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.

Internal Medicine Shelf Exam

I would love to tell you how to do well on this exam, but instead I'm going to tell you how I did, which is average, and how little I had to study.  My scaled score was a 75.

Now, I would have liked to do better, and I missed honors on this shelf by a few percent, but I'm here to set your expectations based on how I studied, so that you can do better.  Like I've been saying before, I'm a pretty average student, so most of you readers should get some benefit.  So here's what it takes to get an average grade.

First, start off your clinical year with internal medicine.  You won't know much of anything outside of step 1 material at this point.  Tell yourself how you're going to study really hard to do well on the shelf.  Start off strong by doing Pretest questions, and some Uworld questions.  Consider watching the Emma Holliday review video (link), and then don't actually watch it.  Consider watching the onlinemeded videos (link), and then don't actually watch it.

So far you're doing great, it's halfway through your clerkship, and you've done about 200/1200 of the medicine uworld questions, and about 1/2 of the pretest questions.  Most of your learning is being done at the hospital based on your patients and researching stuff on uptodate.

In other words, you need to kick it up a notch.  At this point you should get serious about studying.  Start breezing through uworld, and if you get something wrong, then learn that topic, and learn it well.  The books I used to learn stuff well was Case Files Internal Medicine, and Kaplan Step 2 CK.  I didn't even bother with Stepup, it's too dense for my liking.

Finally, you're in the last 10 days before your shelf exam.  You have about 300 uworld questions left, you stopped doing pretest, and you're only going to do the Emma Holliday review video because it's short.  Great! Now finish the questions, do 3 nbme practice exams, and watch the review video two times.  Take your test, and get an average score.

Next time:  How to honor your Pediatrics shelf because all it is is an internal medicine shelf.