After a year of clinical rotations, my short white coat has a permanent grey/brown tint that no amount of bleach can seem to remove and two stained spots where I washed it with green gum in my pocket (don't worry I bought a new coat for next year) and my stethoscope (the pediatric side) is cracked after smacking it on the counter in Family Medicine, but other than those minor setbacks it's been an incredible year! My three month internal medicine rotation ended Friday. On internal medicine I rotated for six weeks with the inpatient team, three weeks with the infectious disease team, and three weeks in an outpatient clinic and small group learning sessions. We also had a lecture every day to help reinforce concepts. At the end of the rotation we had a computer exam and a four hour exam called the OSCE where we had patient actors set up in simulated clinic rooms and took care of them on our own making treatment decisions including deciding if they were extremely sick and needing to be admitted to the hospital.
As a medical student on every rotation we are responsible for visiting patients in their rooms before rounds and writing a note about the patient's concerns, the physical exam findings, new labs, and the plan for the day. During formal rounds with our attending we would present the patient formally to the group and discuss the important findings and plans for each day. Residents of course had already visited the patients too and formed the plan, but as a student we practiced these skills by doing this every day.
Inpatient:
We alternated between pre-call and post-call (no new patients, just caring for the ones we have) and call days where we accepted new patients.
6:15a.m. Browse the computer electronic medical record to see how my patients were overnight, what their morning labs were, and any procedures scheduled for the day.
7:00 a.m. Visited patients in their rooms, performed a physical exam and asked them about their concerns. Then wrote up notes in the computer about any findings or updates. During this time we also visited with the residents to discuss ideas about plans for the patients.
8:00 a.m. Morning report for education, where residents presented interesting cases and we all could discuss labs, educational topics, and work the patient up on a white board to help care for him/her
9:00 a.m. - 12:00 Rounds with our attending and residents where we finalized plans for the day for each patient and visited with them in their rooms.
1:00 p.m. Lecture
2:00 p.m. - ?
At this time we would accept new patients by interviewing them and doing a physical exam when they were transferred to our care from other hospitals in the area or if they presented to the emergency room and need to stay overnight in the hospital. We also had time to study or sometimes the residents would teach us. We went home at different times every day, on a pre or post call day it was usually earlier (4:00) and on call days it could be 8 or 9p.m., or overnight, or 5:30/6:00.
Infectious Disease
7 a.m. Pre-round on my patients
8 a.m. Lecture with our infectious disease attending
9 a.m. Rounds begin and we would visit all of the patients in the hospital that required infectious disease specialists to either manage their antibiotic regimen, handle rare or complicated infections, or help determine what infection the patient has and the best treatment.
1 p.m. Lecture
2 p.m. - 5 p.m. Continue Rounding on our patients - we had a lot of patients on this service!
Infectious disease was one of my favorites during this rotation because our hospital is world renown for our biocontainment unit which my attending taught us about and toured with us!
Outpatient
8:15 - 12:00 Clinic
I worked in an acute care clinic where we saw patients that could call in that same day and be seen. Things like pneumonia, rashes, and severe wounds or diabetic foot ulcers. I also worked in a sleep clinic which was a ton of fun and we helped people with sleep apnea, narcolepsy, hyper somnolence, and insomnia.
1:00 p.m. Lecture
2:00 p.m. - 5:30 p.m. Small Groups working through patient cases
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Up next I'm taking my second boards exam in 17 days!