I'm in the middle of week 2 on my internal medicine rotation. Before beginning the rotation, I was apprehensive. I thought I was going to be worked to the bone, rounding all day long and not getting any time to study. And, therefore, I didn't think I was going to be very enthusiastic about going to work.
Much to my surprise, my experience has been very positive. Work here is efficient. The hours are manageable (about 8-9 hours on average/day). We don't round all day, and I'm not getting scutted out. I'm being given my own patients. I work them up on my own and consult with my team. I'm actually involved in the care decisions. I do exams, help with orders, follow lab results, and do presentations on rounds. I feel like I'm actually doing something significant rather than running around in some endless academic exercise.
I've seen several interesting cases, ranging from syncope to adrenal insufficiency. I'm sure I'll see a lot more by the time this rotation is done. After rounds, I get plenty of time to read on my patients. I'm learning so much. Because I'm not saddled with 10 patients to care for and I'm not being a scut-monkey, I can think about the underlying pathology, diagnosis and treatment of the patients we're working with.
The environment is very cerebral. My teammates are very kind. The attendings, residents and my classmates are all smart, professional and fun to be around. I was expecting this rotation to be all business. Getting pimped every second. Scolded for not knowing enough, or getting shot down for not being a "good enough medical student." But nothing of the sort has happened. Rather, I feel respected and part of the team. I enjoy discussing cases that aren't even mine with the residents and students in the workroom.
I also feel a new motivation and urgency when I'm studying, and therefore, it sticks. I see patients. I don't know something. I look it up. I've got my ipad on me, so I'm reading UpToDate, Harrison's, doing my Anki. It's just a flood of information, all day. In conference, someone drops a nugget of wisdom, and I capture it on Anki so I can remember it another day.
All in all, I'm very satisfied. Finally, after nearly an entire year of dragging along unenthusiastically through most of my rotations, I'm now experiencing what I had always hoped this year would be. I like coming to work. I'm learning. I'm excited. Things are good. :)
So I wanted to comment a little bit on my workflow and resources that I'm using on the rotation.
I've got my iPad on me at all times, so that's my go-to device for all my reading.
For general studying, I keep my computer on me so that I can make Anki cards easily.
I use a mix of resources depending on my needs. For specific treatment guidelines for patients, I use UpToDate as a first-line and also PocketGuide. If there is a good nugget in them, I'll make an Anki card on the iPad or computer.
For general studying of medicine, I've been reading Step Up to Medicine. I cross reference with PocketGuide if Step Up's treatment guidelines are too vague. I don't bother remembering specific doses or anything, but I prefer the more precise, current recommendations of PocketGuide.
For differential diagnoses, I use Diagnosasaurus app on my iPad. I'll also sometimes use Medscape for DDx or treatment guidelines.
Then of course there is the venerable Harrison's Principles of Internal Medicine textbook. Lots of people keep this in their bookshelves, but because of its size and length, few people use it everyday. But now, with iPad, I can keep Harrison's on me all the time. I've got it on my favorite e-reader, Inkling. I thought Harrison's was going to be too verbose and long for my needs, but I was wrong. It's extremely well written and the figures are fantastic. Step Up is great for making factoid flashcards, but I sometimes want to read a story in prose, and Harrison's is the best for that.
In particular, I think Part 2, which is the Clinical Manifestations of Disease section, is a must-read for learning what different symptoms mean in terms of underlying diseases. When we see patients, we see signs and symptoms. So that's the starting point for thinking about a diagnosis. Therefore, for a fledgling physician-to-be like me, getting some basic understanding of what different signs and symptoms mean is crucial. Part 2 of Harrison's has chapters such as "Syncope" or "Headache" or "Chest Pain". These go through the etiologies, pathological processes, treatment/approach and diagnosis of these symptoms. It's only about 300 pages. I'm not trying to remember every single fact from these, so I read them when I have some downtime without making cards. A little chapter everyday ends up being a lot by the time this rotation is over. That's my goal.
Also, physical exam. I feel pretty deficient in my exam skills. I thought I was going to be doing really comprehensive exams on this rotation, but that hasn't been the case. Even the residents kind of cut corners. So I've been reading when I can to try to improve my skills. Bates (little) pocket guide has been good. I also have Sapira's, but it's a little verbose. Schwartz' Textbook of Physical Diagnosis is also quite good. I try to read a little bit here and there as needed. The clinical urgency of needing to know something before going to see a patient or right after makes the reading I'm doing stick so much more.
Anyway, that's it for now. I'll try to keep this blog updated. For the med students out there, if you've got suggestions, I'm all ears.