Some common cases we have seen in Intenal Medicine:
ACS rule out
So far, our attending has been extremely helpful and willing to teach us many different topics including metabolic acidosis. Now, in PA school, we learned the basics about how to tell if acidosis is respiratory or metabolic. We briefly talked about how to tell if there is compensation; however, we did not learn more details about types of compensation, anion gap, or if the problem is acute or chronic.
Thankfully, this attending was very patient and presented many different problems we could work through to practice calculations and cases. It was interesting to see that the residents, medical students and myself, the PA student, were all really benefiting from this review. This is just one example of his teaching sessions with us, we have also discussed, cirrhosis, hyponatremia, and DKA so far. I am extremely grateful for this experience, because without these teaching sessions, I would not even have a grasp on this material like I do now.
Daily Routine on IM:
In addition to my team's attending, there is another attending who lectures to us on a daily basis (each morning). Medical students present a patient case to him and he works through the thought process about how to approach the work-up and treatment of the patient. His approach to medicine is very logical, group things together, each diagnosis is coupled with certain presentations. Instead of looking at problems individually, we should be looking at them through pattern recognition. Over time, this way of thinking makes approach to various cases much easier and faster.
After these amazing lectures which are both informational and humorous, we each round on our patients on our own, then round/present together with the attending. See outline of daily schedule below for our team in particular. For the most part, this rotation seems relatively organized from a learning perspective and it is very helpful for building and solidifying our medical knowledge.
Example of a Day on IM:
6:30am: arrive to follow-up on previous patients, look at any new labs, imaging, consults or other reports
7:15am: varying by day, all the medical students (and PA students) typically have a lecture at this time by the Chair of Medicine attending (who is also an infectious disease doc)
8:30am: return to floor to finish rounding on patients, gather more information as needed
9:00/9:30am: start rounding on patients with attending, present new patients or any updates on patients, typically we have been finishing around 11:30/11:45
12n: depending on the day, a conference or just lunch time
1:00pm: Wednesday's there is "junior rounds" where another attending from a floor comes to discuss a case and the thought process for approach to work-up, management and treatment.
Anytime in the afternoon: Our current attending and residents run a "teaching session" where we discuss various topics related to our patients. For example, I presented on hyponatremia yesterday because we have had multiple patients with various presentations of hypoNa+.
After the teaching sessions, we can stay if there are new admissions to the floor, if not, we are typically dismissed.