Sorry for the late reply. I did internal medicine throughout the year so not quite the typical CTU model. I usually started early in the morning to round on the patients I had seen before, checked if there had been any changes before awaiting consults from my attending.
When I did get consults, one of the first things I did is lay eyes on a patient. If they looked stable, I would usually gather information from the chart - progress reports of the last few days, latest labs etc. - to have an idea of what the situation looks like. I may even quickly reference some material to pre-read around the reason for consultation before talking to the patient.
The history and physical of internal medicine is the same as any history or physical you have taken but it is in broad strokes to cover a whole slew of topics and differentials. When presenting, make your presentations differential focused. If you have a patient that has chest pain that includes differentials from a lot of systems, describe the patient story (subjective from SOAP) before moving into your rule in/rule out spiel by system. Does he have any cardiac features from this, this, or that differential? Does he have any pulmonary features from this, this, or that differential? And so on. This systematic approach helps the logic flow and shows you are thinking about the differentials.
From there, mention pertinent points of history with non-contributory information left aside unless asked.
The final impression and plan should be a problem list with your thoughts on what to do. At this point as a third year medical student, I think it does not matter if you are wrong about your plan. It is more important to show that you are thinking about a plan and have some reasoning behind them.
Afterwards, I would usually write up the orders and the rest of the consult before dictating. Rinse, lather, repeat.
And just like that, year three passes into my memory, a destination in the rearview mirror. There has been so much to see, so much to process, so much to reflect on this entire year it is difficult to know where to start. Perhaps we should go back to the beginning.
In the quiet conference room overlooking the hospital atrium, we sat down with our clerkship site director for the last time to wrap up some loose ends. It was here, less than a year ago, that we gathered for the very first time as a group to discuss what the rest of the year would entail. Now, we had come full circle, gathered to reflect on our experiences, our growths, and our recommendations for improving the experience for the incoming crew.
For a moment, it seemed casually regular, like our typical weekly sit downs. That feeling was broken when the director closed with some heart felt words that hit home the thought that by the turn of this week, this group will be disbanded and a new class will assemble in our stead.
"I congratulate all of you. You all worked very hard this year and you have come so far. Congratulations on surviving third year. Good luck to all of you on your future endeavours and on your final year."
We looked at each other in nostalgia, at the memories we had collectively collected within these walls. There would be no more small talks with the staff, no more late night walks through empty halls, no more patients to follow up. Though I looked forward to my two weeks off, the thought still made me feel hollow like I had lost a part of myself.
After a brief conversation about handing in our paperwork, logs, and badges, the meeting was over and we were set free. The director came around to shake all of our hands before departing with a final farewell and invitation.
"I will see you when I see you."