The internal medicine rotation was an interesting one and brought many new lessons. The experience was a new one to me in many ways, but most notably it was interesting to finally spend time on a medical inpatient unit. So far, I have been in rotations that deal with more acute problems in an outpatient setting, so seeing patients that have been admitted for weeks to months at a time posed a new challenge. Catching up on patient histories, diagnostics, treatments and overall hospital course was very time consuming but imperative to getting to know a patient. Understanding how different treatments have affected a patient with a complicated diagnosis allowed for brainstorming about future possibilities and interventions.

This rotation allowed for expanding on my physical exam skills. Previous rotations required focused exams for most patients so getting to practice a full exam was rewarding. Most patients on the units I rotated on were very weak and had advanced dementia, so it was challenging to perform a full physical exam but was also a lesson in perseverance and adaptability. Some exams required modifications and I learned how to perform them thanks to the experience of my preceptors. This experience will definitely be helpful in my future rotations, especially in long term care.

This rotation has also been the first one in which I got to learn proper documentation for a hospital stay. The documentation required more than just noting physical exam findings and a history of present illness. Learning to write up admissions, medication reconciliations, and discharge summaries were all new to me. Documentation of admitted patients also required extra attention to detail, as many different consults and treatments are present during an average stay and a broad variety of medical notes are present in a patient’s chart. Reviewing studies and notes from weeks prior and compiling the information into a succinct and informative summary was a new skill I got to practice during this rotation.

Another new experience I’ve had during this rotation were the bonds that are formed with patients. Seeing the same patients for a few weeks allowed me to get to know them beside their medical course. I’ve interacted with the same family members multiple times, given them updates on the patient’s status, and explained what was happening on a given day and plans for the week. The providers really get to bond with patients on this kind of unit and get to know them on a deeper level than just pertaining to their immediate medical care.

I’ve also gotten to see the use of diagnostic modalities that were not available in my previous rotations. I’ve looked at and interpreted MRI and transesophageal echo findings, as well as participated in preparing a patient for a radioactive blood scan. I have also seen the use of BiPAP and high flow nasal cannula for the first time and learned about the individual settings that are tailored to a patient and their respiratory status. I have started to feel more comfortable with x-rays, CT scans, and ultrasound in previous rotations, so getting to expand on other radiologic modalities was rewarding.

Overall, this was a very rewarding rotation where I was exposed to new documentation practices, diagnostic modalities, treatments, and environments. The most interesting part of this rotation was being part of the stroke team responsible for the initial assessment of any possible stroke patient that comes to the emergency department. I learned how to fully assess a patient using the NIH stroke scale and discern between presentations of ischemic stroke, hemorrhage, and non-stroke diagnoses such as bell’s palsy, dementia, or intoxication. Having experienced all this while working through a pandemic has also been enriching, as the process of seeing a patient is much more complicated and requires more preparation than in a time before Covid-19. This rotation allowed me to expand on my current skills as well as learn new things that I can bring with me to future rotations.