Internal Medicine Clerkship

I started my Internal Medicine clerkship in July and my shelf exam will be on August 25th. Since I’m just over half-way done I figured it would be a good time to do a recap of the past few weeks.

Don't Put Hospital Pens In Your Mouth

image c/o of photostock

Internal Medicine

Internal Medicine is a specialty that primarily deals with diseases in adults. As our clerkship director put it, I-Med is basically everything minus pregnancy, kids and surgery. It’s a very broad specialty and not unlike family medicine in some ways, but quite different in that it specifically excludes obstetrics and pediatrics.

The Clerkship

  • 8 weeks – 6 on inpatient, 1 in clinic, 1 with an IM subspecialty (mine was Heme/Onc)
  • “Teams” consist of 1-2 medical students, an intern, resident and an attending.
  • Daily lectures, weekly “Grand Rounds” lunch meetings and various additional conferences
  • “Q4” Call, which means we’re on call every fourth day. Call for this rotation is 7am – 9pm and you’re required to be at the hospital that entire time, unless your resident tells you to go home. It’s a lot of call days, but we don’t have overnight call for this clerkship, so it’s not bad at all.

Daily Life

What time you get to the hospital and what time you leave highly depends on how your team operates, what your patient load is, how complicated your cases are and when your scheduled conferences/lectures fall in. This week we had one hour lectures at 7am and my team was rounding (this means discussing & seeing all the patients on our service as a full team) at 9am, so I didn’t have to be at the hospital until 6:40am or so to print out patient info, go to lecture at 7:00am and then see my patients. Some days we leave at 2pm or 3pm and some days we leave at 6pm or 7pm. On call days we leave at 9pm. It’s very random and different each day.

Twitter Questions

  • “How little sleep do you actually get?” I probably sleep about 6 hours per night, but I could honestly sleep more than that if I would be more disciplined about bed times.
  • “How much do you study now?” Not enough. This shelf exam is notoriously hard, so I should be studying more than I am, but it’s hard to come home and concentrate when you’ve been running around all day.
  • “What do you actually do?” Talk to patients, practice writing notes, pretend I can come up with diagnoses and treatment plans (they’re basically always wrong), practice history-taking and physical exam skills, help out the residents with paper work and other random stuff that makes their day a little easier, incorrectly answer questions my attending asks, fumble with BP cuffs despite knowing exactly how to take a blood pressure and doing it 10 times a day for the year I worked as an allergy tech, basically walk around looking and sounding goofy and out of place.
  • “What’s the scariest thing you’ve had to do on your own?” I really haven’t had to do anything scary on my own! My school did a great job preparing us to be third years by giving us ample opportunity for clinical experience during the first two. In this rotation we don’t do a lot of procedures, so it’s been pretty much without fear so far. I’ve gotten to assist with central line placements and bone marrow biopsies, though – that was lots of fun even though my job was pretty much limited to opening packages and tying sterile gowns.
  • “What books are you using?” Ah, good question.

Medicine Clerkship Books

  • Step-Up to Medicine: This is by far the most recommended book for this rotation. It’s a great overview, written in bullet-format (similar to First Aid). It’s a good review.
  • First Exposure Hospital Medicine: Our clerkship director issued copies of this book and the one below. They are pretty good – short chapters, quick overview and easy to read, but not enough a solo-resource for the shelf exam.
  • First Exposure Ambulatory Medicine: We had a quiz over this at the end of our clinic week. It’s a good, easy-to-read book, but like the other it’s probably not efficient enough for the shelf.
  • MKSAP For Students: I don’t actually own this one, but it comes highly recommended from a few 4th years. There’s a copy in our I-Med office, so maybe I’ll give it a looksy next week.
  • USMLE World Step 2 CK Q-Bank: There are over 1400 questions in Q-Bank that cover Internal Medicine. We just got access to Q-Bank on August 1st, so I havent used it much, but I think it will be helpful. The questions seem pretty tough.

What I Like

  • Instant Gratification: Inpatient allows for longitudinal care of hospitalized patients, so you get to see first-hand how treatments are helping (or not) over the course of a few days.
  • It’s Busy: There is always something to be done. I’d much rather be running around, busy and exhausted, than sitting around bored with nothing to do.
  • Skill: There’s a lot of diagnostic skill and brain power necessary for Internal Medicine. They are kind of like the physician investigators of the hospital…if someone isn’t sure what’s going on, they call the Medicine team. So far I’ve felt like every resident & attending I’ve been with has been a great diagnostician.
  • Complexity: Along those same lines there is a lot of variety and complexity in this field. It’s interesting to see people use little pieces from literally every part of their education – from Biochemistry to Fellowship training.
  • Opportunity: There are tons of fellowship opportunities in Internal Medicine – Cardio, Endocrine, Hematology, Oncology, GI, Infectious Disease, Pulmonology, Rheumatology, Nephrology and more. I absolutely loved my specialty week with the Heme/Onc team.
  • The People: I’ve really enjoyed the patients, house staff and physicians on this rotation.

image c/o of arztsamui

What I Dislike

  • Something’s Missing: Kiddos. I really enjoy working with kids and Internal Medicine specifically excludes them.
  • Something Else Is Missing: While I’m getting to where I truly am enjoying this rotation (the first few weeks were rough), I don’t have that “feeling” people talk about getting when you’re doing what you should choose as your specialty. Internal Medicine doesn’t make me incredibly excited and I don’t feel like it’s something I’d be amazing at, but I also don’t hate it (anymore, like I said – first few weeks were rough…I think that was more the process of getting my role as a 3rd year nailed down). Who knows, though? I absolutely do not dread my days at all and I definitely enjoy what I’m doing most of the time. I just don’t know if this is “it,” so to say. Although, I seriously fell in love with Hematology/Oncology, so maybe it is.

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13 Comments + Add Comment

  • This is probably a stupid question…but I am going to ask it anyway. Are you allowed to return to some of the rotations before you chose what specialty you want to make sure that it is what you want to do?

    • Not a stupid question at all, Christine! We do 6 rotations during 3rd year and then in 4th year you can rotate through subspecialties or back through certain 3rd year rotations as a “Sub-I”. Most people tend to pick prior to that, though because residency applications start pretty soon into 4th year.    It isn’t required that you make a decision before that or that you don’t apply to more than one type of residency, but most people choose one towards the end of year 3 and apply only to one type. 

  • Great post! I have IM starting in september- we have 8 weeks too, plus a 4 week elective. I haven’t gotten uworld yet- have you heard anyone talk about kaplans q bank? I wanted to save uworld for step 2. I get what you mean about being too tired to study- my surgery shelf is sept 16 but I have inpatient surgery last so I’m starting to freak out because I won’t have time to study- but I’m worried I’ll forgot stuff if I start now.

    • I will try to remember and let you know. My thoughts are that I will be able to go through it again for Step 2 – no way I’ll remember these answers purely on memorization one year from now.

  • Thanks for the post! I’ve been following your blog for awhile now. I start my IM rotation (and first MS3 rotation) August 15. Very excited and very nervous, but sounds do-able. I too am interested in Heme/Onc. Let us know how you like using World QBank for the shelves, as I’ve heard pros and cons from 4th years…some say it’s good to start the QBank now to study for shelves and some say save it for Step 2. Eeegads! Who knows?!

    • Glad you liked it! The rotation is my first as well, it’s definitely do-able – a little tough to get used to, but not bad at all. Like I told @cate1985:disqus I think that the questions I use for now will be long forgotten by the time I’m studying for Step 2 and I’ll be able to erase my Qbank and repeat them when that time comes around. We’ll see. I got MKSAP today and it’s definitely great as well. 

  • Hey!  I’m also in the middle of my IM rotation.  We started July 5 and my day is pretty similar to yours.  I enjoyed your post and I will be following your blog from now on to get a feel how others are doing on this crazy path to being a doctor!

  • Great post!! I started rotations in January with Internal Medicine and absolutely loved the breadth of patients I encountered – this post was a friendly reminder of that. :-) Thumbs up to using MKSAP, Step Up, and UWorld. Best of luck on the shelf and the rest of the rotation!

  • Great post [and blog] — I’ll definitely be keeping up. 

  • Questions from a non-med student: What is hemetology?! And, do you have any say in the order your do your clerkships in or is it predetermined for you? If you don’t get to choose, do you know how they decide? Just curious!

    • Hematology is a subspecialty that takes care of blood diseases, like Hemophilia and stuff. It’s often lumped together in training programs with Oncology, because the two fields overlap so much (especially when it comes to things like Leukemias).

      The order we do our rotations in is sort of up to us. At my campus one semester is Internal Medicine, Ob/Gyn and Psyc and one is Surgery, Family Med and Pediatrics. You can rank which semester you want first and then which order you want to have the rotations in, but you aren’t guaranteed to get that preference. I had to do Psyc second because I’m going to the Betty Ford Center for a week and those two had to overlap. If I had not been doing that and had my idea choice I would have done:

      Surgery – Family Med – Pediatrics – Christmas Break – Ob/Gyn – Psyc – Internal Medicine

      It’s not really recommended to do the things you think you’re interested in last, because ideally you’ll be setting up 4th year rotations and asking for residency recommendation letters before you finish the last rotation. It’s unfortunate I ended up in Pedi last, because it is something I feel like I will enjoy a lot. However, I did a preceptorship last year in pediatrics and got to know the residency director here pretty well through that, so that is good. I have Ob/Gyn at a great time. All will work out, it’s not absolutely necessary to do things in a certain order, just convenient.

  • Hey ….did you ever use a washington manual, if so which one is it? if not, what do you know about it?

    There are so many of them….I am confused!

    Please help!

    Thanks for creating such a great site!

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About The Author

I'm an ObGyn. I started this blog as a medical student (some would call that doctor school) and now I'm working as an Ob/Gyn, which is seriously the coolest job ever. I'm a twin mom and recently added a baby brudder to the mix. My life story through November 2010 can be viewed here. The events in the many years following can be summed up as wedding bells, books, exams, babies, and doctoring. I started this blog in hopes of landing a role in a Lifetime movie so I could quit medicine and move to Hollywood, but that hasn't if you wouldn't take medical advice from Angelina Jolie, you shouldn't take it from me. I may not even be a real person. In fact, I'm probably a spambot. Or possibly a 15 yo boy blogging from a dingy basement. If you're really interested you can read more about me here. If you have any questions or want to guest post contact me.

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