What I learned on my Internal Medicine Rotation

If there is a specialty that is close to my heart, it's internal medicine. I'm 100% biased because the internal medicine department offered me my first "real" job in medical school. After that summer in third year, I was so enamoured by the experience as a whole that I applied for a substitute doctor position there for the next summer. That summer completely solidified not only my understanding of the complexity of internal medicine, but also, the importance of collegiality. I loved the department, the science, and my colleagues. I learned so much after two summers that applying to do my internal medicine rotation at Mikkeli Central Hospital was a no brainer.

To my great fortune, I was accepted and started my six week internal med rotation immediately after my pediatrics rotation.

A tight schedule, but there's nothing as refreshing as a change of pace, right?

Wrong 🙂

I was completely exhausted by week 3 of the practice. I felt faint. Exhausted. And burnt out.

To further my fatigue and understanding, I signed up to be on-call twice a week. In this department, you have one main specializing doctor on call, one "second" call who can be either a student or a licensed physician and a consult who usually chills at home (unless chaos ensues.) As a 6th year student I got to work quite independently which  was rewarding and very educational!

During the six week practice, I was mainly in the bed ward but also in the emergency room. The bed ward was highly under-staffed which meant the responsibility load on this amateur was quite high. A lot of consultations were made and I felt like my phone was ringing non-stop. Nearly 14 patients for myself everyday was overwhelming but I learned not overthinking, trusting yourself and thinking logically got me pretty far, although the level of self-doubt was still... extraordinary. Fortunately, I had wonderful colleagues to guide me through the process when I felt like I was in a maze without a map or compass. Or brain.

One of the more relevant things I learned was the importance of writing thorough patient reports. I admitted a patient in the ER with high fever and a positive urine sample. I assumed it would be a pyelonephritis so I started i.v. antibiotics and sent the patient to the ward. Later my colleague asked me why I didn't take a spinal tap. "Why would I?" I wondered. To an infectologist, a slight headache and fever, even without nuchal rigidity calls for a CSF sample. When you don't take a test, you must be able to explain the absence of a certain diagnostic test based on your report. You should always be able to defend yourself solely based on your written reports, so make sure they're clear, and thorough. But not too thorough because that's annoying to read. It's a fine line, my friends...

Working as a physician while still being a student is intimidating. The ability to ask appropriate, concise questions, adapt to the situation, apply your knowledge and learn from this experience is perhaps the most valuable lesson one can learn in their rotational year. Right now, we're just dipping our toes into the world of being a doctor. While the water is cold, learn to bear it, because I'm sure there are bigger icebergs ahead.

After the practice and before the exam I had a two week practice at our University clinic.

Truth: More times than ever before I questioned my career choice.

More times than ever I used four letter words to describe my day.

My job and practice was grueling, then I came to Pécs, alone, and studied in the library, alone, ate Cup Noodles, alone.

I felt unhappy, unmotivated, unexcited. The usual pre-exam depression. Nothing unusual.

By now all this exam preparation should feel easy and routine but for some reason, it just never gets easier! I had high hopes and expectations for myself for this one, which of course escalated the stress factor even more. But at times like those it's important to just get out of the study funk and get a breath of fresh air.

Hit up McDrive

Or go outside just to appreciate the beauty of the town you had the priviledge to live in for 6 years!

The Exam

The internal medicine exam was important to me simply because internal medicine is important to me. While I know everyone says "Grades don't matter!" I still wanted justification that my three summer's worth of work in the department were worthwhile. I wanted to be ensured I was doing everything correctly, and in a way wanted to "prove" myself. I thought, if I don't know the basics by now, shame on me. My oral exam experience was very pleasant, and focused on basic aspects of heart failure, atrial fibrillation, hyperthyroidism and multiple myeloma. I had two professors in the room and each asked a few questions. The best part of my exam was hearing "Ah, you did your practice in Mikkeli!" (as if they had any idea where that was 😀 ) I felt proud to put Mikkeli on the map for them and after having a successful exam, I was proud to represent Mikkeli! I truly loved my job each summer, and this rotation was no different. The examiners commented on my confidence and said "You must have learned all of this really well in Mikkeli!"

I'm so grateful to all my incredible colleagues who have patiently taught me so much from autoimmune hemolysis to how to do a one handed push-up (<-- clearly, I still have a lot to learn...)

Kyllä, miä <3 Mikkeli!

(To think there's only five post-exam selfies left, EVER. )

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