Lessons From My First Month of Internal Medicine

Saturday, May 14, 2016




Internal medicine, clinical rotations, MBBS, year 4, almost a dr
"The only way you are going to have success is to have lots of failures first."-Sergey Brin





With the first month of rotations behind me there are a few gems of advice I'd like to share. Some are things that I've heard from Consultants, the Director of the School or simply what I've gathered from mere observation. 

Year 4 is nothing like the first three years of MBBS in that there isn't a formal structure of lectures, Skills sessions or time that you can schedule simply to study or read. You're now at the mercy of the Consultants, Registrars and SHOs. At times this may be fine and dandy other times, I'll admit I'd rather hang up my coat for the day and read about the pathophysiology of patients illness, but I digress. Hopefully the following would allow you to gain a little more structure than what I had in the first few weeks and assist with a more pleasurable experience. 


General Advice

1. Stick Around

This may seem obvious and all but trust me, it can be easier said than done.

As we were told by the Director of the School of Clinical Medicine and Research, "Medicine begins after 10". By no means am I telling you to stick around until 10 p.m. on a daily basis.  However I am saying stick around at least until 7 p.m.

A typical day of Internal Medicine Rotation for me began at 6 a.m. daily and ended at least by 8:30 p.m. excluding calls.

By arriving to the hospital earlier than my colleagues, I was able to find a spot either in the student lounge or around the hospital where I could gather my thoughts, read up on anything I may not have completed the night before and quickly S.O.A.P. my patients. By doing this I was able to make the Interns meeting that students were expected to attend at 8:15 a.m. and had time afterwards to either meet up with the team or make a quick stop to my locker before rounds. By seeing my patients earlier, I didn't have to rush to do so before rounds started and had ample time to work on my presentation for rounds in the event we rounded.

Sticking around also allows you to get some experience with drawing bloods, seeing or performing some procedures like DREs or catheterizations and participating in a code. It also shows your enthusiasm to learn and that you're an active team player.


2. SLEEP

As medical students we are known to go days on end without sleep. Regardless of what you may have heard from whomever, reducing the hours of rest your body gets is ridiculous and not wise at all not even in the name of medicine. 

Trust me, I have said it repeatedly to myself and to some of my friends, I don't know where the Consultants expect us to pull more hours from in a day to be actively participating on the wards, reading up on every patient and still have time to study for exams. That's before I got smart. 

It's easy to complain and make excuses and to cry or scream over spoilt milk, however, in doing so, you're simply wasting time. It wasn't until I started to plan EACH minute of my day that I realized it is doable to stay abreast of each patient on the service, assist where you can on the wards and still have time after leaving the hospital, eating dinner and showering to study and still get a good night's rest all to do it again. 

By getting adequate rest and I'm talking about 6 hours each night, you're allowing yourself to be well equipped for the day ahead and limiting yourself from getting sick. 


3. Be a Team Player

Medicine is all about team playing. Needless to say there are some who overlooked the memo when they initially applied for medical school and they end up learning the hard way once clinical rotations begin. 

No one wants to be on a team where the members aren't team players and are constantly throwing each other under the bus. It looks bad, makes it awkward during rounds and the rotation becomes hard to endure. By trying to be more a team player early on in your medical career, it will go a long way when you start your clinical rotations. 

The team doesn't only consist of the Consultants, Registrars, SHOs and Interns; it also consists of every person who is involved in the well-being and care of the patients on your service and yes that includes the nurses, laboratory technologists and technicians as well as your Imaging personnel and even housekeeping. 

I've learnt that by being around actively on the wards after rounds are completed, to assist the intern and even the nurses on the wards that a simple act of willingness to help where you can goes a long way in your favor in the end. By assisting your intern, you're lightening their load which allows them to be available to teach you a thing or two. 


4.  Don't take shortcuts

This should go without saying but I'll still mention it. 

Medicine is not about shortcuts. Clinical years are all about making the most of your times on the wards and enjoying a new means of learning and experiencing the facets of medicine. 

Dedicating time to learning certain things will ensure you're not skimming on any area. Each rotation is vital despite the fact that some are more interesting than others. 

If you start your rotations with the thought that you can take shortcuts and will get by, think again. It will show in one way or another. Be it on your written examinations or your OSCE. 

For medicine we're expected to know each person assigned to the service and to be prepared if called on during rounds to present that person. It sounds like a lot, but let's think about it. If you're in the hospital and you're assigned to a team responsible for your care and management, wouldn't you want each member of that team to be knowledgeable of your situation? 

By ensuring you dedicate necessary time to each aspect of your learning will ensure that you won't have a need to take a shortcut. 


5. Do EVERY procedure offered

Although this may seem a bit far fetched you'll be glad you took my advice here if it's the only one. 

As students we're expected to know certain things and have a willingness to assist where possible. We also believe that we'll possibly see a procedure again at some point before we graduate medical school and would have countless opportunities to perform them. Erase this thought from your head right now. 

Think of each patient and procedure as being your first and last encounter because the reality is you don't know when you would see something or have the opportunity to do it again. 

From inserting IVs, drawing bloods, catheterizations, DREs get in as much as you can now. By the time you graduate and become an intern, everyone will expect you to know how to do them and they won't be smiling when you're all hesitant and nervous because you never took the time to perform certain procedures as a student. 




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