Internal medicine can be very stressful and the medicine can be very complex – so I was really worried about how I would do going into the rotation, but I ended up having a wonderful time and learning SO much! I was at a hospital in lower socioeconomic area of DC, which means that my patients had a lot of medical co-morbidities and weren’t regularly getting care. That was daunting at first, but my preceptors were very enthusiastic about teaching. At the end of my rotation, I was able to handle my own set of patients almost entirely on my own with very minimal direction by my preceptors. It really did wonders for my confidence and I feel like I learned so much.
With that being said, I definitely got a lot of use out of my pocket resources. I was looking things up on a regular basis since I was so independent! I wanted to do a lot of the research on my one before I went to my preceptor, because I wanted to get more of a realistically feel for what it would be like when I graduated and was with a supervising physician.
What was in my pocket:
Pocket Medicine: Internal Medicine: I thought that this was one of the best resources I could have used, and I used it multiple times a day, every day. The book tackles the diagnosis and treatment of the most common disorders in cardiology, pulmonary medicine, gastroenterology, nephrology, hematology-oncology, infectious diseases, endocrinology, rheumatology, and neurology. All of these coincide really well with the areas on the PAEA end of rotation exam topics. Within each section, the book’s break down important diseases. And then for the disease, the book presents you with the background, clinical manifestations and diagnosis, treatment, and complications of that disease. One thing I really like about this book is that they credit the article they got the information from, so if you need to know a little more in-depth information, you can go check out the article
How I used it: When I saw a patient, I would look over the section in this book to get a brief review of their medical condition. I will be honest and say I leaned towards using Up-To-Date a little more than this book, but if you don’t have access to Up-To-Date, this book is a great substitute!
Perfect H&P Notebook: I found this incredibly helpful when doing admission History and Physical. While at this point in my medical career, I know the history questions I should be asking, it can sometimes be challenging to remember all of those important things to hit (especially since most of my patients were very poor historians and I had to ask the question in 5 different ways to get the real answer). It gives you one full page (front and back) for each encounter. On the front, you have a space to take the History of Present Illness, Past Medical History, Family Medical History, Surgical History, Social History, Medications, Allergies, and Review of Systems. For each section, it gives you some key words to make sure you hit all of the major points. The Review of Systems is a check off area. On the back is an area for Physical Exam with Lab fishbones. Then you have an area to go more into detail on lab findings, come up with differential diagnoses, summarize your findings, create a problem list, and then blank space for additional notes. The entire page is basically everything you need to do to create a good, full note.
How I used it: Any time I saw a new admit for a H&P note, I used this book to guide my questions and take notes on. I thought it was super helpful to ensure I hit all the major points, and the organization of the book really helped with my organization in my questions asking.
Instant Access Hospital Admissions: I bought this book last year during Didactic year. We have a small groups class in which we had a “patient” (portrayed by our advisor) and had to write a full progress note on, including admission orders. For every condition in the book, it addresses: Disposition, Monitor, Diet, Fluid, O2, Activity, Diagnostic Studies (Labs, Radiology Studies, Special Tests), Prophylaxis, Consults, Nursing, [things to] Avoid, and Management. It’s super helpful for when you’re first started out and haven’t gotten down your standard orders yet!
How I used it: I used this mainly when I saw a diagnosis for the first time or to double check the orders that I did put in. I definitely ended up making a lot of edits to the book and adding in my orders that I liked to have. The thing I liked the most about this book is that I didn’t have to write EVERYTHING out, only the edits that I wanted to make. I strongly recommend this book.
The Sanford Guide to Antimicrobial Therapy: This is a godsend. Confused about what medication to give for a fungal infection or for an ear infection in a pregnant woman or someone with an allergy – its all in there. The book can be kind of confusing to use at first (there’s a LOT of information in it), so I suggest definitely familiarizing yourself with how to use it before you go on rotation. There’s a couple of ways to look things up in the index: by drug, infectious agent, or disease. Or you can use the tables to look things up. I like using the tables initially, and if I’m still struggling look up specifics in the index. Some of the tables I like are “Clinical Approach to Initial Choice” (which goes through each body part and the diseases you can find there), “Antibiotic Activity Spectrum” (which indicates what the drug is effective against), “Pregnancy Risk”, and “Antibiotic Dosing and Side Effect”. I find these the tables that I am using the most. You can also get an app version of it, which charges you a yearly fee but updates content regularly.
How I used it: whenever I saw a case that was going to be prescribed an drug, or if I was on the fence about if the symptoms warranted a drug, I looked it up in this book. I think so many people want to follow an algorithm of “If this is the problem, treat with this drug” and there is so much more to prescribing than that. Looking up possibilities helps to prevent any complications.
Differential Diagnosis Pocket: This is another book that I bought last year for my small groups class. It’s basically an all-encompassing list of differential diagnosis for a simple complaint. Mainly a little too encompassing, and it doesn’t necessarily list them by most likely, but it is a good value for how cheap it was.
How I used it: I mainly used this if I was ever stumped on thinking up a differential diagnosis for a complaint. It was small enough and light enough that it didn’t weigh down my pocket too much and was easy enough to carry around. I ended up highlighting the most severe differential diagnoses for each complaint, and I found once I did that, the book became more helpful – because you always want to rule out the worse case scenario.
Maxwell Quick Medical Reference: My school recommended my class get this resource when we first started. It has a ton of different information in it, including ACLS Algorithms, Lab values, how-to’s for different notes (progress, discharge, pre-op/post-op, etc), History and Physical Exam, Neuro/Mini Mental Status exam, etc). They told us that we would be able to use it through out the entire clinical year, and that it wasn’t as “limited” as some of the resources we would find (i.e. They could just be used during one rotation)
How I used it: I mainly used it for the ECG information in the front, the ruler on the back of the book, and the normal lab values. I know people who have normal lab values memorized, but I don’t have the brain power for this. Whenever I saw a patient with altered mental status, I used this book to remind me of all of the components of the MMSE. And, when we had Code Blues, I would double check the ACLS algorithms and follow along. It was a great cheap purchase (and you can actually get it as a gift when you sign up for a AAPA student membership!)
One of the great things about my rotation site was the fact I had my own computer. This can be unheard of during clinical year for students; normally you have to fight to get access to a computer that might or might not work
Up-to-Date:I was so incredibly thankful that my hospital gave access to Up-to-Date on all of it’s computers. It was the first time I had really seen the site in action, and it was amazing. It has information on every possible disease or disorder you can imagine, patient education, calculators, and drug interactions. It also has a whole section on “what’s new” for you to have the most cutting edge information. But one of the best features of Up-to-Date is the algorithms. They’re incredibly easy to follow and very helpful.
How I used it: Every time I saw a patient was a “new” condition (by that I mean one I hadn’t seen before on this rotation) I would look it up in Up-to-Date. I wanted to make sure I understood it as best as I could, and I felt by utilizing Up-to-Date I would be able to.
Don’t have the money to afford a subscription? If you’re an AAPA member, you can sign up for a 2-year student subscription for $169. Personally, I waited until the last possible minute to purchase mine, because I knew a lot of my rotations would have it on the computer and I would need it more as a new grad.
Also consider Epocrates or Medscape. Both are a little more simplistic in the information provided, but they’re great options for students and very helpful!
Other things I kept on me:
- My stethoscope (duh!). I ended up using my Medelita ERKA stethoscope for most of this rotation, and I absolutely loved it! I could hear all of the asthmatic wheezing perfectly.
- Pens: my favorite is is the Paper Mate Ink Joy Quatro because having four colors in one pen is wonderful, and I really like the ink and colors of this pen. I feel like they are very bold, smooth, and don’t smear.
- My Moleskin Notebook: I used this less for writing down cases during the day (since I had a computer to log cases on). Instead I used it to write down everything and anything I learned. I wrote down orders that I found most helpful, the go-to antibiotics for my hospital, numbers of all of the consults I got in touch with. Literally anything and everything went into the book. It was a little disorganized (read – a LOT disorganized), but I found it incredibly helpful.
- Snacks: the hours for this rotation were long and chaotic. I ended up having a wide assortment of snacks in my pockets that would stay good and give me the fuel I need to get through the day.
- Water bottle: I get some pretty awful migraines if I don’t stay hydrated, so this was a must for me!
I WOULD LOVE TO HEAR WHAT YOU KEEP IN YOUR POCKET DURING YOUR PRIMARY CARE ROTATION, OR YOUR THOUGHTS ON A RESOURCE I SHARED! COMMENT BELOW AND LET ME KNOW WHAT YOU THINK. AS ALWAYS, YOU CAN SUBSCRIBE TO THE BLOG TO GET UPDATES ON NEW POST SENT TO YOUR EMAIL. OR YOU CAN FOLLOW ME ON SOCIAL MEDIA (FACEBOOK, TWITTER, INSTAGRAM)-ER