Inpatient Medicine: A Review and Survival Guide

I just wrapped up my first rotation of my MS3 year–8 weeks of inpatient medicine! Now that I’ve had the weekend to de-stress, enjoy some quality time vegging out with good movies, take-out and my very handsome husband who I’ve missed–I wanted to devote this post to a run-down of the rotation and my hints for success. Think of it as one med students’ mistakes are another one’s treasure?

What is it: Inpatient medicine covers almost every aspect of medicine. If you get “admitted” to the hospital and you are not critically ill enough to be in the ICU, the inpatient medicine team will be the ones taking care of you. For details about how it all works see my previous posts. (Daily run down) (Inpatient medicine post)

Typical day: This rotation is one of the brutal ones–so just be prepared to be tired all the time and go in knowing that you won’t see your friends. You may not even see your cat, but you’ll learn a whole hell of a lot. There will be days you will get home and you will be unable to do anything except plop down on the couch and nap until the following morning–yes, skipping dinner and all because it’s almost 9 pm anyways and you need to be up soon. But don’t let me scare you. This will be one of those good types of tired, where your body and mind are exhausted, but your heart is happy. It is the type of tired you only get when you are chasing after something you truly care about. It is the tired of medicine. The one that makes you feel alive. Welcome friend. Yes, my feet were sore but my heart was happy.

Schedule: The schedule is 6 days on, 1 day off per week of your choosing. The hours were something between 6:30 am and 8:30pm, although depending on your senior Resident you may be going home at 5pm. My advice, don’t schedule your day off on a no call day because you are wasting a valuable shortened day. Depending on your location you will be long call (meaning you admit patients until 7:30pm), short call (meaning you admit until 6:30pm) or no call meaning you don’t take any new patients after 5:30pm (woo hoo!). If you take off a week-day as your scheduled day off then you may miss out on some lectures/didactics, but that also means you are working during the weekend, and the weekends are much chiller and they usually let the med students off earlier than usual. So just see which you prefer. Don’t make any grand plans for your day off, you will want to sleep. And to be honest, you’ll need to recharge. Rest– a lot. Also, you’ll have to study.

Studying:  Now that I just told you all about how tired you’ll be, well, dig deep and carve out 30 minutes each night to do some questions. Trust me, it will save you in the end if you can do even a handful of questions each night. The options are either MKSAP (now called IM Essentials) or UWorld. I am on the fence about which one is better for the shelf. The shelf exam questions were much shorter than MKSAP but MKSAP covered most of the topics you will need for the shelf. If you do all 500 MKSAP questions and maybe another 200-300 Uworld questions you should be in fairly good shape. The key is that you actually understand the answers. The shelf, as well as the oral exam are testing key concepts. Bread and butter medicine like chest pain, AKI, COPD, shortness of breath, asthma, edema, GI bleed, thyroid disorders, neoplasms, etc.

What to know:
-You should aim to know differential diagnoses for the main chief complaints people get admitted for
-Presenting symptoms and
-What differentiates one diagnosis from another based either on symptoms or labs
-Key labs and any work up that will need to be done
-And then of course treatment plan

If it seems overwhelming at first, it is. For the first 2 weeks or so I felt like a real idiot. But eventually, as you begin to see cases these “symptoms” start to come to life in the form of real patients. You will easily be able to recall what your team did for Mr. Johnson, the GI bleeder in bed 8. The best advice I received was to read up on my patients’ conditions. You will always have 10-15 minutes of down time so spend that time reading UptoDate or Step Up to Medicine and getting some background information on the condition you are treating. This is seriously golden. Several things may happen as a result: 1) you will actually understand what is happening to your patients and why you are implementing the treatment plan you’ve outlined 2) you will understand critical things to look out for or complications you are working hard to avoid 3) in going to UptoDate or a similar source you may find that there are new guidelines/recommendations and you can share those with your team 4) even if you have nothing “new” to share, you can always help your team understand a medical topic in more depth by putting together a short little memo or presentation.

How to Be a Rockstar MS3: This brings me to the most important information. If you want to succeed on your rotation my advice is simply this: don’t be lazy. Don’t cut corners. Be eager. Be passionate. Show up with 2 missions–1) you are there to learn and 2) you are there to be an advocate for your patients. If you show up early, volunteer to stay late so you can see that late night lumbar puncture or the new interesting case that just got admitted at 7:30pm– people will notice. If you see your resident isn’t sure what the dosage adjustment is for renal impairment go to UptoDate and find out for them.  If you get a Turner’s syndrome patient and the team isn’t sure if renal anomalies are part of the syndrome, look it up for everyone and present to your team. Learn your patients really well. No one should know your patient better than you. Go see them in the afternoon, even when you don’t have to. Go check on them after they get a CT and keep checking the computer until the results are read. Explain your patients condition to them–this is the best way for you to check if you truly understand it. Make yourself available to your patient’s families. Be confident. Believe in the skills you’ve amassed up to this point. Don’t start your rotation feeling like you are “just” a student. You are part of the team and depending on your own outlook, desire and work ethic, you can become an essential part of the team.

Below is a list of things you can do on your rotation as the “student”:

1. Learn your patients’ condition and treatment

2. Talk with your patient and their families about their condition and treatment plan

3. Examine your patient thoroughly, doing the complete physical exam, even if others on your team skipped it

4. Page consults and explain what we need from them

5. Observe procedures and ask to assist or learn to perform things like arterial blood gas, lumbar puncture, wound dressing, I&D, etc.

6. Call the lab for critical lab values

7. Go down to radiology and look at scans with the Radiologist

8. Call the pathologist and discuss results of a new biopsy with them.

9. Call down to radiology to see when your patient will get their MRI, CT scan, etc.

10. Check labs throughout the day and inform your resident with your recommendations for corrections, new treatment plans.

You will learn a tremendous amount on this rotation. Prepare yourself for hard work and you may actually enjoy it quite a bit. Spend time with your patients, make them feel cared for and take in as much knowledge as you can. Just like before, the best way to learn is through repetition. So do questions, read a ton and have fun!

Final words: inpatient medicine is challenging yet rewarding–make the most of it and it will be a great foundational rotation that all the others build from.

 

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1 Comment

Filed under Rotations

One response to “Inpatient Medicine: A Review and Survival Guide

  1. Hannah

    Wow! Reading this makes me incredibly anxious, yet very excited to get to third year rotations. I’m only just about to start second year now, but looking forward to whats ahead (aside from STEP 1). Thanks for the great advice. You’ve gained a new reader 🙂

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