I'm getting my ass kicked on rotations...

[Arthua]

Quite frankly, I'm blowing on rotations. In classes I was a solid B- to B student. I could've definitely been an A student, but I didn't think it was necessary.

I am currently on my internal med rotation and I'm not doing so hot.

My issues:
1) low confidence in clinical setting due
2) poor recall of information
3) Not as outspoken (I've never really been unless I'm 100% comfortable).

Does anyone have any books and or recommendations?

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[Saiyo]

Internal med is supposed to be hard, but its also where you learn the most and everything comes together. Some preceptors can be brutal though and expect you to know minute details that aren't clinically significant. What areas are you struggling with? Is this your first rotation?

 

[confettiflyer]

I see this all the time, this is what I have my students do:

1) Deep dive into disease states (like one per day) - I start with the common ones with good/established guidelines from major entities (IDSA, etc...) early on (CAP, COPD, UTI). By the end of the day (or next day, depends) I expect you to be able to spit out what you need to look at lab/pt wise and common treatment modalities & alternatives. I'll reinforce via repetition over the next 5-6 weeks.

2) Force the students to talk to providers - if I page a doc, I'll make the student do the ask for whatever it is we came up with. I'll have them do it on speakerphone at first and make sure it's a relatively friendly provider. Feet to the fire! Sometimes I do this knowing my student will fumble their way through the call, but I won't do this if I think they're not ready at all.

3) I'll start with what a student knows and build from there, even if it's limited. Usually this is through leading questions to guide them logically through a patient work up. If your preceptor is just straight cold asking you for factual regurgitation, they're doing it wrong. Not like you can do anything about it, just read read read.

4) Any other students at your site?

 

[radio frequency]

I see this all the time, this is what I have my students do:

1) Deep dive into disease states (like one per day) - I start with the common ones with good/established guidelines from major entities (IDSA, etc...) early on (CAP, COPD, UTI). By the end of the day (or next day, depends) I expect you to be able to spit out what you need to look at lab/pt wise and common treatment modalities & alternatives. I'll reinforce via repetition over the next 5-6 weeks.

2) Force the students to talk to providers - if I page a doc, I'll make the student do the ask for whatever it is we came up with. I'll have them do it on speakerphone at first and make sure it's a relatively friendly provider. Feet to the fire! Sometimes I do this knowing my student will fumble their way through the call, but I won't do this if I think they're not ready at all.

3) I'll start with what a student knows and build from there, even if it's limited. Usually this is through leading questions to guide them logically through a patient work up. If your preceptor is just straight cold asking you for factual regurgitation, they're doing it wrong. Not like you can do anything about it, just read read read.

4) Any other students at your site?

You sound like a great preceptor.

 

[Charcoales]

Review the Rx prep chapters for each disease state you stuggle with so you don't look like an absolute **** on rounds (you'll only look slightly incompetent instead).

 

[Arthua]

Internal med is supposed to be hard, but its also where you learn the most and everything comes together. Some preceptors can be brutal though and expect you to know minute details that aren't clinically significant. What areas are you struggling with? Is this your first rotation?

I am struggling at approaching problems in a critical manner. I just don't have the info readily available in my mind. I cannot openly display my lack of knowledge, as the times I've done so my preceptor has notified me of my weakness (Which he is correct about). I am also quiet and passive in discussions.

There are two other students at my site, and they're amazing, top of the class students. I'm happy for them.

I know I have to study, but for those that have gone through this, what was your method of solving this?

 

[Lnsean]

I am struggling at approaching problems in a critical manner. I just don't have the info readily available in my mind. I cannot openly display my lack of knowledge, as the times I've done so my preceptor has notified me of my weakness (Which he is correct about). I am also quiet and passive in discussions.

There are two other students at my site, and they're amazing, top of the class students. I'm happy for them.

I know I have to study, but for those that have gone through this, what was your method of solving this?

It has alot to do with your school and how they're teaching their curriculum as well too...especially therapeutics classes (the year before clinicals). At my school, they emphasized alot on case studies and patient scenarios...so our students were usually better prepared. I'd actually focus on whatever disease/conditions that you've been seeing the most on your rotations and look up cases in text books or online...see and understand how each case is worked out/triaged...from patient presentation to treatment to monitoring parameters...basically a SOAP for each case. This will definitely prepare you more than knowing random facts and stuff...it's about putting it all together. The other option is to just passively get by...it's only a few weeks...just don't screw anything major up and you'll get your C and move alone and graduate soon.

 

[Saiyo]

I personally had a hard time with antibiotics, couldn't remember what covered pseudomonas and forgot things quickly. In practice you see the same things over and over again. With rotations when you don't know, say you don't know but will look it up and get back to them. Dealing with real patients makes it easier to digest material more than didactic coursework ever did. After you look it up, you will remember it if its something frequently utilized in practice, and if you forget, you will still remember where you found the info and can readily access it.

 

[Twentytwelve2]

Just do it one step at a time. SOAP
Think it through your head. Patient is currently on A,B,C,D. Critique it in your head, is it 1st line, any contraindications, what should I monitor, is dose appropriate?
The plan will come naturally to you.

 

[Sparda29]

Quite frankly, I'm blowing on rotations. In classes I am a solid B- to B student, I couldve definitely be an A student, but I didnt think it was necessary.

I am currently on my internal med rotation and I'm not doing so hot.

My issues:
1) low confidence in clinical setting due
2) poor recall of information
3) Not as outspoken (I've never really been unless I'm 100% comfortable).

Does anyone have any books and or recommendations?

This is what I did during internal med rotations. I was expected to show up at 9AM but I showed up at 7AM, went straight to the floor that I was assigned to and did pre-rounds on my own. Went through all the patient charts while it was early to gather up all the info on new labs and meds. Go downstairs to the cafeteria, grabbed some breakfast, and worked on my SOAP notes and getting everything together for rounds while eating breakfast. Go to rounds. Spend the rest of the day on the floor reading up and shadowing the medical interns and residents on procedures.

I made friends with the medical interns and residents. By the third week, they were coming directly to me for pharmaceutical recommendations.

 

[RxPreceptor]

This is what I did during internal med rotations. I was expected to show up at 9AM but I showed up at 7AM, went straight to the floor that I was assigned to and did pre-rounds on my own. Went through all the patient charts while it was early to gather up all the info on new labs and meds. Go downstairs to the cafeteria, grabbed some breakfast, and worked on my SOAP notes and getting everything together for rounds while eating breakfast. Go to rounds. Spend the rest of the day on the floor reading up and shadowing the medical interns and residents on procedures.

I made friends with the medical interns and residents. By the third week, they were coming directly to me for pharmaceutical recommendations.

I would second this; helped gain experience for hospital settings in reviewing patient med regimens, labs, protocols, & a general sense of workflow in this type of environment. Would also keep notes on what was changed from the past day & for what general purpose based on the course of stay/changes in status/pending lab data, etc.

 

[MM2013]

Internal med is supposed to be hard, but its also where you learn the most and everything comes together. Some preceptors can be brutal though and expect you to know minute details that aren't clinically significant. What areas are you struggling with? Is this your first rotation?

My preceptor expected me to remember details when she asked me questions. I could just say "I don't remember, but I'll look it up and get back to you." But internal medicine was a tough experience for me. I think I need to listen more than talk more...

 

[Abby Atwood]

I had the same problem when I started rotations. I found that a willingness to say I don't know and look up an answer was ultimately more of a strength than a weakness. I didn't trust lecture notes beyond acting as a jumping off point. That created more situations where I had to look up information, but it also saved me in a few places where guidelines had changed or the lecture information wasn't 100% accurate (e.g. wrong pregnancy category for a drug). I don't think it's bad to not know something or to feel that you can't confidently say something that you think you know. Confidence is easy once you have a bigger knowledge base and know what sources you are referencing. Direct knowledge of guidelines and studies is critical, but it takes time to build. I'm still working on it (I probably always will be). I don't think anyone feels confident when their point of reference for a recommendation is a pharmacotherapy lecture from their P2 year.

 

[RxRetailRx]

Rx-prep book is a good resource to review those points, especially on Abxs

 

[Rouelle]

Some preceptors like to humble you and remind you that they know more than you. Prepare as solidly as you can. Beyond that: be serious (don’t joke around too much), be helpful, be respectful, and get as much out of the rotation as you can. Usually even the class idiot passes the rotations, so assuming you’re not the class idiot, you will probably be fine.

 

[Digsbe]

Internal med is usually always hard. Just know your patients, review pharmacotherapy, and learn to read your preceptor and learn what makes them happy. Feedback from other students who did the rotation is also usually helpful.

To be brutally honest, P4 year was educational and nice, but it felt more like a hazing into getting your PharmD. Some rotations you will just have to do what you need to do in order to get through.

 

[Amphetamine Salts]

i've only had the misfortune of being hazed on just one of my rotations. the rest have been cake walks to a pharmD, just how i like it