Majority of medical school rotations in a clinic!

[TimeforAction]

So I'm an IMG where all my medical school rotation experience occurred in private clinics. Even my IM rotation was in a private clinic! I had one rotation that was hospital based but I set up that up myself and my school penalized me for it (long story). I've graduated from medical school.

My question: What do I need to do between now and July 1st 2020 when I begin IM residency? I know the obvious answer is do additional rotations but I'm currently researching at a teaching hospital and due to my schedule and commitments I am not allowed to do rotation in another hospital. Is there a resource(s) that you recommend I review that will teach me the practical side of medicine so I dont crash and burn my first few weeks in IM residency?

Thank you.

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[Mass Effect]

Do you know that you have a residency spot July 1st? If you already have a spot (pre-match), then you need to figure out some way to do some IM observorships or something. I don't know how those work when you've already graduated, but you need to figure it out. Doing research at this point is not going to help you and you will likely be somewhat behind your peers if you've never done hospital IM.

 

[Dral]

Oof, pray you don't get an early ICU or nightfloat rotation.

I guess an observership is the best option.

How good are you with EMRs? That is another thing to concentrate on since inpatient is often different than outpatient in terms of the general idea of how the EMR is used.

 

[GoSpursGo]

Yeah, there isn't really an online resource that's a substitute for actual patient interactions. There's not much to be done about it at this point, but I'll echo what others have said in that if you can do some observerships before you start residency that would be a good idea (and might help if you wind up having to re-apply, TBH).

 

[TimeforAction]

Do you know that you have a residency spot July 1st?

Yes. I prematched in IM at a New York program.

If you already have a spot (pre-match), then you need to figure out some way to do some IM observorships or something.

So the good news is I was able to convince to the PD to allow me to do an observership. But still is there any resource I can read that can help prep for this clinically?

 

[TimeforAction]

Oof, pray you don't get an early ICU or nightfloat rotation.

I guess an observership is the best option.

How good are you with EMRs? That is another thing to concentrate on since inpatient is often different than outpatient in terms of the general idea of how the EMR is used.

I am using their EMR on a regular basis. So I have some familiarity with it.

 

[Mass Effect]

Yes. I prematched in IM at a New York program.



So the good news is I was able to convince to the PD to allow me to do an observership. But still is there any resource I can read that can help prep for this clinically?

I'll defer to my IM colleagues on a good IM text for you to read. Also calling out @aProgDirector in case he has any ideas.

 

[NotAProgDirector]

Doing an observership at the place where you'll be an intern is really your best option. You should be able to figure out real quick whether you're just a bit rusty or terribly unprepared.

If you're looking for an old fashioned book to read, look at Pocket Medicine (from MGH), Master the Wards (Conrad Fisher), or Ferri's Practical guide. I haven't looked at any of them for years, so have no sense of which is "best". You can at least browse some pages on Amazon for a few of them, and none of them are terribly expensive.

 

[Gastrapathy]

Do they have a traditional morning report where patients are presented?

 

[MedicineZ0Z]

Honestly for a quick and dirty overview, I'd start with the online med ed videos pertinent to inpatient IM. They are pretty basic but can help identify some knowledge gaps you might be missing since you have hardly done any inpatient as a med student (and they're free!). From there you can branch out to more specific resources, uptodate, etc to get a more advanced level of knowledge. I would also reach out to your PD or chief resident (whoever makes the schedule) after match day when they're asking for scheduling preferences for vacation time, etc and let them know that you haven't really done inpatient. They might be able to set up your rotation schedule to ease you into it, have you carry less patients, have a little extra help/support, etc until you get your feet under you a bit more if you feel like that's what you need.

I disagree with this. You don't want to paint yourself as being weak from day 1. It's better to stay your inpatient experience was very early in MS3 and that you want to ease back into it. Residents also get fired due to incompetence and we don't know the OP's program culture. No reason to make things risky.

So I'm an IMG where all my medical school rotation experience occurred in private clinics. Even my IM rotation was in a private clinic! I had one rotation that was hospital based but I set up that up myself and my school penalized me for it (long story). I've graduated from medical school.

My question: What do I need to do between now and July 1st 2020 when I begin IM residency? I know the obvious answer is do additional rotations but I'm currently researching at a teaching hospital and due to my schedule and commitments I am not allowed to do rotation in another hospital. Is there a resource(s) that you recommend I review that will teach me the practical side of medicine so I dont crash and burn my first few weeks in IM residency?

Thank you.

How is your program accredited if you did not do any inpatient? Also, no elective time?


Seriously, clinic rotations as a med student provide very little in terms of learning. Outpatient in general provides a fraction of inpatient learning.
Now if you were super active in clinic and were allowed to do A LOT and saw a ton of patients - then your clinical knowledge base should help you at least.

 

[TimeforAction]

Do they have a traditional morning report where patients are presented?

Yes I attend morning report and afternoon conference with the residents.

 

[TimeforAction]

How is your program accredited if you did not do any inpatient? Also, no elective time?

This is not to paint every Caribbean med school as the same. My medschool in particular was cutting corners and mainly gave us rotations almost exclusively in clinics. They discouraged us from booking our own elective rotations. They actually required us to pay more if we choose to do an elective outside their ****ty rotations. I never understood that policy. I booked one elective in 4th year where I had inpatient experience. I quickly realized how unqualified I was in that rotation compared to other American med students.

Medical knowledge wise, I preform well. Just the practical side of things is another story...

 

[TimeforAction]

Honestly for a quick and dirty overview, I'd start with the online med ed videos pertinent to inpatient IM. They are pretty basic but can help identify some knowledge gaps you might be missing since you have hardly done any inpatient as a med student (and they're free!).

Ya. I saw that they have an intern boot camp. Have you heard anything about it? I'm guessing by my situation, its best I do that course.

 

[MedicineZ0Z]

This is not to paint every Caribbean med school as the same. My medschool in particular was cutting corners and mainly gave us rotations almost exclusively in clinics. They discouraged us from booking our own elective rotations. They actually required us to pay more if we choose to do an elective outside their ****ty rotations. I never understood that policy. I booked one elective in 4th year where I had inpatient experience. I quickly realized how unqualified I was in that rotation compared to other American med students.

Medical knowledge wise, I preform well. Just the practical side of things is another story...

But why? What's the reasoning?

 

[TimeforAction]

But why? What's the reasoning?

Regarding?

 

[MedicineZ0Z]

Regarding?

Why clinic only and why no electives?

 

[TimeforAction]

Why clinic only and why no electives?

I had electives. All my electives were clinic rotations except one. The exception was when I found an inpatient rotation on my own and fought the school to let me take it. My school must have found it cheaper to send me to do rotations in private clinics than hospitals.

 

[AdmiralChz]

I feel the need to be honest here - Hearing this would make me very wary of accepting someone from such a school into a residency program. If you have no clue about hospital-based medicine, how are you even going to function as a resident? Yikes.

 

[TimeforAction]

If you have no clue about hospital-based medicine, how are you even going to function as a resident? Yikes.

Yes, its quite a predicament. Now you understand why I am looking to learn some clinical skills before beginning my observership and then residency.