For my third rotation, I had the pleasure of spending my time learning in Internal Medicine at NYPQ. The internal medicine rotation has been different from most of my rotations since it takes place in an inpatient setting; it was definitely a change of pace from my previous rotation in emergency medicine. Saying that the pace was slower isn’t to say that it was bad, but you had the opportunity to spend more time getting to know your patients. You spend the first half of the day chart reviewing and checking to see what the patients’ vitals have been like over the course of their stay, their labs and how they’re trending, any consult notes from specialties, etc. Eventually, after you have chart reviewed, you head over to see your patients for the day to see how they’re doing and discuss any updates regarding their labs or treatment. Being in internal medicine really taught me how much really goes into caring for patients on a more long-term basis as most patients are hospitalized for several days, weeks or months; therefore, building a rapport with these patients is of great importance. I also learned that as a provider, you must be very meticulous when chart reviewing as to not miss anything that could potentially be life-threatening for your patient. 

Another thing I learned while being on this rotation is that you must have patience. A lot of the admitted patients you come across have an extensive history and multiple comorbidities, so when you ask them how they are feeling, they can go into a long talk about every little thing going on in their life. While it is important to listen to your patient, you must also take into consideration that you have many other patients that also require your attention; therefore, a skill that I learned is redirecting the patient to focus on the main problem list without downplaying any other issues they may be experiencing. I also learned that you can always address any other issues by consulting with the appropriate provider. I haven’t perfected the skill as a I still feel rude interrupting the patient, but it’s a skill I will continue to work on as I continue my interactions with patients throughout my clinical year. 

A skill I feel I did become great at is performing an ABG. I did so many ABGs, and at first, I wasn’t super great at it. I had done ABGs in emergency medicine but still hadn’t quite mastered getting a sample of blood. I learned that you must be really precise and have a steady hand. After doing two ABGs in the internal medicine, I learned how to troubleshoot and managed to get a sample of arterial blood every single time. Learning how to master performing an ABG is essential to manage patients who may need to be placed on BiPAP or to decide if the patient needs to continue being on it. It’s also useful to be skilled at it so you’re not sticking your patients repeatedly as the procedure can be uncomfortable.

I also spent some time working on the stroke team while I was in internal medicine. I learned a great deal during that week and I thought it was super interesting because I don’t have much experience working with stroke patients. While on the job, I learned how to properly assess a patient using the National Institutes of Health Stroke Scale. I was aware of the NIHSS, but never actually used it to assess a patient for a stroke. Another thing I garnered was knowledge on the work-up and treatment plan for stroke patients. While each person is different regarding their history and type of stroke they experienced, I now have a better understanding of the types of tests and labs that are order and basic management for stroke patients. I am not sure if I will get the chance to work with this specific population again, but my plan is to continue reviewing the NIHSS and neurological exam to not forget how to evaluate these particular patients. I did find that sometimes I would forget some part of the neurological exam, so I just need to practice and review it a bit more.

Overall, my time in internal medicine was very informative. There’s definitely a lot more to learn, and I have been assured that you learn a lot even as a new graduate on the job. I look forward to using the knowledge to become a competent and compassionate provider.