 Internal medicine can be one of the most overwhelming rotations to do well on, but if you want that coveted honor, here's how to do it. Hey friends, welcome back to channel. Before we get into all the tips for today's episode, make sure if you do enjoy the content today, then check out our other episode on all of the best resources for the internal medicine rotation as well. I'll link that down below, but let's get into it. Number one is to get into the management ASAP and fire your reporter. One of the biggest issues with medical students, particularly on rotations, and I know now because I've been working with them for three years, is that I can easily tell this difference between a student who's gonna get honors on one of my internal medicine rotations and the one who's not based off of simply how they approach problems. The typical average medical student is going to be comfortable with what was taught during the first two years of medical school, being how to essentially take a very good subjective and objective data. On the other hand, the student who's much more likely to get honors spends much more time focusing and flexing their muscles on practicing the assessment and plan and management of the individual patient. And so one of the best things you can do for yourself while you're on the rotation is regardless if it's a brand new patient or if you're seeing a patient on a following day that's already been admitted, is to think about them based off of their top three to four problems and what you want to do to work up things as well as treat things. So to give you an example of a brand new patient, usually the typical medical student is going to dive into the notes and want to know the history of the patient, if they're smoking, you know how long they have high blood pressure, they come out with chest pain, they want to know all the things that medical school teaches you about. But in reality, the bottom line is that most medical students can do that. So to help yourself stand out, you have to think differently. And so whenever I have a student on my rotation or have a subline rotation, the first thing I tell them to do is to look for the problems they're going to cover. An approach tip on how to do this if you're admitting a new patient is to not go to the notes first is usually a national inclination, but instead to go to the other objective data. And then I may actually dive into their history and their past notes and their medications to get an idea of who this patient is. But by doing so, I'm essentially trying to create a big list of problems. And then eventually I should be able to group three to four of them together and saying, oh, their fever, their hypotension and their high white count is actually from the infection. Their urine looks dirty. This patient looks like they have a UTI. Cool. That is one problem. You're essentially starting to manage this patient and diagnose them without diving into the reporting phase of what most medical students do. And on a similar note, if you're taking care of a patient who's already been in the hospital and you're about to think about writing your progress note or present them as an update, then always think about what are the main things that we'll be doing to this patient today to help them get closer to home or to discharge. So what are their main problems? Ideally, find three to four things. Ask yourself, do I need to work up anything more? Do I need to change my treatment plan? And then focus on your subjective and objective. If you can do that, you're already starting to think as a future physician, much less of a third year medical student, that's as much easier to get on her. So again, fire the reporter, focus on the management. Number two, and this goes without saying, make sure that you're an authentic team member. Now I say authentic because I have a lot of medical students on my rotations or personally that I worked with at medical school. I try to force the fit. They essentially try to look more impressive than they are actually trying to be helpful. You want to figure out the dynamics of who your upper levels, your interns are, your attendings are, essentially understand what their expectations of you are. So usually on your first day of the rotation, try to simply ask like, what do you expect me to be doing and what can I do to best serve you, the team, the patients and as well grow so I can get the best results possible. If you have a quality group of residents and attendings, then they will tell you what their expectations are. But whatever they tell you kind of think of that as like the bar of just doing good enough. Your plan should be to become phenomenal, to be memorable and to leave a difference not necessarily a mark. And so one of the best ways you can do that on your team is saying, cool, if you expect me to see four patients on a daily basis, I don't need to like flex and try to do five, but I'm going to take care of those four patients as best as I can. One pro tip that I will give to students on rotations is that you should know your patient better than I do and they should know you better than they know me. So if you can go into a room with your entire team, the patient looks at you first, that already gives me a good impression that you built a good report and that you've worked to try to see that patient multiple times. An easy way to do this is to focus on the rule of three. Try to see your patients at least two to three times a day, whether it be number one during your pre-routing when you're in the hospital, number two when you go with the entire group again to see the patients, ideally a third time once in the afternoon to make sure that the patient's doing okay, particularly if you've made any change to their management. They have pain early in the day and you try to make a change to it. Go back and say, oh, this patient is now not in pain or they're nauseous or this treatment is still not working. Maybe we should do X, Y, and Z. Going back to number one, you're giving a management suggestion of what to do next now that the original plan didn't work out. I'm being very careful to highlight that being a good team member doesn't just mean you're doing work or trying to find old records from hospitals or doing busy work that is in the way of your other team members. Sometimes you can do the same quality of care that your interns, your residents are providing but just because you'll be able to see less patients, ideally you should have quality rapport and relationships with those people so then you can practice making true management decisions as if they were your own patients because they really are. Tip number three is to keep a daily to-do list for the entire team. One thing that I found to be very successful when I was a sub-byte particularly on a cardiology rotation is that although I only had four to five patients of my own the team had 14, usually for every patient I was paying attention to what was going on with them as well as what type of things needed to be done. Now not everything was something that I could actually do but because I had that list I could easily look at my interns and say, hey, you have a lot of patients today. I can easily help you something with Mr. Johnson, Mrs. Evans and blah, blah, blah. Even though they're not my patients there's something that I could easily take care of and if I have any questions I can ask you, is that okay? Any intern or resident who hears that understands that one, you were paying attention to rounds to patients that weren't even yours but two, you actually are giving a really wholehearted desire to help them without any strings attached. If you do that you will realize your rapport between your interns particularly and your upper level residents will start to shine and they'll start to basically speak your praises without you really having to do so in front of your attendings. And on the flip side one benefit that I found from this daily to-do list is when I transitioned to my early years in residency my work that I had as an intern didn't feel that much different than a sub-byte because I was almost kind of mini managing whatever tasks were left for my interns after I was done with my own tasks. So because I already had some experience of doing more than a sub-byte level but less than an intern, the transition was a lot more natural. Number four is to do your daily U-world practice and review. Now most students know that U-world is going to be the king of all resources when it comes to step two setting and particularly shelf exams like internal medicine. But when you deal with a rotation and a topic as broad as internal medicine you really need two things. One, you need enough consistency and number two, you need to make sure that you review your mistakes as much as possible. And so depending on how long your internal medicine rotation may be the main recommendation I would give you is to find amount of questions that you have to do on a daily basis to ideally get all of the questions that you've all done within about two thirds of your rotation. So for example, if you have six weeks try to finish all of the U-world questions in internal medicine within four weeks. So then you have two weeks to essentially do other practice exams as well as go and review your mistakes. Now once again, this is a minimum bar of doing well but again, if you want to increase your chances of doing well on your rotations as well as remembering things for yourself and actual rotation, then the next thing I would tell you to do and this actually worked well for me is whenever you take a question if you miss it just blatantly or if you guessed what you guessed correctly but you didn't actually understand the connections between ideas and U-world or whatever practice questions you were doing then make sure that you collect those into some kind of system. If you're interested, you guys can check out some of the programs that we have down below either the question clinicals or the level of your studying or we talk about essentially good ways to collect your mistakes. Regardless of what method you use whether it is a Word doc or an Excel document writing them down or using flashcards again, we recommend a bunch of different options down below in any of those programs. Regardless of what you do make sure you do it consistently. So you may decide for example to have an eight week rotation and thus to do all of your questions between six to seven weeks you wanna do about 30 to 40 questions a day that may be your situation. Also make sure you give yourself a dedicated time where you're reviewing the mistakes from the past few weeks. And so if I had a notebook where all my missed questions were there or an Excel document I would make sure that would take about 10 to 15 days and go through those mistakes and essentially move on to the next one. That way again, I'm not likely to make the same mistakes on my shelf exam, step two but I'm also learning for the rotation itself. Tip number five is to be interested and most importantly in your personal growth. Obviously it's important to be interested in our rotation but I find that most students will try to force this particularly if they're not interested in internal medicine. If you're trying to go into surgery like you're not offending me by choosing a different field I actually don't care and I'm actually encouraged to try to teach you things practically that I know that you may have to know as a surgeon and then try to make the rotation as useful as possible. So you don't have to feel like you have to force internal medicine on yourself to make it look like you're interested. In the flip side doing things like taking care of your patients and actually just wondering like where am I on different levels of patient care? Where am I on presentation? Where am I on patient interaction? Where am I on management decisions? And then even within each individual disease maybe you know really well how to take care of a patient with heart failure but you suck when it comes to a patient who has cirrhosis or may have alcohol which are all you name it. If that's the case then go ahead and read about those situations ask yourself like what type of things that I not do that my patients and my residents ended up recommending maybe my attendings added to the patient's care that I can now add to my future patients. If you focus on your growth and specifically if you're asking feedback from your residents and saying how are my presentations? How is my management skills? What type of things would you do differently if you were me? And working on those on a week to week basis if you had an eight week rotation that is a lot of room for growth but the only way you can actually have consistent growth is by asking for feedback being reflective on your own skills and most importantly working on them. One thing that I don't share enough on the channel is while I'm an internal medicine physician now there is a part in the middle of my internal medicine rotation I actually considered not doing the field because I didn't think that I was good enough I didn't think that my knowledge base was good enough I didn't feel like my management skills were good enough but because I reflected on that fact and the fact that I also had three weeks left I made small adjustments into my management my patient interactions as well as just focusing on what I was doing and what I wasn't doing to take care of the patients that my upper levels and my attendings were. But this tip goes for any single rotation to be interested you don't have to force it you don't have to bring journal articles take care of your patients understand what parts of their care you don't understand ask questions about those read about those come the next day take care of that patient even better and most importantly if you have a patient with the same problem really make sure that you can actually dominate it it's almost like if you had a same test question presented to you every single week you want to make sure you don't miss it over and over again so take those opportunities find those signs of progress I promise you you will do well and most importantly you'll actually be noticeable without forcing it and if these tips on how to do well and I am rotation were helpful then make sure you check out all the resources that can help you get those honors as well as checking out the crushing clinicals program down below on how to get honors on every single rotation but as always my friends thanks for being a part of my journey hopefully I was a little helped you guys on yours and I'll see you guys in the next one peace