Hello all,

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I'm a current PGY-3 Psychiatry resident and I'm starting to plan my 4th year rotations and looking for some advice and/or recommendations of worthwhile rotations to be targeting for next year. For background, I'm a little lost when it comes to my specific direction in Psychiatry. I entered PGY-3 year thinking I'd really, really enjoy outpatient life and therapy, and come to find that I actually dread doing therapy most days. It was a difficult realization to come to. I generally enjoy a change of pace with lower acuity patients, and I don't think I will end up dedicating a lot of my practice to therapy in the future, though will likely incorporate SOME therapy techniques in the way I practice. When I originally did my inpatient rotations (at an urban/underserved hospital), I found it really disheartening and unfulfilling because although we could stabilize a patient, they'd often come back and decompensate within 3-4 weeks. Part of me wonders if I'd find inpatient more fulfilling in a more suburban community where perhaps not all of the hospitalized patients are quite so decompensated.

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So back to the electives - we're required to do a consult/liaison elective, 2 inpatient electives, and a crisis response center elective within our hospital. Beyond that, it's kind of up to us to choose. Other electives I'm thinking of are:

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- ECT elective

- TMS elective if I can somehow get this

- Somehow finding an inpatient psychiatry elective in a more suburban area to compare to my experience

- I've also heard of collaborative care models for consultation psychiatry, in which a psychiatrist works at a primary care center and helps with outpatient consults, but I literally have no idea what this actually entails or how to go about finding something like this. I think it would be an interesting experience and if anyone has any ideas of places in the greater Philadelphia area that do this, I'd be very interested in learning more so I can reach out!

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Are there any other interesting electives that I should be looking into or exploring in 4th year to solidify my interests, or perhaps another aspect of Psychiatry that I'm not aware of to explore? The idea of sleep medicine also intrigues me, but again I have zero idea of what that entails or how to pursue it for a rotation. Thank you again!