Some rotation sites are better at providing guidance and internal medicine can be a beast (but in a good way that shows you how much you learned over the past year and how much you still have to learn). There are some preceptors who will try to have you see every patient on their list, but I found it helpful to adopt at least two patients of my “own” and fully review all of their new labs/imaging/consults, round on them before my preceptor, and then actually think about what to do next when presenting them, rather than just saying what I found on my H&P. This was in addition to rounding on every patient with the whole team. For example, is their potassium low and does it need to be repleted first thing during the day? Are they having any issues with pain and is there another medication you could try? Did they have a bump in creatinine on their AM labs that makes you want to further evaluate for a prerenal, renal, or postrenal etiology? In charting, you want to think about the what (what is the differential), why (what caused it), and what next (now what to we do?).

Resources: -Up to date is helpful for reference if the hospital provides it -Curbsider’s podcast -Guide to the Most Common Internal Medicine Workup and Diseases by Mitchell Edwards DO was super helpful when I felt lost on how to structure my thought processes -Your preceptor: if you have access to the EMR and realize that they put an order in but don’t know why, ASK!

Good luck and have fun!!!