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Internal Medicine Selectives

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I have to rank my preferences for internal medicine selectives in my clerkship.


I want to pick the easiest one with the best hours and least amount of call.


Which ones are the best?  Here are my choices, I need to rank 5 of them.


GIM Consult
Infectious diseases
Occupational medicine
Rehab medicine
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I take it you're not interested in IM? I can imagine you'll end up doing GIM call one way or another. As a clerk, you can't really get away with choosing rotations to minimize it for the most part. 


Having said that, the best hours are probably Endo, Rheum (though not necessarily!), GIM consults, Oncology, and probably Occupational or Rehab. I don't know much about those two latter ones. Any consult service is going to vary a lot depending on who else is on (other clerks, residents) and how the staff work. Some don't end up reviewing until 4:30 everyday. Others make sure to be out the door by the same time. So it's pretty hard to know. 


I'd just pick the areas you're most interested in and go with that. Time always passes quicker if you're not bored. 

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I think it probably depends a lot on the school.  Here almost none of our IM selectives have call, or call is optional.  I only ever did call when I was on CTU.


It's hard to imagine what your specialty of interest could be that NONE of the selective possibilities are relevant to your future practice.  I'm doing psychiatry, so I can't say that GIM is a massive interest of mine, but I know I will have to manage my patients on the ward, and many of them will have comorbidities, so I picked an extra two weeks of emergency, to get more experience with semi-acute issues I might get called about, and neurology to get a better handle on my neuro exam.


I wouldn't have picked something crazy like ICU, but if it's a choice between really easy and really boring and normal workday and interesting, I'd pick the latter.


It also depends what you hate.  PM&R is light hours but I HATE MSK so I would have been pretty unhappy.

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I did ICU and Neurology clinics/consults for my clerkship selectives.


Neurology would probably be typical of any other ambulatory/consult rotation. Clinics were 8:30 or 9 to 4:30 or 5, sometimes with a fairly decent lunch break. Consults could be completely variable but 9 to 5 is a reasonable expectation. We had to do inpatient CTU floor call during that block, which occasionally entailed completing a ward admission or else going to assess some typical ward event that residents mostly deal with over the phone. 


I don't know that ICU in particular should be considered particularly onerous as a med student. Often hours are something like 7:30-4:30, and you won't be given more than a few patients to see. It's a steep learning curve but pretty much always interesting. Any "call" you do as part of it as a med student won't exactly be taxing either. You might get to see a patient in the middle of the night or see some acute issues overnight, but the nurses will not call you for anything and you won't be managing anything either. 


Finally, as a brief word on med student call, I would say that while it's understandable that you might want to minimize it, I would encourage you to recognize that call is the time when you see most interesting (and memorable) cases. It's not wrong to say that you learn a lot more when fewer people are around and you never know what's coming through the door next. As a clinical clerk, you will be expected to perform thorough histories and physical exams, and to attempt to arrive at an appropriate assessment. You should take a stab at a management plan too. But the expectations for management are not high, and it's an excellent time to make mistakes and learn stuff when you have little to no real responsibility. 


But you are responsible for your learning and for finishing your work in a timely and complete manner. The best clerks I've worked with arrive at thorough, appropriate assessments, always read around their cases, show up on time, and complete tasks as requested when requested. The worst have poor knowledge but - worse - fail to finish assigned tasks and display a lack of professionalism. Even if not interested in a particular speciality (like IM apparently in this case), it is an absolute expectation to show up on time, do the work, and - yes - study relevant topics. When it comes to your exam, rotations that are the highest yield for knowledge and experience are stuff like Cardiology, ID, Nephro, Heme, Resp, and ICU. 

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It depends on if you need to do call...


Rheum and ID generally don't admit (a whole lot) and work more as consultants, so tend to be quite easy. Neuro can be light as well unless you have to be part of the stroke team. And if you have to do call this service tends to be underserviced and swamped in many centers so I'd stay away. Nothing like dozens of consults of strange eye tinglings and jumping sensory deficits at 3 AM.


Stay away from cardio and GI. As an aside, If I have to watch another scope in my life I'm going to shoot myself.


If you plan to go into family, I'd highly recommend GIM consults. You learn a lot and work is fairly reasonable (~9-5)

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