I’ve been on my Internal Medicine rotation for almost two weeks now. For those of you unfamiliar, during your third year of medical school (or MS3 year), med students across the country spend a year rotating through various clinics and hospitals to get their clinical experience. My school provides clinical experiences during the first two years as well but the bulk of it is during year 3.
So what is Internal Medicine? An internal medicine doctor is trained to see adults. It is a three year residency (residency is specialized training you do after you graduate medical school) and when you’re done you can be a hospitalist (the person who admits patient to the hospital from the ER) or work in an outpatient setting in primary care. If you’d like you can further specialize by doing a fellowship in a specific field such as cardiology or gastroenterology (GI), or anything else.
Internal Medicine (IM) is one of the hardest rotations and it has one the hardest shelf exams during third year (shelf exam = the standardized exam you must take after each rotation ends). It’s hard because it is very broad and there’s a lot of details you must know. In addition, the hours are long so you have to make time in the evenings (or early mornings) to study.
Today I’m sharing one of my days on IM. Each day varies but it pretty much sticks to this format:
5:00 am = Wake up!
My current hospital assignment is about 30-40 minutes away depending on traffic. My official report time is 7am but my team usually gets there by 6:30am so I try my hardest to get there around the time that they do. I usually wake up, get dressed, and grab a bite to eat. I recently discovered that with my student discount, breakfast is $3-4 and I’m always tempted to just eat at the hospital but it saves time and money to eat at home. When I make breakfast at home, I usually opt for a frozen waffle, eggs, or smoothie, or yogurt + fruit depending on how much time I have. Sometimes I make a coffee in the am. I’ve been trying to limit my coffee intake for days that I’m super tired or didn’t rest well so that I don’t get addicted to caffeine.
5:30 am = leave the house!
The elevator in my building is kind of slow. By the time I get to my car, pull out of the garage, 5-10 minutes have already passed by. Best case scenario, I leave at 5:30 and get to the hospital early, but worst case scenario is I leave my house at 6am and get there at 6:30am on the dot. I hate rushing so I try to leave as early as possible.
6:30 am = Start pre-rounding (on my own)
When I get to the hospital I usually drop off my stuff in the resident lounge and then meet my team in the library to pre-round. My team is currently me, an MS4 who is on a sub-i (audition rotation for residency), a first year resident (PGY-1/ intern) and a third year resident (PGY-3). We have an attending (supervising physician who has finished residency and has been practicing medicine) however we don’t meet with her until later on in the morning.
Usually in the morning I pre-round on my own. This means that I am on the computer, looking at patient charts, seeing if there were overnight events from the night team, and seeing what labs and orders have or have not been fulfilled.
8:00 am = Pre-round with my PGY-1/ intern
After looking at the chart, I see the patients. Sometimes I go on my own but usually my PGY-1 comes with me and we see everyone together. During this time we visit the patients, do a physical exam, and think of the plan for the day. After seeing the patients I start my notes for each patient I saw and document my encounters with them and any updates from the day before.
9:30 = Pre-round with my team (minus attending)
In the morning, my team and I will meet up and talk about our patients together. We usually meet in one of the resident call rooms for this meeting. One of the key parts of the patient note is the assessment and plan (basically what we will be doing for the patient that day). I usually write my note on my own and share the assessment and plan with my team. They let me know if I’m on the right track and make sure I have covered all the key interventions for my patient’s stay.
10:30am = Attending Rounds
Around 10:30 we meet with the attending physician to round with her (or him). The Attendings I’ve worked with like to meet somewhere quiet to discuss each patient and then we go together to visit each one. During these discussions, we present the patients assigned to our team. This is where the pre-rounds with my team come in handy. I present my patients and end with the assessment and plan. By this time, I should have a pretty organized presentation and plan for each patient. Some Attendings prefer walking rounds where they go door to door and discuss the patient quietly in the hallways but the ones I’ve worked with so far prefer sittings rounds and then going to see the patients.
12:00 pm = Noon Conference
Every weekday afternoon we have noon conference with the IM department. Sometimes noon conference are practice boards questions, other times they are discussions about different topics pertaining to care. Either way, noon conference is always catered by the hospital so I never have to worry about packing lunch. The plus side is I save time and money but the downside is I have no self-control and really struggle with choosing the “healthy options”. I decided that I may start bringing my lunch but we’ll see. I’m trying my hardest to be healthy but it’s so difficult when yummy carbs and cookies are tempting me.
1:30 pm = Back to Rounds
I think in an ideal world, we would finish rounds before noon conference. Realistically, we usually finish up rounding on the last few patients in the afternoon after noon conference. When rounds end, we spend the rest of the day editing our notes, calling consults for our patients, updating orders and making sure everything is ready for the night team.
2:00 pm = Lectures
The medical students have required didactics about 2-3 times per week. Usually for about an hour a day we have a lecture specifically for us. I usually step away from my team for an hour and attend these sessions since they’re required. Yesterday’s lecture was on heart sounds and was very informative.
3:00 pm = PM report
I think these are required at my hospital for the students and residents, but recently my team has been so swamped that we skipped them #oops. Usually during this time, all the IM residents come together and discuss a case.
4:00 pm until end of day
We tie up any loose ends for our patients. Depending on their needs and reason for stay we check on them one last time. I try to finish my notes early and spend the rest of the afternoon helping my team with notes or calls or anything they may need. I usually leave somewhere around 6, although it can be earlier or later depending on what needs to be done. The residents stay a bit later and wait to do sign outs of the patients to the night floats.
6/7ish pm = workout/ study time
I am usually home by 7pm. Sometimes if traffic is very bad, I go to the gym next to the hospital while I wait for it to die down. When I get home I usually relax for 30 min to an hour and then try to study. Key word is “try” because I’m usually to tired or simply don’t feel like it after being in the hospital all day.
9:00 pm = Ready for bed
I created a rule that I will shut off all devices by 9. This way I can get ready for bed from 9-9:30. During this time, I do my bedtime routine, lay out clothes for the next day, pack my bag and my gym bag, and make sure to charge my iPad.
10pm = Bedtime
This is really important because I can’t function with less than 7 hours of sleep. I know some people survive on way less but I cannot. I know my body and 7 hrs is perfect for me.
That’s pretty much my day in the hospital. Some days are “call days” which means that it’s our teams turn to “admit” or accept patients from the ER who need to stay overnight in the hospital. Those days are really busy so while we’re following the schedule above, we’re also getting pages from the ER asking us to come see patients that we need to admit. Post-call days (the day after call days) are also kind of hectic since we have to follow up on all the orders we placed the day before for everyone.
Honestly, this schedule is very do-able for me. I think it’s because I did a good job with work-play balance. My school gives us 1 day off per week (usually Sunday’s for me) and that’s my day to sleep in, grocery shop, get my nails done, or whatever. A lot of my classmates really dislike the schedule of Internal Medicine, but I really don’t mind it. I’m at this hospital for about 2 more weeks. And then I have another 4 weeks of IM at a different hospital so this is pretty much my life for a while.
Hope you enjoyed a behind the scenes look into my day! Also I hope this kinda of explains why I’ve been a bit MIA here recently. Recently I’ve been going home too late to study or even write a blog post. As much as I enjoy IM, I’m looking forward to my next rotation because it has a much lighter schedule.