Med-Ace Internal Medicine Clerkship Resource Page

Everything you need to know to honor your internal medicine clerkship.

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If you are reading this page, then odds are that you are interested in learning about the internal medicine clerkship. Internal medicine is almost universally a core clerkship in all medical schools and all medical students rotate through internal medicine or one of its subspecialties at one point or another. As you probably already know as well, clerkship grades are some of the most important factors in determining competitiveness for residency as well as class rank. In summary, it is in your best interest to perform well in your internal medicine core clerkship. In this page, you will find a list of extremely helpful tips on how to perform well in your internal medicine clerkship. 

How is the internal medicine clerkship usually graded?

Every medical school has its own grading policy which can usually be found on the clerkship syllabus or equivalent document. You should always consult this document before the start of your clerkship in order to determine how the clerkship will be graded. Pay particular attention to the requirements for “honoring” the clerkship. Having a designation of “honors” makes you stand out during residency application and you want to have as many “honors” designations as possible. 

What to expect in your internal medicine clerkship

Your experience during your internal medicine clerkship is likely to vary significantly between medical schools and hospitals. However, there are some things which generally occur in most internal medicine clerkships. These are listed below.  

  1. Expect to spend a lot of time on rounds so wear comfortable shoes. A big part of internal medicine is following up patients on a day to day basis and ensuring that they remain medically stable.
  2. Although not universal, many internal medicine services (especially outpatient) will require medical students to dress professionally rather than scrubs. Always check the dressing policy of your hospital. 
  3. If you are doing inpatient internal medicine, expect to see a lot of chronic illness and older patients. 
  4. If your hospital has an internal medicine residency, be ready to get paired up with an internal medicine resident. 
  5. Expect to do a lot of walking. Internal medicine is all about being on the move as something new evolves. You may have to walk from hospital building to hospital building. Again, wear comfortable shoes. 

How is a typical day in internal medicine?

  1. Arrive at around 5:30-6:00 AM
  2. Pre-round on all your patients. Pre-rounding is the act of seeing all your patients (or rounding on all your patients) before you perform rounds with the attending physician. Usually, your attending will assign you a list of patients the day before which you are expected to follow up on the next morning before rounding with the attending. 
  3. Present all your patients to your attending physician while on rounds.
  4. Eat lunch. 
  5. Complete all your SOAP notes, admission notes, discharge notes etc. 
  6. Show all your documentation to your attending physician and receive feedback for the day. 
  7. Go home at around 3:00-4:00 PM. 

How should I prepare for my internal medicine clerkship?

Always, before starting any clerkship, READ the syllabus document. This document often contains useful information such as grading policy, honors policy, required textbooks, dress policy, required equipment and more. You need to read this document in order to be fully prepared to succeed in your clerkship. After reading the syllabus, every medical student should perform the following list of things to be fully prepared for their clerkship. One last thing, there is no such thing as being over-prepared in medicine. People will notice this and give you a lot of credit for being very prepared.

  1. Bring a good stethoscope with diaphragm and bell. In internal medicine, you will auscultate every patient you see even if they are only in the hospital for a thumb  splinter.
  2. Practice how to do a good cardiovascular, abdominal, lung and neurological examination. The odds are that you will likely be seen performing these exams in front of the attending or other medical professionals. Attending physicians love a medical student with good clinical skills.
  3. Practice how to take a good history (HPI, PMH, Meds, PSH, FH, etc). You will most certainly be expected to take a good history. 
  4. Practice how to interpret basic chest radiograph findings such as pneumonia, pulmonary edema, emphysema, cardiomegaly, & effusions. 
  5. Practice how to interpret basic labs such as CMP’s and CBC’s. 
  6. Practice how interpret an ABG and oxygen saturation.
  7. Practice how to write a SOAP note (progress note), admission H&P & discharge summary.

What topics should I review for my internal medicine clerkship?

Although many medical students don’t do this, a brief review of common topics commonly encountered in the clerkship you are about to embark on can make you shine and stand out. Here is a list of essential internal medicine topics which are likely to encounter and get tested on while in your internal medicine clerkship.

  • Principles of congestive heart failure diagnosis & management
  • Principles of COPD exacerbation management
  • Principles of pneumonia diagnosis & management
  • Classes of antibiotics, microbial coverage & indications. 
  • Common causes of acute kidney injury (AKI) & management.
  • Common causes acute pancreatitis & management. 
  • Management of chronic illnesses such as diabetes, chronic renal failure, CHF, COPD, Asthma, Cancer, Lupus, cardiomyopathies, HTN, & hyperlipidemia.
  • Diagnosis of GI pathologies such as Ulcerative colitis, Crohn’s disease, diverticulitis, ischemic colitis, & common causes of diarrhea.
  • Diagnosis of cardiac pathologies such as acute coronary syndrome, valvular heart disease, cardiomyopathies, & pericardial disease 

What equipment & tools should I bring to my internal medicine clerkship?

  1. Stethoscope 
  2. Foldable clipboard or small notebook for taking notes.
  3. Smart phone with dosing calculator app such as Epocrates
  4. Smart phone with medical reference app such as UpToDate
  5. Quick reference book such as Pocket Medicine 6th Ed
  6. Pen light
  7. IV needles (if you are expected to place IV lines as part of your internal medicine clerkship)
  8. Digital watch 

How can I impress my internal medicine attendings?

The best way to impress your internal medicine attending is to be professional, hardworking, eager to learn and independent. Generally, if you display all these characteristics, you will get a great evaluation or letter of recommendation. The following strategies in addition to those mentioned just now can help you impress your attending. 

  1. Arrive a few minutes early (especially if you attending has a habit of being in the hospital extremely early).
  2. Never ask to leave or go home unless it is an emergency and you can prove it. Especially, never ask to leave early to study for an exam. This can be perceived as you trying to undermine your clinical responsibilities.  
  3. Ask for feedback frequently and demonstrate an effort to apply this feedback (even if the feedback is silly such as always wear black tie or always stand on the right side of the patient’s bed)
  4. Offer your help or ask your attending how you can be helpful and what things you can do to improve the functioning of the team. 
  5.  Always accept any learning opportunity even if it appears trivial. For example, if your attending says “hey, why don’t you go with Dr. X and see a few bronchoscopies” you should gladly accept this learning opportunity even if you have seen them before in another rotation. 
  6. Do not be rude. Many times in clerkships you will find yourself in situations which upset you. Unless the issue is something huge such as harassment or discrimination, try to brush it off and keep a good attitude. Realize that this is a part of medicine and being emotionally intelligent is a valuable skill for coping with this and many other issues in medicine.  
  7. Take rough feedback well. Many times you will encounter difficult attendings which provide mean and harsh feedback. When you receive this kind of feedback, do not let it hurt your feelings or upset you, simply ask the attending how you can improve and explain to them the strategies which you will use to improve. 
  8. Always offer to help with the medical documentation. Attendings and residents generally do not like documenting in the patients charts and if you offer to help with this, they will likely accept. This will automatically bring your status in the team from being a simple observer to being an active contributor to the functioning of the team. Attendings love this because it shows you are hardworking. 

How should I study for the internal medicine NBME shelf exam?

The internal medicine NBME shelf exam is notoriously difficult because it has a very wide scope. In other words, many different topics are liable to appear in the exam.  If you are taking the official NBME Internal Medicine Subject Examination (shelf exam) then you can expect to see 110 questions and be given 2 hours and 45 minutes to complete all them. Med-Ace recommends the following resources and strategy for preparing for the internal medicine shelf exam.

  • Complete all the internal medicine questions in UWorld Step 2 CK question bank (approximately 1400 of 2019) or USMLE-Rx Step 2 CK Qmax. 
  • Read Case Files Internal Medicine 5th Edition OR watch all the OnlineMedEd medicine videos.
  • Other useful resources to consider are Step Up to Medicine 4th Edition and First Aid Step 2 CK 2020.

Official Med-Ace tools for the Internal Medicine Clerkship

Check out the Med-Ace History & Physical Template! This template includes all the major information required to take a full history and physical. Print a couple of these sheets and take them with you to clinic!

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