From my experience talking with people attending European medical schools (and with that as the caveat -- I haven't actually done rotations there), the biggest difference seems to be the role you are expected to take on the team. Namely, you are expected to make yourself part of the team. And to complicate matters, for you, it doesn't always happen naturally -- you are just supposed to figure it out. Usually third year is all about adjusting to this and figuring out the seemingly impossible task of making yourself part of the team when no one tells you what you're supposed to do. Doing this as a fourth year won't be fun.
If you do an inpatient rotation, you can expect to have anywhere from 3 to 7 patients (more on busy services), for which you will take primary responsibility. You should expect to write their admit note as well as daily progress notes, and both will be cosigned by your intern or resident. You may also be expected to dictate their discharge summaries (ask "how do I dictate here?" and they'll tell you whether there is a system where you can dictate it vs. an MD having to do it). You should write their orders to be cosigned by a resident or intern. Because the RNs won't be calling you directly at most hospitals, you should start each day by giving the RNs your number and asking them to call you if anything comes up with your patients. Really stay on top of this, because it's embarrasing not to know major events with your patients (and even though no one thought to tell you, everyone expects you to magically know). If this is an audition rotation, you should pay attention to the way your residents and interns are presenting and model your presentations after them. Make sure you get early feedback from more than one person about your presentations, as cultural differences probably affect this dramatically, and much of your attending evaluation comes from your presentations. Also get feedback on your notes, since this is another easy way to evaluate you. Finally, you should do little mini-presentations on topics of interest (preferably relevant to a question that came up discussing one of your patients) -- 10 minutes tops, single sided hand out for everyone on the team. One presentation every week or two should be sufficient. Run it by your chief resident before you do it to make sure the topic is good and so they can say to the attending "Oh, I think Blondbondgirl has a presentation on X! Do you want to hear it now?"
As far as the structure of the day, on my neurology rotation I arrived about 6:00, rounds were 7:00 to about 10 a.m. The period from 10-12 is the "hour of power" where you can get things done easily -- scheduling radiology studies, calling consults (who will often give you a very hard time if you call them after noon for anything other than an urgent issue), writing orders, placing notes on charts, talking to the nurses regarding what the plan is for the day, etc. 12-1 was a conference, then on non-call days finishing up work, dealing with issues that came up during the day, until done with work usually around 5 or 6 p.m., sign out to the on call team. If on call, obviously mix admitting in with all of this (try to see any new patient within 30 minutes of getting report, and have a note and preliminary orders by 1 hour from getting report) and you take sign out instead of giving it (although on many services as the med student you won't be expected to cross cover, on some you are and this is torture). If you are not cross covering anyone formally, talk to your intern or resident and see how you can help them with cross cover -- even little things like putting in IVs or drawing blood or putting in NG tubes can really take a lot of the load off them.
As a fourth year, people want to see you acting at the level of an intern they want on their team. So, anything the intern is doing for his patients, you should be doing for yours. You won't always know the plan, but you are expected to look it up quickly and have some kind of plan by the time you present to your resident (unless there is something urgent/patient decompinsating, in which case you should bump it up quickly).
I've only spent 7 weeks on outpatient, so I can't help you much with the fam med thing -- maybe someone else can give you some pointers there.
Best,
Anka
p.s. If your sick, you should go in anyway. If your team isn't going home yet, you don't go home. And don't sit there asking if you can go home.
It is not as you seem I do not think. We round on patients but then it is OK to just follow the residents for the day and learn from them. This is good I think.
