Rotations in IM residencies

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DarkProtonics

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What are the rotations like on IM residencies? Do the fellows in the specific rotation area teach you whatever you're supposed to learn; ie in the cardiology rotation a cardiology fellow teaches you how to do and interpret an echo. And in a cardiology consultation does the resident just watch the fellow? Or do they just assign you to the rotation, and have you figure it out by yourself, w/ a fellow supervising you? Or is it some combination.

What is the cardiology rotation like in an IM residency?

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What is your question? Are you inquiring as to how much autonomy residents have during an IM residency where there are fellows?

At any rate, moving to the IM forum since this question is specific to that field.
 
What are the rotations like on IM residencies?
Usually you rotate for 1 month at a time on a particular medical "service". This could be the intensive care unit, general inpatient medicine, cardiology (where patients with heart failure, irregular heart rhythms, chest pain and heart attacks, etc. would be admitted) ...at some hospitals the kidney doctors, lung doctors, GI doctors, etc. also have their own separate "service" (i.e. have a med student, a couple interns, resident and a fellow and an attending taking care of a group of patients all admitted with a GI problem like liver disease, ulcer, etc.).

Do the fellows in the specific rotation area teach you whatever you're supposed to learn; ie in the cardiology rotation a cardiology fellow teaches you how to do and interpret an echo.
The teaching is often "self teaching" by following around the intern, residents and helping them when you are a student. when you are an intern or resident, YOU are the one taking care of the patient, writing the notes in the chart, ordering the medicines and often deciding on the treatments. YOU admit the patients to the hospital and discharge them. The fellow and attending dictate the ultimate plan (when they are there in the hospital) and they have the ultimate say over when the patient will go home. You won't learn to read echocardiograms as a medicine intern or resident. Cardiology fellows are taught how to do that, but not medicine residents. As a resident you might learn some VERY basic things about echo, but you'll be way too busy taking care of your patients, answering their family's questions, and writing a bunch of notes to be able to sit around learning to read echos.

< And in a cardiology consultation does the resident just watch the fellow? >
No. Normally if you are rotating for a month on the "consult service", other doctors will call you (or the fellow, depending on how your hospital chooses to do it), and then you and fellow will split up the day's consult requests. You'll work on 1/2, he'll work on the other if you are lucky. You'll go see the patient and examine him and write a note and see if you can figure out what should be done with him. After a couple of hours you'll meet with the "attending" and he/she will decide what to do, ultimately.

<Or do they just assign you to the rotation, and have you figure it out by yourself, w/ a fellow supervising you? Or is it some combination. >
As above. Sometimes you'll be on a rotation that doesn't have a fellow...i.e. it's just you and the attending. At my hospital that never happened in cardiology, but it sometimes did for other specialty areas. In that case, you have to handle all the requests for consult, see all the patients and write all the notes, then present all the cases to the attending doctor, who will tell you what to do. You basically suggest what you think should be done, if you have a clue. Sometimes you'll know, other times it will be really hard and even the attending will have to think really hard to try to figure out something to do for the patient, or whether anything CAN be done...that's internal medicine for ya!

<What is the cardiology rotation like in an IM residency? >
This varies according to what kind of hospital you do your IM residency in, and what particular hospital. Some of them will have interns do 1-2 months of cardiology "service", where they work on a team with another intern, one resident, one attending, and maybe one fellow (if you have a fellow...). Pretty much the interns do most of the paperwork, history and physicals on all the patients, ordering the medications, etc. The resident supervises this, particularly at night and whenever the team is on call or otherwise admitting patients (b/c you can admit patients even on days you aren't on call). Some hospitals also have a separate cardiac ICU floor where they keep the sicker cardiology patients (like ones who have bad heart failure or just had a heart attack). This floor you also might rotate on for a month per year (either as an intern, and/or as a resident). usually the team is either an intern and resident, plus attending (with or without a fellow), or it might just be a resident, fellow, and attending, with no intern. All this stuff really is hospital and residency-dependent. They all do it slightly differently. Even how much responsibility you have at each level of training is different from hospital to hospital. usually the med students are the ones "following around" people. The intern and residents WORK WORK WORK. that's kind of the story.
 
If you are really curious about how all this stuff is set up, there is a book called "First Aid for the Wards" that you could probably buy a cheap used copy of on Amazon or ebay. It kind of tells you how the typical work teams are set up in a teaching hospital, and what would be the roles of a med student, intern, and resident on the work teams.
 
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