Internal med rotations

[leviathan]

I'm curious how everyone's IM rotations are set up. How many days/week are you at the hospital, and how long are you there on an average day? How often is call? How many patients are you expected to see? What procedures do you get to learn, if any? How much free time do you have, if any? Do you have time to study things after you get home or do you do all your learning in-hospital?

[Steve-0]

I haven't started my clerkship yet (do next month) but have spent some time on the MTU. Days generally start around 8-9, and depending on whether time is set aside for you to examine your patients in the morning you may need to be there beforehand. Rounding is done in the morning/early afternoon and anything that needs to be done (tests, labs, etc) is completed after that. Generally the team goes home around 4-5 after quickly reviewing important cases again. This is the case Mon-Fri. Clerks will be on-call as well though. It is 1 in 4 call where I go, which I think is pretty standard, so each 4th day you stay in hospital overnight until you are relieved the next morning (at 10am by the 26 hour rule we have in Alberta). Generally they try to make it fair so everyone gets the same amount of weekend call. The number of patients each clerk is responsible will vary by site and the size of the team, but 3-4 would prob be reasonable.

 

This is what I have seen at least. Let me know if your experiences have been different.

[justletmein]

I would like to do my rotations at that hospital...

 

in my experience days are more like 8-6

[Smurfette]

This is my experience at one hospital in one city.

 

Morning report 8-9am

See your patients 9-11am

Interdisciplinary rounds 11-12 noon

Noon rounds 12 noon - 1pm

Do stuff for patients 1pm until 6pm-ish or whenever you're done.

 

I had meetings with my team for informal teaching 1-2 afternoons/week, half-day lectures 1 afternoon/week, and physical exam and chief resident teaching 1 afternoon/week. On days when stuff is scheduled in the afternoon, I found it's really busy scrambling to get all my work done in the couple hours in the am or in the hour or two after noon rounds. Try to be organized and order all your tests (esp. imaging) in the AM so that stuff gets done during that day.

 

Plus call is approx 1 in 4. Which means usually 1-2 nights/wk plus 2 weekends a month. You're done post-call ~11am next day.

 

UofT is probably a little heavier on the teaching than other schools.

[national]

highly dependent on the school and hospital

 

community hospital - lots of clinical, less teaching

 

tertiary centre - usually the opposite

 

but that's not always the case. depends on your attendings, residents, how many other students at the time, and just general luck of the draw with the type and number of patients presenting while you're there.

 

i've done IM at different hospitals. at one, clerks were essentially expected to function as interns - lots of responsibility. at another, they just took up seats at morning report.

 

you can really anticipate most IM rotations will be at least 8-5, with approx. 1 in 4 call.

 

on IM rotations - be proactive. if you want procedures, ask for them. if you want specific clinic experience, ask for it.

[Lactic Folly]

A caveat: if an opportunity to do a procedure comes up, not jumping for it can be construed as lack of interest.

[A-Stark]

I think the only time I've turned down a procedure was when an off-service R1 on-call for IM asked me if I wanted to put an NG down (or something, I can't really remember). Keeping in mind that I was on-call for gen surg that night. I thought it was kinda weird that she even asked me and, in any case, I wanted to get in some sleep before the that fun 2:30 page. (well, maybe it was more like 3:00).

[national]

have to disagree on that one - never seen or heard negative feedback on a clerk or resident gunning for procedures, as long as they aren't pushing others out of the way for it (e.g. psych intern volunteering to put in a chest tube when IM intern is on the same team, but not in the vicinity)

 

In regards to procedures, they can be fun and all, but in my experience nobody gives a crap whether you do them or not. The most important things on these rotations are to prove your knowledge, efficiency, and ability to conform to the status quo of the wards, as well as to be tolerable.

 

To all med students: don't be jerks, slack-offs, or worst of all adulating sycophants. The world only needs one Whalon Smithers.

[Lactic Folly]

Only downside I can think of is that if you attempt the procedure, but botch it, this will stick in people's minds as representative of your technical skills..