IM clerkship

[obiwan]

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so just finished my first week of medicine and I'm pretty exhausted. i haven't really had too much patient interaction since I'm at the VA for the 1st month and it can get pretty slow. i feel like my team dynamics is kinda weird since my resident keeps more to himself like going on pre-rounds by himself without me or the intern. also, i've had 3 attendings for rounds in the past 3 days so I can't really establish any sort of relationship with them.

just wondering how your first week in medicine has been?

 

[getunconcsious]

so just finished my first week of medicine and I'm pretty exhausted. i haven't really had too much patient interaction since I'm at the VA for the 1st month and it can get pretty slow. i feel like my team dynamics is kinda weird since my resident keeps more to himself like going on pre-rounds by himself without me or the intern. also, i've had 3 attendings for rounds in the past 3 days so I can't really establish any sort of relationship with them.

just wondering how your first week in medicine has been?

Medicine generally sucks. Just be glad that at least it's slow. I do know what you mean about lonely rotations where there's nothing going on and no one talks to you. I'd bring something to read. Pro is that it's slow. Con is that you feel like you don't exist. This will probably happen to you again sometime in the course of MS3 but in some ways it's better than the rotations where there's way too much going on and you're working 80+ a week. I know I didn't technically answer your question (i.e. I'm an MS4 and thus not in my first week of medicine), but just trying to give you an answer since no one else has. Good luck, and hang in there!

 

[medstylee]

so just finished my first week of medicine and I'm pretty exhausted. i haven't really had too much patient interaction since I'm at the VA for the 1st month and it can get pretty slow. i feel like my team dynamics is kinda weird since my resident keeps more to himself like going on pre-rounds by himself without me or the intern. also, i've had 3 attendings for rounds in the past 3 days so I can't really establish any sort of relationship with them.

just wondering how your first week in medicine has been?

mine was very similar. i'm at our university hospital, where everyone is really sick. and it's not really the bread and butter stuff like copd and chf. our resident is so busy that she's never really around and i'd be surprised if she remembers any of our names. our interns are good, but they're almost as confused as us at this point. i spend a lot of time standing around pretending to play around with my palm pilot. it just feels like wasted time to me. i'll ask the residents/interns if they need help with anything and they always say "no, i'm ok for now." so then i just sit around waiting and wondering why they won't just let me go home and read. all in all, i don't feel like i'm learning much at all outside of reading at home. i'm looking forward to going to the va where i will supposedly get much better teaching and hands on experience. as of now, i'm really disliking IM.

 

[obiwan]

thanks for the replies guys, good to know i'm not the only 1 feeling like i have no role

 

[lyn2006]

I think it really depends on the team you're on. I'm in my second week of IM but my resident and intern have been great at doing a TON of teaching even though they're really busy. I also ask to do procedures any chance I get, and ask to see patients so I can help pre-rounding. And they're very receptive to all this. However, other MS3's at my hospital haven't had the same experience... hopefully you will be on a better team at some point!

 

[JustPlainBill]

I agree that it generally sucks. I do enjoy seeing patients and getting to hear real pathology sometimes but it's the prima donna nitnoy crap that makes it a generally sucky rotation.

In this particular IM department, there's a couple of attendings and a few residents that feel like the best way for people to learn is for them to squash them like a bug and make them feel like **** and point out the fact that they don't know diddly about medicine in front of a room full of their peers at morning report. Obviously, this proves how superior they are as human beings and that their defecation isn't odiferous.....

The intern is struggling to just survive, one of the residents evidently has an inferiority complex and figures that the quickest way to the heart is through the back, the other resident is cool and helpful but is really busy.

Standing around and wasting time seems to be the norm. Listening to 'lectures' and trying to look interested in some really basic material "Orthostatic hypotension is caused by what?" is an effort.

But it's only two months of my life and then I can move on.....just pass the freakin' shelf and final and get the piece of paper that says 'JustPlainBill, D.O.' .....

 

[lilzelda2]

I'm actually surpirsed at how IM works. I'm not sure if its just like this at the hospital I'm at now but we spend more time looking at lab reports and charts than we do talking to the patients. And everything is like consult, consult, consult. Or lets wait for the CT or the lab results.

All I know is IM was a possibility but now its Def. Not. Not to mention that I feel like I'm suppose to be learning way more than I am now.

 

[fang]

Some advice for the rest of your time on IM --

Even though it's slow and your intern/resident are not making things easy for you by ignoring you, you should probably take on a more active role:
1. Come in and see your patient before the intern does
2. Finish your note before rounds
3. Just before rounds start ask the intern if you can present your patient so they don't cut you off before you can start
4. Do all the work for your patient in the afternoon

Doing all of this while being minimally annoying will make for less work for your intern, which will probably translate into an honors. Good luck!

 

[medstylee]

after a couple more weeks IM has definitely gotten better. most of it has had to do with me trying to make the best of the time i previously spent sitting around waiting to be dismissed. if my patient had a CT or had a biopsy i go down to radiology or surg path and have someone read the result with me. if my patient is a newly diagnosed diabetic and they've just had diabetes education, i'll go in and quiz them on symptoms of hypo/hyperglycemia, etc. if my patient needs follow up appointments, i'll call up and make them (being on hold for 15 minutes actually eats up some downtime and i can read a quick article on emedicine or uptodate while waiting). these are things i probably should have been doing anyway, but i guess it's hard to know what exactly to do on the first week of third year...

if you're on inpatient medicine, i'd definitely recommend trying to pick up one really complicated case. it gives you the opportunity to go home and read up on the case and then make some suggestions on rounds that the residents or attendings probably haven't even thought of. the ideas might be over the top, but if you happen to pick up on a good lead you'll look fantastic.

 

[drdr2010]

i just finished my first week of IM (my first rotation). it was alright, a lot less busy/crazy/hard than i anticipated.

but i feel completely utterly useless! i feel like i create more work for my already swamped intern. we are only allowed to carry 2 patients max at a time. i pre-round on those, present them to him, then go with him to pre-round on the same patients. then he has to try and see all the rest of his patients (i go with him, of course) before morning report. then the whole team rounds for HOURS. i really love my team and i feel like i've seen and learned a ton, but i wish there was more i could do.

we are allowed to write progress notes in the electronic record, but they can't be used for billing purposes, so my intern still has to write his own note even if i already wrote one. we also switch attendings every single week and the senior on our team is so busy dealing with the ICU/step down patients that i have hardly even spoken to him. i'm not sure how to be more involved with him, since in addition to my intern, he is the only other one giving me an eval for my 6 weeks of inpatient.

we don't reallly get pimped during rounds, because the attending we have is super nice. i ask questions and he shows me and the interns cool imaging findings and stuff, but i'm just not sure what else i could/should be doing?? i know everything about my intern's patients and speak up when someone ask for a lab value, symptom, etc that my intern can't remember. other than though, i stand around and listen a lot. i haven't done any admits because we are only on call until 7pm and any day admits go to the non-teaching service team.

any suggestions on what else can i do to help my intern and not be such a waste of space?

 

[obiwan]

i just finished my first week of IM (my first rotation). it was alright, a lot less busy/crazy/hard than i anticipated.

but i feel completely utterly useless! i feel like i create more work for my already swamped intern. we are only allowed to carry 2 patients max at a time. i pre-round on those, present them to him, then go with him to pre-round on the same patients. then he has to try and see all the rest of his patients (i go with him, of course) before morning report. then the whole team rounds for HOURS. i really love my team and i feel like i've seen and learned a ton, but i wish there was more i could do.

we are allowed to write progress notes in the electronic record, but they can't be used for billing purposes, so my intern still has to write his own note even if i already wrote one. we also switch attendings every single week and the senior on our team is so busy dealing with the ICU/step down patients that i have hardly even spoken to him. i'm not sure how to be more involved with him, since in addition to my intern, he is the only other one giving me an eval for my 6 weeks of inpatient.

we don't reallly get pimped during rounds, because the attending we have is super nice. i ask questions and he shows me and the interns cool imaging findings and stuff, but i'm just not sure what else i could/should be doing?? i know everything about my intern's patients and speak up when someone ask for a lab value, symptom, etc that my intern can't remember. other than though, i stand around and listen a lot. i haven't done any admits because we are only on call until 7pm and any day admits go to the non-teaching service team.

any suggestions on what else can i do to help my intern and not be such a waste of space?

That pretty much sums up my first month at the VA. The attendings say I'm doing a good job but it does seem that I should be doing something more tangible to contribute to the team but since i can't write orders... any suggestions?

 

[yohimbine1]

There's way too much paperwork in IM. I don't like it. About to start my second month and not looking forward to it.