Internal Medicine

Last updated: Dec 2024

High-yield "What I Wish I Knew”:

  • Internal medicine rotation is one of the most tiring rotations because it is usually 6 days on, 1 day off. Your day off usually will coincide with when the intern or senior resident you are working with is off. However, don’t be afraid to advocate for specific days off in advance in case those don’t line up with the intern/senior resident schedule (i.e. if you have personal events, religious obligations, etc.) as long as it is within reason. Your team/site however, may not want you to miss “long-call days” (because that is a day packed with new admissions/learning) or “post-call days” so just keep that in mind.

  • Lunch is provided on IM!

  • Try to prioritize morning report, especially as an MS3! This is where a lot of great learning happens (you may not be able to go to them as consistently as an MS4 or resident!)

  • Don’t be offended if, on occasion, the intern/resident ends up seeing a patient without you or responds to a page without telling you. Their to-do list can be very long and they may need to get things checked off their list.

What to expect for the rotation:

  • 8 weeks long, generally ~5 days off a month (day off may or may not coincide with weekend)

  • All of internal medicine will be in-patient wards. That means you’ll be on a team with 1-2 interns, a senior resident, +/- another MS3, +/- MS4 and the attending. You’ll generally start off with 1 patient and build up to 2 or maybe even 3 depending on patient complexity; you will co-manage the patient with an intern, meaning you will have plenty of guidance!

  • Typical day (may vary depending on site/team):

    • Get in around 6:30am-7am, preround on patient (chart review to check latest vitals/labs/consultant notes/etc.), see patient (often with intern to do an exam and see how they are feeling)

    • ~8am (or depends which hospital you’re at): try to attend morning report (interactive teaching session for all medicine teams). Or if running behind, finish prerounding

    • ~9am (exact time may vary): Rounds: present patients to team via SOAP format; get input from team. May “table round” meaning just talk about the patients without seeing them as an entire team. Or “bedside round” meaning you’ll present to your team outside the patient room, then all go in together to see the patient and the MS3 often may take a stab at leading the convo to update the patient on the day’s plan

    • 11am/12pm: put in orders, place/follow up on consults, work on notes, update patients/families

    • 12pm: noon conference - another interactive teaching session that is optional but encouraged. People usually eat lunch while attending

    • 1pm - onward: continue finishing notes, calling families, working on any follow-ups, respond to pages, update hand-off

      • For a non-call day (day where your team is not admitting new patients to your team, MS3s often can leave anywhere from ~2pm - 6pm depending on the workload and if unexpected things arise). Your team generally may try to get you out early on a non-call day

  • What is a call day?

    • Every ~4-5 days (depending on hospital site) your team will be “on-call”. That means your team is open to admitting new patients. Patients could either be coming from the ED, could have been temporarily admitted overnight but now need to be assigned to a day-time/primary team (aka “holdover”), could be “stepping down” from the ICU now to medicine wards, or could be transferring in from different hospital

    • For these patients, you’ll generally do a full H&P note and presentation first before transitioning to SOAP.

      • “Fresh admits” aka patients coming in from the ED, these patients often still have a lot of diagnostic uncertainty.

    • As an MS3, you’ll generally only get 1 “fresh admit” per call day

Helpful studying resources (in addition to UWorld):

  • Step-Up to Medicine (helpful IM textbook)

  • Note on UWorld - most people don’t finish all the Internal Medicine questions because there are so many!

  • Emma Holliday videos

  • Divine Intervention videos and podcasts