Tuesday, March 27, 2018

Internal Medicine Clerkship Tips

Oh yes, the internal medicine clerkship rotation.  Where you will go to learn that you don't know shit about some arcane thing about an organ system you brushed over in physio because you were gonna pass the class anyways and had to bust your butt on biochem just to pass.

But really the best way to impress is to show up early, and be eager.  Yes, eager.  That's how my resident told me I can get a good grade.  When I say eager though, don't be overbearing and annoying.  There's a fine line between the two.  You need to show interest, be happy to help, and bring a positive attitude to the team you're working with.  This, along with trying your best, will be enough to get you good feedback.

Don't worry about having to know certain things and details.  The knowledge you need to know will come from your shelf studying.  More important for your clinical grade is being able to write good notes, and being able to present well.  That is, presenting with confidence and conviction.  You'll get better at these things as time goes on.

Make sure to use some kind of MS3 survival guide to focus your efforts.  I used this one: http://som.uthscsa.edu/StudentAffairs/documents/MS3_Survival%20Guide.pdf


Here are some general topics you WILL encounter in your medicine rotation.

Know the majority of the chest pain differential.
- MI, esophageal rupture, pneumothorax, pericardial effusion, PE, aortic dissection.
- These 6 are potentially fatal chest pains you must rule out.

Know the shortness of breath differential.
- PNA, PE, pneumothorax, asthma, copd are obvious ones

Know the abdominal pain differential.
- This is more prevalent for surgery, and I'll address it in the surgery post.

And finally, know what to do in certain emergencies, such as hyperkalemia.
CBIGKDie
C - calcium gluconate - stabilizes cardiac membrane
B - bicarb or beta agonist
I - insulin
G - glucose to go with the insulin
K - Kayexalate
D - Dialysis

You'll need to know more than this stuff of course, but for some reason these stick with me over a year after the clerkship.