- For this rotation, both Katie and Emily were placed out of Tampa Bay in Homosassa, Florida although they were there at separate times. Each student in our program was required to attend a rotation here as it was our “rural/cultural” rotation. Barry University has a house here and it holds up to 4 students at one time. This area of Florida is actually quite fun and located near a beautiful spring/river called, Crystal River. We both had the opportunity to swim and kayak with manatees while here. If anyone has ever seen the Netflix series “Hart of Dixie,” this is exactly what it’s like practicing medicine there. Both Katie and Emily drove up for the week on either Sunday nights or Monday mornings and would come home on the weekends. Emily did spend 2 weekends in the area exploring, however, and was also there during Thanksgiving and Christmas so it was her longest rotation.
- In regards to the actual rotation, both Katie and Emily had the same preceptor. There were multiple locations where clinics were held and overall it was a bit chaotic but we both learned a lot. Most of what we did was clinic based outpatient internal medicine.
- For internal medicine we recommend studying daily/nightly for this rotation. This will be your hardest EOR, but the most pertinent to studying for boards as it is all encompassing.
- Prior to starting the rotation brush up on common labs and electrolyte abnormalities and carry a reference chart for normal ranges (there are clipboards that have these on them). CBC, CMP, Arterial/venous blood gas, AST, ALT, Alk Phos, troponin, lipase, procalcitonin, lactic acid, BNP, CK-MB, NaCl, K, Ca, Mg, Phosphorus
- Prior to starting the rotation brush up on common disease processes such as hypertension, diabetes, heart failure, urinary tract infections, COPD, asthma, gout, DVT/PE, myocardial infarction, hyperlipidemia, kidney disease, HIV, electrolyte abnormalities, vitamin deficiencies (yes, basically everything)
- Carry a pocket reference book and or download these Apps
- Pocket Medicine: The Massachusetts General Hospital Handbook of IM
- MDCalc, Epocrates (free or full version), UptoDate, CDC guideline, Sanford Guide for Antimicrobial, FP Notebook
- Listen to podcasts if you have long drives – PA Boards, Medgeeks, EMCRIT
- Pick a disease process that you saw that day and brush up on the facts of that disease that night. It’s the best way to get the facts to actually stick as you now will have a patient to reference and remember.
- This is a great rotation to practice physical exam skills for the entire body. Be thorough and take your time with each patient. Address all of their chronic problems at each visit.
- In summary, IM is a fast paced, challenging, overwhelming but rewarding rotation. You are exposed to basically everything and anything that medicine has to offer. This is the rotation that will serve you the most in regards to prepping you for boards. This rotation tends to have long hours so it’s vital to get rest, stay hydrated, eat healthy and set aside at least 30 minutes to exercise and clear your head daily. If you get pimped and you don’t know the answer, the correct response is “I don’t know the answer but I’d be happy to look it up and read about it tonight.” Ask questions, don’t assume you know what the answer is. Take every opportunity you can to see new things in this rotation. Not every rotation will be this hard, remind yourself of that as the days go on.
- This was Katie’s first rotation and her first thought was “how am I going to know EVERYTHING my first rotation?” It was Emily’s last rotation and by that point she was over rotations, which happens, but she still made the most of it. It was within Tampa Bay and was in a small office with one physician, one PA, one nurse and a few other faculty members. The PA mostly ran clinic and the physician was seldom present.
- Ironically again, we both had the same preceptor although our experiences were entirely different. For Katie, it was very close to her home, and for Emily it was a long drive. Katie got to do a lot more urgent care hours whereas Emily only did one evening. At this rotation, we were lucky to have a lot of autonomy with seeing patient’s and charting (even though they still had PAPER, yes I repeat PAPER, charts).
- Our advice for Family medicine is basically the same that we gave for IM so see above for things to brush up on, apps to download, etc. It is less likely that you will see the Zebras that you may see with IM, however there is always that possibility. The one thing you may see more of in Family versus IM is orthopedics and women’s health issues, so add those to your study list. In family medicine you are the patient’s first point of contact for anything and everything that could be wrong with them. You serve not only as their medical practitioner, but their mentor, their advocate, their psychologist and sometimes just a friendly face and reason for them to get out of the house.
- Prior to the rotation, brush up on screening guidelines. PCPs are responsible for these!
Don’t forget about all of the resources available at: https://doseofpa.blogspot.com/2014/04/clinical-rotations-end-of-rotation-eor.html
Katie’s roomie making dinner in our Homosassa house
Emily and the manatees
What’s your biggest takeaway from your internal medicine and family medicine rotations? Email us at firstname.lastname@example.org!