1st rotation is IM... what can I do?

[dingleberry007]

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hi everyone...

I'm about to start my 3rd year and am really nervous about clinical rotations. I start 3 months of IM in 2 weeks. I wanna go into IM so I figure I need to be pretty impressive and get a good recommendation.

Since this will be my first rotation, I really don't know what to expect. I have 2 weeks to prepare I guess. Does anyone have any suggestions on what I might do to be productive in my preparation?

thanks... any advice would be much appreciated

 

[pincheeric]

Read Step-up to medicine to get a solid foundation. Then just do question bank questions for the rest of your time on the rotation. You'll do very well on the shelf. In terms of your clinical grade just work hard and don't complain. They know this is your first rotation and that you don't know how to do much. Always offer to help and if someone asks you to do something do it if you can. If you don't know how then ask them to show you how to do it once and then remember how to do it for the next time. Ask appropriate questions and think before you answer questions. And NEVER make your fellow med students or intern/residents look bad.

 

[Pinkertinkle]

I have some thoughts on this regarding grades.

I did IM in the middle of my third year to try and honor it and in retrospect there would be some advantages to doing it first. First of all it'll prep you real well for your other rotations, increasing your likelihood of honoring them. I had hoped my other rotations would help me honor medicine but I didn't quite make it. So if I had done IM first and then went onto honor a few others it would have been higher yield in terms of grades.

 

[tacrum43]

As others have mentioned, there are some advantages to having IM first. It is a broad discipline and will give you a good foundation for the rest of your rotations. I think IM can kind of be a little overwhelming at first because there's so much that can be going on with your patient, but I also think you get to see a lot of the stuff you learned about during the 1st two years in action.

Just try to learn as much as you can, don't lie, don't backstab other students, and always be available and willing to help out your team. Also read up about the conditions your patients have; it'll help you to remember the details when you're dealing with an actual patient and you'll look smart on rounds. Pocket Medicine also helps you look good on rounds. If you want to read up ahead of time, some good things to study are diabetes/DKA, CHF, GI bleeding, pneumonia, acute renal failure, pyelonephritis, asthma, COPD, MI and stroke. But again, these conditions will mean more to you once you have patients that have them. I thought the MKSAP questions were helpful for the shelf. Also, wear comfy shoes on rounds...you'll usually be standing for about 3-4 hours straight.

 

[jbp100]

hi everyone...

I'm about to start my 3rd year and am really nervous about clinical rotations. I start 3 months of IM in 2 weeks. I wanna go into IM so I figure I need to be pretty impressive and get a good recommendation.

Since this will be my first rotation, I really don't know what to expect. I have 2 weeks to prepare I guess. Does anyone have any suggestions on what I might do to be productive in my preparation?

thanks... any advice would be much appreciated

I had IM first as well this year. I found that having just finished studying intensively for the USMLE, a lot of the shelf questions felt similar. In something as broad as IM, practice questions are definitely your friend.

 

[njbmd]

hi everyone...

I'm about to start my 3rd year and am really nervous about clinical rotations. I start 3 months of IM in 2 weeks. I wanna go into IM so I figure I need to be pretty impressive and get a good recommendation.

Since this will be my first rotation, I really don't know what to expect. I have 2 weeks to prepare I guess. Does anyone have any suggestions on what I might do to be productive in my preparation?

thanks... any advice would be much appreciated

Go pick up a copy of First Aid for the Wards (as good as anything out there) and read through the section on Internal Medicine. Another great book is called How to be a Truly Excellent Junior Medical Student by Lederman. It is pocket sized and tells you everything that you need to know
to function well on any rotation.

It doesn't matter what rotation you do first, second or last because everyone knows that third years in July are less clinically sophisticated than third years rotating in June of the following year. If you don't know something, ask a question but don't ask questions about things that you should know. Be a good member of the patient care team and know more about your patients than anyone else. This means labs, studies, pain relief etc. Write down everything and follow-up on every test and study that is done on your patient. If possible, accompany your patient to studies like UGI or chest x-ray so that you can see the actual films.

When you are not busy, read. Read about your patient's condition and then read about the things that you need to learn for the clerkship/shelf exam. You actually can't read too much. If one of your colleagues is busy, offer to help out. Don't just stand around and watch the rest of the team get swamped. You can hunt down labs or gather other information to help the team.

 

[kenshin1]

As others have mentioned your reading should primarily consist of prep for the shelf and articles relevant to your pts. However, I also think the IM rotation is a good time to learn the basics of ECG reading and CXR. (you will look good on rounds if you are even remotely able to do either). ECG is the more important topic. I recommend "The only EKG book you'll ever need" by thaler

 

[indo]

you've just taken step I so you'll be all over most pimping questions. The hardest part during the first rotation is figuring out the step-by-step patient management process. This is important because in an academic hospital you have micromanage every single step of the process.

On your first day your intern will ask if you have any questions. Have them talk you through where patients come from, what must be done in order to admit a patient, how orders are submitted, how you contact a nurse to make sure she knows about the order, how to contact the lab to add on one more lab to that morning's blood draw, how to contact radiology since they never read images in time for rounds, etc.

Figure out the code to the supply closet on each floor. Print out some of those scut sheets from medfools.com because if your attendings are like mine they'll want to know what the patient's H+H was during their hospital visit in 2007.

Also, find someone to teach you how to call consults.

finally, use usmleworld for the shelf.

oh, one more... don't get upset if a patient tells the attending something that is absolutely opposite of what they told you. This is a well-known phenomenon commonly seen in VA hospitals.

 

[45408]

Definitely use USMLE World - buy the Step 2 question bank, and do the IM questions. VERY helpful.

you have to take the shelf, right? how much of your grade is it worth?

 

[bigDinLV]

Best advice..

Bend over and grab your ankles

 

[DaveinDallas]

I would:

1) Be extremely, extremely, grateful it worked out this way. If you study
like a banshee and are all over you assigned patient's conditions like a pack of Mongols, you'll do fine.....IM first gives you a great foundation for everything else...no joke.
2) For the shelf - Case Files, MKSAP and the Kaplan IM Qbank.....
3) Don't get too tied up in procedures at the hospital but be friendly, eager, and a bit of a scut monkey. Here's where you really learn H&Ps, how to present and ways to become more efficient. My 2nd year showed me how to do a full neuro exam in like 3 or 4 minutes with a patient remaining in the bed.
4) Enjoy the hell out of this rotation. You'll do great if you're not afraid to work....Smile a lot and enjoy yourself.