Internal Medicine at Mount Sinai Chicago

SCHEDULE:

Almost exclusively inpatient

 

6 weeks at Holy Cross Hospital (2 weeks general IM, 2x 2 weeks with subspecialty of your choosing: cardiology, pulm/critical care, heme/onc, nephrology)

HCH only: some outpatient clinic time

Weekends: general rule of thumb is we are required to have 1 day off per week. It’s hit or miss if you’ll work a weekend at all, so clarify with your preceptor for that time period

 

6 weeks at Mt Sinai (1 week of nights, 1 week of 2N/3N - SICU/pre-op/telemetry, 2 weeks of 5N - telemetry, 2 weeks of 6N - observation/hospice)

Sinai only: rotating call days until 6pm based on your team’s schedule

Weekends: You and your partner will share weekend days (one works Saturday, the other Sunday) unless it’s a call day in which case you’ll both work together and have the other weekend day off.

 

Lecture schedule is released monthly and only requires your attendance at Sinai. HCH may offer some lectures, but to date there have not been many. 

 

GENERAL: Internal medicine has come a long way under the current program director. It’s a really outstanding experience. It can be VERY difficult, but really great as well. Dress code is business casual.

 

ORIENTATION: Is very short (1, maybe 2 hours). It’s a time for the program director to hand out the rotation guide and schedule and to go through the information. After orientation you’ll be released to your assignment (so, expect to work from day 1).

 

HCH DAYS

Each segment of the HCH rotation will have rotation-specific scheduling, so follow the information in the HCH guide. In general, plan to come at least an hour before your attending tells you to arrive. They’re all incredibly nice but wildly underestimate the amount of time it takes a student to familiarize ourselves with the chart on top of doing our own evaluation of the patient. 

 

Some of the rotations will have you write notes (general medicine floors, heme/onc, and pulm/crit care). Even if they don’t require it, ask if you can. It’s really good practice!

 

SINAI DAYS

Arrive as early as you need to in order to be prepared for rounds. In general, expect to be on your floor no later than 6am. You will only be responsible for picking up new patients. Any holdovers from a week before you joined the team (unless you followed the patient before), will be covered by the residents. You’ll obviously help with random tasks even with patients that aren’t yours, but you’re only expected to automatically follow up on everything for your patients. At the start of each day you can access the signout sheet through sharepoint and see any new admissions from overnight. Both 2N/3N and 6N only have 1 team of residents with students, so you can automatically divide those patients and get to work. 5N has 2 different teams, so unless the patients are labeled with your resident, you’ll have to wait for the residents to give you new patients. You’re responsible for reviewing all of their past records and then going to see the patient. Perform a focused H&P on all of your new patients and then write it up. 

You’ll round at the computer with the attending sometime after 9am. Discuss all plan details with the resident who is following your patient so that you are on the same page. For new patients, you’ll be responsible for giving a full presentation with all PERTINENT information (DO NOT READ OFF NORMAL LAB VALUES UNLESS YOU WANT TO WATCH THE ATTENDING’S EYES GLAZE OVER). It’s okay to print out your HPI and read that off to the attending then highlight any pertinent positive/negative physical/lab/imaging findings. At the end of your presentation make sure you present your plan for the patient in a problem-based fashion (“for syncopal episode, stable now, ruling out blah blah blah, ordered XYZ labs and imaging, for diabetes, POCs have been xxx>xxx>xxx, we’ve got him on an x-dose sliding scale” etc etc). For subsequent morning rounds, you’ll give a 1-2 sentence reminder of the patient (“this is our guy who came in because of syncopal episode…”) followed by updates to the plan (“for the syncope X labs showed this, we got back X imaging showing, still waiting on xyz…but we’ve ruled out X... for his diabetes his POCs have been xxx>xxx>xxx and we’re changing/not changing the insulin…”). Take notes on what the attending wants you to follow up on for the rest of the day/by the next morning. 

After computer rounds, you’ll conduct bedside rounds with the attending and residents. Be ready to remind the attending in the doorway what we were concerned about with that particular patient (they only need quick 1-3 notes and they usually have it). 

At the end of rounds, you’ll grab lunch then follow up on any labs/imaging or schedule appointments for your patients. Check in with your residents and be willing to aid in every way possible. You’ll also help update the sign-out sheet for your patients. It is especially important that you include a list of labs or imaging that need to be acted on as soon as they come through.

The floors stop accepting new patients at noon every day. Any new patients presenting to the ED or as direct-admits to the floors will go to the on-call team. 

On a normal day you can expect to leave by around 3pm with your residents’ permission.

 

SINAI CALL DAYS

Call days rotate amongst the teams. Check the call schedule in advance of starting a new floor. Because the resident teams rotate monthly, there’s a chance that you may repeat the same call schedule when you move to a new floor.

On your call days you still arrive like normal by 6am, but these days you’re allowed to wear scrubs. You’ll follow up on your patients and round like normal. 

For the whole day your team will be responsible for responding to all Rapid Response calls anywhere in the hospital. At noon the on-call team becomes responsible for any new admissions so that means you, the student, will be sent to the ED or floor they’re admitting to (likely all day long) to conduct new patient interviews/physicals and give report to your resident. It’s up to you if you want to write HPIs for these patients. If they don’t end up going to your floor, you likely won’t follow them after their initial intake. 

At 3pm all of the other floors will pass off their sign-out sheets to the call team. 

At 4pm any new patients will be held over for the night team. 

Typically you’ll meet with the attending on call around 5:30pm for computer rounds. You’ll present your HPIs and plan just as you do for your normal patients, but you’ll usually not be expected to do bedside rounding with the on call attending. Note that these patient presentations tend to be even more concise than during morning rounding. 

The call shift will end at 6pm and you’ll usually get off on time.

 

SINAI NIGHT SHIFT

Night shifts are a lot more laid back and relaxed and run Monday night until Saturday morning (you have Saturday day and all of Sunday off). You may or may not see an attending physician until you round in the morning. The floors are a lot quieter just in that there aren’t as many people in the hospital. You’ll wear scrubs and can bring your belongings to the resident lounge. 

Your schedule is 6pm-6am. Get there on time, but you don’t need to arrive ridiculously early.

The night team is responsible for all of the medicine patients in the hospital. Your resident may ask you to follow up on the sign-out sheets to see what needs to be monitored overnight. You’ll assist with returning pages and going to check on borderline patients. You’ll also respond to all Rapid Responses in the hospital overnight.

Initially at the start of the shift you’ll split up all the new patients held over from the call team and go see them in the ED, present to the resident, write your HPI (sometimes just in Word). By around midnight-2am things tend to relax a bit. You can order food, study, watch Netflix. If you’re feeling crazy, attempt a nap (just know the residents might not wake you up). 

By about 5 or 5:30am you should be prepared for computer rounds with the overnight attending. You’ll provide a full H&P for all new patients you saw just as with morning rounds. 

The attendings don’t have students with them for bedside rounds, so by 6am you should be good to go home. 

Pro-tip = put a huge amount of emphasis on resetting your sleep schedule when you come off of nights. Stay up all day Saturday and go to sleep at a normal time. It is much easier going on to nights than it is switching back to days. 

 

HOW TO SUCCEED:

Ask for feedback from everyone you work with. The program has evaluation forms that you should have your residents and attendings fill out after they’ve worked enough with you. Always show your interest and that you’re trying to improve. 

 

Take full advantage of your HCH weeks. You will have much shorter days (arrive later, leave earlier). It’s very tempting to laze around and not study, but these 6 weeks should be the bulk of your studying. At Sinai, you have much longer days and you’ll find it pretty exhausting to balance with studying. 

 

Step Up to Medicine is a crowd favorite, but First Aid for Medicine is also good. Invest early in the Pocket Guide to Medicine (blue cover) and reference frequently. 

Good luck on your rotation!

Brandon Byers 

Tropics MD