Team Discussion

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┬áis 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.
Newborn
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.