Geri Fox, M.D.
Associate Professor of Clinical Psychiatry
University of Illinois at Chicago/ Institute for Juvenile Research

Should I consider a senior elective in psychiatry? Choosing to do an M-4 elective in psychiatry is an excellent way to help you decide if this is the right career for you. An elective can also give you the opportunity to get to know the faculty better at a program that you hope to join. If you have decided to go into another field, a psychiatry elective can build on your third-year experience, and give you exposure to specialized skills that will be useful in other areas of medicine.

What kinds of electives are available?

There are a remarkable variety of psychiatry electives to choose from. Here is a sample list compiled from elective offerings nationally:

• psychiatric consultation to community agencies, schools, and to general medical inpatient units in hospitals
• sub-internship on an adult or child/ adolescent inpatient unit or partial hospital
• outpatient psychiatry (children, adolescents, adults, and families)
• geriatric psvchiatry
• emergency psychiatry consultation and crisis intervention
• child and adolescent psychiatry
• infant psychiatry
• women's mental health
• family psychiatry
• addiction psychiatry
• forensic psychiatry
• community psychiatry
• sexual disorders clinic
• pain management
• eating disorders
• psychopharmacology

Some programs give credit for attending the annual meetings of the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry. Psychiatric research opportunities are available in areas such as geriatrics, schizophrenia, mood disorders, and violence prevention. And if there isn't something on this menu that interests you, most programs are willing to work with you to design an individual package that best suits your needs. When should I plan my elective? You should inquire during your M-3 year. The more advance notice the better: most programs suggest planning your elective at least 3 to 6 months before the desired rotation, with a minimum of 30 days in advance. Some medical schools have an "elective fair" in the spring of the M-3 year when M-4 rotations are offered for their own students, after which the remaining electives become available to students visiting from other institutions. The peak demand for electives in psychiatry is generally summer through early fall.

How can I get the most from my psychiatry elective? Make sure you allow enough time: electives are usually a minimum of one month, but can be as long as three months in duration. Clarify the degree of mentorship you will receive: will there be any individual instruction or advisory meetings? How is the elective organized? Will there be readings or formal lectures? How much direct patient contact can you expect? Are there clearly defined objectives and methods of instruction? How will you be evaluated and by whom? Think through your own goals for the elective in advance, and discuss them with the person in charge of the elective before you start, to make sure your goals are realistic and mutually acceptable.

Whom should I contact to arrange a psychiatry elective, or to get more information? Most medical schools have a Director of Medical Student Education in Psychiatry, who would be happy to help you arrange your elective. Another good alternative is to contact the Director of Residency Education in Psychiatry or the relevant subspecialty (such as geriatric, addictions, women's mental health, or child and adolescent psychiatry). Your medical school may have a handbook of electives. If you need information about electives offered at other medical schools, university web sites often list indexes of available electives, either under the general education/ curriculum page for the medical school, or under the department of psychiatry. There is a list of psychiatry residency and subspecialty program directors at the Accreditation Council of Graduate Medical Education's website: http://www.acgme.org. You can find a list of child and adolescent psychiatry training programs and other information on the American Academy of Child and Adolescent Psychiatry's "Medical Students and Residents" page.

Are there special requirements for doing an elective at another medical school? Most medical schools require successful completion of the third year medical student psychiatry clerkship before considering a request for an elective. Some medical schools accept only M-4's from U.S. medical schools for electives; others allow international medical graduates to do electives. A few schools charge tuition for visiting student electives; at the other end of the spectrum, a few schools pay a stipend. The "perks" also vary widely; some institutions provide free housing and on-call meals, while others have no dormitories but will assist you with your living arrangements.

The registrar's office generally handles the logistics of fees and insurance. As a visiting student, you will be asked to complete a form which must also be filled out by your medical school, certifying that you are a student in good standing, have the school's approval to participate, and are covered by malpractice from your home institution as well as personal health insurance. In addition, the Dean of Student Affairs at the host institution usually must be notified whenever outside students are coming to the university.

If you have questions or would like additional information regarding child and adolescent psychiatry, please contact the Office of Research and Training at the AACAP at (202) 966-7300 ext. 113.