internal medicine wards {a day in the life series}

This was my first rotation as a third year med student. Needless to say, I was in for a shocker. 

5:30-6a wake up and get ready for the day. I learned soon enough that dressing comfortably is the key. Comfortable shoes and professional outfits. No low v-cut necklines. No micro mini skirts for me. I wore a lot of black pants in the beginning. Then as i got more and more depressed, I realized I need to wear what I want to wear. Not what I think 'the wards' want me to wear. Halfway through, I started pulling out my skirts (below the knee, or just a little bit above) and wore my pinks and bright colors. 

7a meet the team for sign out. As med students, we listened in during sign out of the on-call person to the day team. 

7:15-7:30a we received our patient  list from our interns/upper level residents. 

7:30-8:15a pre-round. Time to look at charts, look at significant events overnight. Talk to nurses about the patients and actually see and examine them. The number of patients per student depended on how fast a learner a med student is, or how many the residents think one can handle. In the beginning, one or two is plenty! At some point, I might pre-rounded on 4 patients. There were 4 med students in my team. I was the only female. We had 2 interns or pgy1s and one upper level resident. 

8:15-8:45a morning report. This is a learning opportunity led by chief residents for the students and residents. Usually, a case is presented. Typically a patient case from overnight. History and physical exam findings are discussed. Then differential diagnosis and work up listed. At the end, there will be a few announcement. Sometimes updates given regarding old cases discussed on past morning reports. 

8:45a-9a meet up with our interns to discuss our assessment and plan. Our interns were so awesome. They made sure we look like we know what we were doing in front of our attendings. That's something I gave back when I was a resident. I made sure I touchbased with my students and gave them pointers for their plan.  

9-10:30/11a table rounds and bedside rounds. Student doctors present the SOAP format. 

Subjective: what happened overnight. Any significant events or crosscover issues.  

Objective: vitals, Physical exam. Meds. labs. 

Assessment: one liner with patient's age, pertinent history and working diagnosis. This is the perfect time to wow your attending with your long list of differential diagnosis. 

Lastly: plan. It's not expected for med students to know everything about the plan. It's definitely a resident level to know all work ups. (Even at the resident level, management is a learning process) But it will help you get that honors in the wards if you have an idea or at least thought about what you want to do. That's why talking with your interns and residents  before rounds is important. they will help guide you. 

11:30-noon: write orders if not done yet,  talk to families, discharge patients, call other teams for consults, call social work or case manager etc. 

12-1p noon conference
Another lecture format geared towards residents. But usually med students are also invited. Unless there's a lecture  just for med students that day. It's basically eat lunch and learn. 

1-4p continue writing orders, check up on your patients, call consulting teams, talk to nurses, read notes from OT or PT or consulting teams and implement their recommendations. Write daily notes. 

If our team was the admitting team that day, part of the afternoon is admitting folks from ER. The ER resident will page the intern for the admission. The intern then gives the med students the patient's info. I've gone down to the ER quite a few times to see a patient, interview them, do an exam and come up with my impression and plan. I then presented the history and physical exam to my residents. A lot of times I presented again to my attending. If I admitted a patient, that's another note to write. 

I had an amazing upper level resident during my internal medicine month. He always made sure to give us mini lectures in the afternoon. Even if it's just 10-15 minutes. 

He also let me perform a lumbar puncture, help collect sputum (not so glamorous), perform I/O catheterization, intubation and other procedures. 

4-5p sign out. If the resident or med student is not on call, this time is closing time! As a med student, I didn't have to give changeover to another med student on call. I usually gave updates to my resident if something came up about my patients that he didn't know yet. Then he signed out all of our patients to the on-call/overnight resident. 

As an MS3, I was required to take 4 calls. But they were not overnight calls. I stayed till 10p until I was sent home. 

When on call, I saw patients at the ER who needed to be admitted. Basically I repeated what I have been doing since 7a and kept doing that till 10p. See patients, write notes, call consults if needed. 

In our institution, staying till 10p is called short call. It's not an overnight call so it's short. I didn't like those nights bec I still had to get up early the next day. And there was also no time to study during those short calls. I ended up sleeping around midnight and then only getting 5 hours of sleep. 

For books: I used the following:
Step-up to medicine
Washington Manual of Medical Therapeutics
Case Files

I used pubmed and OVID for my literature search and evidence-based medicine.
For textbooks: there is Cecil's or Harrison's.

Previous post on the series: USMLE 
Next up on the series: a day in the life of outpatient internal medicine

Thank you for reading! I can be found on:
 photo 561d1e96-3aca-407d-8f85-e05427ba2d2a_zpseiwtzqml.jpg

No comments:

Post a Comment

Thank you for your comments!

Related Posts Plugin for WordPress, Blogger...