Medicine Clerkship Tips

The medicine clerkship is a jam-packed rotation where you’ll get to learn the core principles of internal medicine. Here are some of my tips for how to excel on the shelf exam and on the wards. 

Shelf Exam

Shelf resources:

Sketchy IM and Sketchy Pharm: Of course! There are a couple different ways that you can structure your review. I’d recommend watching videos from a particular organ system followed by UWorld questions from the same system. Since there are so many good videos, you’ll need to watch at least 2-3 a night.

NBME exams: Plan to do these for every clerkship, including medicine. 

UWorld Step 2 Qbank: Just like for Step 1, the UWorld medicine section is your go-to question bank to prepare for the medicine shelf. Make sure to look at how many questions there are at the start of the rotation--there are a ton! Again, I think you’ll benefit from watching the Sketchy IM and Pharm videos on a particular topic then following them with UWorld questions from that system. 

High Yield Internal Medicine (Shelf Exam Review) slides: This is a great set of slides made by Emma Holliday Ramahi. A quick Google search should reveal the PDF file. There are also accompanying Youtube videos narrated by the great Dr. Ramahi herself. 

Other shelf resources that students have used: MKSAP 5 Review Book, Case Files Internal Medicine, PreTest Medicine, MKSAP for Students, First Aid for the Medicine Clerkship, Internal Medicine Essentials for Clerkship Students.

Miscellaneous tips:

  • Because this is a busy clerkship, you need to hold yourself accountable to a regular shelf study schedule. At the beginning of the rotation, make a calendar and divide up your questions, NBME exams, and Sketchy IM and Pharm videos for each day. 

Clinical

Ward resources:

Pocket Medicine (The Massachusetts General Hospital Handbook of Internal Medicine): This is the little orange book that you see a lot of students carrying in their white coat pockets. It provides basic overviews of most of the conditions you’ll see on the wards, with recommended workups and helpful citations to the relevant studies. 

The Washington Manual of Medical Therapeutics: Similar to Pocket Medicine but a bit more flushed out. Not pocket-friendly but a great reference to have in the workroom and when writing up notes. Electronic version has helpful quizzes and a search function. 

Miscellaneous tips:

  • In your free time, it’s helpful to have review articles handy that you can look over. This will help your performance on the wards and on the shelf. Plus, it makes you look cool.

  • Ask for feedback. Try to come up with specific questions for your team member to answer rather than asking a general, “how am I doing?”.

  • Print out the most recent EKG and be comfortable interpreting it in front of others rounds. 

  • Review any recent images before rounds. It can be helpful to read the radiology report after looking at the image yourself, but try to come up with your own interpretation to share with your team members. 

  • When admitting a new patient, make sure to check recent outpatient labs. This may require contacting the PCP.


Common medical conditions:

When I was on my medicine rotation in school, I received some helpful advice about specific questions you should ask patients who present with common medical conditions (in addition to all your other history questions). Make sure to ask these, document them in your note, and mention them in your presentations.

  1. Asthma 

    1. What are your triggers?

    2. Have you ever been hospitalized for your asthma? Have you ever been intubated?

    3. What are your typical peak flows at home?

    4. How often do you need to use your rescue inhaler each week?

  2. Chronic kidney disease

    1. What is your baseline creatinine? (Hunt through past medical records to find this information, or call the patient’s PCP)

    2. What is the cause of the CKD? Is this diagnosis proven on biopsy? 

    3. Are you dialysis dependent? Where do you go for dialysis? What days of the week? What is your access (fistula, etc)? 

    4. You can call the patient’s dialysis center to get a recent “Rounding Report” that summarizes the patient’s recent dialysis sessions. This will include things like blood pressure during the session and dry weights.

  3. Cirrhosis

    1. What is the cause of your cirrhosis?

    2. Are you listed for transplant?

    3. Have you had any complications due to cirrhosis? This includes things like hepatic encephalopathy, SBP, ascites, and esophageal varices. 

    4. Calculate the MELD score.

  4. COPD

    1. Obtain the most recent PFTs. 

    2. Stage the COPD using the GOLD score. (In general, MDCalc is a great resource for any scores that you need to calculate).

  5. Diabetes

    1. Do you have type I or type II diabetes? (Make sure that they are sure!)

    2. At what age were you diagnosed?

    3. What is your most recent HbA1C?

    4. Any neuropathy or retinopathy (or other end-organ damage)?

    5. Do you use insulin? 

    6. What is your medication compliance?

  6. Heart failure

    1. When was your most recent echocardiogram? What was your EF?

    2. Is your heart failure non-ischemic or ischemic?

    3. Have you ever had a cardiac catheterization? What were the results?

    4. What is your dry weight?

  7. Sickle cell

    1. Have you experienced any of the following: vaso-occlusive crisis, avascular necrosis, priapism, stroke, acute chest syndrome?

    2. Do you require regular exchange transfusions?

    3. Are you on any medications for sickle cell? Do you take hydroxyurea?

    4. How is your pain when you are not having a flare?

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I hope these tips help you during your rotation. Have fun!