please describe an IM residency 4 me

[EclecticMind]

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Hello,

I'm one of the unfortunate few that is torn b/w FM and IM. I am now a 2nd year and I have heard from several people that a residency in FM is like doing 3rd year rotations for 3 years and that you're never treated with any respect. I have also heard from people that describe IM (general) as incredibly boring. Please give me some first hand advice/opinions that will hopefully give me better insight as to what a residency/career in IM is actually like. Thanks!

 

[DrQuinn]

So, Dr. edinOH, what do you think of the sensitivity of the Legionella Urine Antigen?

Well, Dr. QuinnNSU, I have read reports where the sensitivity is 97% but the specificity is a palty 83%.

-In interrupts the IM PGY3, "I have to disagree. True, the sensitivity is 97%, but the specificity is a much stronger 84%... there was a new article on it in the Annals of New Journal American Medical England Lancet, I suggest you get yourselves a copy as it may change your usage of the test."

Q, DO

 

[maxheadroom]

Depends upon what you want.

If you want the opportunity for sub-specialization (Cards, GI, Hem-Onc, Pulm, Critical Care, Renal, Rheum, etc) then obviously you need to go IM. If you enjoy the more cerebral practice of medicine (coming up with weird infections, strange renal problems, blood dyscrasias) then IM is your deal.

If you want Peds contact, some OB/Gyn (ugh), and the more general practice, then FP is probably your deal.

Don't worry too much. As a 2nd year you have more than enough time to decide. Don't pick a research year for anything other than your own personal desire. While it might impress a few IM faculty, lots of people go to strong Medicine residencies without a big research background.

Wait and see how third year goes before starting to worry.

 

[DrMom]

Originally posted by QuinnNSU
So, Dr. edinOH, what do you think of the sensitivity of the Legionella Urine Antigen?

Well, Dr. QuinnNSU, I have read reports where the sensitivity is 97% but the specificity is a palty 83%.

-In interrupts the IM PGY3, "I have to disagree. True, the sensitivity is 97%, but the specificity is a much stronger 84%... there was a new article on it in the Annals of New Journal American Medical England Lancet, I suggest you get yourselves a copy as it may change your usage of the test."

Q, DO

ROFLMAO

I spent 1 day with IM residents & thought I'd have to shoot myself!

Of course, I'm glad that there are people out there who actually find such discourse stimulating. 😉

 

[sanfilippo]

I have to agree with the above post regarding subspecialties. In family medicine you're limited to subspecialities (geriatrics, sports medicine). In internal medicine you have more flexibility. I am considering IM strongly because I like diagnostic challenges and the need to keep reading up on things...at least till I subspecialize (primary care vs. subspecialty is a whole other topic).

Family medicine is largely confined to the outpatient realm; you do have inpt. experience, but most FP's gear themselves to general health surveillance (Pap smears, mammograms, flex sig, etc)., preventive medicine, and common clinical problems. IM outpatient encompasses most of this with the exception of not dealing with much gyn or pediatric issues, although women's health "fellowships" are becoming more frequent these days in IM.

Just my two bits
-S.🙂

 

[EclecticMind]

thanks for the replies, and yes, I do think that I would enjoy knowing that I could further my training if I wanted to. But I'm still curious about what an IM residency is like. You know, the "typical day" type stuff.

thanks

 

[Silvertip]

Check out scutwork.com. Most residents describing their programs explain their hour-to-hour/day-to-day activities.

Grizzle

 

[odoreater]

Originally posted by QuinnNSU
So, Dr. edinOH, what do you think of the sensitivity of the Legionella Urine Antigen?

Well, Dr. QuinnNSU, I have read reports where the sensitivity is 97% but the specificity is a palty 83%.

-In interrupts the IM PGY3, "I have to disagree. True, the sensitivity is 97%, but the specificity is a much stronger 84%... there was a new article on it in the Annals of New Journal American Medical England Lancet, I suggest you get yourselves a copy as it may change your usage of the test."

Q, DO

The EM attending then chimes in "So what # would I call for the consult to teach me what to do for a patient with legionella?"

 

[P Diddy]

Originally posted by odoreater
The EM attending then chimes in "So what # would I call for the consult to teach me what to do for a patient with legionella?"

That's completely inaccurate and insulting.

The ED attending wouldn't even see the patient.

Instead, the PA/resident would call various services repeatedly after giving the patient the standard ER antibiotic (moxi or Zosyn), whining repeatedly until the patient either signed out AMA or medicine helped them out with the patient's management.

 

[Renovar]

Originally posted by P Diddy
That's completely inaccurate and insulting.

The ED attending wouldn't even see the patient.

Instead, the PA/resident would call various services repeatedly after giving the patient the standard ER antibiotic (moxi or Zosyn), whining repeatedly until the patient either signed out AMA or medicine helped them out with the patient's management.

Yea, and the medicine call attending/resident kept on getting called and will start cursing the ER resident's grandparents for calling for the "nausea/cough" admissions at 2 am. And they'd be real cynical the next morning and either pisses off the patient so they sign out AMA from hospital wards, or they'd bust out a discharge summary and send the patient OTD. Which results in the patient bouncing back to the ED the same night with same symtpoms, but of course, it will be the next ward team on call's responsibility now.


BTW: Zosyn is kinda mad big gun for ED... My ED just loves IV levaquin, which is the bane our (the IM crew) existence. "Oh! Meningitis... 500 mg levaquin.... Oh! Bacterial Endocarditis... 500 mg levaquin..." ARHGHGHGHGH!! I hate that antibiotic with a passion.

 

[ckent]

Originally posted by QuinnNSU
So, Dr. edinOH, what do you think of the sensitivity of the Legionella Urine Antigen?

Well, Dr. QuinnNSU, I have read reports where the sensitivity is 97% but the specificity is a palty 83%.

-In interrupts the IM PGY3, "I have to disagree. True, the sensitivity is 97%, but the specificity is a much stronger 84%... there was a new article on it in the Annals of New Journal American Medical England Lancet, I suggest you get yourselves a copy as it may change your usage of the test."

Q, DO

It's funny, when I first read this, I didn't get this because I thought that the IM resident was making a valid point. If the specificity is much stronger, that might change your clinical decision. I guess you that's why I'm going into IM.

 

[odoreater]

Originally posted by ckent
It's funny, when I first read this, I didn't get this because I thought that the IM resident was making a valid point. If the specificity is much stronger, that might change your clinical decision. I guess you that's why I'm going into IM.

Just shows you the mind-set of your friendly shift-working, triaging, shot-gun medicine promoting emergency medicine resident.

 

[Apollyon]

Originally posted by odoreater
Just shows you the mind-set of your friendly shift-working, triaging, shot-gun medicine promoting emergency medicine resident.

Witty and incisive, and not instigatory. Bravo!

 

[Whisker Barrel Cortex]

I thought I'd give an answer to the original poster since everyone else is just bickering.

Internal medicine residencies vary in the types of rotations you do. Most have a combination of 3 types of rotations:

Ward rotations: May include general medicine and subspecialties (cardiology, ICU, hematology, oncology, etc). Whether there are other subspecialty services depends on the program. These are the tough months. Round or preround around 7 am, round with your staff later in the morning, and do work during the day. Take call every 4-6 nights and admit patients. There are innumerable permutations of the call and admission protocols. Almost all programs will have a morning report where an interesting case is presented and teaching points are given. Most will have some other conference during the day. Average hours range from 7-6 with some days leaving at 4pm and some at 9pm.

Consults: Subspecialty consultation in any of the specialties. These include cardiology, gastroenterology, endocrinology, oncology, pulmonary, hematology, rhuematology, infectious disease and others. These months you consult on patients on general medicine or surgical services. Generally, these months have no call or less call and you learn a lot about the specialty.

Clinics: Vary greatly from place to place. The program I did my inteship had month long clinics ranging from Veterans Hospital clinics to university health clinics. Also, all residents will have a continuity clinic. This is in addition to regular responsibilities. Usually 1 or 2 half days a week you see patients in your own clinic with a staff overseeing your work.

Again, each program will vary, but this is the general framework. Its actually pretty interesting at times and very busy most of the time. You're usually busier on call than surgical teams except for the trauma team. You will be surpised after just a year of medicine how much more you know about the effects of medicines and how to treat diabetes, infections of every sort (I took care of several epidural abcesses), myocardial infarcts, and many many more specialties than your surgical counterparts.

With that said, I have since moved on to radiolgy. Medicine is interesting and it is the gateway to some very interesting specialties. In the end, the difficult patients have chased me into the dark rooms. Good luck with either FP or IM. Either way you have much more patience than I do.