Internal Medicine Rotation

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I am a current 3rd year student and I will be doing my internal medicine rotation in the spring. I feel as though I may not be sufficiently prepared for it just from my IM course at school. Does anyone have any suggestions as to good text books/reference books I can use to adequately prepare myself and/or any pointers or advice?

Thanks in advance.

Originally Posted by PodStudent2014

I am a current 3rd year student and I will be doing my internal medicine rotation in the spring. I feel as though I may not be sufficiently prepared for it just from my IM course at school. Does anyone have any suggestions as to good text books/reference books I can use to adequately prepare myself and/or any pointers or advice?

Thanks in advance.

I heard "step up to medicine" was a good review. Washington manual should be useful as well.

There really isn't anything you can do to prepare, other than make sure your physical exam skills are refreshed and up to par. You could read over old systems lectures from second year, focus on CHF, CKD, CVA, and anything and everything GI, but that's about it. If you are on a "teaching" team at a teaching hospital, you are going to have complicated (but very interesting) patients. I just don't think there is anything I could have done to better prepare for my rotation....and I didn't do much. I show up, work up my patients to the best of my knowledge/ability, write down questions I have and things I don't know, look them up that afternoon/night, and never make the same mistake twice. You should have time between rounding and presenting a patient that you can look up anything you don't know in terms of physical exams, symptoms, drugs, etc. And more than likely the attending and residents will expect you to be pretty stupid (as a 3rd year and especially as a podiatry student). So low expectations help too.

As far as resources. Bring your phone, everyone (attending included) has and uses their cell phones. You won't be unprofessional by doing so yourself. For pocket guides I would get a copy of Maxwell (it's like $7) and either the Washington Manual or Ferri. A lot of medical residents and students will carry around Pocket Medicine (Massachusetts General) but I really don't like it. It is HEAVILY abbreviated which made it hard for me to quickly read through. I found my self flipping to the section with all the abbrev constantly. But they all have most of the same info. It's really personal preference.

Also, your school should have a list of resources and advice from students in the past. If not, I would encourage my faculty/administration to start one.

dtrack is right on the money. In my experience, i have the feeling that some attendings are just fed up with podiatry students, so i had to really take the initiative in following my own patients and working them up. The learning experience in IM rotations are extremely valuable, and to this day i still wish i had pushed myself to take even more initiative. I recommend following 1 patient and knowing every detail about that person including: why were they admitted, why are they taking each medicine they're on, what were the reason for certain adjustments, what was the reason for these diagnostic studies done in the past, what was found and then what was done. Then.. know what is the plan for that patient that day/week, why are they staying in the hospital for the next few days, and then why are they finally discharged.

Don't be scared of asking stupid questions (even if its stuff like not understanding an abbreviation or straight up can't read their handwriting), now is the time to get them out of the way. we all start somewhere.

Resources:
I used "Case Files: Internal medicine 3rd edition - Lange".. awesome concise explanations and coverage of important topics

Just work like hell. It was out of my realm of comfort but I soon got over that. I managed 1-3 patients at any given time. My job was to know every last single thing about that patient. I spent a lot of time researching/looking things up but with a little extra effort everything played out quite well. I enjoyed that rotation. I'll see it again next year.

If I were going to buy a pocket manual for IM I would get Pocket Medicine (the little green book). Like dtrack said, it may be very abbreviated, but it's what I see almost all of the residents and students use here so it would make the most sense to me. That said, I didn't buy a manual for my first month of IM and I don't plan on buying one for my second month.

I didn't buy a pocket guide either and I was fine for my 3rd year IM rotation. That may change for 4th year/residency but I could definitely see its use. I've been seeing a lot more attendings/residents/students using Epocrates. That may be something to consider.

Another alternative to Epocrates is Lexicomp. Both are very good apps with tremendous amounts of data in them.

Medscape is much better than epocrates. It also has a bunch of referenced articles on many medical conditions which you can quickly look up on your phone/ipad/tablet. Its a free app also.

The book I'd recommend is Internal Medicine Essentials for Clerkship Students. Its a great brief overview on a lot of stuff you will encounter. You can usually find a PDF copy floating around.

UpToDate has to be the best resource out there. It's an online resource and you need to have access to it. Our school gets us proxy access (similar to PubMed). Everything is referenced with the latest literature. It's very detailed, but to the point.

Medicine is a lot of knowing how to manage your patients and how to make your intern's life easier. You own your patients. I would have at least 2-3 everyday. Know all the labs, consults, radiology, and meds. Keep your own list of everything. There should be nothing about your patients that you do not know.

If you see something, formulate a plan and present it to your intern, It's OK to suggest things that you read about. Interns are not masters of medicine either. Anticipate when your pts will be discharged and have all the paperwork ready just in case (med rec, d/c note). Be quick about writing your progress notes -but do a thorough job.

I may not have been smarter than my fellow medical students on IM rotations, but I worked the hardest, knew everything about my patients, made my interns jobs easier, and even caught a couple of pts going septic before anyone else (SIRS criteria -know it!!). I was told numerous times that I knew IM better than most med students. Of course I didn't believe that, but hard work can make up for a lack of knowledge anytime!

How many butts did you have to stick your finger in during your internal medicine rotation?

Originally Posted by fruitybooty

How many butts did you have to stick your finger in during your internal medicine rotation?

The bigger question is not "have to" but actually "wanted to"

Originally Posted by fruitybooty

How many butts did you have to stick your finger in during your internal medicine rotation?

One.

None - I hope this streak continues for a long long time

Originally Posted by dyk343

One.

Are you upset about this?

I mean, only being able to do just one digital rectal exam?

I've been practicing rectal examinations for awhile so when I get to IM rotations it should be a breeze.

I've used both "Pocket Medicine" (little green book by Mass General) and "The Practical Guide to the Care of the Medical Patient" by Ferri. Both have come in handy during my general medicine rotation this month, though the pocket medicine is easier/faster to flip through. Got them on ebay and amazon for cheap. I like reference guides so I'm okay with owning both, but you could get away with not having any like other students have said previously.

FYI Only one prostate exam so far, but plenty of OB/GYN.

I had an intern who always said that there are only 2 contraindications for doing a rectal exam on an admission H&P... 1) The pt has no butt hole 2) You have no fingers.

So ya, I did a few. My first one was a pt with C diff. I was told to make sure I didn't stand in the "line of fire!"