Internal Medicine Clerkship Tips: Insight into Internal

Torey here!! Our internal medicine clerkship was 2-months long and included 1 week of specialty (I did GI), 1 week of nights, 2 weeks out outpatient, and 1 month of inpatient. I am so incredibly happy that I did this clerkship early in my third year because the knowledge gained and skills learned are things that I will use during subsequent clerkships. My expectations coming into this clerkship included complicated patients with extensive medical histories, lots of time spent rounding, and plenty of diabetes, hypertension, and obesity. While each of these was true to some degree, I found the complicated patients intellectually stimulating and rounding to be my most important educational tool. The repetitiveness of the hypertension, diabetes, and hypertension was something I disliked about this clerkship, as well as the fact that many of patients presented with self-inflicted conditions such as alcoholism, smoking, and poor nutrition.

 

General Tips:

  • Don’t take on too many resources. There is a TON of material and my best advice is to pick a couple a stick to them. For me, those resources were U-World and the OnlineMedEd videos.
  • Present CONFIDENTLY! The content of your presentations and the assessment and plan will always be the subject of constructive feedback from your residents and attendings as each one of them have slightly (or vastly) different styles and things they like to hear. However, presenting with confidence and sticking to your plan is one way to stand out. Some attendings will attempt to lead you astray from your plan by asking questions or offering up other options (a teaching style I personally enjoy and find thought provoking). Staying true to what you think should be done (whether it be right or wrong) can leave a great impression.
  • Spend time on your assessment and plan during presentations. I know I just touched upon the fact that you will not always be right, but the assessment and plan is an incredibly important way of demonstrating your thought process behind patient care. It affords you the opportunity to impress your residents/attendings by showing them that you can not only collect and present the right information, but incorporate it into a care plan for the patient.
  • Include your differential diagnosis in an opening statement during your assessment and plan.  Often times, attendings will interrupt your presentation to clarify and take advantage of teaching points, thus a strong initial statement allows you to showcase the effort you made to work through a diagnosis yourself. After your patient summary in the A&P, using a statement such as “This patient most likely has _____ secondary to _____, less likely secondary to _____, _____ and _____ ” is a great way to show that you have thought of a differential diagnosis in the first statement of your assessment and plan. This becomes slightly more complicated with patients with multiple problems, however its a good starting point and allows you to provide your own plan before teaching occurs.
  • See your patients before leaving the hospital each day. This bit of advice was passed along to me by one of my senior residents on the floors. While it might not be true for everyone, some residents and attendings might take what a patient has to say about you into account during your evaluation. In my opinion, you should see your patients multiple times per day (more than just during rounds) and checking in with the patient on the way out the door shows them that they are more than just a disease-process to you.
  • Spend time with your patients. As medical students, we are not as limited as residents and attendings in the amount of time we are able to spend with our patients. Use this opportunity to be thorough and get to know your patients and their lives outside the hospital. Patients consistently told me the best doctors they’ve seen have spent adequate time with them, and as a student you can contribute to their current care by giving them more face time and opportunity to talk.

Worthwhile investments:

You’ll notice that these are the same as from my previous surgery post. These all served me well during my Internal Medicine clerkship as well.
  • WhiteCoat MedInfo clipboard. I love this because it keeps all my notes organized and in one place. It conveniently fits in my white coat pocket and allows me to keep my notes neat while rounding. A little spendy (about $30) but totally worth it.
  • Maxwell Quick Medical Reference. This pocket-sized book is a great overview of many of the basics you need to know for the hospital, regardless of the clerkship you are. It contains lab values, note templates, physical exam review and other miscellaneous scales/algorithms that might come in handy.
  • iPad. Helpful, but not necessary. Be careful to not be that medical student always looking down at a screen. This is more so a way to be able to look things up about your patient (or about topics you’re unfamiliar with) on-the-go when the time is appropriate.

Resources:

  • U-World. Still the gold standard. Beware that there are a TON of questions for internal medicine, so start early and do them DAILY (10-20 per day + additional questions on the weekends will ensure that you’re not trying to cram hundreds of questions in the week before the test).
  • OnlineMedEd. There is a daunting number of videos to get through, but they are very straightforward and summarize the material in a quick, organized fashion. If you don’t like watching videos, they have PDFs that accompany each lecture (although you will have to pay for these) that are equally as helpful!
  • Step-up to Medicine. I used this as more of a reference while doing questions, rather than reading it front to back. While it wasn’t one of my primary resources, many of my classmates relied upon it and it came highly recommended!
  • MDCalc app. This app includes a ton of equations, scoring criteria, and medical references useful for this floors, not so much for the shelf exam. For someone with an M3 level of clinical experience, it is a helpful way of evaluating a patient’s clinical picture and displaying a more in-depth assessment to your attending.
  • Other resources to check out: Firecracker (a little spendy, great if you like flashcards) and Case Files.
If you have any questions, don’t hesitate to shoot us a message on our Instagram page. Feel free to comment on any of your tips you learned on your surgery rotation in the comments below!
Be aware that differences between hospitals and hospital systems make these tips applicable to some more than others. Using common sense and evaluate appropriate times to utilize these tips. These experiences and opinions are our own and do not represent the views of the hospital where we rotate.
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