Fourth-year student and Laredo, Texas native Raul Madrigal has served as Clinical Student Government Association (CSGA) representative for Florida since August 2017. Earlier this year, Raul was offered and accepted a pre-Match position in Psychiatry at Metropolitan Hospital, which is affiliated with New York Medical College in New York City. In this article, Raul discusses the factors that led him to psychiatry and shares advice for medical students as they approach clinicals.
What specialty are you pursuing and how did you make your decision?
It was during my psychiatry core rotation that I became interested in the field. I found it to be the most fascinating and very different from my other clinical rotations. Although medicine itself is very analytical, psychiatry requires another level of investigative skills. Running labs and imaging will not confirm or provide a working diagnosis; you must engage the patient, critically reason through the subjective data they provide you, and then put together the puzzle with your observations and reasoning. I was fascinated with the interesting cases that we saw on a daily basis.
The psychiatry residents also explained many of the benefits of this discipline: flexible work schedules (which offer more balance between their professional and personal lives), opportunities for progressive research, and numerous fellowships within the field (such as child & adolescent, addiction, or forensic psychiatry). I find all of these to be very advantageous.
Did you always know that you wanted to go into psychiatry?
I actually started medical school with the idea of wanting to go into surgery but during my surgery core rotation (which also happened to be my first rotation), I realized that it wasn’t for me. I found that I would much rather spend time connecting with patients and establishing relationships rather than primarily being in an OR where there are limited interactions. After my surgery rotation, I decided to begin each new rotation with an open mind so that hopefully I would find the one that would ignite my passion and be a perfect match for my personality.
I began my psychiatry core rotation towards the end of my third year, and that is when I found my niche. I decided to sign up for a Psychiatry Sub-Internship, which was an excellent experience, and one that confirmed that psychiatry is the specialty that I am meant to pursue.
What is it about psychiatry that inspires and motivates you?
There is never a dull moment in psychiatry. Patients come in with different problems and conditions, and you have to gather a very detailed history to correctly diagnose and treat. One of the things that I love is witnessing the before and after results of each patient, and how different they are after a few days of proper treatment compared to when they arrived at the hospital. I also find every patient to be unique. Although many will have the same diagnosis, they all have their own story, and each will require a different treatment plan.
There is greater awareness of mental health issues today than in previous years, but there is still a stigma attached to the field of psychiatry and to mental illness in general. My goal is to educate and help people understand mental illness and allow those in need to gain easier access to treatment.
How did you navigate choosing a specialty in time to plan appropriately for the Match?
Once I decided that psychiatry was what I was most interested in, I was determined to sign up for an elective or sub-internship. I felt it was important to gain more experience and obtain the exposure necessary to be certain that it was the specialty I wanted to pursue for residency. Electives provide students with additional hands-on experience that allows more insight. It also allowed me to obtain solid letters of recommendation from physicians that would enhance my application and opportunity for interviews.
Are there any resources that students should use when trying to select a specialty?
The best resources that I had as a student were the attendings and residents that I worked with, as well as my fellow classmates. By discussing each specialty with them, I was able to get a better picture of what each entails, which allowed me to debate the pros and cons of each specialty.
What advice would you give students who are just entering clinicals?
Pursue your clinicals with an open mind. It isn’t until we are in our clinical rotations that we gain insight and hands-on experience in each field.
Students should consider all the facets of each specialty. Everyone has personal preferences and priorities, and it is important to consider details such as contact with patients, lifestyle, and job opportunities. Also, try to get as much information from the physicians you are working with; they are excellent resources to gain perspective. Finally, signing up for an elective or sub-internship prior to applying to residency is important. It can help you solidify your choice of specialty, as well as give you an advantage in your residency applications. Sub-internships are often used as a trial to see how you would perform as a PGY-1 resident, and it is a good opportunity to demonstrate your attributes and network.
