Order Of Medical School Rotations – Start With Internal Medicine

On the first day of orientation for internal medicine (IM), the faculty noted that they now have statistical evidence which supports the notion that students who start on IM tend to do better on all their subsequent rotations. Why? The reasons are up for debate, but halfway through the rotation, I think it deals with the breadth of cases students encounter on the wards coupled with the extensive preparation we do for the IM shelf exam.

This isn’t to downplay any of the other rotations. Psychiatry has their own history-taking. Pediatrics requires a keen knowledge of developmental milestones. Surgery has a unique skill set, etc. It’s just that IM gives you such a great overview of medicine as a whole that you’re forced to address all aspects of a patient from here on out. For example, if a patient comes in with a three-vessel occlusion and is deemed a candidate for a coronary artery bypass graft (CABG) procedure, how will this affect his diabetes? What kind of measures will be taken for rehab? What nutrition guidelines should he follow? How does his end stage renal disease complicate the post-op recovery? What medications should he be taking for prophylaxis against infections? I’m sure these issues are addressed very well by surgeons and the like, but it’s nice to see the process unfold first hand on IM.

With a week left on the GI consult service at St. Luke’s, I’m preparing to be thrown back into the “primary team member” role at the VA hospital next month. I’ve also been very productive over the weekend trying to get as much studying in before spending all of March doing practice questions for the shelf exam on the 25th. All in all, I’m looking forward to finishing this week strong and ultimately applying my “comprehensive internist approach to cases” (hah) to all my patients in the future. ๐Ÿ™‚

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