{Internal Medicine}

WOO! Folks, I’m {almost} officially done with my Internal Medicine Clerkship. I’m still waiting on my OSCE score, but I got my shelf score back. I definitely didn’t do anywhere near as well as I want, but I kind of expected that. I had SO much going on during this clerkship as a result of moving into our house and, on top of that, internal medicine is just so FREAKING all-encompassing, AGH! I’m proud of myself for successfully transitioning from second to third year. Honestly, it was harder than I thought it would be. People always tell you how much different the non-clinical years are from your clinical years — and they are right.

During my first and second year, I heard upperclassman and professors talking about how amazing clinical years are, but I didn’t really know what to expect. I’m here to give you a little preview and then some pointers based off of my experience.

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{Internal Medicine Clerkship: Typical day} 

This is hard because there weren’t really any “typical days.” The clerkship at OUWB is broken up into three parts: night float, outpatient clinic and inpatient floors. I’ll forgo explaining night float since I already posted about it, here.

For clinic: I spent two weeks at the resident’s clinic, which is located in a building on the Beaumont hospital campus. Some of my other classmates went to locations more off-site for their outpatient clinic, ranging from 5-40 minutes away from where most of us live. My clinic hours were about 8AM-5PM depending on how many patients were scheduled for the day.

[630AM]– WAKE UP! [7AM]– head into the hospital, I’m lucky & have a two-minute commute [7AM-745AM]– review patient cases for the day, catch up on any misc. things [8AM]– clinic duties start [NOON]– grab lunch & attend noon lecture w/ the residents [130PM]– afternoon clinic duties start

Clinic responsibilities for me really changed based on which resident I was working with that day. Some residents let me go see/interview/examine patients on my own and then present the case to the attending after discussing with them. Other residents had me more in a shadowing role. I was writing notes on patients and looking up various topics on UpToDate in my spare time between patients. I really enjoyed clinic because I felt like I had more time to talk to each patient than when I was on the floor. My *tip* for the clinic is to try to look up your patients at the start of the morning so you have a little bit of time to look up any weird medications or diagnoses on their chart. I always felt more prepared when I did this.

For inpatient floors: I spent four weeks total on the inpatient floors {for those of you who don’t know what this means, it’s just seeing patients who are staying in the hospital vs. outpatient clinic is more like a walk-in doctor’s appt}. During this time I was put on a team with one intern {first-year resident}, one senior resident {second or third-year resident} and one sub-I {fourth-year medical student}. I really enjoyed working with the same team because it meant I always knew what to expect and there was a lot of consistency.

[545AM]– WAKE UP! [620AM]-commute & head up to the floors [635-7AM]– read up on patients’ events overnight [7AM-9AM]– check up on old patients/take history & physical for any new patients [9AM]– morning conference {all the resident’s & students & some attendings go over an interesting patient case from beginning to end} [10AM]– table round w/ attending on old patients {this means we talked over each patient and their updates over the past 24 hours} [11AM]– visit old patients w/ attending [NOON]– grab lunch and attend noon lecture {lecture w/ residents on various topics} [130PM]– table round or bedside rounding w/ attending on new patients *Our rounding schedule varied based on the attendings schedule. Most days we were done rounding no later than 3PM {except for long-call we rounded from about 5-630 PM}. But, every team functions differently. After rounding, you have time to finish up all of your patient notes and see if your intern/resident needs any help. For the majority of my classmates, I’d say our floor hours were about 645AM-430PM on any day except long-call.

When you hate waking up early, but know surgery will be way worse.

544AM when you hate waking up early, but know surgery will be way worse

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12PM grand rounds lecture

Finally, heading home after long-call.

836PM finally, heading home after long-call {we have 13ish hour long calls}

My floor schedule was very variable based on what “day” we were on. At Beaumont Hospital internal medicine has several different “days” that indicate how many patients the team will take on. For example, on Admit 1, 2 and 3 days our team would take a different # of new patients. For teaching day we wouldn’t take any new patients, but we would present different topics to our attending that we researched the night before. For night float pick-up we would take two new patients who were seen by our night team the evening before. For long-call, we would take 5 new patients and be on the CPR team, which meant any adult codes that occurred in the hospital our team would be running the code. You can see that the day to day schedule can be highly variable based on which day your team is on.

*Tips* for floors include: 1) Always ask your team how you can help them 2) Learn how to write a good note, it will serve you well for other clerkships 3) Practice your oral presentation skills- you are constantly presenting to different attendings during the medicine rotation 4) If you can look up interesting research that pertains to your patients and present this to your attending when rounding {my attending told me this advice at the end of the clerkship, LOL thanks} 5) Start questions as early as possible, but seriously don’t procrastinate

Internal medicine was incredibly challenging because of the volume of information. I personally wish I had started on UWorld questions earlier on {there are literally 1300 lol} and would have tried to dive deeper into my patients’ cases. Friends who did well on this clerkship really learned a lot while they were on their clinical duties. Sometimes this is just luck of the draw based on how much your team is willing to teach or how often you ask questions!

At the very least, internal medicine definitely helped me reach my step goal everyday!

At the very least, internal medicine definitely helped me reach my step goal everyday!

Pros & Cons 

So, an upperclassman told me that since I’m technically undecided on what speciality I want to go into, I should keep a running list of pros & cons for each clerkship that I can reflect on next year when applying for residency. Thought I’d do that here so we can all benefit. Overall I really enjoyed my first clerkship and it was WAY better than sitting in class all day. I had no idea how much learning the residents still do {they attending at least two lectures a day}, on top of all the learning they do just with each patient case.

PROS: Huge patient population giving you tons of variety // Lots of fellowship options to choose from if you want – cardio, GI, endocrine, etc // Interaction with lots of different physicians due to consultations w/ dermatology, infectious disease, cardiology, etc // You treat patients for some of the most deadly conditions in our nation aka cardiovascular disease

CONS: Numerous social issues to deal w/ in the elderly population such as hospice, palliative care, etc {not necessarily a bad thing, just difficult to deal w/ in this day and age because of insurance issues} // You refer out a lot to specialists, so sometimes it feels like you really aren’t helping certain patients because you need a specialist to deal w/ some of the complex issues // You deal with a lot of very sick patients, many of whom are non-compliant {in comparison to pediatrics where the many of the patients do very well}

Well, I hope this was informative for those of you who haven’t done this clerkship yet & gives the M1s/M2s/pre-meds a little inside look into how a clerkship runs. I’ll be doing a little review like this for all of the clerkships as I go. 🙂

PS stay tuned for my #giveaway later this week.

X/O A

{How to Study for Anatomy}

Hi, everyone! Hope you are all having a lovely day. In Michigan, it’s quite a hot one today! I will be spending some time studying on my back porch in the sunshine! I was super lucky and got done with my floor patients around noon today, holla! I recently got some questions about two specific courses at OUWB called AFCP and BFCP. These courses are basically an anatomy course and a foundational science course. I gave some advice to a friend, so I thought I’d share with everyone my tips on how to study for anatomy. This advice will probably be applicable to any school that has a course dedicated to gross anatomy and works with cadavers.

A little background — I worked in a cadaver lab for three years at the University of Michigan and really enjoyed my time there. This sounds crazy to anyone not in medicine, right? Who likes to spend time with corpses? Well, for me, I learned a lot about the donation process and donating your body to science. I have such respect for the people who are selfless enough to give their bodies to science to help us learn.

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LOL, this is from before my MSK exam. My friend fixed him, don’t worry. On that note, let’s get started.

#1 & #2

You really need to have a great anatomy atlas to refer to. When I took anatomy we were given the Netter’s atlas, which I highly recommend and basically is a little mini-bible for anatomy. Find a copy here. The second item that is super key is the  Grey’s Anatomy Review questions, which can be purchased here. Honestly, I would say these two books [or two similar books] are absolutely essential and worth the $$.

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#3 In regards to anatomy lab

Don’t waste time in the lab! Many schools, including OUWB, spend extensive numbers of hours in the lab dissecting. Some people complain and say they don’t learn in the lab, BUT you need to set yourself up to learn. I recommend coming prepared to the lab so you get the most out of it. For me, this entailed looking up all the structures I knew I would be dissecting/looking for that day. I would use Netter’s and highlight away and even sometimes black out terms and write them in myself. I would look up anything I wasn’t sure about including muscle actions, bony processes, etc. The more familiar you are (you don’t need to know them by heart), the more you will get out of the dissection. Secondly, some schools, including mine, have several students dissecting each body. Meaning some people aren’t necessarily dissecting every time they go to lab. My lab group had these “extra” people pull up lecture notes and quiz the group on key concepts or, if everyone was clueless, that person would try to teach the information to us while we dissected. This was super helpful because many questions came straight from lecture notes on our written exam.

#4 In regards to the lab practical

Many schools require students to take a lab practical that entails walking up to a body, being prompted with a question (and usually timed) and then you answer and move to the next body. We had roughly 50 questions on our practical for each midterm/final for anatomy. For this what you want to do is be sure to see as many bodies as you can in the lab. For our school, there were about 20 bodies that were fair game for the practical. Once you start dissecting you will see quickly that everybody is SO different. The general pattern is the same, but you will want to be oriented to as many bodies as you can. Outside of lab time head into the lab and practice finding structures on a few bodies that you didn’t personally dissect. This will help immensely! I always went in with friends who were in different lab groups and we would quiz each other on the bodies. Also, if your class is willing to work together to set up a mock lab practical, that’s what my class did!

One other tip for being successful on the lab practical is to make sure you know which structures are fair game. For OUWB pretty much everything is — we get questions about muscles, nerves, muscle actions, bone landmarks, radiology images, etc. DON’T FORGET THE BONES! Bones are such easy points if you’ve looked at the images even just a few times. But, remember to try to orient yourself to each bone in several views. For example, I got a scapula on a tray once and they asked what a specific bony prominence was, but the scapula was rotated in a way that wasn’t exactly “normal.” I had to re-orient myself to realize what they were asking me!

I hope these tips help; feel free to comment any other questions below!! Oh, PS always study anatomy in the beautiful sunshine, because most of the anatomy labs have no sunlight {except OUWB, #humblebrag}! Wish I had my sunny porch during 1/2 year!

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X/O A

Advice for the Noobs {aka M1s}

Wow, the past four weeks have been an absolute whirlwind. I spent two weeks on night float, another two in the resident’s clinic and now I am working with the internal medicine team on the inpatient floors. Aside from my crazy school schedule I’ve been attempting to study, moved my entire life into our new home and finally am starting to feel settled! I will post pictures of our house soon, I absolutely love it! And more on finances, etc in medical school and how in the heck we managed to purchase our first home in an upcoming blog post.

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On to the REAL topic of this post! So the new OUWB M1’s just started Monday (yay!) and I thought it’d be a good time to get some tips out there for how to start with your best foot forward. I can’t believe my first day of medical school was two whole years ago — time seriously flies.

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As much as I tried to prepare myself for what was to come, you can’t ever truly be 100% ready. There are a lot of unknowns in medical school and sometimes you never see what you could have done better until after you’ve made it through the storm. So, I’ve got some tips for the newbies now that I’m post-step1 and in clinicals.

  1.  Be very careful about what you triage. Every exam is going to have a very large amount of material on it and thus some inevitably gets triaged to the side as “less important.” Although I think this is OK and sometimes necessary, be cautious when picking and choosing what to triage. I can confidently say that nearly all information from years 1/2 comes back either for Step 1 or in clinicals. Focus on getting a good understanding of each disease, it’s pathogenesis and some of the high-yield facts about it. In addition, focus heavily on nailing down microbiology and pharmacology and you will definitely not regret it!
  2. If you are struggling in one organ system get the help you need sooner, rather than later. Organ systems tend to build off of each other so understanding each section is important. Obviously, some topics you will feel weaker at. For example, I have a tough time with renal, but I still tried my best to understand as much as I could.
  3.  Make an impact in at least one student organization or within research. First and second year is really the best time to do this as your involvement may gradually decrease due to the business of 3/4 years. Plan to really invest some time in at least one extracurricular activity that you are very passionate about.
  4. I’ve said this before, but I’d recommend getting some type of long-term study aid. A lot of people I know use Anki cards or Firecracker. I think this is much more important during 1/2 years than clinicals. It’s really hard to remember things when you aren’t seeing patients, so sometimes having a reinforcer gives you that extra time seeing material that you need.
  5. Reach out to your elders {cough, cough me or any other upperclassman}. Seriously, we have been through exactly the same thing you are going through and honestly, we have better advice than advisors who never actually went through medical school. Find a few people that you trust and go to them for advice as much as you need! Don’t be afraid to reach out via Facebook, text, etc we won’t bite!
  6. Don’t stress out  too much. I know this sounds nearly impossible, but just try to keep in mind that school is school. Although it is incredibly important, it is not the end of the world to do poorly on an exam or even fail something. Everyone has a different life path and what matters most is that you are doing the very best that YOU can. Try not to pay attention to other classmates, just do what works for you. I can personally say that one thing I absolutely do not regret is taking time for myself during 1/2 years. Maybe I got a little bit lower grades than other people that put in more effort, but I had a very enjoyable experience (up until step 1 — more on this later). Try to start each day with at least one positive thought and remember that you were chosen to be at your medical school. If all else fails, here is a link to the best motivational clip ever. I watched this right before I took my Step 1 exam: Here.

 

Well, I’m back to studying for my internal medicine shelf. Stay tuned for my synopsis on a typical day on internal med!

X/O A