What was the internal medicine core like?
Well everyone, my first core rotation has come and gone. Internal medicine core was a 12 week rotation that included 8 weeks on the hospital floor and 4 weeks of electives. My electives included outpatient clinic and cardiology. A typical day would start at 6:45 am and we would go home around 4 pm, this was Monday-Friday with weekends off. We were “on cover” every 4 days which meant your team stayed until 6 pm that day. We also had one week of night shifts (8 pm- 8 am, Monday night through Saturday morning) during the rotation.
A typical day on the floors started around 7:00 am and usually began with morning rounds which was a lecture led by an attending and usually covered a patient who was admitted overnight. Then at 8:00 each team of residents and students would go to their floor and split up their patient list. A team consisted of one senior resident, two intern residents (PGY-1), two third year medical students, and one fourth year medical student doing a sub-I (internal medicine elective). Usually as a student you got to know 1-3 patients per day- this meant you knew all the details about your patient by reading their chart, meeting and interviewing them, and performing pertinent physical exams. Then, the attending would meet with all the residents and students to round on everyone’s patients. Rounding included presenting your patient, going in as a group to see and examine the patient and then making decisions on their care. At the end of rounds, attendings would typically sit down with the group and teach a topic for 15-45 minutes. Most days, we would have a noon conference with the residents where we ate lunch while listening to a lecture. In the afternoon, we had our own student lectures from 1:30-3:00 where we would do case presentations (a patient we had seen previously) or learn another topic from an attending. We would then help our residents with any new admissions from the ER by going down and doing full interviews and physical exams and then writing a History & Physical.
My outpatient clinic elective was a two-week long elective that was from 8 am to 4 pm Monday- Friday. I shadowed residents and attendings while they saw patients for follow up appointments or physical exams. It was a short, yet good experience in primary care.
The cardiology elective was also a two-week long elective. I worked directly with the cardiology attending during this elective. In the mornings, I would meet up with the attending and we would see her patients who were in the hospital or any new consults that she had for the day. She would review their ECGs or echocardiograms with me and discuss management of their conditions. She also taught me how to best hear and identify murmurs in patients. Mondays, Tuesdays and Thursdays we would then go to her office and see her patients. Wednesdays she would do stress tests, stress echocardiograms and echocardiograms in her office that I was able to observe and then review with her afterwards. On Fridays, I would go to the resident cardiology clinic where I shadowed the IM resident and cardio fellow while they saw patients for follow up appointments. I really enjoyed this experience!
What we loved about internal medicine.
Patient care: one of our favorite things about internal medicine was having the chance to form relationships with patients. As students, we had a lot of time during the day to spend with our patients that we were following. Lending a sympathetic ear to patients, I believe, is something special we are able to offer. It is quite rewarding to gain trust with patients and sometimes that trust can lead to discoveries that change the patient’s care plan.
Having to be inquisitive: something Denzel and I found to be enjoyable during our internal medicine rotation was having to search for answers and put together a full story when meeting patients. Patients would present with a chief complaint and it is then your job to dive into the full story of that patient’s presentation. This was not always easy, especially when interviewing patients who were talkers, had dementia, or were too lethargic to give a full history. We found ourselves often researching conditions and treatment options. I really enjoyed this part of internal medicine, I felt like I was constantly learning something new while working through patient’s cases.
Wide variety of presentations: in internal medicine, you see so many different patients of all ages (adults 18 and older). Even though most of the time patients had common illnesses (CHF, A.Fib, COPD, etc.), there was always an interesting case or twist.
Our personalities fit well in the field: we both felt like being “people persons” served us well during this rotation. It felt comfortable and natural to meet patients for the first time and get down to the details we needed from them. I feel like the more extroverted and open we were, the better response we received from patients.
The opportunity to learn from intelligent, well-rounded attendings and residents: Our program has a large internal medicine program with residents and attendings from many different backgrounds which I felt enriched our experience as students. We had residents who had previously practiced abroad, residents who used to be nurses, and several residents who went to RUSM. Every resident I met shared stories with me from their personal experience that I was able to gain insight from. We felt like no matter what question we came up with, our residents and attendings always had a good answer for us.
How we studied for the internal medicine shelf.
The resources we used for the internal medicine shelf included UWorld, Online Med Ed and this YouTube video by Emma Holliday. We also learned a lot during the rotation in the various lectures and in rounds. We were always looking things up on Up To Date for our patients conditions and a lot of what was tested we had seen as patients in real life! We also purchased and completed all the NBMEs for medicine shelf on the timed mode.
The shelf exam was 110 questions and we had 3 hours to complete it with no scheduled breaks. Overall, we found the exam to be quite challenging, perhaps because it was our first shelf exam. Also, for the first time in my medical school career I was presented with fill in the blank questions. There was about 2-3 of this style of question.
I would suggest starting UWorld questions and studying early, rather than putting it off until the last half of the rotation. I think starting with Online Med Ed plus some MCQs would outline the “expectations” for internal medicine studying. Like I said above, the information is broad and there is a lot to know. I wish I would have reread First Aid for the USMLE Step 1 before I started rotations since it had been a few months since I had seen all the material, I had to refer to my First Aid book multiple times while studying since a lot of the information is still relevant.
Some topics I would recommend mastering before the exam include and are certainly not limited to this list. These are just topics I remember coming up several times throughout the rotation and on the exam:
- Chest pain work up and the treatment of common causes of chest pain
- CHF work up and management
- UTI management and how to understand the results of a UA
- Syncope work up
- A. Fib EKG and treatment
- Management of common arrhythmias
- Liver enzymes and LFTs
- Management of DKA and treatment of diabetes (medication MOA and side effects)
- COPD exacerbation management
Comment below or reach out to me if you have gone through the internal medicine core rotation and shelf and have anything to add to this!
Are you going to IMF soon? Check out my blog post about my experience in IMF.