I just completed my Internal Medicine rotation at North Shore University Hospital. Overall, I enjoyed the rotation a lot, in that I got to learn and experience many different things that will be useful for my upcoming rotations and career in medicine going forward. My preceptor definitely contributed to my learning experience; she did her best everyday to get me on different floors and into different units no matter the specialty, just so I could learn as much as possible and to keep every week interesting during the short time I was there. For example, I got to spend a day in the cardiac cath lab, where I saw firsthand how angiograms, stent placements, and other percutaneous catheter interventions are done, as well as the different providers that play a role in that medical department. I got to spend time with the X-Ray technicians, who are extremely knowledgeable and gave me some useful radiology tips that were definitely appreciated, since radiology is not my strong suit. My preceptor also had me work in the Endoscopy suite one day, which I loved because I’ve always been interested in gastroenterology. I got to watch routine colonoscopies and polypectomies, and saw some peptic ulcers and GI bleeds. While in the Endoscopy suite, I was also able to familiarize myself with some of the anesthesia medications, and learned how endoscopic biopsies are done. I also got to spend a day on the Heme/Onc floor and learned a lot about the different blood cancers, specifically AML. I learned that these cancers are especially difficult to treat since a lot of the therapies involve weighing costs versus benefits heavily and making decisions based on the “lesser of two evils.” For instance, the PA in that unit taught me about important labs to look out for in heme/onc patients, specifically hemoglobin, platelet, and white counts. He explained that while patients with blood cancers present with aplastic anemia where all blood cell lines are diminished, they are also at an extremely high risk for clots since cancer patients are in a hypercoagulable state. So although they are already at high risk for bleeding, you still have to anticoagulated these patients for DVT, PE, and DIC prophylaxis. Therefore, weighing the patient’s platelet counts against their risk for clotting can be a big challenge.

Regarding my experience on the Medicine floor, I really enjoyed getting to practice routine procedures such as blood draws, IVs, and Foley catheter insertions. Although my technique was initially very poor, the nurses were extremely helpful in teaching me how to hold the equipment and where to place it on/by the bed in a way that was accessible, easy, and comfortable. I learned that holding the IV catheter like a pen is much more comfortable, and that when choosing which vein to use it’s better to choose the one that is most palpable rather than the one that is most visible. Additionally, the nurses taught me to always point the needle in the direction the vein is going, and that if I don’t get any flashback I should try to reposition the needle while still inserted instead of taking it out completely (because then I would have to try again and re-stick the patient with a brand new needle). For catheter insertion, I felt catheters were much easier to insert in male patients than female patients due to the female anatomy. I think I still need to practice catheter insertion in female patients for this reason. Also, it was especially hard to insert catheters in female patients who were contracted because a lot of the technique involved positioning the patient in a way that optimizes visibility; so this is something that I definitely need to work on. Finally, I feel this rotation taught me a great deal about operating the EMR systems, in terms of how to navigate them and also what information to focus on. Since oftentimes, especially in hospitals, I will have to collect as much valuable information on my patient in a short amount of time, it’s important to know where to look and in what order to read things. I learned that it was best for me to look first through recent Consult Notes and Progress Notes, then recent lab and radiology reports for any abnormalities, and then through the medication list so that I could gather pertinent information to present to my preceptor. I learned that the most important thing to look for on when on an inpatient Internal Medicine floor is for any emergent electrolyte abnormalities that need quick correcting. Although my preceptor taught me a lot about writing notes and proper formatting, I think coming up with a differential diagnosis, Assessment, and Plan are the areas I still need the most practice with and most improvement in.

Overall, I believe this rotation prepared me a lot for my next inpatient and especially outpatient rotations, because I got to learn how to do different skills quickly and efficiently. I believe starting off with Internal Medicine helped familiarize me with an extensive amount of medications, as well as how the hospital system is structured, how different providers in the hospital work together, and how different departments work together to provide optimal patient care. Although I am definitely still learning and still need much improvement in many areas, I feel less intimated than I was a month ago!