Hi SDN,

I am currently a third year medical student, and started my medicine clerkship almost two weeks ago. I have wanted to do internal medicine since I started medical school, and plan on going into private practice in general internal medicine. Needless to say, I was so excited that my medicine rotation had finally arrived - but I quickly discovered that I have a lot to learn. I still like the idea of having a broad knowledge base, but am concerned because I feel like I know nothing at this point. Is this a normal way to feel at my stage of training?

I want to do a good job on my rotation, but this feels so much harder than other rotations I have done (surgery, OB-GYN, peds, and family thus far). I quickly grasped things in those rotations and did well in them, even though I did not particularly enjoy them. On medicine, I have no trouble getting a decent H&P and gathering data but feel lost at times when it comes to prioritizing multiple problems for each patient and deciding how to proceed in treating them. My attending expects a lot, but I think she is fair. I tell myself that her high expectations a good thing for my future. She said that I am doing a good job at this stage, and that I am where she expects me to be (she knows I want to do medicine).

I guess I am hoping for some reassurance that things are going to click for me at some point. I don't expect to be an expert, but I do want to feel comfortable in my understanding of my patients' problems and how to manage them. Plus, the fact that my clerkship is 100% inpatient (and I want to do outpatient primary care) might have something to do with it. Thoughts?

Hi SDN,

I am currently a third year medical student, and started my medicine clerkship almost two weeks ago. I have wanted to do internal medicine since I started medical school, and plan on going into private practice in general internal medicine. Needless to say, I was so excited that my medicine rotation had finally arrived - but I quickly discovered that I have a lot to learn. I still like the idea of having a broad knowledge base, but am concerned because I feel like I know nothing at this point. Is this a normal way to feel at my stage of training?

I want to do a good job on my rotation, but this feels so much harder than other rotations I have done (surgery, OB-GYN, peds, and family thus far). I quickly grasped things in those rotations and did well in them, even though I did not particularly enjoy them. On medicine, I have no trouble getting a decent H&P and gathering data but feel lost at times when it comes to prioritizing multiple problems for each patient and deciding how to proceed in treating them. My attending expects a lot, but I think she is fair. I tell myself that her high expectations a good thing for my future. She said that I am doing a good job at this stage, and that I am where she expects me to be (she knows I want to do medicine).

I guess I am hoping for some reassurance that things are going to click for me at some point. I don't expect to be an expert, but I do want to feel comfortable in my understanding of my patients' problems and how to manage them. Plus, the fact that my clerkship is 100% inpatient (and I want to do outpatient primary care) might have something to do with it. Thoughts?

Yes. It is normal to feel this way at this time. I am sure we all have felt this way, and anyone who denies it is probably lying.

Medicine, in contrast to some other specialties is really about seeing and doing rather than just reading about a problem. So experience really helps one improve in this area.

I would recommend continuing to work hard. Read as much as you can, especially on your patients.

boF

Hi SDN,

I am currently a third year medical student, and started my medicine clerkship almost two weeks ago. I have wanted to do internal medicine since I started medical school, and plan on going into private practice in general internal medicine. Needless to say, I was so excited that my medicine rotation had finally arrived - but I quickly discovered that I have a lot to learn. I still like the idea of having a broad knowledge base, but am concerned because I feel like I know nothing at this point. Is this a normal way to feel at my stage of training?

I want to do a good job on my rotation, but this feels so much harder than other rotations I have done (surgery, OB-GYN, peds, and family thus far). I quickly grasped things in those rotations and did well in them, even though I did not particularly enjoy them. On medicine, I have no trouble getting a decent H&P and gathering data but feel lost at times when it comes to prioritizing multiple problems for each patient and deciding how to proceed in treating them. My attending expects a lot, but I think she is fair. I tell myself that her high expectations a good thing for my future. She said that I am doing a good job at this stage, and that I am where she expects me to be (she knows I want to do medicine).

I guess I am hoping for some reassurance that things are going to click for me at some point. I don't expect to be an expert, but I do want to feel comfortable in my understanding of my patients' problems and how to manage them. Plus, the fact that my clerkship is 100% inpatient (and I want to do outpatient primary care) might have something to do with it. Thoughts?

I'm a fourth year in the middle of applying to Internal medicine residency programs. My medicine clerkship was the most difficult and stressful clerkship of my third year. It sounds like you're doing better than I was so keep up the good work. I think it's definitely okay to feel like you don't know enough, it's part of what drives us to read and learn more!

I'm a fellow in an IM sub-specialty. I actually didn't feel overwhelmed at the beginning of my IM rotation as an MS3 and that was a huge mistake. I felt like I was doing better than I was. Fortunately, my first attending gave me some excellent advice at the midpoint of my first 5 week rotation (of two) and I changed my attitude and approach to things and ended up doing very well.

What you're feeling is normal and I would be concerned if you felt like you were completely nailing it at this point in your education and in this rotation. Trust your attending and look to him/her, as well as your senior resident(s) for more help in managing your time and patients.

Yes, it's normal.

The patients on inpatient medicine service tend to be old and/or have a lot of chronic health issues and multiple problems.
Just continue to read a lot, maybe bring in a review article or two with copies for your team, so that they know you are reading up on your patients.

If you find it hard to prioritize the most important problems, you can ask your senior resident for help...the intern may not have as much time to talk with you.

It's important to find out from the attending what he/she wants from you. I had one when I was an MSIII who docked my grade on an H and P for not including ulcerative colitis in the Ddx of an 85yo patient with bright red blood per rectum (no diarrhea). He wanted me to include EVERY POSSIBLE THING IN HARRISON'S THAT CAN CAUSE BRIGHT RED BLOOD PER RECTUM, while I was thinking that I should just include the most likely ones (AVM, diverticular bleed, etc.) and that ulcerative colitis would be really, really unusual to present first at this age and that perhaps he would dock my grade for writing every random possible dx, no matter how unlikely. If you are asking what to do to get a good grade, I would say kiss up to the attending to the max and make sure you know exactly what the attending wants in your H and P's, and get really, really good at making a concise oral presentation.

If you are just asking how to learn more, and "will this feeling of being overwhelmed get better?" then I'd say just keep at it, and it sounds like you are doing a good job. You can read books like Blueprints in Medicine, Blueprints in Cardiology, or other "help me!" med student books to get a start, and then read UptoDate, Harrison's or a good review article from a good internal med journal, the Net England Journal or medicine, etc. if you have a little more time or are feeling more ambitious.