Rotation: Internal Medicine Wards

Name/Location of Clinical Rotation

IM wards (4 weeks) at our local University hospital.

What did I like most about this specialty?

Establishing a relationship with adult patients. Several of my patients gave me nicknames and would at least be happy to see me in the mornings. That, to me, was a great compliment. I also really enjoyed the hospital environment and even having call days where we’d rush down to the ED–it was so exciting! I also liked that we could do procedures. At the end of a call day, right before we were all getting ready to leave, we got a call from the ED about a patient that needed a paracentesis. The intern on my team passed on the opportunity, so my upper level asked me if I would like to do it…. and of course I said yes! So I got to do the full work-up: H&P, informed consent, and the procedure. That day, I really felt fulfilled. I know that in my future career, I do want the opportunity to perform procedures.

Plus, my team rocked. It always helps when your teammates encourage you and are enthusiastic about teaching. I think that’s another reason why I loved my month on inpatient wards.

What did I like least about this specialty?

In Kentucky, we see so much obesity, diabetes, and heavy smoking… and the consequences… that it can be draining to give the bad news about a person’s health. Giving the bad news is not fun. At times, patients were even upset with me and/or the hospital because of the bad news. Learning to apologize and learning to communicate with people despite bad news was a learning opportunity in and of itself.

Did this clinical rotation give me a good sense of what practice in this specialty would be like?

I really think that it does, apart from not really seeing what adult outpatient medicine is like.

Did my interests, values, kills and personality fit with this specialty? If yes, how did they fit? If not, why might they not be compatible?

I feel like they do–lots of work one-on-one with patients, and I felt like I got enough time with them that I wasn’t rushed. In the long-term, though, I’m not sure if the IM I’ve been exposed to has enough community involvement and advocacy/outreach that I’m wanting in my future career. That would take more investigation.

What are the possible practice settings exist for this specialty? Do any of them interest me and do I know enough about them?

There are so many opportunities in IM that it’s no wonder that most students apply to IM residencies. General outpatient, hospitalist, subspecialist… there are so many options and so many fields! I don’t think that two weeks on subspecialty was enough for me to make a decision about what type of medicine I’d want to practice long-term, but it was nice to get to see those things as well.

What info do I still need?

None. I feel like I got a well-rounded experience and that I understand the work and workload of what it would take to be a successful IM resident.

Has my perception of this specialty changed? If yes, how?

Yes! I was honestly dreading working with adults, but I loved getting to spend time with my patients. I didn’t really think IM was on my radar but now it at least has a chance.

Did my clinical rotation experience influence the likelihood of choosing this specialty?

I found that I really enjoyed working with adults more than I thought I would. I felt like I had great rapport with most of my patients, and I never once thought that I didn’t want to go to work that day.

Right now, how interested am I in this specialty?

Being my first rotation, I didn’t really have anything to compare it to, other than the two two-week subspecialty rotations I’d had. However, I am keeping IM on my list of choices; I definitely think I could be happy working as an internist.

What information do I still need to evaluate this specialty? Any other comments or reflections?

Our rotation gave us a lot of exposure to this field, and I have to say, I loved it. Also, working in more than one hospital gave me exposure to working with more than one EMR/EHR which I thought was a valuable experience.

Things I did not expect: We encountered a LOT more heavy drug users/OD’s and inmates as patients than I anticipated. And I was surprised by how at ease I was with working with them–even if a patient came in in an orange jump suit, giving them the best care I could muster was the same as I would give to any of my patients. I was also pleasantly surprised by how my assumptions were challenged by some of our patients.

Resources I used to study for the shelf: Step Up to Medicine and Case Files: Internal Medicine. This was a LOT of reading and a LOT of work to do during my first rotation while I’m still trying to figure out exactly what my role is as a third year medical student. I really wish I would have front-loaded my study time, as I didn’t get to read all of Case Files or Step Up. I didn’t even finish all of the UWorld questions in Internal Med (which has the most questions on the Step 2 Qbank). So I performed ok on the shelf, but I was disappointed in myself. Lesson learned.

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