Internal Med at the U

Orientation on day one, they will go over grading criteria, basic expectations, and give you a so-called 'power-chart' training which is so brief that if you blink, you'll miss it, so before hitting the wards, or that first day, call the IT people to make sure you are on it, and then get on it and spend an hour figuring where to find everything. You will be place on a team with 1 resident, 2 interns, possibly a sub-I and 1-2 med students. You'll have a team room on the 5th floor of the hospital that is your home base. You can leave your bag, books, etc. in there. There are computers in the team room, but remember that the resident and interns always have priority over you. Most team rooms have a fridge where you can store a lunch.

Typical day: Morning report is at 7:45 and you have to have seen all your patients, done the physical exam, and written your note by 7:40 so you can make it to morning report on time- what time you need to show up in the morning depends on how many patients you are following and how long it takes you to get your stuff done. Remember, if you haven't read up on your patients problems and you are not adequately prepared to defend your plan for the day, you'll need to show up earlier to do the reading you need to do. Usually show up 6:00 to 6:30. Morning report goes from 7:45-8:45-8:50. Look up those lab values that you were waiting for that hadn't come back yet, and be ready to round by 9:00. Most teams meet in the team room before heading out. Some attendings round in the team room, some round in the halls outside the patient rooms and then you go in to see them after saying hi, and some do bedside rounds (if you do this, know your plan in and out and be careful of what you say in front of the patient! -leave crazy psych or emotional stuff out, and don't say stuff in a differential that is going to give the patient a heart attack or make them super defensive...yes I did this). Rounds usually take a few hours, but it depends on your attending and how many patients are on your service. After rounds, help get stuff ordered and arranged for your patients. Do reading. Some attendings assign you a topic to research and give them a presentation on during this time. 12:30-1:30 noon conference. You must attend. They usually have lunch for you. One day a week you will have to attend science of medicine instead of noon conference, and one day a week after noon conference you will have topics in medicine w/ the chief resident who will teach you about EKGs, ABGs, etc. 1:30 to whenever... Either you will have new patients to work up, more work on your current patients, check in on them, or research to do on your patients' problems. End of the day= when the resident tells you to leave. Never just leave without finding out what else needs to be done.

Schedule: Q4 call. Long call, post call, short call, golden... and repeat. Long call- show up at 6 am and work all day and night (some residents allow students to switch off staying over night, some require all students to stay over night, I think being there over night can be a good educational opportunity sometimes, and sometimes is a waste). Post call- you've been there all night and you need to leave by noon (to stay within 30 hr work shift limits). Again, don't leave until the resident tells you to do so! Short call, your team admits until 5 on weekdays. You could be there until 5, or until 8. Golden, your team admits until noon. You could be there until 3 or 4. You get one day off a week. oh, and post-call rounds start at 7:00am instead of 9. You are not required to go to morning report or noon conference on post-call days. If you are on a specialty service, you don't have overnight call, but you will have long days (admits from 6-6 or so every day).

Responsibilities: Be on time. Know your patients inside and out. Know their problems. About their diseases- know what causes it, the epidemiology, the typical symptoms, the diagnostic work-up, and the treatment. If you want to reach honors, you have to take initiative yourself. The interns are not going to baby you so you can achieve this as most times it is just easier for them to do it themselves. You have to beat them to the punch in terms of knowing what tests to order, putting in the orders on powerchart for them to co-sign, making follow-up appts for the patients, etc. This is tough to do when you have to spend time away at 'awesome' science of medicine meetings, etc.

Read, read, read. Read a review book. Read on your patients (some attendings like you to read uptodate, and some hate it). Do questions. Make a schedule and goal of how many questions you'll do and pages you'll read every day or it will just fly by you and you won't have read anything. Be ready to be pimped and always sound like an idiot no matter how much you study, but let the pimping help your study. Some of these attendings know A LOT and what they pimp you on is extremely useful info.

How do you hide a dollar...
How do you hide a dollar from an orthopod? - Put it in a book.
How do you hide a dollar from an internist? - Put it in a wound.
How do you hide a dollar from a plastic surgeon? - You don't.

... a joke with a lesson... make sure you do a good physical exam on your patient. If they have an abnormality, know everything about it... pull the dressing out of the wound if you must. You are the one on the team with the most time, so you are expected to do this. Also, if you can't accurately describe a lesion or abnormality that you are sending for a consult, with the onset, frequency, severity, etc. of symptoms, they are just going to be annoyed with you for wasting their time. Doing a good exam can be difficult if you are going in there to see the patient for the first time with an intern as they end up doing most of it and you have no idea what they were noting as they were doing the exam. Either ask them or go back and do the exam again yourself.

As scary as it is- it is awesome, and I am loving it so far. Good luck, and see ya around.