I need more practice

Something that helps me (and this might be person dependent), everytime I read something, I scribble some notes and try to think out exactly what the ramifications of what I'm reading would be to patient care. I try to think of what in the physical exam/history can actually be realistically and reliably obtained from patients given your own time constraints and the relative health awareness of your patient base. I try to think what lab tests or imaging studies can rapidly narrow down a differential diagnosis, in particular weeding out or ruling in the most common causes on the differential list. I try to think of the side effects of the proposed treatment and try to imagine what threshold the severity of the patient's problem would have to be in order for me to consider using those treatments. But nothing really replaces actual clinical experience, being on a team managing several patients. If you don't really get that experience until your medicine rotation, well then you'll just have to aim to learn quickly then and work hard. Your surgery rotation will deal with several management issues, but your surgery team most likely won't spend the time in discussing their rationale behind those management decisions.