Internal Medicine

Josh is now well into his 12 week Internal Medicine rotation and I know that as an SO during his first and definitely during his second year of school I had so many questions about the clinical years.  It seemed that while there was an over abundance of information on how the basic science years went, there was an equally large lack of information regarding 3rd and 4th year.  I feel like we started year three blindly.  Yes, SGU had a couple of meetings during 5th term to inform us of the health criteria that needed to be met and the names and locations of hospitals that we could choose from but there was little to no information that explained what the day to day life of an MSIII might look like.

While I can't speak for every hospital that SGU is affiliated with, nor can I speak for different clinical rotations within each hospital, I can tell you some information about Internal Medicine at ARMC (Arrowhead Regional Medical Center). 

First of all, Josh is really enjoying the hospital.  He likes every intern, senior resident, and attending that he has worked with thus far.  At ARMC, students are placed on a "team" consisting of four student physicians (some may be 4th years), two interns (first or second year residents), a senior resident, and an attending.  If you are keeping track, that's an eight person team.  Four students, four MD's.  Pretty darn good ratio of students to MD's which is especially good for learning.

At the meetings during 5th term, SGU hammered into the heads of the students that what makes or breaks your time during clinicals is not so much the hospital, but the attending/residents that you are working with.  But, maybe you are thinking to yourself small teams are great but what if my student hates their attending, maybe your husband just got lucky.  Well, the good thing about IM at ARMC is that every four weeks, you switch teams.  So you get to be on a total of three teams.  You rotate with the same students, but your attending/resident team changes.  That way, if for some reason you didn't get along with your attending on Team 1, your grade isn't solely determined by that attending. 

Which brings me to grading.  How does it work?  And this can be said for all hospitals during clinicals.  Your final grade is broken up into categories.

80% of your grade is based on your attending(s):
          -20% medical knowledge
          -20% clinical skills
          -20% professional behavior
          -20% performance on end-of-clerkship oral exam (given by attending)
For the oral exam, the students at ARMC were given a list at the beginning of the clerkship with all the topics they could possibly be tested on.

The last 20% of your grade is the NBME clinical subject exam or shelf exam as you will hear it referred to.  This exam is the same for every SGU student in every hospital for each clerkship.

SGU expects that many/most students will get A's and B's in their clerkships. 

So how much will your student have to study?  Well, I suppose that all depends on your student.  So far, Josh has had mini assignments from his attending where he has come home to read up on certain topics or if there have been things he has seen in the hospital that he feels he is lacking knowledge in, he has come home to read about them.  But overall, his nose hasn't been in the books like it was first and second year.  Hallelujah!  At ARMC, in Internal Medicine, the students will get one week off at the end of the 12 weeks to study for the shelf exam. 

Okay, so he doesn't study much, but really, how BUSY is he?  The answer to that, extremely.  The students at ARMC in IM work A LOT.  Maybe more so then most SGU students at other hospitals.   Josh is taking two 28 hour call nights a week (about every 4 days) and when he's not taking call, he's going in at 7am and getting done around 3 or 4pm.  Those days aren't half bad, but when you are still lacking sleep from your last call night, it can be rough.  He's averaging about 80 hours a week in the hospital. 

I suppose you can look at this as a negative, but Josh and I are seeing it as a positive.  He has his own patients (since day 1) that he sees.  I'm talking Josh goes in the room by himself, no doctor, no resident, and sees patients and then chiefs it (reports to the attending).  It's actually pretty darn cool.  And because he is in the hospital so much, he is learning a ton!

We know that not every rotation will be this intense.  We can expect that Internal Medicine and Surgery will be especially time consuming, but that Family Medicine and Psychiatry will be a little less stressful.  Thankfully, we already know his schedule for the whole year.  Twelve weeks of IM, followed by Surgery, Pediatrics, OBGYN, Family Med, and then Psych.  I'm sure I'll be able to post the some information on those as they happen.  For now, we are taking one rotation/one week at a time.  Over two years in and this medical school thing is still a learning process!