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Year 3: First Clinical Rotation





My first medical school rotation is internal medicine. Half the time is spent in my attending’s private clinic and half the time is spent in the hospital rounding. I was scared since I did not know what to expect and what I needed to know or what I would be doing.

I started in early September at his clinic.

first-clinical-rotation

first clinical rotation

Internal Medicine

Clinic: The clinic is fast paced as the doctor has appointments every 15 minutes and extra time he spends with the patient, me, or anyone is extra time all the other staff including the nurses and admins have to stay at the end of the day which means more expenses. There is not much pimping in these sessions but I have permission to ask both the doctor and patients questions at any time. I find it easiest to converse with the patients while the doctor is writing outing prescriptions or filling out the billing sheet. If I come across an interesting patient, I will ask my attending to skip the next couple patients and then look up material on the computer in his office along with using my Robbins Pathology book or other books I may have brought. This is a good way to learn. When I have read up on it, the doctor often asks me what I learned and so I give an informal couple minute presentation.  Basically, the clinic is a lot of self learning but the hours are steady as I am usually home by around six and have the weekends free.

Hospital:  Hospital rounds are by far the best learning experience as you have a huge variety of cases and more time to learn. Half the time I am with the attending making rounds and half the time he gives me my own patients for whom I have to read through the charts, look up the labs, and talk to the patients. He comes later and discusses and reviews everything with me and the patient later in the day.  There are no hours for rounding, he just has to get through all the patients on his list which so far, has been in the low twenties every day.  It varies depending on the number of discharges and admits every day.  When I am on my patients alone I am not on a time line so I am very methodical.  I read through as much as I can on the charts including their current medications and look up information on the internet on http://www.uptodate.com/ so I can learn more about the patient’s condition, the diagnosis, and the treatment which is useful for learning for Step 2 & 3 along with being able to answer the patient’s question and/or their family.  The days are longer in the hospital. We usually start around 9am and come home anywhere from 8pm to 1am.  Occasionally, I also get to do the admissions in the emergency room. Basically, these are the patients who are stable or become stable and need to moved to a regular room from the emergency room. It involves getting all the information for admission from the patient and doing a full physical.

Things of Note for Internal Medicine:

1. There are two types of Internal Medicine doctors at the hospital.  The first one is the kind who is simply trying to get the paycheck and get home in time for dinner. The second, and the more rare from my limited experience, is the kind who wants to help the patient as much as possible even if it means staying and answering all of the family’s questions for one hour. Fortunately, my attending is the latter and he also wants me to learn so unfortunately, he probably stays longer at the hospital because of me.

2. Knowing what to bring with me has been a challenge. At the clinic it is easier because I can put all my things in my attending’s office so I bring a backpack with my Robbins Pathology and an Internal Medicine book. At the hospital, there is not a place to keep your things in a safe manner and not one place that you always go back to since we have patients on five different floors.  It would look unprofessional to carry a backpack. I have seen some doctors carry a shoulder bag but I find it cumbersome. Some, such as my attending, carry a book in hand which I also find cumbersome so ultimately I do not carry anything.

3. What to carry in my white coat.  I keep lots of pens in one pocket for me and my attending. Sometimes I have found pens hard to find in the hospital. in the same pocket with the pens I have a cheat sheet card of normal lab values.  I keep a pocket book pharmacopoeia in one pocket. The Washington Manual of Medicine in one pocket which is extremely useful. One pocket has my patient notes which include things I wanted to ask my attending or questions the patient asked which I could not answer but said I would find out and the list of patients.  One pocket has my stethoscope. Some people put the stethoscope around their neck but I am paranoid that it will fall off especially when I go to the bathroom so I keep it in my pocket.  Occasionally, I keep a general Internal Medicine book for Step 2 review for periods of time when I have nothing to do.

4. Often times the doctor does not know the answer. Never be afraid to say you do not know and ask another IM doctor or a specialist for their help.

5.  Having passed Step 1, I am now coming across another level to the game. Often times I can name the drug of choice or diagnostic of choice but then I come to find out that it costs too much or the insurance company prefers you try another drug first (usually a cheaper one) before going to the DOC.  Not surprising, but it involves another level of knowledge.

6. Filling out progress notes at first was scary but now I find them easier and very educational. I found the First Aid for the Wards very useful.

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