My Internal Medicine rotation was the most surprising of them all so far. Starting with my very first day, I was surprised by how little patient interaction occurs throughout the day, and how much charting is done instead. Almost all of the patients I encountered had very complex medical histories and hospital courses, which made for what appeared to be a lot of dynamic charting with constant consults for my daily preceptors, and a lot of chart reading for me. 

The amount of information in the charts made my first couple of weeks feel very overwhelming. Between the specialties consulted and their progress notes and what that meant for the patient’s course, orders, and lab and imaging results, there was a lot to sift through to ultimately determine what actually needed to be done that day. This was the first rotation where I truly felt my “medicine” knowledge being exercised (often – especially during the first couple of weeks – beyond what I felt capable of). But like with previous rotations, I felt that I was getting the hang of going through all the notes, consults, imaging, etc. by the end of the 3rd week. I also enjoyed that there was a lot of “downtime”, because I was able to take my time going through each chart starting with ED admission. This gave me a lot of practice coming up with differential diagnoses, which is something I committed myself to practicing starting with this rotation. 

I overall appreciated this rotation for how it reminded me that I hope I go into a specialty that allows me to practice at the top of my license, which would make me feel both professionally and personally fulfilled. Ideally, I’d want more patient interaction and patient education throughout the day than what Internal Medicine gave me, but the 3×12 schedule definitely opens up the possibility to pursue that per diem. Going forward, I’m excited to continue practicing my differentials (Rosh Review questions worked well for this also), and I also plan to work on my assessment and plan by making sure I come up with one for as many patients as I can during my next rotation, even if I am not going to be presenting on them. This rotation taught me that those two components are probably the most important thing for inpatient continued hospital service because they keep the ball rolling and tell everyone else on the team where things stand and what to do next.