Halfway There!

29 01 2012

As of Friday, my internal medicine rotation was over (and this marks not only the halfway point of MS3, but the halfway point of my MD/MPH journey).  While the shelf was no fun, I mostly have good memories of the clerkship, and I’ve had a number of people tell me that I’d make a good internist.  At the moment, as far as the career choice is concerned, it’s between internal medicine or pediatrics. 

Overall our clerkship was relatively well-run.  One big difference that I noticed was I had a significant amount of time to work with actual attendings instead of just residents.  In psych, there were 4 residents that the 4 students worked with, and while students presented patients to the attendings at rounds, there was no other real contact with them.  Their evaluations for us were basically written from the residents’ feedback.  In family medicine, I was at the resident clinic, working with a different resident every half day and never with the same person for more than 3 half-days.  There were 4 attending physicians at that site, but I worked one half-day with two of them, 2 with another, and the last one evaluated me without having worked with me at all.  Because there was never any consistency with who I worked with, the residents never got a chance to now what I was capable of or what I should have been doing, and I didn’t have time to figure out 15+ different sets of expectations that they had for me.  Not surprisingly, my evals for that one weren’t great, but can you blame them?

I’ve said this before, but I loved internal.  It was a ton of information to learn, and I had a lot more clinical responsibility than before.  The first month (night shift followed by cardiology) were 98% observational, but then it got real.  During inpatient, there was an expectation that I would be the primary contact person for the patients, and for the patients that I admitted and followed, that was the case.  I gained the confidence to walk up to patients and their families and establish myself as a caregiver (even though I didn’t truly make any real decisions).  I became better at educating the patients, explaining the breadth of what was happening and what they could expect in the future. 

And in outpatient, I started answering their questions independently of the attending, counseling people on things like diet recommendations for kidney disease and how the patient with Hep C should never take Tylenol and how a spacer is just as good as a nebulizer in COPD exacerbations, or to use distilled (not bottled) water in the Netty Pot, and how important it is for diabetics not to eat too close to bedtime.  Of course I told my attending everything I had said to the patients, just in case, but it was pretty awesome to play doctor every day.  It was the coolest thing ever when one lady came back for a repeat visit and her peak flow readings were almost normal, she grinned at me and said thank you, she’d taken my advice and she was breathing so well that she was walking with her husband again.  All I did was tell her to take her inhalers every day even if she felt good, which seems trivial and simple, but most of the population receiving the healthcare doesn’t understand.

I’m grateful that we were tested so often during the clerkship, too.  Every week was a TBL quiz on a different organ system, and every month an exam on the 4 preceding topics.  So by the time we hit the shelf, we’d already been tested on everything twice.  It was a giant pain in the neck to have quizzes the day after Thanksgiving and New Years weekends, but in the end, if nothing else, it helped me to learn pattern recognition and what the testmakers are looking for when the write the questions.  And truthfully, having that schedule helped keep me on my A game throughout. 

Going into this second half of the clerkship, I feel better about almost everything.  My notes are better, my presentations are way better, and my ability to remember the patients and their stories is better.  When I started this year, I actually had to write out my presentations before I gave them.  Now, I can (at least for my clinic patients) go into the room without my notepad and still have a decent and organized presentation when I report to the doctor a minute later.  Obviously I have a long way to go and my presentations are far from finessed, but it’s rewarding to see some real signs of improvement in myself.

The people running the clerkship were also fantastic and easy to talk to.  The clerkship coordinator was organized and very responsive to student concerns.  The clerkship director was really chill, very straightforward, and was truly an advocate for the students’ best interests.  Having such great people working behind the scenes made the clerkship somehow seem easier and much less chaotic. 

So internal medicine is finished, and tomorrow I start the trek through vaginaland (aka Ob/Gyn).  True to clerkship form, I won’t know anything about my schedule until I get to orientation.  At this point, I’ve learned to roll with it. 

Until then, I’m going to enjoy the rest of my free Sunday afternoon J




One response

14 10 2012

Hello my friend! I wish to say that this article is awesome,
nice written and include almost all vital infos.

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