Clinical Year: Internal Medicine


I'll go ahead and say this was one of my least favorite rotations, not because of the area, but because of where I was.  Just a disclaimer. 

My internal medicine site was an outpatient clinic that also took care of multiple nursing homes and did home visits, so I spent some time at those as well.  There was an MD and a PA in the office, and a PA who only saw nursing homes and home visits.  

Over time, the site I was at had somewhat transitioned into a pain management clinic, which is questionable territory for an IM practice.  There were a lot of suboxone patients (a medicine to help patients addicted to pain medication) and a lot of chronic patients, some who were getting over 300 pills of hydrocodone or oxycodone a month (if that sounds a little excessive, it's because it is).  This practice also regularly prescribed drugs for ADD and weight loss.  There were also some regular IM patients just coming for check-ups, but not as many as I would have expected for an internal medicine residency.  

Anyways, I definitely learned a lot during my month there.  They would call me to come and do every physical and rectal exam.  Lucky me!  (Thankfully, I don't have to do those in dermatology, but I got plenty of experience there.)  It was the 2nd day when I was let loose to go see patients on my own, and when I started to feel slightly uncomfortable.  Everyone was very nice, but after presenting to either preceptor, there were times when I was encouraged to go forward with my treatment plan and let the patient go (without them ever seeing the patient).  That is just not appropriate.  I was a student.  I learned to stand my ground and I let them know that I was not comfortable with that.  I also let my clinical director at my program know what was being encouraged.  

The good things about this rotation were I got lunch everyday because if there wasn't a rep on the schedule, they would call around and find one.  I did get to see a lot and I learned a lot, especially about pain management and being in uncomfortable situations.  That physician has recently lost his DEA license, so I think that speaks a little bit to what was going on.  

So this is an example of how where you do your rotation can make a huge impact on your feelings for the specialty.  If you have a bad experience, you may want to consider doing one of your electives in that area just to get another look in a different place.  And again, never do anything you aren't comfortable with and tell your program if you feel like a rotation site wouldn't be good to use in the future.  

Some other blog posts and articles that may be helpful: 

  • A blog post with an interview with a cardiology PA
  • A blog post with an interview with a nephrology PA
  • A blog post about a student's experience on her IM rotation.  And some recommended resources.