IM is a stressful rotation and many students find it to be the most intimidating. The hours are long, many of the cases are complicated and you will likely have overnight call shifts. You will be responsible for direct patient care and busy juggling this responsibility amongst orientations, clinical teaching sessions and rounds. You will likely be assigned a few patients and be responsible for checking their lab results, reviewing investigations, and writing progress notes.
2. What to Bring
Professional clothing, clerkship coat (may not be mandatory), ID, small pocket reference, stethoscope, pager (usually assigned by the hospital).
3. Approach to Internal Medicine
Knowing which antibiotics are commonly used for major issues (UTI, pneumonia, skin infections, etc) along with the common bugs you’re targeting will be very helpful
Develop an approach to chest x-rays and EKG’s – you will encounter a lot of these
Ensure your physical exam and history skills are thorough and up to date. You will likely be expected to assess a patient on your own before reviewing with a resident or attending, so know what you’re doing. Knowing a targeted physical exam (i.e. respiratory, cardio, abdomen, neurological etc) will be beneficial
Read around your cases. Usually the day is quite busy and the emphasis will be on approach and management instead of physiology – use your free time to make sure you have a solid foundation
IM is a huge field – you will feel like you know nothing and will definitely forget to do something related to patient care as it is difficult to track everything there is to know and do for one patient. Ask for help as soon as you need it!
4. General Approach to Wards/Hospitals
Be friendly and professional to other staff members. Nurses, physiotherapists, pharmacists, social workers and many others can provide a lot of useful information
Become efficient at dictations, consultation notes, admission notes and SOAP notes. For example, there is no point in recording the same daily lab values if they aren’t changing. Try to write a note so that an attending physician or on-call resident can easily see what the issues are and the plan to address them
Be succinct when presenting a case to a Resident or Staff. You can demonstrate a thoroughly thought out history/exam/issues/plan without listing off every single detail. Highlight the pertinent history, and clearly identify the issues and your plan.
If you have messy handwriting, get in the habit of writing as clearly and legibly as possible. This is especially important for written orders and prescriptions.
If a resident or staff ask you a question and don’t know the answer, explain your reasoning or explain what you don’t know and where your knowledge gaps are... don’t try to make things up!
Be aware of what is expected in terms of additional paperwork. Knowing when an extra requisition is needed (i.e. MRI or CT scan requisition) or if pre-printed orders are available will save you a lot of time.
5. Keeping Track of Your Patients
You may be asked to update information on your patient in a group document (i.e. google docs) to facilitate handover between on-call residents/students.
You will need to figure out your personal preferences in terms of tracking your patients’ information. Some students prefer a pre-made sheet they fill out and update daily. Others prefer to just keep a notebook to track patient information, results or outstanding orders. Checklists can also be really useful to track each patient. Remember that all patient information is confidential
6. Topics to Review
The following are symptoms or diagnoses most commonly seen during your IM rotation. Having a logical approach to workup/management of the following would be beneficial as begin your rotation (and will give you a good foundation).
Approach to a patient presenting with: fever, chest pain, confusion/delirium, shortness of breath, weakness/dizziness/lightheadedness (including syncope)