Medicine SubI for education's sake?

[Perrotfish]

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So I'm coming up on the end of my medicine rotation, and I feel like my education from this particular clerkship has been pretty sub-par. I've gotten a lot of patients who mainly needed social work when I had patients at all, there hasn't been a lot of teaching going on, and there's only so much the MKSAP can teach you. I'm not interested in being an Internist, but I do feel like I should have a basic handle on Internal Medicine if I'm going to be a doctor. So, opinions: is it worth subjecting myself to a medicine Sub-I just to get some more experience with medicine? My school has 7 months of electives, so I do have some time to play around with here.

 

[rachmoninov3]

ask yourself: did the sub-i's have a better experience? If not, consider doing a medicine sub-i somewhere else. Other considerations are:
1. depending upon what you want to do, you will get a lot of medicine your intern year.
2. You might also consider an inpatient family medicine (lots of medicine, generally slightly more laid back and social work isn't AS big of an issue)

 

[Perrotfish]

ask yourself: did the sub-i's have a better experience? If not, consider doing a medicine sub-i somewhere else. Other considerations are:
1. depending upon what you want to do, you will get a lot of medicine your intern year.
2. You might also consider an inpatient family medicine (lots of medicine, generally slightly more laid back and social work isn't AS big of an issue)

Just about everyone in the clerkship, SubIs and MS3, has had a better experience than me. I talked to the clerkship director and he said that I really 'drew the short straw' and that he would do absolutely anything to fix the situation other than do anything to fix the situation.

I guess my biggest concern is looking incompetent during Intern year. I'm in the Navy, so I have to reapply for PGY-2 and if/where I am selected is going to be based largely on how I perform during the first half of Intenship.

The family medicine thing is a good idea (I already have 6 weeks of FM core coming up, though I wouldn't mind adding elective time) but do you really think that will replace IM? I've also considered electives in Cardio, GI, Renal, and/or ID, but I don't know if any of those things would be as good as a general IM sub I. Other opinions?

 

[rachmoninov3]

at my school you can choose to take 2 weeks of your two month FM rotation as inpatient. Usually the service is heavy on adults and really light or nonexistant peds population, so you get a lot of I.M. Email or call your clerkship director or point person and see if you can do two weeks of inpatient. Then you'll have a better idea of if you think you should do an I.M. sub-i or not.

best of luck!

 

[C5toC9]

there is such thing as inpatient FM? isn't that like an oxymoron? i've never heard of inpt FM.

 

[cpants]

there is such thing as inpatient FM? isn't that like an oxymoron? i've never heard of inpt FM.

Yes there is inpatient FM at a lot of places. In most academic centers, at least in urban areas, they don't admit peds cases.

 

[Jolie South]

there is such thing as inpatient FM? isn't that like an oxymoron? i've never heard of inpt FM.

My school's FM program definitely has an inpatient service.

 

[confuse]

I think it depends on what your school allows you to do as a SubI. Do they really treat you like an intern (ie. putting in orders, respond to floor pagers)? If they do, then I would say definitely if you want to be more prepared for internship. If your SubI means you will be like an M3 with just some more responsibility, then I don't think you will gain much from your experience. You will probably be better off picking an elective in the field that you feel weakest in. Looking back through my rotations, I haven't learned more from carrying a larger load of patients. Most of my learning come from the teaching of my residents/attendings (real teaching, not random pimp questions) and listening in to those lectures/conferences held for interns.

 

[C5toC9]

that's interesting. i just always associated FM with outpatient clinics and have never seen one that admits patients.

 

[rachmoninov3]

Family medicine does a lot of cool things C5C9 (we just don't get paid as well). First assist on C/S and some laproscopies, doing the prenatal care, the deliver, then the well child care, and while i'm cheering for my chosen specialty, the great thing on inpatient service is that there is usually less socialwork B.S. and your attending or attending's collegue knows this patient.
Less social work issues: patients have a PCP, otherwise they wouldn't be on your service. No matter their income, this helps in kind of a self-selection way to see people who are motivated to have a PCP. This usually makes discharge much easier.
You could have John Doe come in completely post-ictal, unable to give a good history, but if Mr. Doe has been seeing attending XYZ for years, you can easilly call or access old records. Granted, the old records thing works for anyone, but it does save a lot of time if someone knows them personally, and you don't have to start from old ER records that say they're John Doe.

stepping down off my soap box...

Good luck in rotations everyone!

 

[IHeartNerds]

I've gotten a lot of patients who mainly needed social work when I had patients at all, there hasn't been a lot of teaching going on [...]

This sums up the entire field of internal medicine. The Sub-I won't be any better. If you want to learn general medicine, do an ER Sub-I - you can discharge the patients you can't do anything for, or give them to the medicine services.