A few weeks back I tweeted something to the effect of “I’m SO excited for my Ob/Gyn rotation, but terrified I’m going to fall in love with it. I don’t want to love Ob/Gyn!” My tweet referenced the underlying fear I harbor of loving a specialty that is demanding or lacks family friendliness. One of the first responses I received was along the lines of “Being miserable every single day at work is not worth choosing a specialty based only on lifestyle.”
The fact of the matter is – Ob/Gyn is tough. The residency is surgical, the hours are long and the lifestyle is suboptimal for people wanting to spend time with their families on a regular basis…babies don’t just decide they will grace us with their presence between the hours of 9am and 4pm and in the absence of your kid’s T-ball game or theater performance.
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.
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.
8 weeks – 6 on inpatient, 1 in clinic, 1 with an IM subspecialty (mine was Heme/Onc)
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.
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.
“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.
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.
A few weeks ago, while I was consumed with memorizing what causes a left shift on the O2 Dissociation Curve, I received an email that made me giddy with excitement and overwhelmed with gratitude. MomMD.com, a site I’ve frequented many times since deciding to apply to medical school, contacted me asking if I’d consider coming onto their team as a weekly blog contributor. I am ecstatic to have this opportunity and can’t wait to get started over there.
The blog there will be separate from Mind On Medicine and, among other things, I’ll be writing more about topics related to being a woman in medicine. Don’t worry, though – this blog isn’t going anywhere! This is still my personal outlet and I’ll be here just as much, but I’d love to have your support and encouragement as I get started as a contributor for this rockin’ resource.
In the mean time, I would love it if my awesome Mind On Med readers would help me choose a name for the new MomMD blog! Vote for one of the options below, or add a new one. If you come up with something great, I’ll definitely add it to the options!
Later on I’ll announce the winner and let y’all know where you can find me on MomMD!
As a medical student on the inpatient Internal Medicine floor my job is not just to learn about history-taking and practice my physical exam skills, it’s to be a part of the team caring for real, live patients. I actually have the chance to make a difference. Since I’m a noob I am usually only assigned to a couple of patients at a time. This small patient load plus my low magnitude of responsibility means I have the time to sit down with people and tell them, in layman terms, what their diagnosis and plan is.
I’ve had two patients in as many weeks specifically ask me if I could be their doctor. While I know that the patient’s health would be severely at risk if I were their primary caregiver, it is eye-opening when a patient grabs your arm and thanks you for explaining their diagnosis in terms they could understand. What this tells me is that patient’s value our time as much as they value our knowledge.
As I continue in my career and get more accustomed to the lingo and ways of medicine I hope that I can hold on to the ability someone new to medicine has to educate in understandable terms. I want always remember how much patients value our time and dedicate myself to efficiency in other areas so I can still devote an acceptable amount of time to patient questions and concerns.
What has become most apparent to me in the past two weeks is that patients are confused. They don’t understand their conditions, which is terrifying to them. I’ve seen that if I can give them my undivided attention for even 5 minutes and hear their concerns and questions I can play a huge role in putting their mind at ease. So, while I know I will not have this much freedom in terms of time as my future responsibilities continue to expand, I hope that I can focus my care on ensuring my patients are informed and involved.
The role of a medical student on the healthcare team is undeniable. While I know it may be scary to have someone as young and new as me offering you healthcare, as a patient you should take advantage of the person in the short white coat…they have time to give you and are in a unique position to directly relay information to your doctor. I enjoy talking to you, I enjoy answering your questions and I have a true desire to improve your quality of care.
I truly adore sitting down with patients and ensuring they understand what’s going on. It overjoys me to hear a patient tell my attending “that girl right there…she explained this to me and I feel like I can go home and deal with it now.” Statements like this don’t make me happy because the attending may take a mental note for my clerkship evaluation, but because, for the first time since I started my journey into medicine, I finally feel like I’ve actually made a difference in someone’s life.
is about to drastically change. My job is no longer simply learning about the basic science of disorders and regurgitating answers on exams…starting next week I get my first real taste of what a doctor does. My first clinical rotation is Internal Medicine and I am very excited to see the ins and outs of hospital work. I’m ready to get into the nitty gritty of what I came to medical school for in the first place – patient care.
Original Photo Courtesy of Flickr Creative Commons user Plutor
A few things I need to tackle before next week:
Clinic Clothes: The past two years I have mostly been able to get by with hole-ridden jeans, casual t-shirts, and Toms. Starting next week I will be dressing nice on an almost daily basis and it’s high time I hunt down a wardrobe that doesn’t make me feel like I’m playing dress-up in my mom’s church clothes every day.
Confidence:Confidence is a huge part of success – you’re entirely more likely to be taken seriously, to learn and to accomplish if you’re confident in your abilities to do so. I’m trying to stay cognizant of the fact that I’ve come a long way in the last two years and maintain an attitude of humbleness, while reminding myself that I am capable.
Sleep Schedules: I hate getting up early (I know…wrong profession), but it’s much easier when I’m doing it on a schedule. Some medical students claim to sleep 4 or 5 hours a night and well, that just won’t work for me. I need a reasonable amount of sleep or my brain literally feels like a fog machine…and we all know an 80’s dance party is no place to learn the art and science of doctoring.
Time Management: As I discussed earlier my time is no longer my own and, as such, it is going to be absolutely pivotal for me to maintain schedules of time management in order to keep spending as much time as possible with my husband. I also want to make sure I have adequate study time and free-time to devote to my furry children and to this blog. I should probably also work towards devoting a little time to some form of …*gasp*…exercise (not that I want to or anything). So, scheduling and efficiency becomes my newest obsession.
And, because I have no witty or creative way to end this post, I’d like to put it out there that I was carded while buying a 5-Hour Energy yesterday.
From this experience I learned two things:
Must be 18 to buy energy drinks.
I look somewhere in the vicinity of...”I just got my driver’s license!” years old.
I know, everyone older than me is saying “you’ll appreciate it when you’re 50,” but people have been telling me that since I was driving myself to restaurants and still getting the “12 & Under” kid’s menus and it’s never made me feel better. Right now all it does is make me think that I’ll be a 30-year old doctor pregnant with my first child and still getting the stank eye from old ladies for being pregnant before I can buy lottery tickets.
And, just so this is a completely random, how about you share some tips with me as I go into 3rd year? I’d love to hear your advice!
2nd Photo Courtesy of Flickr Creative Commons user rynosoft (attributed here due to Blogger formatting issues).