Those who can, do. Those who cannot write standardized tests.

Today I took my psychiatry NBME shelf exam after 8 weeks of psychiatry clerking, lectures, and reading ("Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision) (Diagnostic and Statistical Manual of Mental Disorders)" (American Psychiatric Association), "Essential Psychopharmacology : Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series)" (Stephen M. Stahl), "Psychiatric Mental Status Examination" (Paula T. Trzepacz, Robert W. Baker), and "Psychiatry" (A. Mezzacappa, Giulia Mancini-Mezzacappa, Pretest) plus a few papers of interest on electroconvulsive therapy and other topics). So needless to say, I felt like a good student, I had worked with my patients and prepared more than I should. I'm told I have excellent clinical acumen and will perform brilliantly as a clinician.

Boy was I wrong.

Psychiatry is a self-contained clerkship at my school without prerequisites. Fortunately, I've had internal medicine and surgery because somehow these came up extensively during my exam, not to mention pediatrics (whoops hadn't done that yet), intensive/extensive pharmacology (would of studied whole lists of non-psychiatric medications that cause delirium and their withdrawal effects), child development (covered one day in behavioral science TWO years ago), substance abuse/addiction (which is managed by internal medicine here and apparently not covered in either clerkship), and reading x-rays (never made a psychiatric diagnose based on x-rays in 8 weeks). My fellow clerks have had less experience than me and probably got hosed on more questions. The test developers seem completely out of touch with the clerkship goals. Psychiatry has a false reputation as being a "weak" or "easy" field of medicine. In patient psychiatry is brutal, approximately the same complexity, morbidity, and mortality as critical care medicine but without the fancy monitoring systems. But apparently, psychiatry's inferiority complex is in full swing at least as presented by the Exam (has to be capitalized as it is the benchmark for 1/3 of my grade). There was a good deal of poorly thought out internal medicine, that is, internal medicine questions written by people who don't practice that type of medicine. If the Exam cannot do justice to the field of psychiatry in only 100 questions, perhaps psychiatry then deserves its shoddy reputation, not because it is true but because of the way it measures its students and makes them remember their time as psych clerks.

And if the NBME thinks this to be a "violation of testing policy", I have two words: "Bring it".