Internal Medicine Clerkship, end of week 1 thoughts

Finished up week 1 of internal medicine and I wanted to jot down some quick thoughts.

-When you’re carrying >= 4 patients, you need to be efficient. I prefer to get sign out from night float, then immediately sit down at a computer and skeletonize all the notes (labs, one liner, orders pending, review the medication administration record). This takes about 4-5 minutes per patient unless there is neuroradiology that I want to really look at, but I try not to get too lost and try to postpone that until afternoon downtime. So, by 7:00 at the latest I can go see the patients. I try to spend 5 minutes per patient if it’s a patient that I know well, maybe 10 minutes if it’s someone I don’t know as well. I always try to at least ask the nurse if there’s anything I need to do or if they’re aware of acute events overnight. I usually won’t go back to the charts to read the nursing notes unless something happened or I have extra time. Usually by 7:30 I am done, although stuff can happen. I make sure to at least see everyone by 8:00 (morning report time), even if I can’t finish the notes. Sometimes I need to finish scribbling the last few notes during morning report or social work rounds, but my goal is always to have my notes done by morning report.I try to sit down at a computer during the end of social work rounds or to at least peek at the labs on my phone since most of them won’t be back by 6:30.

-The main thing I need to do is to have a more efficient note format. The medicine progress notes we have are really inefficient and the blank paper makes me nervous that I’ll miss something. I got a template from some of the interns and MS4 but it’s not really on point. I hope to develop something that I can use this weekend.

-It’s amazing how variable rounds are depending on the senior resident. It doesn’t take much to turn rounds into an awesome learning experience. In fact, it usually only takes one question per patient we’re seeing to keep all of the medical students thinking for quite a while. So we *REALLY* appreciate it when the senior or the attending actually takes the five seconds to ask us one or two teaching questions (“what would your plan be?” “why are we doing x, y,z? why not p, q, r?”) per patient. Without that, it is easy to be ignored for an hour or two on rounds. It is neither fun nor educational to stand around and watch the senior read through the EMR all morning. So please, attendings and seniors out there in internet-land, don’t think that teaching is something that happens in front of a chalkboard in a classroom. Take five seconds per patient to talk to your medical students.

-Even though I’m not going into internal medicine, I’m learning a tremendous amount from this clerkship. Most of the medical management of my neurosurgical patients will have to be made under tremendous time pressure using my limited mental resources (let’s face it, neurosurgeons don’t devote much of their cortical area to internal medicine), and I’m really grateful for this opportunity. I want to spend even more time on medicine and critical care during medical school since I think that this is an overlooked area for surgeons … and let’s face it … it’s an area that surgeons might not be the best at compared to our medicine colleagues.

-Studying. Right. I need to do more of this. It’s only week one. But an entire week has already flown by …

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