Medicine Shelf & Wedding Dress Shopping || Internal Medicine Rotation Pt. 2
Disheveled and done with IM!
Life
Hi everyone! Internal Medicine was amazing but exhausting. I’m currently on my two-week break before my surgery rotation begins. Two weeks of break, wooo! Feel like I’ve earned it after 12 weeks of a hospitalist schedule. My next break will be the last two weeks of the year. Thankful to get any time off really.
So what did I do this break? I’m a double Virgo. So of course I overscheduled my vacation, but let’s start with the positives! My inner child is ecstatic because I finally bought all my PC parts! Now I just have to figure out how to build it (Edit from future Rainee, omg this hurt to build). So if any of you are playing any games, let’s link up on discord! I plan on trying out Apex, Valorant, and hope to play some cozy/horror games.
During ft. the boys
After!
The goal is to get the house ready for our backyard wedding next Spring! We’re planning a micro wedding, basically teetering on the edge of a big garden party. I’m surprised that I’m drowning in the details with a smaller event. Not even my spreadsheet is lifting me above water. I thought medical school was hard, but planning a wedding - oof.
My highlight of this process was trying on wedding dresses! Magical. I chugged along my last couple of weeks of IM as a slug. It felt like a cute kick in the butt when I stepped onto the pedestal in the most beautiful and impractical dresses I’ve ever touched. My parents, my teenage brother, my newly coined adult sister, and my best friend were all cozied up on the couch with cute “yes” and “no” paddles. Core memory for sure. I didn’t walk out with a dress, but there is one that I can’t stop thinking about. That’s a sign right?
My Medicine Rotation
My friends, I still know nothing.
Ending My Internal Medicine Rotation
In my last week, a weird cloud of limbo loomed over me. It felt like the end of something. Over the weeks, I joked about being a permanent fixture to the residents as they rotated through my team. My rotation became comfortable, a habit, and a little homey. Despite my stress-induced eye twitch near the end, I genuinely enjoyed Internal Medicine. Besides playing Elden Ring, it’s been some time since I’ve been involved in something where timely quietly slips by. I’m usually one to constantly count down the clock because there are a million and two things to do. I could see myself doing this for years. Maybe not forever because I have to open my boba cafe/senior dog rescue but for a while!
I was so nervous when I started this rotation, especially being an online student. I knew I lacked many technical skills and my knowledge was shaky. Everyone was so kind and welcoming. They would offer advice and sometimes even food. They got me with the food. The first attending I ever worked with had a tradition of bringing donut holes every Friday. It felt full circle to do the same for everyone else. I’m not sure if I told you all, but I considered quitting medical school. Right before the term started, I called my parents for our usual weekly call. I blurted out that I’m ready to quit if this rotation didn’t feel right. I love medicine, but there are incredible amounts of hoops to jump through. Also when I’m away from medicine, I remember all the other stuff I love! So I really have to thank everyone I met in my rotation for teaching me what working in medicine could be like.
Final Thoughts on Internal Medicine
Uhm this rotation is as hard as they say! The schedule is tough no matter what hospital you rotate at. My schedule consistently started at 6 am every day, but some of my classmates rotated through different IM subspecialties. Their schedule would change every 1-2 weeks. They would work weekends and nights. So studying can be hard to balance. Especially since IM basically covers everything! So if you’re starting IM, I would be prepared (but not anxious) about the workload. You’ll be able to handle it! I heard after IM and surgery, life gets better though.
Internal Medicine Shelf Exam
Signing Up
Even though the syllabus states our vouchers come about halfway through the rotation, the coordinator told me that’s incorrect. I received my voucher about 2-3 weeks before the end of my rotation. We are to take the shelf exam before the end of the rotation. For me, that meant the Saturday after the rotation ended. Many students I know asked for the last week or a couple of days of the rotation off to study for this exam
Grading
I was surprised to find out that grading for shelf exams is different for every school and shelf exam! The grade is usually based on the percentiles that NBME returns, but the school translates the percentage to honors, high pass, pass, or fail for SGU at least. Right before I started clinicals, SGU just changed the cutoffs and procedure if you were to fail the exam. So in July 2022, if you score above 70 that is a pass. If I were to fail, I would continue with my rotations as planned. At the end of my 3rd year, I’d have to take 4 weeks off to study and retake the Shelf exam before moving onto 4th year rotations.
How I studied For The Medicine Shelf Exam
I really tried to stay on the Firehouse Prep schedule. It is a lot. What made the rotation more challenging was balancing out wanting to do well during my rotation, but as stay in line with SGU’s study schedule. My attendings would recommend I study certain topics for the week and give presentations about them and that didn’t always align with the firecracker quiz. I’m interested in IM, so I ended up prioritizing what we were doing in the hospital and switching around my topics for the week. I wouldn’t do as well on Firecracker quizzes, but those aren’t graded numerically anyways.
For cumulative review, I loved these video series:
There are also 4 NBME practice exams available for purchase. In July 2022, they were $20 a piece. I believe in the internets the earlier versions also float around if you’re handy.
The Exam
My exam started at 8 am. The only proctoring location I could book was 30 minutes away. The exam felt sadly familiar to haunting of Step 1. The exam was 110 questions. Luckily a resident warned me prior to taking the exam, there are fill-in-the-blank questions. I had a couple. One I was pretty sure, but for the second one, I felt like I could answer a million things - which were they looking for? I’ll never know. There were no designated breaks, but I drank too much coffee and had to use the restroom in the middle of the exam. I used the whole 2 hours and 45 minutes. It was difficult! It covered a lot of topics. I left feeling like I thought I failed. I got my results about a week later on the mycampus website. I didn’t get the notification that the results were in until a week after that. Guess it paid off being anxious!
Lessons from my attendings, residents, & patients
Over my 12 weeks, I’ve gotten a lot of advice. Here are the ones that stood out to me.
About Medicine
Feel like you’re your patient’s physician. It doesn’t matter where you are in your training, if you embrace the responsibility you’ll do a better job. You’ll also not go into shock when you’re finally a resident. Well this is a translation from a different language, so imagine what I said but prettier.
Think about the endpoint of the hospital stay. What marks when the patient can safely go home? It’s not benign to stay in the hospital! During my rotation, there was a COVID wave. Suddenly every time we wanted to send someone home to a nursing facility, they would test positive for COVID :(
Understand why. Why do you want to order this test? What will you gain from it? Why did this patient’s lab change? A big part of this part of training at this point is to understand the reasons why before we have to start making those decisions.
It’s boring and lonely being a patient! As a medical student, you have the most time on the team. The biggest difference you can make is to give some people your time because you want to treat patients as you would want your family member to be treated.
About Life
Just try! One attending whom I loved working with, would often ask the group a question AKA pimp. I tend to be more timid in groups. One day, he called me out on my hesitation. He said “Just try. Say anything. It’s okay if you’re wrong. You’re here to learn. If you knew everything, you wouldn’t need to be in training right?” So cheers to all my introverts out there for pushing yourselves and learning how to shine in group dynamics. It’s tough!
Don’t lose yourself to the process. It’ll never feel like there’s enough time or the right time to do anything! 5-10 years of training isn’t a small price. At the end of it, of course you want to be proud of your accomplishments but also be proud of who you will be. Life seems to flash by.
My third-ever patient came into the hospital for constipation. We would chat for 5-10 minutes every day when I pre-rounded. She loved talking about her children. When the team introduced the topic of possibly going home soon, she beamed as she talked about all the things she was going to do. On that Friday, I wished her well just in case I wouldn’t see her before she left. When I returned on Monday, I walked down to her room in the ICU. The wheezing of the ventilator was so loud. She came in for constipation. It was difficult to reconcile our light conversation on Friday with this reality. Life changes so fast. So do the things you want to do!
Warmly, Rainee
Can’t wait to chat about my big, bad, scary Surgery rotation - talk to you soon!