Medicine clerkship is generally your longest and in some cases, your most important third-year clerkship. It is during this clerkship that you will learn most of the practical information that will help you practice in any specialty.
Your main job as a junior medical student is to lessen the load of the team to which you have been assigned. This may take on many aspects such as obtaining a good history and physical exam, doing phlebotomy, tracking down radiographs and studies, keeping track of laboratory results, getting daily progress notes written and doing simple bedside procedures such as arterial blood gas sampling, starting IV lines, placing NG tubes and generally participating as much as possible in the total care of the patients assigned to you. The more that you participate in the care of your patient, the more you will learn.
1. Read everything you can on your patient’s disease and its process. This will help you anticipate problems as they arise and will help you learn to manage cases more independently.
2. Read about every medication that you patient is on both in hospital and outside the hospital. This will help you keep current on clinical pharmacology. Are there other drugs that might be a better fit your patient?
3. Try to be present if you patient has studies and procedures by interventional radiology, cardiology or gastroenterology. Nothing is better than seeing the original pathology or procedure. Learn to write a procedure note.
4. Learn the anatomy and proper placement techniques for: Central lines in the internal jugular, subclavian and femoral veins; arterial lines and Swan-Ganz catheters. Know your landmarks and ask to assist on these procedures.
5. Review your patient’s radiographs with your intern, resident or the radiologist often. Learn how to systematically read a chest radiograph. Look at every chest film in the same order so that you do not forget anything.
6. Learn how to insert a Foley catheter using proper aseptic techniques.
7. Learn differential diagnoses for: abdominal pain, chest pain, back pain, shortness of breath, fever of unknown origin FUO, anemia, fatigue, weight loss and syncope.
8. Learn how to work up: chest pain, pulmonary edema, shortness of breath, fever of unknown origin, gastrointestinal bleeding, anemia, rectal bleeding and change in mental status.
9. Know how to write general admission’s orders for patients: ADCVANDIMLS A-Admit; D-Diagnosis; C-Condition; V-Vitals;A - Allergies;A-Activity;N-Nursing; D- Diet; I-IV fluids; M-Medications; L-Labs and S-Special stuff. Ask your intern or resident to let you write admission orders on every patient that you can.
10. Learn how to do a good patient presentation to your resident and attending. Get your intern to go over your presentation before you present to the attending.
11. Learn how to write a good ICU progress note that is systems based. Learn your ICU parameters and indices.
12. Find a method of organizing your data and stay with it. Palm pilots, note cards, papers on a clip board and other methods are good but you have to be able to get your hands on your material quickly.
13. Read at least one hour each day and review on weekends. Try to cover a major topic per week such as cardiology, endocrinology, gastorenterology, infectious diseases, nephrology, hematology, oncology and rheumatology. Do some questions and case studies.
Good pocket books that I have found useful:
The Washington Manual (available for Palm)
Pocket Pharmacopaea (available for Palm)
Epocrates on Palm
Ferri Manual of Patient Care
For lengthy reading:
Harrison’s Internal Medicine (the gold standard)
Cecil’s Internal Medicine
Hurst’s The Heart
Textbook of Intensive Care
Read the case resports and review articles in the New England Journal of Medicine. This material is often pimped on Medicine clerkships. Read at least the abstracts for the other articles in NEJM and JAMA.
Finally, enjoy yourself. You probably won’t be asked to stay later than 10:30pm on call nights and 5pm on other nights. Try to be a good team player and pitch in when things are busy. Don’t whine! Even if you hate internal medicine, don’t whine! Your evaluation is very subjective and is largely based on how helpful you have been to the team. The team includes: Attending, Chief Resident, Senior Resident, Intern, Acting-Intern and other Medical students.
Have fun and learn!
(Edited by njbmd at 11:32 pm on Mar. 25, 2002)