Internal medicine is a vast specialty covering all major organ systems, common diseases, rare diseases, and everything in between. Not even a seasoned internal medicine specialist can possibly know it all. The excellent news is that most Internal Medicine attendings don’t expect a third-year medical student to know it all.
How can you make a good impression with so much to do and learn? We’re here to provide valuable insights and suggestions to help you make a lasting impression during your internal medicine clerkship.
Here’s a list of helpful suggestions to get the most out of your IM clerkship:
Be Prepared for Rounds
It may seem self-explanatory, but you’d be surprised how far a little bit of promptness and preparation can get you. Have all your assigned patients seen and notes written before rounds start, then show up when and where you’re supposed to be. The motto “early is on time and on time is late” is good to keep in mind! Plan to arrive 5-10 minutes before the scheduled time. You will feel much more relaxed with a chance to get a little “breather” in before rounds begin, and it will help keep you on time when unexpected things like long elevator waits and traffic jams in the hallway inevitably occur.
Self-Care for Your Day
Long days at the hospital can be draining. It is important to make sure you are taking care of yourself. Your physical health, mental health, and well-being matter for yourself and for your patients! You can offer the best healing when you first care for yourself. Be well-rested; prioritize sleep and relaxation during your time off as much as you can. Eat a good breakfast and carry a small snack, such as a granola bar, in your white coat pocket (if allowed). Carry some money with you to buy food as needed. Avoiding distractions will also help keep you focused and help you get as much as you can out of your learning opportunity, so it’s nice to have good habits early, like avoiding checking social media and personal email while working. If you are feeling overwhelmed, reach out for help early and often using school, healthcare, or national resources*(see information below).
Be a Team Player
Good patient care isn’t a one-person job but a collaboration. There will be times that you are asked to do tasks that might seem mundane or repetitive, or jobs that involve things that have an unpleasant odor, etc. There is a learning opportunity in everything, and keeping a positive attitude and showing enthusiasm for everything you do, no matter how small or undesirable the job might be, will go a long way to making a good impression as a team player. Remember you are helping a person, and patients can tell when you are unhappy about what you are doing. You will work your way up to exciting procedures, but a doctor needs to know how to do every step of patient care well, so willingly take the opportunity to practice whatever you can, as much as you can.
Know Your Patients
Take the time to review your patient’s charts thoroughly. Know their medical history, how they presented, the plan of care, and the interval changes that have evolved during their illness and treatment. Get to know your patient and their personal goals for their health and their hospital stay. Thinking ahead to what barriers to healing the patient may face after discharge and working with the team to try to address these will help your patient maximize their recovery.
Understand Your Patient’s Diagnoses
While there are any number of questions a medical student might be asked during rounds, it’s most likely you’ll be asked about your patient’s diagnoses. For instance, if your patient has atrial fibrillation, be ready to discuss risk factors, ECG findings, complications, and common treatments. Don’t expect yourself to know it all right away; use your resources to read about the condition overnight or during lunch and make notes for yourself to carry with you.
Be Considerate of Your Team
Another student on your team may be asked a question during rounds that you know the answer to. Give them the opportunity to answer first. If they don’t know and you’re given the chance to answer, it’s your opportunity to shine. Remember, though, that people may have any number of extenuating circumstances going on in their lives that can make their day difficult, so have compassion for someone who is struggling, offer to help if you can, and avoid judgment. The medical community is very connected, and the people you meet on rotations will be your colleagues throughout your career as a physician.
Leverage Other Members of the Care Team
Nurses are often THE most in tune with the day-to-day and even minute-by-minute circumstances of a patient’s care and can offer a quick synopsis of information that may not be included in the patient’s chart. Politely introduce yourself to the patient’s nurse (ideally not during their shift change), and ask them how the patient did overnight and if there were any note-worthy events that occurred. Do this after checking the chart so you are up to speed on what has already been documented. Ask if there is anything specific they would like addressed for the patient during rounds (and be sure to follow up!). Don’t forget to consider the physical therapist, nutritionist, specialist consultants, and other team members as good sources as well!
Recognize the Value of the Residents on Your Team
Often, a resident physician will be assigned to your internal medicine team who knows the facility, where to go for information, and has an established line of contact with the attending physician. Try to establish a good rapport with your resident early on, as they often serve as the great equalizer of the team. Willingness to work and enthusiasm for learning typically make a good impression. If a resident is taking the time to “quiz” you about a topic or teach you something, don’t be intimidated. Take it as a compliment that they are investing themselves in your education.
Engage In Didactic Activities
Most internal medicine rotations take place in established academic medical centers with scheduled didactic activities like morning reports, lunch lectures, and a monthly tumor board. Take advantage of scheduled didactic activities for additional learning. Be attentive, ask questions, and identify areas for further study. This is also a great time to learn about different physician roles and specialties. Feel free to approach a speaker after a lecture and learn more about the path they took to get there.
Make Time to Study for Your Shelf Exam
Depending on the specifics of your rotation, internal medicine wards can create a demanding schedule. Don’t forget that there will be a test at the end of the rotation! Make time to study and consider more efficient methods of studying (like watching Osmosis videos). If you have a long commute, podcasts can be helpful or incorporate listening to tutorials while working out or taking a walk. Another tip is to record yourself reading your notes while you study, and then you can play it back to yourself when you have downtime.
Know Your Audience
Medicine attracts a wide variety of personalities. Your team, including the attending physician, resident, and other medical students on service, will likely have a unique dynamic. Try to be engaged and meet the team where they are while staying true to yourself. Avoid polarizing topics and terms that others may find offensive. Always be mindful that in a hospital or office there are usually other people around you who can hear your conversation, and especially exercise care when speaking outside of patient rooms. Avoid photography of any kind while on rotation. Often, patients or patient information are visible in the background, and even images or information without patient identifiers are protected. Not only are there serious consequences for unauthorized photography in healthcare but patients are putting their trust in you to guard their most sensitive information.
Stay Humble
Keep in mind the intensity of this rotation, the amount of material being covered, and the variety of ways your patients may present. There is no way to master it all, so set realistic expectations, and don’t hesitate to admit when you don’t know something—it’s an opportunity to learn.
We hope Osmosis contributes to your success in clinical rotations. We wish you the very best for your internal medicine rotation!
*P.S. If you or someone you know is in crisis and needs support, here’s the number for the U.S. National Suicide Prevention Lifeline: 1-800-273-8255 or text HOME to the Crisis Text Line at 741741 or visit www.iasp.info/suicidalthoughts/ for international resources. You are not alone.
About the Authors
Randy Davis, DO, is a Clinical Content Editor for Osmosis from Elsevier, with a focus on Internal Medicine clerkship content. He’s an Internal Medicine physician with sub-specialty training in Pain Medicine and completed his medical education at the UNT Health Science Center in Fort Worth, Texas.
Christine Strunk, DO, is a Question Writer and Editor for Osmosis from Elsevier. She completed her medical education at Philadelphia College of Osteopathic Medicine, followed by residency training in Family Medicine.
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