The mother of them all, internal medicine rotation. How do you get honors in internal medicine anyways?
Don’t worry I’ll be sure to answer that! Because of all the fields, IM appeared the most attractive to me. After my 8-week experience, I can say that the field is something I’m still highly considering.
Regardless if IM is your calling or you can’t wait for it to be over, I hope this post will help. The rotation is challenging. You’re always on your toes and constantly learning.
In this post, I’ll provide my top tips to help you honor your internal medicine rotation.
But first check out the YouTube video to this video below! Subscribe if you enjoy it!
Next – are you interested in learning a step-by-step way to study for your rotations?
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Then download the free How To Study For Clinical Rotations guide! It’ll surely help you with your internal medicine rotation!
Now let’s get to the tips to honor your internal medicine rotation1
Be Your Patient’s Advocate:
I suggest this in almost all my clerkship posts.
As the medical student, you have the most time with your patients. Make sure they know who you are and visit them multiple times during a day.
Don’t take the surgical approach (no offense) and simply ask about the symptoms they came with.
Instead ask about their pain, how are they sleeping, and are they eating? How are they dealing with their illness?
All of these factors, if unwrapped, can help improve the care they receive.
The residents, however, may not always have the time to explore these questions.
Spend time talking to your patients and understanding their complaints.
they have concerns about a treatment plan or a diagnosis, inquire if they fully understand the reasoning behind it.
For example, many patients with uncontrolled or newly diagnosed diabetes don’t understand the logic behind medication and insulin dosing. You’re competent as a student to walk them through this.
If your patient comes forth with a complaint that you feel is not being addressed, approach your team with potential solutions.
Suggesting treatment options, however ridiculous, will make it known that you care about your patients and thus your opinion is important enough to be heard.
So if your patient is not eating enough, advocate to add in supplemental smoothies or have a dietician consult for them.
If their pain is uncontrolled, advocate changing the frequency, dosing, or medication. If you feel like they have an underlying infection, pneumonia, worsening asthma, constipation, etc. make sure these are known to your team.
After making it known, be sure to provide a suggestion.
You may be totally wrong in your reasoning.
Your concern may already have been handled by the resident – perfect, the patient is being taken care of. But don’t become spoiled by your residents picking up on everything.
Your patient may tell you something they forgot to tell the resident. Communicate everything and don’t worry about redundancy.
Sometimes my suggestions have led to patients being diagnosed with a PE, UTI, aspiration pneumonia, drug toxicity etc. This changes the management of the patient thus it’s important to not remain quiet.
Refer to my patient rapport post on how to build a strong relationship with your patients. This will help you be the best advocate for them you can be.
Use Review Articles to Become Adept:
This tip is universal but most applicable during your internal medicine rotation.
There is way too much to know. While your resource text may help provide a broad overview, broad care is not what your patient needs.
For this reason, I loved reading about my patient’s illnesses through review articles. If I was encountering my first patient with heart failure, I would quickly Google “heart failure review article” and find a recent one from a highly respected journal.
Read through it and start to picture how your patient compares to the symptoms and severity the article lays out.
What treatment plans are recommended and which one has your patient previously taken and currently on? Why haven’t they tried treatment A? Do they have a contraindication?
This approach will not only help you with the shelf but also in becoming a better clinician. You’ll transition from memorizing heart failure to approaching it like a resident and attending.
If your patient presents with an illness that is more rare, then definitely use a review article to provide yourself an in-depth view of their condition.
What’s the pathophysiology, what other symptoms do they have, what’s their prognosis, and what treatment plans are available?
Often your patients will have all their bases covered. The residents will know how to approach their care. But when they’re unsure or unfamiliar with a case, you then have your opportunity to shine.
Before your resident can even ask you to look something up, beat them to it and have the answer. You’ll be functioning at the level of an MS4 and maybe intern if you stick to this.
Use a Scuttsheet:
Typically you’ll care more patients on IM than any other rotation. I had between 3-5 on a daily basis.
In addition, most of your patients may be there for at least 2-5 days. Thus it’s important to be able to track their progress. But you don’t want to just do by physically examining them. You also want to trend their labs and vitals.
If you have a patient with kidney disease, you’ll be expected to trend their creatinine. If you have a heart failure patient, you’ll be expected to track their weights and I&Os.
So using a new paper every day for your patient can be difficult. Rewriting the labs and vitals from 2 days ago is pointless. Thus enters the scuttsheet.
I used a scuttsheet from Medfools.com. Here’s a link to the one I preferred. There are more on the site depending on your style.
Here’s an example below.
As you can see the scuttsheet has sections for everything you need to know about your patient.
When I would admit a new patient, I would write down their pertinent history and physical on the front. I would also try to lay it out the way I would present it to my attending.
The back is where the true gold mine is.
Every day I could insert labs and vitals. I would put a star next to anything abnormal. I would also briefly write any complications or new physical findings for the patients.
Also include any new medication, procedures, or imaging the patient has on the respective date.
Now if my attending asks what day we started Vancomycin on a patient, you’ll be able to say exactly when. You’ll be able to list out the last 5 creatinine for your patients without even look up.
The internal medicine rotation became much easier using these scuttsheets. Try them out for yourself!
[Update] Check out this video on how I now create my own scuttsheets to stay organized on rotations!
Always Be Inquisitive:
Get used to asking yourself internally “why” all the time. Why is my patient receiving diuretics? How did their insulin regimen get decided on? Why use Mg sulfate vs Mg Oxide to replete their electrolytes? Why IV over PO medication?
Look up the answer if you or your classmates don’t know.
If you can’t find anything then come up with a guess. This is important when you turn around and ask your resident. A good resident will turn the question and ask you why you think they choose to give IV vs PO Lasix.
If you just think of the question, you’re not being inquisitive enough.
This will be one of the best ways you learn on IM. Large noon lectures may teach you a thing or two, but addressing any shortcomings in your knowledge is more powerful.
In addition, as you become more curious, you may actually make some good points that can change your patient’s care. Why is my patient receiving Lovenox shots when she can be taking oral Xarelto? Boom, you asked the question and suddenly your patient is no longer getting stuck every 12 hours in the belly.
Have a Plan of Attack Each Day:
During your entire day, you need to be thinking about what to do next.
When you pre-round have a plan of what you want to ask each patient.
After you talk to your patients write down what you want to do for each of them. What labs, procedures, or additional treatment do they need? Suggest these to your residents and see what they agree and why they disagree with the others.
During rounds with your attendings, make a list of everything that needs to be done for each patient. Include this in your scuttsheet.
If you have fellow classmates on your rotation, write what to do for their patient without overstepping them. Remind them politely if it looks like it’s been forgotten, but don’t become a gunner and take care of it yourself. Still, the care of the patient is important enough to simply write down.
Add simple things like repleting electrolytes, ordering an imaging test, or consulting specialist to your scuttsheet. Check off things as they’re completed. Wouldn’t want to just assume your resident has it covered.
With these simple tips you will have the tools to be successful. The internal medicine rotation is challenging but also where you will learn the most amount of medicine. Everything from the first two years will begin to click. That feeling of “oh I get it now” or “That finally makes sense” is amazing.
So stick to the tips I’ve laid out and enjoy your rotation! If you enjoyed this post, check out my top resources honor your internal medicine rotation and study schedule as well.
Here’s a link for $80 off for an annual subscription of OnlineMedEd! Just use Code OME17 at checkout! (This is an affiliate link at no additional cost to you!)
Check out similar tips for other rotations below!
You may also enjoy the following posts!
How to Study For Rotations In Medical School (Step-By-Step Method)
Top 7 Tips For Third Year Of Med School (How To Do Well)
How to Present Your Patients in Medical School:
How to Study for Clinical Rotations in Medical School:
How to Write Notes in Medical School (Step-by-Step method):
How to Build Strong Relationships with Your Patients:
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Until next time my friends…