- Last edited on April 30, 2020
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teaching:stacer-guide-prep [on April 12, 2020] |
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| ====== Psychiatry STACER Preparation Guide ====== | ====== Psychiatry STACER Preparation Guide ====== | ||
| + | {{INLINETOC}} | ||
| ===== Primer ===== | ===== Primer ===== | ||
| - | The **Standardized Assessment of a Clinical Encounter Report (STACER)** is a semi-structured examination of a psychiatry resident’s interviewing and consultancy skills. An STACER examination is usually a 50 minute diagnostic interview of a volunteer patient that both the resident and examiners do not know. The purpose of the STACER is to demonstrate your [[teaching:1-psych-interview|psychiatric interview skills]], present a [[teaching:mental-status-exam-mse|mental status examination]], generate a comprehensive DSM-5 diagnosis (and differential diagnosis), a [[teaching:biopsychosocial-case-formulation|biopsychosocial formulation]] of the patient, and finally, a comprehensive treatment and management plan. | + | The **Standardized Assessment of a Clinical Encounter Report (STACER)** is a semi-structured examination of Canadian psychiatry resident’s interviewing and consultancy skills. An STACER examination is usually a 50 minute diagnostic interview of a volunteer patient that both the resident and examiners do not know. The purpose of the STACER is to demonstrate your [[teaching:1-psych-interview|psychiatric interview skills]], present a [[teaching:mental-status-exam-mse|mental status examination]], generate a comprehensive DSM-5 diagnosis (and differential diagnosis), a [[teaching:biopsychosocial-case-formulation|biopsychosocial formulation]] of the patient, and finally, a comprehensive treatment and management plan. |
| - | <WRAP group> | ||
| - | <WRAP half column> | ||
| Think of the STACER as interviewing a patient for the purpose of taking over their care. This means you must gather as much information as possible during the 50 minute diagnostic assessment. The challenge with the interviews and questions on STACER examinations is that it is not the same as what you do in real life when you see patients. In the real clinical setting, we try to know our patients over multiple visits, we have old charts and collateral, and we don't have the pressure of examiners in the room! | Think of the STACER as interviewing a patient for the purpose of taking over their care. This means you must gather as much information as possible during the 50 minute diagnostic assessment. The challenge with the interviews and questions on STACER examinations is that it is not the same as what you do in real life when you see patients. In the real clinical setting, we try to know our patients over multiple visits, we have old charts and collateral, and we don't have the pressure of examiners in the room! | ||
| - | == General STACER Structure == | ||
| - | * Interview Section (60 minutes) | ||
| - | * 50 minute interview | ||
| - | * 10 minute presentation preparation | ||
| - | * Presentation Section (20-25 minutes) | ||
| - | * Examiner Questions (20 minutes) | ||
| - | |||
| - | </WRAP> | ||
| - | <WRAP half column> | ||
| - | <callout type="info" title="Don't Panic!" icon="true"> | ||
| - | If you panic during the STACER, remember, the goal is to: | ||
| - | - Develop rapport with the patient | ||
| - | - Get the diagnosis | ||
| - | - Understand the person enough to do a [[teaching:biopsychosocial-case-formulation|biopsychosocial formulation]] | ||
| - | - Come up with a management and treatment plan | ||
| - | </callout> | ||
| - | </WRAP> | ||
| - | </WRAP> | ||
| ==== General Tips ==== | ==== General Tips ==== | ||
| <WRAP group> | <WRAP group> | ||
| <WRAP half column> | <WRAP half column> | ||
| + | **Before the STACER:** | ||
| + | * Review treatment [[teaching:clinical-practice-guidelines-cpg|guidelines]] and [[teaching:landmark-studies|landmark papers]] | ||
| + | * Review the basics of [[:psychotherapy|psychotherapy]] | ||
| + | * Practice [[teaching:biopsychosocial-case-formulation|formulation]]! | ||
| + | * Review [[:meds|standard medication dosages]] | ||
| + | * Review [[teaching:on:mha:home|Mental Health Act]] criteria (as applicable to your province) | ||
| + | |||
| + | **During the STACER:** | ||
| * Be succinct with your questions. 50 minutes is not a long time and goes by quickly! | * Be succinct with your questions. 50 minutes is not a long time and goes by quickly! | ||
| * Even if a patient tells you a diagnosis they have been given, you must re-ask the same questions, and make that diagnosis yourself during the interview! | * Even if a patient tells you a diagnosis they have been given, you must re-ask the same questions, and make that diagnosis yourself during the interview! | ||
| * Don't be afraid to interrupt the patient, as long as you do it in a validating, kind, and empathetic manner. | * Don't be afraid to interrupt the patient, as long as you do it in a validating, kind, and empathetic manner. | ||
| * Keep your questions short and simple. Never stack or chain questions together! (e.g. - don't ask: is your mood ever elevated, irritable, and you don't sleep?) | * Keep your questions short and simple. Never stack or chain questions together! (e.g. - don't ask: is your mood ever elevated, irritable, and you don't sleep?) | ||
| - | * Remember all the DSM criteria (especially criterion A, B, and C). Your interview questions need to demonstrate to examiners that you know the criteria. You are basically "regurgitating" the DSM in front of the patient. | + | * Go through the major DSM-5 criteria with your patient (especially criterion A, B, and C). Your interview questions need to demonstrate to examiners that you know the criteria (you need to "regurgitate" the DSM in front of the examiner) |
| - | * The personal history is very important, leave at least 10-15 minutes for this! | + | * Don't just focus on symptoms and the diagnostic criteria. The personal history is just as important, so leave at least 10 to 15 minutes for this! |
| * In the final few minutes of the STACER, **do not ask** questions like: "Is there anything else you want me to know?" or "Do you have a history of trauma or abuse?" -- this could open a huge can of worms and you will not have enough time to explore these adequately with the patient! | * In the final few minutes of the STACER, **do not ask** questions like: "Is there anything else you want me to know?" or "Do you have a history of trauma or abuse?" -- this could open a huge can of worms and you will not have enough time to explore these adequately with the patient! | ||
| </WRAP> | </WRAP> | ||
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| * Safety (SI/HI/driving/children/medical safety – ETOH withdrawal) | * Safety (SI/HI/driving/children/medical safety – ETOH withdrawal) | ||
| * Don't forget the basic psychiatric review of systems, which includes: mood (depression/mania), anxiety, psychosis, substances, organic, cognitive symptoms. | * Don't forget the basic psychiatric review of systems, which includes: mood (depression/mania), anxiety, psychosis, substances, organic, cognitive symptoms. | ||
| + | </callout> | ||
| + | |||
| + | <callout type="info" title="Don't Panic!" icon="true"> | ||
| + | If you panic or lose your train of thought during the STACER, remember, the goal is to: | ||
| + | - Develop rapport with the patient | ||
| + | - Get the diagnosis | ||
| + | - Understand the person enough to do a [[teaching:biopsychosocial-case-formulation|biopsychosocial formulation]] | ||
| + | - Come up with a management and treatment plan | ||
| + | - The emphasis is on competence, not excellence | ||
| </callout> | </callout> | ||
| </WRAP> | </WRAP> | ||
| Line 50: | Line 48: | ||
| ===== Patient Types ===== | ===== Patient Types ===== | ||
| + | One of the most challenging parts of a STACER is you are given a random, real patient to do a 50 minute assessment on. Since patient's symptoms may range from being in remission (i.e. - an outpatient) to being very symptomatic (i.e. - an inpatient), this can each present as a challenge in their own way. Here are some common patient "prototypes" that you may encounter. | ||
| ==== The "Inpatient" ==== | ==== The "Inpatient" ==== | ||
| A STACER with an inpatient can sometimes be easier because there is a clear precipitating factor leading to a hospital admission. This means you can usually formulate the current presentation or reason for admission, and this makes your formulation at the end cleaner. | A STACER with an inpatient can sometimes be easier because there is a clear precipitating factor leading to a hospital admission. This means you can usually formulate the current presentation or reason for admission, and this makes your formulation at the end cleaner. | ||
| ==== The "Outpatient" ==== | ==== The "Outpatient" ==== | ||
| - | A STACER with an outpatient can be more challenging because their psychiatric disorder may be in remission, or they may have minimal symptoms. In this case, you may end up formulating the patient's overall course of illness and diagnosis, or their last episode of illness. Pick one thing to formulate, and stick with it. Thus, you will want to get the past psychiatric history up front, as there is no "real HPI." | + | A STACER with an outpatient can be more challenging because their psychiatric disorder may be in remission, or they may have minimal symptoms. In this case, you may end up formulating the patient's overall course of illness and diagnosis, or their last episode of illness. Pick one thing to formulate, and stick with it. Thus, you will want to get the past psychiatric history up front, as there is no "real HPI." The easiest way to approach the outpatient is to ask them "when were you last unwell?" |
| ==== The "Poor Historian" ==== | ==== The "Poor Historian" ==== | ||
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| * Acknowledge when the interview is difficult and patient is having trouble, try to contain the interview as much as possible by asking less affectively laden questions, return back to thse questions when the patient settles | * Acknowledge when the interview is difficult and patient is having trouble, try to contain the interview as much as possible by asking less affectively laden questions, return back to thse questions when the patient settles | ||
| + | ===== Overall Structure ===== | ||
| + | The STACER lasts usually between 90 minutes to 120 minutes, with the following breakdown of times: | ||
| + | * Interview (60 minutes) | ||
| + | * 50 minutes for interview with patient | ||
| + | * 10 minutes for presentation preparation (patient is gone) | ||
| + | * Case Presentation (20-25 minutes) | ||
| + | * Examiner Questions (20 minutes) | ||
| ===== Interview Structure ===== | ===== Interview Structure ===== | ||
| <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">See also: **[[teaching:1-psych-interview]]**</alert> | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">See also: **[[teaching:1-psych-interview]]**</alert> | ||
| Line 82: | Line 88: | ||
| == Time Allocation == | == Time Allocation == | ||
| <panel type="info" title="Suggested Time Allocation" subtitle="" no-body="true" footer=""> | <panel type="info" title="Suggested Time Allocation" subtitle="" no-body="true" footer=""> | ||
| - | ^ Section ^ Suggested Time Allocation ^ Tips ^ | + | <mobiletable 1> |
| - | ^ Introduction, ID | 3-5 minutes | • Establish rapport | | + | ^ Section ^ Suggested Time Allocation ^ Tips ^ |
| - | ^ HPI | 15 minutes | • Do an organized approach to asking symptoms \\ • You should have a primary diagnosis and differential diagnosis by the end of this | | + | ^ Introduction, ID | 3-5 minutes | • Establish rapport | |
| - | ^ Past Psych Hx \\ Past Med Hx \\ Family Psych Hx \\ Meds/Allergies\\ Substances \\ Legal Hx | 10 minutes | • Identify predisposing biological risk factors \\ • Identify treatment options | | + | ^ HPI | 15 minutes | • Do an organized approach to asking symptoms \\ • You should have a primary diagnosis and differential diagnosis by the end of this | |
| - | ^ Social and Personal Hx | 20 minutes | • If you don't do a good social history, you cannot formulate a patient!\\ • Identify predisposing psychological and social risk factors \\ • Identify personality traits | | + | ^ Past Psych History \\ Past Med History \\ Family Psychiatric History \\ Meds/Allergies\\ Substances\\ Legal History | 10 minutes | • Identify predisposing biological risk factors \\ • Identify treatment options | |
| + | ^ Social and Personal History | 20 minutes | • If you don't do a good social history, you cannot formulate a patient!\\ • Identify predisposing psychological and social risk factors \\ • Identify personality traits | | ||
| + | </mobiletable> | ||
| </panel> | </panel> | ||
| + | |||
| == Introduction == | == Introduction == | ||
| * Explain the purpose of the STACER, and that this is an examination for you and for your own learning | * Explain the purpose of the STACER, and that this is an examination for you and for your own learning | ||
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| ==== Clarifying Symptoms and Diagnoses ==== | ==== Clarifying Symptoms and Diagnoses ==== | ||
| <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">See also: **[[teaching:2-diagnosis]]**</alert> | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">See also: **[[teaching:2-diagnosis]]**</alert> | ||
| - | * Establish the index psychiatric event: | + | * **Establish the index psychiatric event:** |
| * First when you felt you were becoming unwell | * First when you felt you were becoming unwell | ||
| * First when you were in contact with the mental health system | * First when you were in contact with the mental health system | ||
| * These two may not always occur at the same time! For some people, they may //never// remember a time where they were feeling well (//hint//: might want to think about persistent depressive disorder, traumas, and personality disorders) | * These two may not always occur at the same time! For some people, they may //never// remember a time where they were feeling well (//hint//: might want to think about persistent depressive disorder, traumas, and personality disorders) | ||
| - | * For example, if you're not sure whether mood symptoms or psychotic symptoms started first, ask yourself: | + | * **For example, if you're not sure whether mood symptoms or psychotic symptoms started first, ask yourself:** |
| * Is it schizoaffective disorder? (i.e. - are there clear psychotic symptoms in the absence of mood symptoms for > 2 weeks?) | * Is it schizoaffective disorder? (i.e. - are there clear psychotic symptoms in the absence of mood symptoms for > 2 weeks?) | ||
| * Is it schizophrenia? Are there prodromal symptoms (i.e. - was there a significant functional decline during high school/university? Did they become more withdrawn? Other prodromal symptoms?) | * Is it schizophrenia? Are there prodromal symptoms (i.e. - was there a significant functional decline during high school/university? Did they become more withdrawn? Other prodromal symptoms?) | ||
| - | ===== Child, Adolescents, and Geriatric ===== | + | ==== Substances ==== |
| - | When interviewing adolescents or older adults, there are additional things on history to consider. Refer to the specific interview pages for additional information. | + | * If substance use is a primary concern, then address: |
| + | * Substance use disorder criteria | ||
| + | * Impact of substance use on the individual and to others | ||
| + | * Motivation to change | ||
| + | ==== Social History ==== | ||
| + | * Getting the patient to self-formulate can be helpful! | ||
| + | * Discuss the impact of family on relationships | ||
| + | * Understand issues from a cultural and family perspective if possible | ||
| + | ==== Child and Adolescent ==== | ||
| + | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">See also main article: **[[teaching:child-adol-psych-interview]]**</alert> | ||
| <WRAP group> | <WRAP group> | ||
| <WRAP half column> | <WRAP half column> | ||
| - | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">See also: **[[teaching:geriatric-psych-interview]]**</alert> | + | Some key things to not forget during a child and adolescent STACER include: |
| + | * **Safety** | ||
| + | * Cutting and self-harm | ||
| + | * Trauma or abuse from adults at home/school/other | ||
| + | * **Common diagnoses to consider**: | ||
| + | * Depression/anxiety | ||
| + | * Adjustment disorder | ||
| + | * Parent-child conflicts (not really a diagnosis) | ||
| + | * **High yield questions** | ||
| + | * **MDD** | ||
| + | * Irritability is a key feature in depression in children and adolescents | ||
| + | * **ADHD** | ||
| + | * Do you usually find it hard to focus? (inattentive type) | ||
| + | * Are you always on the go, or feel restless? (hyperactive type) | ||
| + | * **ODD** | ||
| + | * Do you get into a lot of trouble? | ||
| + | * **Conduct Disorder** | ||
| + | * Have you gotten into any trouble with the law or the legal system? | ||
| + | </WRAP> | ||
| + | <WRAP half column> | ||
| + | <panel type="info" title="Suggested Child and Adolescent Interview Template" subtitle="" no-body="true" footer=""> | ||
| + | <mobiletable 1> | ||
| + | ^ Interview portion ^ Suggested Time ^ Goals ^ | ||
| + | ^ Introduction, Patient ID | 5 minutes | • Develop rapport | | ||
| + | ^ History of Presenting Illness (HPI) | 15 minutes | • Have an organized approach to collecting the HPI \\ • Establish the primary diagnosis (think of the common diagnoses in children/adolescents) | | ||
| + | ^ • Past Psychiatric History \\ • Past Medical History \\ • Family Psychiatric History \\ • Medications \\ • Allergies \\ • Substance Use History\\ • Legal History | 10 minutes | • Identify biological risk factors \\ • Treatments (biological, psychological, social) | | ||
| + | ^ • Social and Developmental History | 20 minutes | • Identify issues relating to: relationshops-work-school-play \\ • Personality traits \\ • If you don't have a social history, you cannot formulate the patient! | | ||
| + | </mobiletable> | ||
| + | </panel> | ||
| + | </WRAP> | ||
| + | </WRAP> | ||
| + | |||
| + | |||
| + | |||
| + | ==== Geriatric ==== | ||
| + | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">See also main article: **[[teaching:geriatric-psych-interview]]**</alert> | ||
| + | Key things to ask on a geriatric STACER include: | ||
| * **Functional Review** | * **Functional Review** | ||
| * ADLs, IADLs | * ADLs, IADLs | ||
| Line 165: | Line 219: | ||
| * Mild cognitive impairment | * Mild cognitive impairment | ||
| * Neurodegenerative disorders | * Neurodegenerative disorders | ||
| - | |||
| - | </WRAP> | ||
| - | <WRAP half column> | ||
| - | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">See also: **[[teaching:child-adol-psych-interview]]**</alert> | ||
| - | * **School** | ||
| - | * Individualized education plan | ||
| - | * Grades | ||
| - | * Favourite Subject | ||
| - | * Homework | ||
| - | * Teachers | ||
| - | * **Social** | ||
| - | * Bullying? | ||
| - | * Friends | ||
| - | * Social Media | ||
| - | * Relationships (Sexual/Romantic) | ||
| - | * **Home** | ||
| - | * Siblings | ||
| - | * Parents | ||
| - | * **Safety** | ||
| - | * Cutting and self-harm | ||
| - | * Trauma or abuse from adults at home/school/other | ||
| - | * **Legal involvement** | ||
| - | * Truancy | ||
| - | * Skipping school | ||
| - | * **Self** | ||
| - | * Feelings | ||
| - | * "What are the main feelings you usually feel?" (happy, sad, angry, anxious, irritable) | ||
| - | * (lead to) Behaviours | ||
| - | * "What do you do when you have these feelings?" (self-harm, externalized behaviours (e.g. - acting out, truancy, disruptive), internalized behaviours (e.g. - rumination) | ||
| - | * **Common diagnoses to consider**: | ||
| - | * Depression/anxiety | ||
| - | * Adjustment disorder | ||
| - | * Parent-child conflicts (not really a diagnosis) | ||
| - | * **High yield questions** | ||
| - | * **MDD** | ||
| - | * Irritability is a key feature in depression in children and adolescents | ||
| - | * **ADHD** | ||
| - | * Do you usually find it hard to focus? (inattentive type) | ||
| - | * Are you always on the go, or feel restless? (hyperactive type) | ||
| - | * **ODD** | ||
| - | * Do you get into a lot of trouble? | ||
| - | * **Conduct Disorder** | ||
| - | * Have you gotten into any trouble with the law or the legal system? | ||
| - | </WRAP> | ||
| - | </WRAP> | ||
| - | |||
| ===== Presentation Structure ===== | ===== Presentation Structure ===== | ||
| <WRAP group> | <WRAP group> | ||
| Line 258: | Line 266: | ||
| * Describe a fulsome mental status | * Describe a fulsome mental status | ||
| + | * Comment on patient's reliability, accessibility | ||
| * Comment on abnormal motor movements, frailty, hearing impairment, gait aids, tremors | * Comment on abnormal motor movements, frailty, hearing impairment, gait aids, tremors | ||
| * Comment on cognition, even if you didn't do formal testing! | * Comment on cognition, even if you didn't do formal testing! | ||
| Line 266: | Line 275: | ||
| ==== Diagnosis ==== | ==== Diagnosis ==== | ||
| + | Present your main diagnosis and differential diagnoses. Explain why you believe the patient meets criteria for the main diagnosis and why the other diagnoses are less likely. | ||
| <callout icon="fa fa-lightbulb-o" type="success" title="Mnemonic"> | <callout icon="fa fa-lightbulb-o" type="success" title="Mnemonic"> | ||
| Use the mnemonic ''**MAPPSOC**'' to make sure you don't miss any diagnoses! | Use the mnemonic ''**MAPPSOC**'' to make sure you don't miss any diagnoses! | ||
| Line 293: | Line 303: | ||
| * Attachment | * Attachment | ||
| * Loss | * Loss | ||
| + | * Stick with a theme or framework that makes sense to you: | ||
| + | * [[child:attachment:1-theory|Attachment theory]]: secure, dismissive, preoccupied, fearful/disorganized attachment | ||
| + | * [[psychotherapy:psychodynamic:home|Psychodynamic]]: unconscious conflicts and defenses | ||
| + | * [[psychotherapy:cbt|Cognitive behavioural]]: core beliefs and automatic thoughts | ||
| + | * [[psychotherapy:dbt|Dialectical behavioural]]: emotional dysregulation and invalidation | ||
| + | * [[psychotherapy:ipt|Interpersonal]]: interpersonal themes (grief, dysfunctional relationships, interpersonal conflicts, and role transitions) | ||
| <panel type="info" title="Example Biopsychosocial Table" subtitle="" no-body="true" footer=""> | <panel type="info" title="Example Biopsychosocial Table" subtitle="" no-body="true" footer=""> | ||
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| Outline your management plan very clearly: | Outline your management plan very clearly: | ||
| - **Save yourself**: Identify any missing information that you did not get in the interview that you would like to obtain now (shows self-awareness of your limitations) | - **Save yourself**: Identify any missing information that you did not get in the interview that you would like to obtain now (shows self-awareness of your limitations) | ||
| - | - **Safety**: Identify any safety concerns (SI/HI, AH/VH, Driving, Kids) | + | - **Safety**: Identify any safety concerns (SI/HI, AH/VH, driving risks, risks to children) |
| - | - **Status**: Voluntary or involuntary - does someone meet criteria for an involuntary admission or not | + | - **Status**: Inpatient or outpatient, voluntary or involuntary; what is their capacity to consent to treatment? |
| - **Collateral**: Talking to patient's family, friends, doctors, social workers for safety assessment or diagnostic clarification | - **Collateral**: Talking to patient's family, friends, doctors, social workers for safety assessment or diagnostic clarification | ||
| - **Biological**: | - **Biological**: | ||
| * **Short-term**: | * **Short-term**: | ||
| - | * Investigations: Blood work (CBC, TSH, B12, electrolytes, extended electrolytes), neuroimaging, urine testing, urine dipstick (if women of childbearing age), baseline ECG if > 40 years old | + | * Investigations: Blood work (CBC, TSH, B12, electrolytes, extended electrolytes), neuroimaging, urine testing, urine dipstick (if woman of childbearing age), baseline ECG if > 40 years old |
| * Medications: | * Medications: | ||
| * Start a new medication | * Start a new medication | ||
| Line 335: | Line 351: | ||
| * **Intermediate/long-term**: | * **Intermediate/long-term**: | ||
| * Self-help, bibliotherapy | * Self-help, bibliotherapy | ||
| - | * Psychotherapies: CBT, DBT, dynamic, supportive, group therapy, family therapy, couples counselling, mindfulness, AA | + | * Psychotherapies: |
| + | * Pick a psychotherapy is relevant for not just the illness, but also the patient | ||
| + | * CBT, DBT, dynamic, supportive, group therapy, family therapy, couples counselling, mindfulness, AA, etc. | ||
| * Family support and interventions | * Family support and interventions | ||
| * Bipolar disorder: Interpersonal Rhythm Therapy | * Bipolar disorder: Interpersonal Rhythm Therapy | ||
| Line 366: | Line 384: | ||
| == Formulation == | == Formulation == | ||
| - | Biopsychosocial Table | + | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">See main article: **[[teaching:biopsychosocial-case-formulation|]]**</alert> |
| == Management Plan == | == Management Plan == | ||
| Line 396: | Line 414: | ||
| * Long-term | * Long-term | ||
| * Develop an individualized education plan, work with teachers to identify psychoeducational challenges | * Develop an individualized education plan, work with teachers to identify psychoeducational challenges | ||
| + | |||
| + | |||
| ===== Resources ===== | ===== Resources ===== | ||
| * {{ :teaching:advanced:transition_to_psychiatric_residency-_unique_stresses_unique_rewards_belitsky_kennedy_.pdf |Transition to Psychiatric Residency: Unique Stresses; Unique Rewards}} | * {{ :teaching:advanced:transition_to_psychiatric_residency-_unique_stresses_unique_rewards_belitsky_kennedy_.pdf |Transition to Psychiatric Residency: Unique Stresses; Unique Rewards}} | ||
| * [[http://www.nejm.org/doi/pdf/10.1056/NEJMp1614078|Awdish, R. L. (2017). A View from the Edge—Creating a Culture of Caring. New England Journal of Medicine, 376(1), 7-9.]] | * [[http://www.nejm.org/doi/pdf/10.1056/NEJMp1614078|Awdish, R. L. (2017). A View from the Edge—Creating a Culture of Caring. New England Journal of Medicine, 376(1), 7-9.]] | ||
| * [[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843011/|De Leon, J. (2013). Is psychiatry scientific? A letter to a 21st century psychiatry resident. Psychiatry investigation, 10(3), 205-217.]] | * [[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843011/|De Leon, J. (2013). Is psychiatry scientific? A letter to a 21st century psychiatry resident. Psychiatry investigation, 10(3), 205-217.]] | ||
| - | * [[https://www.amazon.com/How-Can-Help-Week-Psychiatrist/dp/1476706794/ref=sr_1_1?ie=UTF8&qid=1508383150&sr=8-1&keywords=How+Can+I+Help%3F%3A+A+Week+in+My+Life+as+a+Psychiatrist|How Can I Help?: A Week in My Life as a Psychiatrist, David Goldbloom M.D.]] | ||
| {{tag>med-ed}} | {{tag>med-ed}} | ||