Internal Medicine Rotation Requesting Help (Please Help)

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Racecar142019

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Hello,

I am about to start my IM clerkship, and I would like some help from the internet. I have a few questions as well and I will make this simple to read:

1. Can anyone send me a full perfect IM clerkship history and physical write-up sample to use in the rotation? I would like to see how it appears for this specific rotation and would like to shine starting on my first day.

2. What are my expectations? What am I to expect on my first day too?

3. What are the best study materials for this shelf exam? I was going to use Uworld and first Aid for CK but would like to know from other people what was most effective and simplest to use.

4. What kind of questions would attending/residents pimp me on the spot? I would like knowing the intel before going into the battlefield.

5. What is the ideal schedule for this clerkship? Balancing clinical duties, shelf studying, and studying for pimping me on the spot questions.

Thank you for your time and help. If other questions come up I will edit this post.

God bless you.

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Your question asks a quite a lot but isn't particularly focused so I'll provide general tips. Also, given that you are nearly a mid-M3 you should have some level of insight into this from your other rotations.

1. This is specific to your team and potentially institution. I don't have any saved on my computer or else I'd share but I highly suggest you make your own, None are "perfect". As a medical student I recommend using an entire sheet per patient until you learn how to boil it down to a notecard or row on a scutsheet. Don't "templify" the HPI. One area that would serve you well to template is the medical history. For that get a sense for the chronicity of each condition and link their medications to their condition. All conditions can be characterized so leave room for that (ex. DM is either IDDM or NIDDM, you'd do well to know the latest HbA1c, and know of any complications-retinopathy, neuropathy).

2. Your expectations are to be able to obtain an H&P on a patient and have some semblance of a plan. Your residents will most likely guide you (or even take over midway through). YMMV. On the first day, expectations are to have developed proficiency in that (ex. not report ROS in the Physical exam section, the report is in proper order, have a plan that makes sense). You are not expected to be right and the attending/residents should be able to kindly point you to where you're messing up. Don't make the same mistake again.

3. UWorld is all you need and should have time for. Don't use any textbooks. Just read the explanations and take minor notes if needed. Watch OnlineMedEd.org to supplement weak areas. Note that wards/boards are very different entities. OnlineMedEd markets itself as for the Boards and the Wards but it's way more useful for the boards. Anticipate significant differences between how you are lectured to do things and how they are done. For an analogy to you, UWorld is almost your own little lab you go and learn things in, in a vacuum.

4. Pimping questions vary. Some attendings/residents try to use medical students are parrots to recite basic science from Step 1 for the team to collectively review (what is the mechanism behind pre-renal AKI). Others try to guide you through clinical reasoning and if you don't know your job is to give your best educated guess and to keep going (is this an AKI and what work up will you do). The attending's trying to get you to get to the answer yourself. Some may ask you obscure factoids about their pet topics that you're not supposed to know yet and you just have to give your best educated guess and move on.

5. Again varies by institution. Find out what time you need to pre-round with your residents (NOT WHEN ROUNDS START). Show up 30 minutes prior to pre-rounds per patient. Allot 10 minutes to following up on notes/labs, 10 to actually seeing the patient and doing an focused interval history/exam, and 10 to discussing the plan with your senior resident/intern. Typically rounds start right after pre-rounds. They're usually much longer and they're where you'll be "pimped". Stay engaged. Afterwards you'll likely be dismissed for lunch while your residents work. If you have notes to write, finish them before or after lunch. Where you'll differentiate yourself from mediocre students is actually following up on the labs, plan etc. from the morning on patients. During this time residents will be busy with discharge work, case management, etc. Don't fall into the trap of being lulled to sleep after rounds and checking out to do UWorld or whatever. Try to stay focused and from 7-5pm or whatever your hours are. Ask residents questions but don't be too annoying about it. If the residents really want to ignore you then have a book or laptop with you. What I do which is well-reviewed is that whatever I'm doing whether it's a discharge summary or case management I'll pull my medical student and just start verbalizing what I'm doing out loud with them and give them the opportunity to ask questions. They can alternate between that and UW. Not all residents will do that. At some point after rounds until you leave an admission may come and these are usually given to medical students if interesting. You should be able to do the H&P, etc. within an hour and have a plan to discuss with the resident. Again it doesn't have to be right. Then before you leave you signout your patients to the night float or call team. This is an important skill to learn. The purpose is to give the bare minimum but essential facts about your patient teams need to know overnight without boring the resident and then give a contingency plans (if X->Y) and be prepared to answer questions the on-call resident will have.

Hope that helps. Your question is a little too broad.
 
When I did my first medicine clerkship 4 years ago, the only resources I needed to get 99th percentile on the shelf exam was brosencephalon anki deck (was a lot less organized back then than it is now), uworld, and step up to medicine (read like half the book).

For pimping questions on the floors, you should know the bread and butter workups and management for typical medicine stuff: AKI, Hyponatremia, Cirrhosis, CHF, COPD, acute coronary syndrome, etc. onlinemeded has short lectures for all these topics that you can watch to prep.
 
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