My first rotation ever was Internal Medicine. I will say that the first day of your rotations is basically like getting thrown in the deep end of the pool without any floats or practice. There is nothing you can do to prepare for your first day of rotations and that is completely ok. I know I came in with a lot of anxiety about how my rotations would go and how I would interact with my patients and impress my attending but to be honest, there was no need for that anxiety and I will explain why in the following post.
SURVIVAL TIPS
There is so much to internal medicine so its fine if you do not know the answer when you are starting off. However, if you see a disease once, you should try your best to research that disease and find treatment plans
Always be thorough when you're coming up with a treatment plan and looking at the chart. Search ANY words that you do not know. Search the mechanism of the drug. Search up why you use that drug. UPTODATE will be your best friend for all of this. This is to avoid the embarrassment you will feel in your attending when he asks you a simple question and you do not know the answer.
The residents will always be your advocate and will always be willing to help. Ask them any questions you have. Always try to be helpful. I know this is hard and it can be hard talking to them sometimes because of the power dynamic but they were in our shoes a few years ago (and interns were there a few months ago). Ask them if you can write notes, call family members, and take more patients if you can. Not only will it help the team be more efficient but it will also show the resident you care and in return, they will take care of you.
Get a laptop bag. The main thing you will need on rounds is your laptop. Don't forget your white coat and stethoscope.
You will have to wake patients up early in the morning. There's no need to be shy about it, tell them you're sorry but you have to check up on them.
If you will work with multiple doctors, remember that every doctor will want different things in their oral presentations. Some like all the labs and others only want abnormal ones. Some like very extensive treatment plans while others want very short and to the point. It will take a few days to get used to the doctor so there's no need to stress if you mess up on the first day.
The hours will be LONG in the beginning but as your team becomes more efficient and works better, the hours will become shorter.
SCHEDULE
Our IM rotations are 2 months so the schedule might change from school to school:
4:30 AM - get up and get ready
5:15 AM - leave my house for the hospital
6:00 AM - get to the lounge and start looking at the morning labs and charts
7:15 AM - go pre-round on my patients and finish notes
8:00 AM - morning report with the residents
9:00 AM - meet up with the attending and discuss patients
(note, sometimes the attending chooses to the bedside rounds where we directly go to the floors and discuss the patient outside the door or sometimes the attending chooses to go to a meeting room and we discuss our patients there)
12:00 PM - lunch + afternoon report
1:00 PM - depends on the day but we either wait for new admits or the attending sometimes presents an interactive lecture
5:00 PM - this is the time we usually leave, sometimes we leave earlier
7:00 PM IF it is a SHORT CALL day, we can stay in the hospital until 7 but the residents are really nice and usually tell us to go home earlier if we already have our admits and notes completed.
Sleep is a major problem so you better get used to having less sleep and more caffeine. Being able to properly study is also huge because most of the time, after a shift, you are super exhausted and do not want to do anything so I recommend either staying in the hospital to study or studying in between downtime whenever you have any.
STUDY PLAN
There are 5 key things to a successful study plan:
Online Med Ed: This is where you will do the majority of your formal lecture learning. The guy that teaches it explains it really well and it will be your first exposure to many of the things he talks about. The foundation you gain here will also really impress your attending. There are A LOT of videos so watch as many as you can
Anki: To cement the concepts and facts in Online Med Ed, you will need to do flashcards using Anki. The AnKing deck has an Online Med Ed section under their STEP2 section where you will find all the cards organized.
UWorld: There are A LOT of questions. Im going to be honest, I only got to around 30% of them because they were so many of them. However, you will cement your learning here by doing questions. The explanations on UWorld are spectacular and I would highly recommend screenshotting tables and charts and putting them in a word document so you can quickly review them before your test. Some people go thru the questions multiple times but it was too much for me.
NBME Tests: There is a Facebook page that has these free tests called the Embience. These tests will just get you used to do the format and mentally prepare you for the test.
Patient Learning: Every patient you see will be a learning experience. You will be able to start putting diseases to faces. For example, if you have a question about CHF, you will remember the patient you treated that had CHF and how you took care of them. Remember that these are real people and you can learn a lot from them so pay attention.
These tips will definitely help you pass your shelf exam. To honors, you will obviously need to put in longer hours on OME and anki while also working thru UWorld many times and taking the NBME tests.
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