Like I mentioned in my post about the resources I used to study for the Internal Medicine EOR, this rotation actually ended up being my favorite so far. I loved every moment of the rotation, especially my preceptors! I saw amazingly complex patients with multiple co-morbidities, and my preceptors let me manage them almost completely on my own with only a small amount of input from them. It was so far outside of my comfort zone, but such an amazing learning experience.
Since I often hear that this rotation is one of the more challenging rotations, I thought it might be helpful if I shared my top 5 tips for survive Internal Medicine with you guys! The first three tips are actually the tips my preceptor gave me the first week, and I just found them so helpful. The last two are the tips that I figured out on my own and couldn’t have survived without.
#1 Establish Cause and Effect
In medicine, especially medicine for the acutely ill, it’s important to get to the root of the problem instead of treating the symptoms. Think of it like fixing the leak instead of putting a patch on it. Treating the problem prevents other issues from arising, while doing a quick fix can lead to bigger problems down the road. So you need to establish cause and effect. Look at every aspect of their clinical presentation and put together the puzzle. That thing that you think might be too small to have an impact could actually be the cause.
And if you aren’t able to figure out that cause, remember that you’re a student! You’re expected to be learning and growing as a provider. So just continue to plug along and get better.
#2 Ask Why
This goes hand in hand with Tip #1. In the real world, medical conditions are’t as clear cut as they are on exams. The second day I was at my rotation, we had a Code Blue. The patient was pulseless by the time I got there. This was the first time I had seen the ACLS protocol in real life, and I still remember every moment of that code. Later on, I found out that patient was supposed to be discharged later on that afternoon. How could a patient who was considered healthy enough to be discharged start coding? Why did this happen? This turned into a huge learning experience for me. I think I learned more from this patient than I did from any other single encounter, and all because I kept asking why.
The patients you see during your internal medicine will be some of the sickest patients you see, maybe not the most acute, but definitely very sick. They’ll have a plethora of things wrong with them, and it can be so easy to ignore some of the smaller things. But don’t. Continue to ask “why”. Why is does this patient still have a fever? Why is the patient repeatedly coming in suffering from DKA?
#3 Never be Satisfied
I don’t care how far along you are in your medical career, there is always room to learn more. You’re never going to know it all because medicine is a constantly evolving field, and we truly only know a portion of the mysteries the body has to offer. Never be satisfied with the amount of knowledge you have, whether its about a patient or about a medical condition. Show your preceptors that you want to learn and that you’re excited, and they’re going to be a lot more open to teaching you and you’re in turn going to get more from the experience. Be enthusiastic and engaged.
#4 Write everything down
I’m a huge believing in learning through writing, and I would literally jot notes on everything during this rotation. Labs, vitals, important items from the nursing notes – it all went on my sheet of paper. I would mark out the trends in labs, the medications the patient took yesterday, everything. Because of this, I was so much more prepared when my preceptors would ask me questions. I never once had to say “hold on, let me go look that up”. And my preceptors loved this about me; they even referred to me as their own little chart. I felt like writing everything down and coming up with a system for it really helped me be able to visualize the big picture for my patients.
I also wrote down notes on protocols, treatment options, when to consult specialties, what drugs were on formulary, weird conditions, etc. Basically anything my preceptor said that I hadn’t heard before, I would write down. I referred to my moleskin as my “little black book for survival”, and I really think it helped me survive. I did try to group things together / color code to help me find information later, but honestly most of the time I didn’t have to look it up because the act of writing it down had helped cement it in my brain.
#5 The nursing staff is your best friend
Realistically, this is a great tip for ANY rotation, but it is especially true for inpatient medicine! You need to know that the nursing staff has your back, because you’re still a student and mistakes can happen, but the nursing staff also needs to know that you have their back. Be nice to them, treat them with respect, actually listen to what they have to say. These are the people who are interacting with your patient on such a deeper level than you are – you might be there for 30 minutes, but they have that patient for their entire 12 hour shift. I can’t even count the number of times I saw my preceptors discussing treatment plans with the nursing staff and listening to their input – because these individuals do know what they’re talking about! There are also so many learning opportunities that come from interactions with the nursing staff. For instance, there was an amazing vascular nurse I met on my inpatient rotation. He would walk me step by step through using ultrasound to insert lines. And yes, I learned this in the SIM lab last year, but this is all he does every day and he knows how to do it so much better than my professors. Because of his advice, I feel so much more confident for those times I’ll use ultrasound guided techniques on my patients.
I hope that you find these tips helpful for surviving your internal medicine rotation! Comment below with your thoughts on these tips, and if you have any others – I would love to hear some of the things that you saw most helpful!
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