Rotation tips: Inpatient Medicine
1. Patient number
Inpatient medicine, sometimes termed your internal medicine or hospitalist rotation, is very different from outpatient rotations. To find out different program types, you can search through myPAbox. In general, you will have at least one inpatient medicine rotation. For one, the patient number in inpatient settings will likely be much lower. Sometimes students just had 2-5 patients a day, and that is totally normal. This is partially due to the number of patients admitted, and also due to the complexity of patients that are staying overnight in a hospital. Therefore, there is a corresponding different approach to the day.
2. Hours
This highly varies from site to site. You could be working more of a standard schedule (ex. 8-5pm M-F) or shift work (usually 10 or 12 hours shifts on random days of the week). It is likely your days will be long. You will usually start off the day with rounding on patients on your service. Then throughout the day there could be consults, new admits, or discharges that you would potentially help attend to.
3. Specialties
You will likely be doing internal medicine/hospitalist medicine. Sometimes, you may be on an inpatient specialty. For example, at my program my rotation was inpatient cardiology. That being said, even if you are not doing any specialty, ask you preceptor if you can spend a day with an area of the hospital or consulting team that you would like to learn more about. For example, common ones are nephrology, cardiology, neurology, infection/immunology, or critical care/pulmonology. I myself got to spend time with immunology, critical care, and in the cath lab, in addition to my assigned specialty.
4. Complexity
Usually the patient panel you will be seeing on an inpatient rotation will be on the more complex side. If a patient is at the point where they are being admitted, they likely are pretty sick. This rotation will likely be the first time you are managing patients with kidney failure and heart failure and COPD and anemia and an electrolyte imbalance and an infection somewhere. Yeah. It can certainly feel like you are in over your head at first, but you will get the hang of it. Try to handle each issue methodically, seek consultation when needed, and ask your preceptor for tips.
5. Down time
Although not guaranteed, it is possible that this rotation has more down time than most of your others. This is because after you are done seeing your panel of patients, you essentially wait around to see if any new admits/new consults come in. So if it’s a slower day, you may have some down time. This time is used to finish up your notes, etc. You can also use this time (once completed with your notes and rotation related responsibilities) to study or log your patients.
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