Hi guys! I wanted to share my experience on my internal medicine rotation so you know what to expect on yours! I’ll also share tips on how you can excel on your rotation- specifically, how to be a valuable team member and how to study for the shelf exam!
As medical students, what is your role?
Medical students are an integral part of the health care team. In general, we take patient’s histories, complete physical exams, develop a differential diagnosis/treatment plan, present during patient rounds, and help with various patient care tasks.
What was the overall structure of your rotation?
At my school, we had one month of inpatient wards, 2 weeks of clinic and 2 weeks of subspeciality.
What was a typical schedule like on wards?
During wards, call days occurred every 4th day. On these days, our team accepted new admissions from the emergency department (ED) onto our service. This means we would complete the appropriate workup for the patient and manage their condition throughout their hospital stay. Call day hours for med students were generally 8am-10pm. Post-call days hours were typically 7am-3pm. Other days were 8am-3/4pm.
On non-call days, we check on patients on our service (could range from 10-20ish patients) in the morning to see how they did overnight, check their labs on the computer and formulate a management plan for the day. When the attending doctor arrives (usually 9-10am), we present our patient and see the patient again as a team. This is what we call ‘rounds.’ After we see all the patients as a team, the residents and medical students will spend the rest of the day on patient care tasks. These include putting on orders (labs, imaging, etc.), calling for a consult from a specialty (i.e. cardiology, nephrology), writing progress notes, coordinating care with other health care members, etc.
What about clinic and subpeciality?
For my 2 weeks of clinic and 2 weeks of subspecialty, my hours were generally 8-5pm, Monday through Friday.
For clinic, we rotated through hemotology/oncology, cardiology, IM, kidney/liver transplant, pain management, sickle cell, endocrine, allergy, cath lab, etc. During clinic, we would mostly shadowed. However, some doctors asked us to see their patients and present to them before they saw the patien
For our 2- subspecialty, we were part of the team that was consulted by different services in the hospital (usually internal medicine or surgery). Our subspecialty options were cardiology, renal, pulmonary, infectious disease or hematology/oncology. I was on the renal service. This meant that any patient who was admitted to the hospital and developed acute kidney injury or who had chronic kidney disease and needed dialysis was consulted by our team. As a medical student, I was in charge of 1-2 new patients every day. Unlike inpatient wards for IM, we had new consults every day. These days were quite long, but I did get weekends off to study.
Did you have lectures/didactics/exams during your rotation?
Yes! We had half-day lectures about once a week the first 5 weeks and had Grand Rounds every Wednesday afternoon. We had a written practical, standardized patient encounter, and a shelf exam the last week of the 8-week rotation.
How can I be a useful med student and make a good impression?
Compared to everyone else, medical students have the most ‘free time’ on the team. Be productive with this time. Try to find small tasks you can do to make your resident’s day a little easier. If you can call the pharmacy for medication recommendations, talk to social workers about nursing home placement, call for a consult on one of your patients, your residents will thank you!
If you don’t know what to do, ask your resident! Even better, if you can anticipate or hear what needs to be done during rounds, take the initiative to do it (check with your resident first!). For example, you can say “I know we talked about getting the prelim results for X imaging, would you like me to call radiology to see if I can get the results?” Even if they say no, they’ll see you as a proactive team player and you’ll more likely get a positive evaluation. In addition, taking on these small tasks, you’ll take ownership of your patients and teach you the technicalities of health care.
What are other ways I can excel in my rotation?
As a medical student, especially at the beginning of your rotation, you want to master in your role as the messenger. Whenever you interview a patient, you should strive to take a very detailed history. The more you know about the patient, the more you will benefit the team when you can provide extra collateral information on your patient.
After you’ve mastered being a messenger, you want to start working on being an analyzer. After you’ve gathered the pertinent information, the next step is for you to interpret it and come up with a diagnosis and management plan for your patient. This can be the most rewarding and educational aspect of internal medicine. Sometimes, you can do it yourself then ask the resident for their plan to compare. Most of the time, I worked with the intern to do these two steps. Don’t worry about not being correct, your team will appreciate your effort and you can always learn from your mistakes. Ultimately, you will always run your differential and treatment plan by the upper-level resident before presenting to the attending during rounds.
How should I study for the shelf exam?
UWorld, Uworld, Uworld! There are 1,300+ questions, so start doing these on Day 1 of your rotation! If time allows, re-do your incorrects. I also used Online MedEd and Anki to study. Make sure you use UptoDate throughout your rotation to read up on your patient’s conditions. Lastly, check out the Emma Holiday video on YouTube. She gives a great 2- hour high yield overview of what you need to know for the exam!
Good luck friends!!