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Internal Medicine: A Flashback

January 5, 2018

(Pictured: Things I kept in my White Coat during IM-- see @KaresKorner for details on each item) 


Hey Guys! This is a for real for real flashback post. In attempts to get caught up in the new year, I will be sharing my reflections and study advice from IM, Family and OB/Gyn. It's been a busy few months! 


Wayyyyy back in September, I completed my 12 week IM core rotation.  After unintentionally falling in love with surgery and the OR, I was a bit nervous about my IM Core.  When I initially started medical school, I thought that I would end up in IM or Family Medicine because I was very interested in primary care, but after surgery my perspective on my future had shifted tremendously.  My best friend told me to make sure that when you go into any core rotation to get as much as you can because unless you go into that field, that's the only time you will get in that particular discipline, so that is a piece of advice that I still took with each rotation. 


Honestly, IM started off kind of slow for me. I think I was still so amped up from being in the OR, and the idea of rounding for 4-5 hours every day was really just unappealing.  Nevertheless, although the first couple of weeks were a little slow, and I was NOT going to complain about leaving the hospital at noon (especially after recovering from my non-sleep cycle on Surgery).  Little by little, things began to pick up and I really began to enjoy the rotation. I worked with a group of amazing residents who were so were so amazing from teaching, to letting students write the notes and take the lead with management, and I felt an incredible amount of growth as a budding baby doc in those "short" 12 weeks.  Despite the long hours of rounding, by the end of my inpatient time, I felt a lot more confident in my presentations, differentials, notes and assessments and plans for my patients.  It was a pretty amazing feeling knowing where I started at the beginning of those 12 weeks to barely being able to really come up with a concrete assessment and plan to having my intern on my last day barely glance over my H&P note for a patient because they had the utmost confidence in my ability to write a complete H&P with fully thought out A&P.  


The one biggest pieces of advice I would give when it comes to being on the floors for IM is not only should you know your own patients inside and out, but I would recommend that you also read up on your fellow students/other patients on your team.  What you should NOT do: Read up on the other patients and make your peers/interns/residents look bad by pointing out information to your Attending that others may have missed. What you SHOULD do: Read up on the other patients to 1) Learn more 2) Be able to contribute a question or recommendation to the discussion when on rounds to demonstrate that you are truly engaged in all the patients on the service and not just your own.  I found that you will obviously know and learn the disease processes, pathology and treatments for your patients, but by doing a little bit of familiarization with the other patients on your service, you are able to review and learn more material and understand the management of multiple disease processes at once.  


Our IM core was broken down into 7 weeks floors, 1 week ICU and 4 weeks outpatient.  I loved my time on the floors, dreaded my time in the ICU ( I was bored-- as medical students in my hospital, we didn't really get to do much except watch the residents and fellows place lines, etc which is cool the first or second time but then...yeah not so much) and I also enjoyed my time in outpatient.  Outpatient IM is pretty much Family Medicine and because they way my schedule was set up, I had 4 weeks of outpatient right before my 6 weeks of Family, it was a nice way to transition into that pace.   The thing I did enjoy most about outpatient is the time that I was able to spend with my patients and the review/improving of my physical exam skills.  



After having now taken Surgery, IM, Family and the OB/Gyn shelf exam, I still think my IM exam was the most difficult.  To be fair, Hurricane Irma hit right at the end of my IM rotation and portion of my last week of studying was spent evacuating and then returning back to South Florida, so yes...things were a little hectic at that time.  However, Irma did allow me to have more time to study.  I personally think the thing that made IM Shelf so hard was the pure length of the questions stems.  They were long in surgery but I think you could skim through them and not miss anything major, but that was definitely not the case for IM.  You needed to read each and every single word because it is ALL important.  

Nevertheless despite me feeling that it was the most difficult, I did the best to date on my IM Shelf.  My resources for IM Shelf were pretty standard but I will share them below. 



Step Up to Medicine 

This is a very popular review book both for IM and also for Step 2CK studying.  I had the PDF version and later also bought the hard copy but never ended up using the hard copy.  I really do like the layout of the book, but I was nervous about using too many sources for IM and also for CK studying and I had already started annotating my First AID CK and Master the Boards, so I decided to not annotate and really use Step up to Medicine.  However, almost everyone that I know who has used Step Up HIGHY recommends it, so I think it is a very good resource for both IM and CK.  


Master the Boards 

As previously mentioned, this is the 1 of the 2 review books that I decided to use for both IM and CK.  I like MTB because it really gives you the bare minimum and high yield details for each subject.  However, that is also its draw back for many...that it lacks those details. But I like it because my First AID CK is very detailed so they complement each other well and because there is a lot of blank space in the pages of MTB, it leaves a lot of room for annotation which I love.  


First AID CK 

Not nearly "bible" as First AID for Step 1 was but it is still a pretty fantastic resource.  I like that is detailed but still pertinent and high yield and the organization is also great.  I like it in addition to MTB because of the previously mentioned reasons, and although I did not use it intensely for Shelf studying, I did annotate it in when reviewing UWorld to start the CK process early in the game.  Of course because it is a complete review book, it covers everything which is the reason I think I leaned towards the combo of MTB and First AID vs. Step Up to Medicine (which is solely just medicine).  


Side note: I have also heard that Step Up to CK is not as good as Step Up to Medicine, MTB or FA...but again that is what "I heard". 




I bought it. I read two cases. That's that. 





Dr. Williams is Bae. 'nough said. 


Emma Holliday Ramahi Review Video

Love love Love her review videos. I get sad when I have a rotation that she does not have a video for.  I watch them usually twice in the last 2-3 days before my Shelf exam just to review everything and bring everything together. 



It is daunting because there are 1400 questions and if you are like me and you have 12 weeks, the 1400 questions is definitely doable.  However, you do not need to do 1400 questions to pass and do well on shelf.  Just put yourself on a schedule and try to get through at least half of the questions, and you will be fine.  



I know students who do not do NBMEs and pass their shelf exams without any issue. I, however, am not those people. I do my NBME exams religiously towards the last couple of weeks of my Shelf studying just to make sure my timing is good and I am roughly testing around where I want to be.  Obviously if any of those things are off, I intensify my studying and review and take another NBME until I feel comfortable with where I am at. 


I hope some of this was helpful...yes it is long, sorry but hopefully the next couple will be shorter!  Up Next: Family Med!






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