 99.9% of them re ctully thnkful by the time they leve. They re thnkful tht we were ble to help them. I tell my ptients tht the circumstnces tht brought them in the hospitl were bd, but by the time they leve, most people re very hppy tht they were helped nd hve good pln to sty on trck moving forwrd. Wht do you find most ch!enging bout psychitry? I ve lwys done inptient work. I hd brief period of time where I hd smll outptient privte prctice. But mostly my pssion is inptient work with very ill popultion. I ve lwys sid we cn only be s good s our outptient counterprts. It doesn t mtter wht we re doing in the hospitl, if on the outside it s ll going to fll prt. The chllenge is coordintion of cre nd mking sure tht the inptient vision nd pln is ctully going to be crried out in the outptient setting. Certin ptients need n extr level of support on the outside nd others not s much. It is importnt to mke sure you re ble to tp into the pproprite resources for those who need it. 6

7 Cn you describe your role s the clinicl site director for the psychitry clerkship t MIHS? I consider my job s Site Director s helping medicl students who rotte through psychitry understnd how to pproch psychitric ptients nd wht the unique chllenges re. I wnt them to see wht gret specilty it is nd how bsolutely rewrding it is. I lwys tell students most of you will not go into psychitry, but I wnt you to be comfortble with psychitric ptients. I stress tht if they cn interview psychitric ptient, they cn interview nyone nd honing those skills is importnt. I wnt them to lern how importnt it is for students to understnd when it is pproprite to get psychitric consult involved, becuse they re going to tke cre of psychitric ptients no mtter wht specilty they go in to. I wnt them to be comfortble interviewing psychitric ptients so they cn seprte the psychitric symptoms from the other medicl symptoms. Given your role s clinicl site director, wht dvice cn you give to incoming third yer medicl students on wht to expect during their psychitry rottion? I would tell them tht they re going to hve more fun nd be more excited thn they would expect. They will be on steep lerning curve into the workings of the humn mind nd behvior. Something is wrong if they re not enjoying themselves, becuse like I sid, there is nothing more fscinting thn people. There is no wy you cn t be moved when you see these ptients drsticlly improve. As I mentioned, there is nothing more rewrding. There is no wy to not be excited bout tht. How cn students get the most out of their psychitry rottion nd best prepre for success? I lwys tell students tht you re going to get the most out of this rottion the more you put in to it. We hve issues of sfety in n inptient psychitric fcility, especilly like the one where I work where the cuity is so high. But s soon s you feel sfe, you should try seeing ptients on your own. Try to spend time with nd interview the ptient. Also, try getting collterl informtion. For exmple, sometimes ptient s ccount of wht is going on nd wht is ctully going on re two different things, since the ptient my not lwys hve the best insight. It is relly importnt to get collterl informtion from fmily members, or previous hospitliztions s it sometimes completely chnges our pproch nd mngement. Being tht person who helped get tht crucil informtion helps them relize they re vluble prt of the tem. Wht could be better thn tht? Andre Fernndez, MS1 Prting Thoughts It is relly importnt to get collterl informtion from fmily members or previous hospitliztions, s it sometimes completely chnges [ptient] pproch nd mngement. Being tht person who helped get tht crucil informtion helps [students] relize tht they re vluble prt of the tem. Wht could be better thn tht? - Dr. Devn Rstogi 7

8 Physicin-Scientist: Ameli Gllitno- Mendel, MD, PhD Dr. Ameli Gllitno-Mendel is n Associte Professor nd physicin-scientist here t the University of Arizon College of Medicine Phoenix. Her lb investigtes the moleculr mechnisms underlying the dul genetic nd environmentl risk for neuropsychitric illnesses like schizophreni nd mood disorders. She received her MD nd PhD from the University of Pennsylvni nd completed her Internship nd Residency in Psychitry t Columbi University nd New York Stte Psychitric Institute. Dr. Gllitno-Mendel then completed postdoctorl fellowship in moleculr neuroscience nd psychitric genetics t Wshington University School of Medicine. Wht ttrcted you to medicine? I first got interested in Neuroscience in high school tking n AP biology course. I red n rticle on sleep nd dreming nd in the rticle it tlked bout how the contents of your drems might be ffected by your physicl stte. I thought it ws so interesting, tht something physicl ws mnifesting in your thoughts nd drems. I knew when I went to college I wnted to prticipte in reserch, which I did t the University of Chicgo. I ws potentilly interested in medicl school, but I ended up tking my pre-med clsses pretty lte, so I hd yer off before medicl school. In tht yer I did reserch t McLen Hospitl in Boston, which is one of the very old psychitric hospitls, nd relly enjoyed it. How did you decide MD/PhD nd ultimtely Psychitry? I pplied to MD/PhD progrms, becuse t the end of college I debted do I wnt to just do clinicl or just do reserch, nd this pth left both options open. I went to medicl school t the University of Pennsylvni nd t the end of medicl school, I ws gin fced with this decision to go stright into the lb or do I wnt to go into residency progrm. I hd originlly been Pssion is the most importnt thing, it is wht gives you the energy nd the drive to ccomplish things. interested in Psychitry, but when it cme time to pply to residency, I decided to pply in Internl Medicine, which provided the opportunity to short trck into fellowship, nd be bck in the lb fter only 3 yers. However, during interviews I hd misgivings s I contemplted creer trying to prctice medicine while doing predominntly reserch. Medicine is so brod, I ws uncomfortble with the ide tht I would not be ble to mintin expertise in my clinicl work if I ws ttending on the wrds only one or two months yer. When I hd the opportunity to spek with Eric Kndel he sid no, no, no, don t go into medicine, MD/PhD s re dime dozen in medicine nd neurology. Go into Psychitry nd 8

9 you ll be big fish in smll pond, nd I think he ws right. I think Psychitry is one of the most exciting fields of medicine in terms of being the one where we hve the biggest discoveries to come. We relly don t understnd how the brin works. We re brely just lerning the lphbet, rther thn speking the lnguge fluently, in terms of our mstery of understnding how the brin works. Psychitry is deling with the cool concepts of the mind, cretivity, cognition, nd personlity. We hve no ide how ll of these things re dictted biologiclly nd physiologiclly. I lso think it is very stisfying creer cliniclly becuse every ptient is so unique, nd every person hs his/ her own story. It is lso gret specilty if you wnt to do something else like reserch, becuse it is more focused. I feel lot of wht you lern is how to interview ptients nd understnd personlities nd behvior, nd those re things tht you cn crry with you throughout your creer. I felt it ws specilty where you could mintin high qulity of expertise nd cre for your ptients while still doing predominntly reserch. We relly don t understnd how the brin works. We re brely just lerning the lphbet, rther thn speking the lnguge fluently. Do you sti! prctice clinicl medicine? How do you blnce clinicl medicine nd your reserch? I prcticed up until very recently. For bout 9 yers I ws t the VA in their PTSD clinic. I ws there bout 10% of the time. My focus hs lwys been predomintely reserch, becuse if you do bsic science reserch, you cn t do it well (in my opinion) unless you do it the mjority of the time. Prticulrly now tht is hs gotten so incredibly competitive to get I think Psychitry is one of the most exciting fields of medicine in terms of being the one where we hve the biggest discoveries to come. grnts. Tody, it tkes this huge mount of time to just get funding nd only bout 5% of grnts will get funds. Describe your efforts s bsic neuroscientist investigting schizophreni? I study genes tht re ctivted in the brin in response to events in the environment. These genes re clled immedite erly genes nd re in clss clled ctivity dependent genes. The genes re triggered by clcium influx, so when neurons depolrize due to n environment trigger, these genes will turn on nd cn be detected within 5 minutes of the stimulus. We hve found tht these re dysfunctionl in mny mentl illnesses. I hypothesized erly on in my postdoc tht they could potentilly explin the dul genetic nd environmentl risk for mentl illnesses becuse ll mentl illnesses re determined by combintion of the two tht we don t relly understnd yet. As the field progresses, we continue to get more nd more support for this hypothesis, which is pretty cool. We currently hve trnsltionl study where we hve tken our findings from our niml studies nd pplied it to humns. We got grnt tht is llowing us to test our hypothesis tht we could develop biologiclly bsed dignostic test for schizophreni. It took us long time, nd multiple IRB pprovls, but we re just finishing our pilot group to determine the correct dosge. Then, we will go onto the cohort of cses vs. controls. It is still pretty erly in the process, but we hve tken long time to get to this spot, nd re excited for the future. 9

10 How is your lb orgnized on cmpus? I hve lb mnger, 1 post-doc fellow, 1 full-time grdute student nd bunch of undergrdutes. We hve rnge of different trinees. In science, prt of the gol is obviously to get to the end product, but lso mjor gol is to trin the next genertion. Do you hve ny dvice to students, prticulrly MD/PhD students? Would you like to offer ny prting thoughts? It is relly importnt to do something tht you re pssionte bout becuse your creer is long. For the MD/PhD students I will sy don t worry bout feeling like you get behind. By the time I finished my postdoc nd got my job here, my collegues from medicl school hd been in prctice for decde. In some sense I ws wy behind them but in nother sense, some of them were mybe not so excited bout wht they were doing nymore. As long s you re doing wht you love the whole time, it doesn t relly mtter. For the medicl students, mke sure to choose something tht you love tht cn keep you interested ll of those yers. Don t just pick it becuse it is more stble or more lucrtive, becuse if you don t love it now, it is going to be pinful in ten yers. Pssion is the most importnt thing, it is wht gives you the energy nd the drive to ccomplish things. Nicole Segline, MS1 Psychitry Interest Group t UACOM-Phoenix Student Ledership Jsper Purcn (jpurcn8298@emil.rizon.edu) Svion Smith (sjsmit15@emil.rizon.edu) Fculty Co-Advisors Jmes B. McLoone, MD, Chir Deprtment of Psychitry (jmes.mcloone@bnnerhelth.com) Ameli Gllitno-Mendel, MD, PhD (meli@emil.rizon.edu) Ronld Hmmer, PhD (ron.hmmer@emil.rizon.edu) Mission Sttement The purpose of the Psychitry Interest Group t the University of Arizon College of Medicine Phoenix is to expose students to the field of psychitry. In working to ccomplish this gol, we will hold events including lunch presenttions on psychitric topics nd discussion pnels feturing physicins nd mentl helth professionls. We lso im to increse wreness of the importnce of psychologicl spects in mny nonpsychitric illnesses through interctive movie screenings nd volunteer ctivities. 10

11 Alen Petty, DO Dr. Alen Petty ttended medicl school t the Arizon College of Osteopthic Medicine before completing her Psychitry residency t Bnner University Medicl Center-Phoenix. Dr. Petty is now member of our full-time fculty t BUMCP where she supervises nd teches our Psychitry Clerkship students nd Psychitry Residents on our Adult Inptient Unit. She lso serves s the Psychitric consultnt in the recently developed Collbortive Cre Progrm with our UACOM-P collegues in Fmily nd Community Medicine nd Internl Medicine t BUMCP. Wht ws your pth to psychitry? I strted medicl school with n open mind, not sure of wht I wnted to do. I considered pursuing creer in ddiction medicine when fmily member relpsed fter we thought he d esily sty sober following huge medicl ordel. I found tht most people entered ddiction fellowships then fter residency in psychitry, so I strted my third-yer psychitry rottion just hoping I would like it. I ended up enjoying it so much tht I didn t wnt to limit myself to work in ddiction only. The first thing tht cptured my interest ws working with ptients with schizophreni. Prior to my psychitry clerkship, I hd never encountered person with schizophreni. It ws mzing to see how tretment could so quickly help people nd improve symptoms. How ws your experience s psychitry resident t BUMCP? I did psychitry rottions everywhere I could s fourth-yer medicl student. Even though it s big hospitl, my experience t Bnner felt like I ws prt of fmily. I felt strong connection there, nd tht ws relly importnt to me in choosing residency progrm, since I knew I d be spending so mny hours there. I hd gret experience in residency, mde lifelong friends, nd lerned more thn I relized. When the opportunity cme up to come bck to Bnner s fculty, I just couldn t resist. Wht re the differences between inptient nd outptient psychitry? Inptient psychitry is often immeditely grtifying. We meet ptients in their hrdest times, such s with severe depression, fter suicide ttempt, or with psychotic symptoms, nd fter bout week of intensive group therpy nd mediction chnges, they re often well enough to go bck home. In the outptient setting, it s very rewrding to be ble to get to know your ptients on deeper level. They trust you with the most intimte spects of your life, nd tht is pretty specil. Right now, t Bnner, I m fortunte enough to spend time in both settings. Wht re your fvorite spects of psychitry? It s lwys rewrding to see ptients improve nd find mening nd enjoyment in life gin. In ny specilty, it cn be esy to get bogged down with dministrtive tsks, but I find tht when I m in n office, fce-to-fce with ptient, the pperwork doesn t seem to mtter, nd I m reminded why I do wht I do. 11

12 Wht re difficult spects of psychitry? It s lwys chllenge to not bring it home, especilly when working with ptients with severe depression or extremely difficult socil stressors like homelessness, unemployment, or disbility. There ws point in my creer when I ws working only with ptients determined to hve serious mentl illness, so I mde it point to look t my schedule t the end of ech dy to focus on success story. Tht intentionl effort mde it esier to nswer how ws your dy? with positivity nd honesty, nd tht s been importnt for my own wellbeing. Wht principles of psychitry would you hope tht every physicin would incorporte into their prctice? It s importnt to know tht mentl illness does not discriminte. No mtter wht specilty you go into, you will encounter it. People with mentl illness often get indequte cre or feel like their concerns re dismissed becuse they hve this lbel. On similr note, we s physicins must relize tht we re eqully susceptible. We her lot bout physicin burnout, even physicin suicide, nd we must tke cre of ourselves before we cn dequtely tke cre of nyone else. Wht re common misconceptions bout psychitry? I think some of the most troubling misconceptions re tht people cn just snp out of it when they re depressed or just relx, nd this doesn t help the stigm of mentl illness or tretment when people re told they should be ble to hndle it on their own. Another common misunderstnding is relted to dismissl of psychitric dignosis when it presents with substnce use disorder. In relity, substnce use cn excerbte preexisting psychitric disorder in the sme wy tht stressors do. Quite often n underl ying psychitric illness ctully precipittes or perpetutes the substnce use. We should be empthetic nd understnding when working with ptients to find wys to help them be successful. It s often not s esy s just eliminting the substnce; we need to identify nd ddress underlying issues tht my be contributing to substnce use. We s physicins must relize tht we re eqully susceptible [to mentl illness]. We her lot bout physicin burnout, even physicin suicide, nd we must tke cre of ourselves before we cn dequtely tke cre of nyone else. Where do you see your creer going #om here? Recently, I hve been involved in strting new Collbortive Cre Progrm t Bnner tht brings together Psychitry with Fmily Medicine nd Internl Medicine. This progrm involves cre mnger to increse ptient enggement in tretment, nd psychitric consultnt to ssist with medictions, while llowing the ptient to continue receiving cre in primry cre setting. This new Collbortive Cre Progrm here is only bout one month old, so hopefully in 5 yers we will be the Arizon experts for this model of cre. Bnner hs lot of primry cre clinics where we could provide lot of eduction nd trining to improve ccess to mentl helth cre for mny Arizon residents. Tnner Ellsworth, MS1 12

13 Recent Grdute: Arielle Rubin, MD Arielle Rubin, recently grduted medicl student from the UACOM-P, will be beginning her Psychitry residency t UT Southwestern in Dlls, TX. Arielle is interested in Child nd Adolescent Psychitry nd Culturl Psychitry. Arielle received her B.A. in Art History nd minor in Spnish before ttending medicl school. When nd how did you become interested in Psychitry? Did you hve ny specilties tht you were considering s close second to Psychitry? I cme into medicl school wnting to do psychitry due to my fmily bckground my dd is child psychitrist nd I hve specil needs brother who benefitted from psychitry, so I got to grow up with it nd see the holistic mentl helth pproch. Yes, you get to provide medictions but there s lso lot of therpy nd socil cre coordintion, so tht seemed more fun thn ny other specilty. My brother hs utism so I knew tht I wnted to work with specil needs kids s my ptient popultion, so I lso considered child neurology nd developmentl peditrics. I shdowed in ll three of these fields nd I liked psychitry best. In child neurology you hve to work with dults during trining, nd in developmentl peditrics you hve to work with non-specil needs kids, nd I found the psychitric issues were the ones tht interested me the most. Did you hve ny mentors or experiences during your pth tht helped solidify your interest in Psychitry? Aside from my fmily mentors, my SP mentor, Dr. Frncisco Moreno, relly plyed big role. Two of my biggest interests re developmentl disbilities or specil needs nd socil justice in medicine nd helthcre disprities, which is relly big thing in psychitry. Culturl psychitry is its own field, nd you don t relly see culturl or liberl rts focus in mny other specilties. Dr. Moreno worked in socil justice psychitry nd border helth psychitry, where he did psychitric evlutions of refugees so they could get sylum sttus. In my scholrly project we evluted risk fctors for depression nd PTSD in Ltin immigrnt women who hd crossed the border nd experienced trum. This work showed me the reltionship between determinnts of socil policy nd helthcre, nd how both of these ffect popultions tht re sometimes forgotten bout in medicine becuse they don t seek medicl help. Dr. Moreno used his own culture nd ction to help ptients tht re normlly scred of psychitry. He ws so smrt nd biologiclly bsed in his pproch, nd he s just one of those people tht you re like I wnt to be like you one dy. Wht did you do to prepre for residency pplictions? There were certin things tht I knew I wnted to hve on my ppliction. With my culturl psychitry interest I knew I wnted to do globl wy rottion nd I wnted to be ble to discuss this in my residency interviews, so I scheduled this erlier in my fourth yer. I found n interntionl medicl student ssocition group nd I did student exchnge progrm in Spin it totlly chnged my perspective nd I loved my experience. I lso set myself up erly with mentor, Den in Tucson, who is prominent in cdemics. 13

14 Reserch nd ledership experience re relly importnt, so I published ppers in few different fields (not just psychitry), nd few clssmtes nd I strted the Ltino Medicl Students Assocition. Awy rottions re lso huge nd I knew I wnted to mtch out of stte. I did two wy rottions nd one 2-week observership becuse I couldn t fit nother one in my schedule. I relly wnted to hve presence, show interest, nd mke myself known. I ended up mtching t one of the plces where I did my wy rottion. Wht dvice would you give students considering future in Psychitry? DO IT! I hve met few physicins tht trnsferred into psychitry from nother specilty, but I hve never met nyone tht trnsferred the other wy. I didn t pprecite the lifestyle portion s much until recently if you wnt to hve time to do hobbies nd spend time with fmily, psychitry is one of the few wellness-oriented specilties. If you re interested in liberl rts, socil justice, or humnism, psychitry people re your people. If you wnt to work with relly vulnerble ptients, psychitry is such specil opportunity. I feel like I ve become better person becuse I m pplying psychitric principles to my own life, so I feel like hppier, more holistic person tht cn hndle lot more in life. I hven t met ny psychitrist tht doesn t love their job. Stigm Around Psychitry A lot of people in the medicl community don t respect psychitry nd don t ssocite it with n identity s physicin. When Nte cme to me to tlk bout the stigm, I just reminded him tht it doesn t mtter wht they think becuse you get to hve relly fulfilling job, then you get to go home nd enjoy your fmily nd you hve the best of both worlds. The stigm of mentl helth stops lot of people from considering psychitry, so my dvice is to be your own person nd if you re interested, don t let tht stop you. You ll help so mny people nd your collegues tht relly know your vlue will mke you feel vlued. - Arielle Rubin Bryce Munter, MS1 14

15 Recent Grdute: Nte Jones, MD Nte Jones, recently grduted medicl student from the UACOM-P, will be strting his Psychitry residency t Bnner University Medicl Center in Phoenix, Arizon. Nte is interested in Child nd Adolescent Psychitry or Sports Psychitry. Nte received his B.S. degree from University of Phoenix nd his MBA from Grnd Cnyon University, where he then worked s Director of Opertions for 10 yers. When nd how did you know you were interested in Psychitry? All throughout medicl school I ws interested in surgery subspecilties, but I went into my Psychitry rottion relly hoping tht I would be interested in it. I hve wife nd four kids, so, to be honest, I wnted lifestyle creer, nd surgery generlly doesn t fll into tht ctegory. I ws lso the guy during first nd second yer doctoring clsses tht struggled with time becuse I loved to tlk to the ptients nd connect with them more deeply thn ws relly necessry in doctoring setting. During my psychitry rottion, I ws fortunte enough to hve gret residents nd ttendings nd phenomenl clerkship director, Dr. McLoone, who hd lot in common with me in terms of fmily nd life gols. I enjoyed not hving to wtch the clock while I ws interviewing ptients. Wht did you do to prepre/wht do you wish you would hve done differently in the first three yers of medicl school to prepre you for now? I decided on Psychitry t the very end of my third yer nd I ws very focused on stying here in the vlley, so the biggest thing I did t tht point ws to strt building reltionships with the residents t Bnner nd with Dr. Wxmn, the residency progrm director. Bnner nd Mricop re the only two progrms in Phoenix, so I mde sure I did well in my rottion with Bnner nd then s soon s I hd the opportunity to do so I signed up for rottion with Mricop so I could compre the progrms. Mricop is n involuntry unit, so I got to tret ptients tht were relly sick, wheres Bnner is voluntry unit so the ptient popultion is bit different. Becuse I enjoyed Bnner so much, I ctully did second elective with them during my fourth yer, so I think tht relly set me prt from the other pplicnts. I lso did n wy rottion with the University of Wshington, which gve me more of feel s to wht the need is for psychitrists nd lso llowed me to see wht kind of creer potentil I hve. Wht dvice would you give students considering future in Psychitry? Wht ws your experience with Residency Interviews? Build good reltionships. Psychitry is so much less competitive thn lot of the other specilties. Anything you do to set yourself prt is going to be beneficil, but wht I gthered during my interviews is tht they relly just wnt to know tht you re going to be cool person to work with. They wnt to be ble to trust tht you re not going to wrek hvoc on their progrm, tht you re going to be consistent on coming to work, nd tht you re going to get long with other people. I felt like my psychitry progrm interviews were very lid bck. In surgery, my clssmtes sid it ws lot more grueling nd they were sked tough questions during the interview, nd the most 15

16 difficult question I hd ws to recount n experience with ptient tht ws impctful. Everything else ws bout my hobbies nd bout my fmily nd bout the progrm, so it ws much more lid bck. It s just bout building reltionships then deciding where you wnt to spend those four yers. Did you hve one specific ptient or experience tht ultimtely mde you decide on Psychitry? There ws no one specific ptient in prticulr. I feel like throughout the dy in psychitry you re meeting with ptients who re experiencing things tht just don t mke sense. You her stories tht re unbelievble, but it is rel for the ptient. Just hering those things throughout the dy is entertining nd fun, but lso seeing those ptients relize tht their experiences re not necessrily norml is fscinting. Bryce Munter, MS1 Stigm Around Psychitry There is certin pride spect of choosing specilty nd even during the first few weeks of my rottion I wsn t convinced Psychitry ws for me. The thought of being surgeon is sexy' in medicine, nd when I told people tht I m going to be psychitrist their first response ws you hve to go to medicl school for tht?. I remember tlking to Arielle bout it, nd it took me few weeks into the rottion to decide tht this ws something I wnted to do. Lifestyle is so importnt even though we don t tlk bout it ll tht much, so my dvice is to relly think bout wht you wnt your life to look like before crossing psychitry off the list. - Nte Jones 16

17 A Converstion with Recent Grdutes: Wei Chen, MD & Erin D. Nelson, MD Erin D. Nelson, MD Wht led you to pursue psychitry over other specilties? Wei: Before I strted medicl school, I used to work t Bnner Alzheimer s Institute so I hd lot of exposure to psychitrists nd psychologists, but I wnted to strt medicl school with blnk slte nd expose myself to every specilty. Then I got to my third yer psychitry rottion nd everything just clicked I relly meshed well with the ttendings nd the ptients were super interesting. I ws lso lucky enough to experience ptient truly getting well nd chnging his life trjectory, nd tht experience ws inspiring. Erin: I cme to medicl school hving no ide wht I wnted to do, but s I went through my first two yers I lened more towrds primry cre. Wei s enthusism bout Psychitry ctully inspired me to consider it s specilty. From ptient cre perspective, I loved tht you relly got to know lot of detils bout your ptients becuse they trust you with lot of relly personl informtion. I liked the pce becuse we spend more time with ptients nd sk those questions tht relly represent the whole person. I lso sw ptients tht hd complete turnround nd I relized how big of difference I cn mke in their lives. Wei Chen, MD How did your medicl school experience impct your decision? Wei: Aside from clerkships third yer, we hd n incredibly cool lecture from forensic psychologist, Dr. Erin Nelson, towrds the end of second yer or during third yer. We discussed rel ptients tht were cutely psychotic prisoners who committed severe crimes. The whole tlk debted if these ptients re truly psychotic nd if so, how do we restore them to competency so we cn try 17

18 them for the crime they committed. It showed us tht there re so mny different venues of prcticing medicine in psychitry. Erin: There ws lso motivtionl interviewing module in Doctoring tht I relly enjoyed, where we lerned skills to help ptients mke decisions for themselves. Lerning those skills is pplicble to mny specilties, but since our ptient interviews re so much longer I find myself prcticing these skills every dy. Where re you in your process (resident, ttending physicin)? Wht is your experience thus fr s psychitry resident/physicin? Erin: We re both finishing our intern yer t Mricop Medicl Center. To be honest, I still think it is wesome. I m so hppy with the specilty. I think it ws the right specilty for me. It s tough yer, but intern yer is tough yer in ny specilty you choose. Wei: In psychitry, the ptients re gret nd we re generlly just hppy group of people. Our ptient lod is lower thn other specilties, but ech ptient is more emotionlly nd mentlly drining thn you would see in different field. Becuse of tht, it is relly nice to hve time off to tke time for yourself nd understnd your own mentl stte nd tht time blnce becomes so importnt. Wht dvice do you hve for medicl students when it comes to choosing field? Erin: My dvice is to think bout your gols outside of work. These gols re not necessrily reson to pick or not pick specilty becuse if you love your job you will lwys mke it work, but it is relly importnt to think bout the prts of life tht we don t tlk bout tht much work/life blnce, slry, creer dvncement, work flexibility. Psychitry is so gret in this regrd, nd there re so mny different pths you cn tke. You cn work inptient, outptient, in emergency settings, even in forensics, so tht gives you lot of flexibility to choose your own creer pth. Cn ech of you te! fun fct bout ech other? Erin: Wei is Dnce Dnce Revolution chmpion! He used to compete in DDR competitions before strting medicl school nd he plced 10 th or 11 th in ntionl competition. It ws so serious tht he now hs osteorthritis in his knee! Wei: Erin is phenomenl bker! She lso just got mrried nd dopted dog. Actully, between the two of us we hve ccomplished every mjor life gol finishing school, getting mrried, dopting dog, hving children, buying cr, buying house, strting fmily, nd dulting (finlly getting pid fter not hving ny income for four yers)! Bryce Munter, MS1 Wei: Don t choose field simply becuse you like the lifestyle or becuse you think it would be cool. Experience it, tlk to the residents, nd mke sure you personlly feel t home when you go to work every dy. It is so importnt becuse residency is quite few yers of your life, but when you re done with residency, you re doing tht specilty for the rest of your life. Mke sure tht it is something you re hppy doing rther thn specilty tht you think you should be doing. 18

19 Mrch 2018 STATS TO KNOW Psychitry (Ctegoricl) Mtch Summry, 2018 No. of Progrms Positions Offered Unfilled Progrms No. of Applicnts No. of Mtches US Seniors : Totl % Filled US Seniors : Totl Rnked Positions US Seniors : Totl 256 1, , : 1, : ,428 : 17,832 Summry Sttistics on US Allopthic Seniors, 2016 Mesure Mtched (n = 737) Unmtched (n = 78) Men number contiguous rnks Men number distinct specilties rnked Men USMLE Step 1 score Men USMLE Step 2 score Men number of reserch experiences Men number of bstrcts, presenttions, nd publictions Men number of work experiences Men number of volunteer experiences Percentge who re AOA members Percentge who grduted from one of the 40 US medicl schools with the highest NIH funding Percentge who hve Ph.D degree Percentge who hve nother grdute degree Specilty Report Newsletter Editors: Andre Fernndez, Mggie Xiong, Tnner Ellsworth, Bryce Munter, Nicole Segline, Rnd Hnn Fculty Advisor: Lis Shh-Ptel, MD If you hve ny suggestions for rticles of interest, corrections, or comments for how we could enhnce the newsletter, plese do not hesitte to contct us t lshhptel@emil.rizon.edu nd comphx-speciltyinfo.emil.rizon.edu 19