Clinical Skills Clerkship: Internal Med Tips

Disclaimer: based on Cat Chamberlains experience and thus subject to change, reviewed 4/16

General:
1. Pre-rounds: means you round before the team. This means you get in at the same time or
earlier than the intern and round (go see/examine) your patients.
a. You can see either patients you saw yesterday or ask the resident to pick up a new patient.
b. Info to get: Any overnight events for your patient? Updated vitals, ins and outs, focused PE. If
there are any EKGs/images LOOK at them, not just the reports.
Ask the resident who is on nights for an update and talk to the nurse.
Start your SOAP note. Try not to just copy and paste the interns plan, even if it
is tempting! The plan is a huge part of the learning process. You have to get there
in enough time to round on your patients and write your note so usually this
means 5:30-6 as you get faster at writing you can go in later.
2. Rounds
. Start around 9 after morning report (usually 8-9) and you round on every patient on your team
with your attending and residents. This usually ends around noon.
3. Presentations:
. You are expected to present your patients. Try not to be too lengthy. You may ask your attending
their preferences on presentation style (eg some prefer to hear only pertinent positives on physical
exams). Try to always go in a logical order when you present (overnight events, subjective, vitals, exam,
labs, imaging, assessment, plan).
a. When reporting labs/imaging, dont discuss how these values or results affect your assessment of
the the patient (wait until the assessment!). You should report whether labs have trended up or down since
the previous day.
4. Then you go to noon conference. After lunch you finish notes, make phone calls, wrap up loose
ends. On some afternoons you have class. If your team is on call (meaning you get patients
who are admitted) you can get a new patient at any point in the day or from the night before.

OSCE: Tests your ability to handle very open questions/scenarios.

SHELF:
1. Start studying early. Most students use MKSAP, Step-up, Uworld, and USMLE for Step. Pick a
question bank and do questions throughout the clerkship.
2. You have more time to study when you are on outpatient medicine so take advantage of that time,
even if you do OP first.
3. Bring reading material/use a phone app to study during potential downtime
4. No one ever feels good after the shelf.
Review/Tips before clerkship:
1. Notes: When you admit a patient you always do a FULL H&P like you did in doctoring. If you
get a new patient who came in overnight, they usually expect the student to write a full H&P even
if the night person did one. SOAP notes are done on the following days.
a. Every note (H&P and SOAP) should always have: Diet, Prophylaxis (PPX), Code status, and
Dispo (pt to be discharged home when stable or pt to be discharged to rehab when stable)
2. Assessment/Plans: Really focus on your assessment and plans!!! A lot of attendings want to hear
your thought process so if you considered a diagnosis, say why you considered it and why it is at
the top or bottom of your list. Sometimes your residents will have time to go over your H/P with
you before you submit it
3. Presentations. Usually attendings want you to do a full presentation. One hard part is things that
happen in ER or on the floor prior to rounding. I usually added this part after I finished the
physical exam/tests/labs. I liked giving the attending a picture of who the patient is when he/she
walked in the door and then catching the attending up to what has happened to the patient before I
give my assessment and plan. With SOAP presentations you just brief them on how the patient
Clinical Skills Clerkship: Internal Med Tips
Disclaimer: based on Cat Chamberlains experience and thus subject to change, reviewed 4/16

is doing and anything that happened in the afternoon, overnight, and any tests that came in. Then
move into vitals and focused PE, and then assessment and plan.
4. ASK QUESTIONS!!! If you dont understand why you are doing something, then ASK! You are
there to learn.