Wow, where do I even start?! Hi everyone! It feels like a lifetime has passed since we last caught up. I just sat down after completing my mid-rotation exam which has neither been confirmed or denied to be worth any points.

Life

Post-Step life was incredible. It felt like I woke up from a terrible nightmare. The loan money wasn’t able to sustain me for the entire duration of dedicated, so I had to get some gig work.

I’m grateful I had the chance to relax on a mini vacation. I even got to revive some of my old hobbies! My favorite - I picked up Elden Ring. Wow, I thought it was going to be like Skyrim. Imagine me skipping the tutorial because I’m scared of caves and then walking up to the Tree Sentinel expecting some kind of dialogue. It didn’t go well. I’ll tell you that.

Anyways, if you’re in California and don’t have the funds to go on a tropical vacation - I would recommend Catalina Island! It was our first vacation since the panini started! We did some excursions so it really felt like we traveled far away. My favorite was also my least favorite. We did this obstacle course in the trees. Well, I discovered I’m a little scared of heights. As I get older, seems I get more scared of everything. However, it was a fun challenge, especially forcing myself through obstacles literally because there’s no other way down except asking the staffers to bring over the ladder. I’d rather not do that ever lol.

I have to tell you about my most satisfying side gig. I finally finished my furniture flip! It took me almost a year. I bought the dresser for $40. It took me learning how to use a paint gun and replace hardware (it’s way more complicated than I thought). After all that time sitting in my garage, it sold within a week for $240! I learned so much, especially about what not to do. I hope to do another project again. It’s fun to give a new life to old furniture, but also it’s a nice side hustle.

My boys celebrated their birthdays! Kalbi turned 7 and Mocha turned 1. We baked them a cake from Amazon. They also got party hats haha. I can’t believe they’re growing up so fast!

My Medicine Rotation

My friends, I know nothing.

I don’t have that natural edge in intelligence or even amazing charm so you’ll forget my shortcomings. I’m still working on finding my way. It’s been an overall positive gut check and I appreciate that.

Getting started

My medicine rotation is 12 weeks. I was anxiously waiting for my assignment since March. 3 weeks before my start date in May, the email finally came! It was such a bittersweet moment.

Unfortunately, I had to work with the administration to get relocated because of certain circumstances. After many email threads and lots of waiting, my final assignment arrived a week later. The assignment email included start and end dates for my whole 3rd year (IM, Surgery, OB, FM, pediatrics, and psychiatry rotations) and locations. Most of my rotations were in one hospital, but pediatrics and psychiatry are in another. I’ve got two weeks off in August and the last two weeks of the year off worked into my schedule. I think I’m going to need it.

Since that’s all the information I got, I emailed the hospital coordinator for more information. They were able to tell me my orientation time a date.

Orientation

I was hyperventilating while I was driving on my first day. Pure panic. I lined up probably 6 podcasts in an attempt to cram information into my brain. I really didn’t know what to expect on my first day. It was a long 43 minutes of me trying to hype myself up in the car. I’m a COVID med student, I’m pretty sure I don’t know anything.

The hospital coordinator met with me first. We did EHR training where I met a bunch of other students who already started. About an hour later, the coordinator handed me off to the senior resident on my team. I was so intimidated. I mean what is a medical student supposed to look like or act like? As we walked to meet the rest of the team, he casually ran through the logistics. At this location, medical students start at 6 AM - 7 AM and are released at the latest 6 PM Monday to Friday, no nights, or weekends. What a relief! Some of my classmates are getting the full experience with nights, weekends, and holidays. Absolutely, I’m counting my lucky stars.

In my location, a team consists of an attending, 1-2 senior residents, 1-2 intern residents, and 1-2 medical students. It can be a big crowd! Since my rotation was changed, I started my IM rotation solo. I can see how it can be nice to have a buddy with you!

Anyways, I squeakily introduced myself to my team. My senior resident said I’ll pick up 1 or 2 patients tomorrow. I would go see them on my own. I was shocked. People had told me they were gently led through their first week. There were no expectations to know anything, especially how to do things. The only patients I interviewed were standardized ones over Zoom. The only physical exams I’ve ever done were on my dog.

Logistics
What to wear

I’ve been home for 2 years. My wardrobe has consisted of floppy comfy clothes. I loved it. Well, that lead to me panic purchasing some business casual outfits from ThreadUp. Eventually, I asked my senior resident what medical students wear. He said to wear whatever is most comfortable: scrubs or business casual. Around my location, I’ve seen medical students in both business casual and scrubs. It seems to depend on your team.

My current favorites:

(Edited by 4th year Rainee in 2023)

Scrubs:
- Amazon (the Adar brand has been comfortable)
- Uniform Advantage Buttersoft
- Mandala: I’ve converted to all Mandala. I really love the jogger style and they have so many pockets so I can horde all my notes and pens. They’re actually on the cheaper side of scrubs and really easy returns. You can use this link to get $5 off which is already a third of the price. The only thing is no free shipping which Amazon has ruined for all my other shopping experiences.
Shoes:
- Addidas ultra boosts (I got mine for $80 on sale!) . Review after 1 year, they actually hurt after a while. Maybe I have weak arches but I wasn’t enough support. I just purchased the new balance x Figs shoes for $98 and hopefully they’re better. I’ll let you know.
- Rothy’s knockoffs for business casual
Compression socks: An absolute must!
Student white coat since the one SGU gave me was the attending one
Stethoscope, the one SGU gave us wasn’t that great for my beginner's ears

What’s in my bag (and all my pockets)

In my rotation, there isn't much downtime so I don’t carry my books or laptop. I bring in my lunchbox, my coffee thermos, and my water canteen. I store these in the resident lounge. My scrubs and whitecoat essentially enable my over-packing tendencies.

In my scrubs, I usually carry pens, masks (we get surgical and N95 supplied by the hospital), and the list of patients for the day. In my white coat, I usually carry:

H&P notebook: I love this thing! It has 100 note templates. Since I’ve only practiced telemedicine in basic sciences, it was super helpful to have a reminder of things to ask, physical exam maneuvers to do, a place to write my presentations, and updates on the plan when we round. It’s my crutch and I love it.
(Alternative) Foldable clipboard: I’ve seen residents and nurses use these which seem super handy. Some even have lab values and random helpful facts. This might be better and more lightweight if you plan on just using loose paper.
Badge reel: My location doesn’t give students badges and requires me to display my school ID. I bought some cute motivational ones to compensate for my anxiety.
Pocket medicine: My PCP recommended this when I was getting my health clearance. It seems to be a tried and true resource. It’s like an ultra condensed version of First Aid for IM. A resident told me if anything it makes you look smart haha!

Helpful Apps & Resources

Up To Date: Please! If you sign-up for Up To Date in some hospitals, the membership is free. Another option is to ask a classmate who has this option, to make you an account. It is incredibly helpful in knowing the presentation, diagnosis, treatment, and all the good stuff about diseases. And flowcharts!
Dynamed: If that’s not an option, you can sign-up for a limited membership of Dynamed by becoming a member of the American College of Physicians (free for medical students). I do like Dynamed. It’s a more paired-down version of Up To Date. It’s helpful for prepping before interviewing patients to know what to ask and look for the physical exams.
Amboss Knowledge: If you already have an Amboss subscription, this can be a helpful alternative. It’s access to the wiki-like pages that we’re familiar with but they also make it more function for treatment/diagnostic algorithms and calculators, and drug information.
Qbanks
- Uworld: SGU gives you a 720-day membership for Step 2 qbank. The Qbank has Shelf exam sections and Step 2 sections. The IM section itself has ~1200 questions. I like to review the incorrect by putting them in an Anki deck and sometimes I’ll write the notes/copy helpful tables and put in my incorrect doc
- Firecracker: SGU requires you to utilize Firecracker. I like the topic flashcards which are quick reviews.
- Anki: I will always love Anki! I use the Zanki deck because I also watch Sketchy and it’s helpful to create an Incorrect deck.
UofL Internal Medicine Lecture Series
Curbsiders

An average rotation day

4:30 AM Wake-up, make coffee, take the dogs out

5:15 AM - 5:55 AM Commute

6 AM - 9 AM

Pick up the list of patients for the day. Communicate with my residents about which patients they want me to follow. I usually follow the same patients for their stay. When I have room, add new patients to my list
Chart check: I go through each patient's chart looking for their vitals, recent labs and imaging, and notes. The goal is to know your patient as thoroughly as possible and be able to tell their story (case presentation), their diagnosis, and eventually their plan or at least have notes about it. This takes me about 1-1.5 hours
Once I’ve chart checked and before I see the patients, I check in with my residents to see if they want me to ask the patients anything in particular.
Pre-round on my patients for 30 minutes to an hour. This involves speaking to the nurse about any overnight events and interviewing and examining the patient.
If there’s time before we round as a team and my resident is available, I’ll ask them if I can practice my presentation or what their plan for the patient is so I can be prepared for the rounds.

9 AM - 12:30 PM Round with the whole team. Some attendings prefer to table round which is to discuss each patient on the list while sitting down. We present each patient and talk about the potential plan and what we’re looking for when we see them. Then as a group, we visit each patient and the attending will talk to and examine the patient. Other attendings prefer to round on the floors which involve going to each floor. We discuss each patient right before seeing them.

The expectations for me as a medical student are the same. It’s expected that I chart check my patients and see them beforehand. For patients I’m following, I present the patient’s case. The flow is usually the one-liner, admission history (vitals, labs/imaging, interventions), their current updates, then their plan by each diagnosis from most important to most chronic. It was advised to me that it’s better to start overshooting and let the attending edit your long presentation than to only offer pieces. Dirty Medicine has a great video on how to do a presentation.

12:30 - 1:30 PM Resident Lecture/Lunch. Almost every day, there is a lecture for the residents that the medical students also attend which cover a variety of topics like board review questions, lectures from faculty, etc.

1:30 - 4/5/6 PM Depending on the workflow of each attending. We may continue rounds after lunch. The residents often have to catch up on orders and administrative things. I try to be helpful in any way possible which I feel like is quite limited. I’ll offer to write notes, or chase down labs/imaging, and make calls for records. The residents will usually release me when the work is done or if it’s a long call day, I usually stay later.

5 - 6 PM Commute home

6 - 6:30 PM Cook/Reheat dinner, feed the dogs

6:30 - 7:30 PM Human time

7:30 - 9:30 PM Study

9:30 PM Get Ready for bed!

How I study

I’ll be honest, I floundered for the first 3-4 weeks. SGU provided us with a rigid schedule of topics to cover before our mid-rotation exam. However, my real-life patients didn’t often (hardly ever) align with each topic of the week. It took me a week to understand the hospital, what my attendings expected of me, and get used to waking up at 4:30 AM. Then another week to figure out what SGU wants from me and attempt Uworld questions. On a side note, life happened! I got food poisoning and my fiancé got COVID so everything went into hyperspeed. All that to say, I have a better understanding now but is it too late?

Learning for the board exams

I started off using Firehouse Prep’s Core schedule. I altered it to include more sketchy and to be a checklist. Then I do 10-15 Uworld questions. Anki. Then firecracker for some rapid-fire review. Honestly, a lot of the time the work overflows to the weekends.

Onlinemeded: My process starts with 2 Onlinemeded videos. These are very comprehensive! After each video, I’ll annotate notes into Step up to medicine.
Sketchy: If I have time, I’ll watch 1 sketchy pharm and 1 to 2 sketchy IM videos. I’ll admit these aren’t as easy as the Path videos. I am a visual learner, so it’s still helpful to watch after the OnlineMedEd videos
10-15 Uworld questions
Zanki + Sketchy decks: I don’t do any cards in particular. I do an “incorrect” deck based on the Uworld questions I get wrong.
Firecracker flashcards: I do these when I have a couple of minutes or my brain is at like 10%. There are some helpful tidbits to review!

SGU requirements (on top of your rotation hours)

Okay, I’m a little lost in the sea of emails trying to understand these requirements, but I’ll do my best to explain and update this when I learn more.

Weekly Requirements

Firecracker
- SGU requires you to sign-up for this website. It attempts to pace out the topics you need to learn. You’re supposed to mark 10 topics a day and review topics through their flashcards and questions. Participation counts towards professionalism.
- Quizzes: The quizzes are done online through Firecracker. They are released on Fridays and due on Monday. They are usually 20-25 questions.
Patient Encounter Log (PEL): You can find this google form-esque log on the SGU clinical site. Before the end of the rotation, you need to submit all 24 required encounters. It’s optional to submit a SOAP note in the comment, but the school mentions you can print this log and show it to your preceptor for the final rotation evaluation. My advice, make it a habit to submit a couple of encounters at the end of each week to stay on top of it. If you don’t run into encounters with these diagnoses, there is a required video to watch. It can be helpful to copy your notes (without any patient info of course) into a google doc while you’re in the hospital.
iHuman: It’s back! It seems every other week, we have to work through a certain case. (Edit: they canceled this bc no one liked it)

Mid-Rotation (Week 6)

Observed Encounter: It would’ve been smarter to do this before week 5. I would recommend printing the form out week 1 and carry it with you. For me, the opportunity to pre-round with a resident was sporadic. This rubric can be signed off by multiple preceptors and can include multiple encounters. Per smarter students, it all depends on who you ask. Play smart, not harder.
Mid-rotation exam: This is done on Examsoft. I know, I deleted it too. It was 110 questions encompassing the 5 topics outlined by the SGU firecracker. Well tbh, my exam also included a little bit of week 6 but this exam is “formative” so I’m reading that as not graded. Hopefully, that’s correct.

Before the rotation ends

Observed Encounter #2
UWorld: Complete 600 questions (there are about ~1100 questions total for the medicine shelf)
Case write-ups? I can’t say I know what this is. It’s a new requirement for my class.
Communication Courses: There are a couple of click-through courses to do as usual.

A COVID note

My fiancé got COVID week 4 on my rotation. As soon as he tested positive, I texted my hospital coordinator. The coordinator instructed me not to come in the next day. Unfortunately, the whole admin office went on vacation until the following Tuesday so I had to text my preceptor informing them I can’t come in. On Tuesday, I took a rapid home test. It was negative and apparently, that was enough for me to come back. Since we see really sick patients, I tested every morning with a rapid and wore an N95 while in the hospital. Some classmates told me that they were able to come back 5 days after they tested positive.

Things I wish I could have told Day 1 Rainee

As a third year, you aren’t expected to know everything or much at all. Even when my residents and attendings pushed me to do things, I was never really criticized for my lack of knowledge. Everyone I met was happy to help me. I know some of my classmates posted about diagnosing cancer and being rock stars and that’s amazing! It’s also okay if you’re just doing your best. I’ve asked for feedback from my residents. I don’t know if they said this to avoid crushing me, but they’ve told me that attitude is much more important. So give yourself space to figure it out!

Anyways besides the physical exhaustion, I’ve really enjoyed my IM rotation so far! Most of the residents I’ve had the opportunity to work with have been absolutely fantastic. They take time out of their hectic day to teach me and watch out for me. I hope to be like them one day. One of the attendings brings a box of donut holes for the residents and medical students every Friday they work. I love every other Friday.

Warmly, Rainee

Can’t wait to tell you about how IM finished and the shelf exam!

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My first month as a clinical student + Mid-rotation Exam || Internal Medicine Rotation Pt. 1