Students in medicine need to have a realistic expectation of the things to come when they hit the ground on rotations.
For me, I felt that starting rotations was a lot like jumping out of a plane into unknown territory where you're expected to do well, support your team, know your role in the hierarchy, and do your job well.
Medicine in the United States is very much like the military. We call it the "academic military" over here.
430am: I wake up, never rested, but there's coffee. Depending on how I'm feeling I'll skip breakfast, because internal medicine isn't as physically demanding as surgery. I'll hydrate with around 1-1.5L of fluids before I leave. I try to find a little bit of time to read.
5:45am: I'm walking into the hospital, thinking about what I need to get done, and what patients I need to see.
6am-630am: Reading the electronic medical records of my patients to get updated on their labs.
630am-8am: Pre-rounds. This is where you round on your patients and see what has happened to them overnight by talking to the patients and their nurses. Usually, nurses change shifts at 7am where they sign-out to each other, and that is a long process. Find nurses before 650am or before sign out.
This is when you will do the physical exam on your patients. Some attendings want every system examined, some want a basic lung, heart, abdomen exam. Never skip these. Always check for pressure ulcers, and for any unilateral swelling on patients. That is your DVT prophylaxis.
8am-X: Full team rounds. Some attendings choose to discuss patient status and plans in the team room, do the aforementioned while visiting the patient, or a combination. I'll have another entry on this.
After rounds: Usually a morning report, patient conference for education.
Lunch is whenever you can find the time, but usually there are many lunchtime conferences when you can eat.
The rest of the day is dedicated to admitting patients, typing up notes, putting in additional orders, and checking up on patients who need a little extra attention. As a medical student, the rest of the day will also consist of you doing things to help your team: mini mental status exams on patients, and other physical exams of various kinds.
End of duties - 1145pm: Studying for shelf exam or reading up on certain conditions or preparing presentations. Most internists are all about presentations on different materials. Many residents who are nice appreciate it because they're too busy managing patients and barely have any time for education.
I usually left around 6-7pm on my medicine rotation. I had similar hours to my surgery rotation, except for the Emergency Room. The Emergency Room shifts are around 12 hour shifts, but getting pulled in so many directions at a time and the constant juggling makes it more intense and draining.
I'll have another entry on the Emergency Room from the perspective of medicine rotation and surgery rotation.
Thanks for your readership.
Rounding kind of sounds like a drag. I think I would have to keep a 10-5 sleep schedule if I was going to survive. I don't do well on little sleep.
ReplyDeleteRounding on internal medicine certainly is dragged out..usually 30+ minutes per patient.
ReplyDeleteRounding on surgery will usually be 3 minutes per patient, which is pretty amazing by comparison, and really, all you need.
You eventually reprogram your body, which is really important for surgeries that start one day and end the next, taking call, or ER shift work. You'll get the hang of it.
All the best.