Inpatient US Clinical Experience in Internal Medicine in Washington D.C.

Information about this clinical experience:

This is an inpatient experience during which you will be under the supervision of a board-certified internal medicine physician. The attending holds a hospital appointment within the MedStar Health System. On a typical day, this preceptor sees 16-18 patients. These are a mix of newly admitted and established patients. Your day will be structured in the following manner:

9 AM – 1 PM: Attending Rounds

At 9 AM, you will join your attending physician, pharmacist, and nurse for hospital rounds. As a team, you will move from one patient to another and discuss each case as a team. These rounds will be an excellent opportunity for you to learn clinical reasoning, observe patient-centered care, and collaborate with healthcare professionals.

Prior to seeing the patient, the preceptor will give you a brief summary of the patient’s situation/diagnosis/condition. We recommend that you pay careful attention to these discussions and take notes on each patient. Record the following in your notebook:

• Diagnosis

• Medical history

• Lab test results

• Treatment plan

• Medications

After your workday, review your notes. Use these notes to guide your reading/learning and clarify doubts. What are the objectives of your daily reading?

• Develop a differential diagnosis for the chief complaint that brought the patient to the hospital.

• Understand how these diagnoses in the differential are made (i.e., history, exam, tests, etc.) and how they are differentiated from one another. Why was your patient diagnosed with a particular condition in the differential diagnosis? What made that diagnosis more likely and the others in the differential less likely?

• Dive deeper into the treatment plan. Why has the patient been treated or managed in a certain way? If a certain antibiotic was chosen for treatment of acute cholecystitis, why that antibiotic and not another one?

• Think about what you will do tomorrow based on three potential outcomes (patient is better, worse, or the same) for the patient’s diagnosis/condition. Anticipating possible outcomes will help you develop independent thinking and form stronger assessments and plans.

Based on your daily reading, create a question plan for the next day’s rounds. When the preceptor invites you to ask questions, you can pull questions from your prepared list. Being proactive about asking questions shows your preceptor your desire to learn.

After 1 PM: Discussions/Patient & Family Meetings

When time permits, the preceptor likes to have discussions with students about existing patients, focusing on aspects of care that are particularly interesting, exciting, or confusing. At times, you will accompany the attending physician back to the bedside to have more in-depth conversations with patients and/or their families.

Tips to Impress

Although this clinical experience is an observership, the preceptor is invested in writing personalized letters for students. The physician evaluates students on their attentive listening and respectful interactions with patients and teammates. Also highly valued are learners who take initiative for their own learning by reflecting upon what they have seen and filling in any gaps in knowledge through focused reading. Please note that the preceptor may ask you to research clinical issues or questions that arise and report back what you find. The preceptor also appreciates rotators who ask thoughtful questions during rounds.