As a third-year medical student, I rotated in the hospital and clinics, a different place every month through different specialties.
My internal medicine experience differed from others because I worked seven days on and seven days off. I previously never had a seven-day work week, since the jobs I had worked before medical school were typically Monday through Friday or part-time in a customer service job with three to four weekly shifts, which may sometimes include weekends.
I felt like by the sixth and seventh day in a row, I was tired despite not even working the full 12-hour shift that my preceptor was working. It felt like the week was dragging on, though I did enjoy the seven days of uninterrupted studying that followed.
A simple way to think about internal medicine is a hospitalist, though doctors can become specialized in internal medicine. Or, internists can work in primary care and essentially function as family medicine physicians but only work with adults. This means they can work in a doctor's office or clinic. Internists typically do not treat kids or pregnant women/obstetric patients. They also do not deliver babies. So they only want to see patients older than 18 who are not pregnant. That being said, most internists are hospitalists, the doctors who care for you while in the hospital. When patients are admitted to the hospital and get a hospital bed, they are divided among the hospitalists on shift that day. So your patient load is just whoever is in the hospital when you show up for work. This ultimately means there are transitions in coverage when one doctor ends their 7 days on and another starts their 7 days. It's important to have good doctor notes in the electronic medical record for efficient handoff. Most of the time, patients present to the emergency department and get admitted that way. The emergency medicine doctor will assess the patient, make a diagnosis or provisional diagnosis, and then decide whether or not to admit them to the hospital or discharge the patient. When the patient is admitted, the hospitalist takes charge of the patient's care.
Many patients will need to see additional doctors or specialists in the hospital, depending on their needs and why they were admitted. If someone comes in with a heart attack, then cardiology is likely to be involved. A hospitalist is separate from that. The hospitalist is the doctor who will call the cardiology (if the emergency doctor has not involved them already). A hospitalist may continue assessing a patient, noticing neurological deficits and either choosing to manage conditions themselves or consulting neurology. You probably can see some similarities between this and family medicine doctors outpatient who are engaged in a similar dynamic. They mostly take charge of a patient's care and coordinate with specialties when needed.
Internal medicine training can also lead to other specialties. It's the training required before pursuing a cardiology fellowship, for example. Internal medicine is a three-year residency, and many subspecialties require another three or four years beyond that. Besides cardiology, other subspecialties include gastroenterology, rheumatology, infectious disease, endocrinology, pulmonology, hematology, and oncology.
Here is a day in the life of a third-year student in internal medicine:
On Monday morning, I wake up at 5:30 am. I make coffee and have breakfast while I do Anki, a free app many medical students use. That's just to review concepts that I have already learned. It's a smart flashcard deck that will remember if I'm getting them wrong and show it to me every day. Or, if I keep getting it right, it provides spaced repetition, waiting longer and longer between reviews of the card, especially if I get it correct a few times in a row. I have some cards that won't show up until a year later because I would get it every time it was shown to me. Around 6:45, I drove to the hospital, about 15 minutes away. I am supposed to be at the hospital by 7:30 am but tend to arrive around 7 or 7:15 am. I like to have a few extra minutes of cushion between in case I encounter unexpected traffic or need to stop to refill gas in my car. Around 7:30, my attending would stop by the student lounge and assign patients to me and two other medical students, though sometimes I would follow up with the same patients from the previous day. I then log into the electronic medical record (EMR), looking up the patient by his/her name or ID number. For a new patient, I would look at what the emergency room stated about the patient and why they were coming in/why they were admitted. I would look at any imaging done if they needed a chest X-ray, MRI, etc. I would look at vital signs, especially noting any changes in vital signs over time. I would see if any labs were done, such as a complete blood count to look for anemia or elevated white blood count that could indicate infection. The basic metabolic panel is also helpful to look at the electrolytes. I would note the kidney function, liver function, and other labs like blood cultures to look for bacteria. It takes at least 15 minutes per patient. I would also look at other doctors' notes, like if a specialist came to see the patient. Knowing all this information, I would think of questions I would want to ask the patient. My physical exam is standardized for everyone, but I can also narrow it down to their chief complaint. For example, I always listen to heart and lungs but would want to do a more detailed cardiopulmonary exam if someone presented with chest pain. I will do more than just listen to the heart and lungs in that case. For follow-up patients I saw the day before, I viewed the chart to see if anything changed since I saw the patient last.
After the initial review of my patients' charts, it's around 8 to 8:30 when I start to go see my patients. Seeing the patients will take less than an hour because most patients take 15 minutes or so to see. Complicated patients could take close to a half hour, especially if it's a new patient and not a follow-up. It's different from an outpatient clinic when you have much more of a time crunch of 15 minutes to see each patient in an appointment slot. You also have the luxury of returning to a patient's room if you forgot to ask them something.
We usually met for morning rounds around 10 or 10:30. So, I would have plenty of time to write the notes and be ready to present my patients at rounds. Early on, I would have the full note written but I would also have handwritten bullet points to have something to refer to when presenting a patient during walking or table rounds without having to read directly from the full note. Usually, the presentations were not expected to be as in-depth as the written notes. Oral presentations were limited to 5 minutes maximum. A good oral presentation is usually a lot shorter than that. We would typically finish around 12, just in time for lunch, if we did walking rounds since it takes time to walk and see each patient. If we did table rounds, we would be done a bit earlier, but we'd often take the time to discuss the assessment and plan with more learning opportunities.
We would normally be given 45 minutes for lunch and regroup around 12:45 for more of a didactic session. Often, our preceptor would review a topic and talk about clinical applications we may not have touched on during the second year of medical school. Our preceptor would assign a topic to a student to present the following day. Usually, these topics were selected to coincide with the presentations we were seeing in our patients to make them more relevant. We would then be dismissed after this didactic session, making it a short day still packed with learning opportunities and not much downtime. I would take the late afternoons and evenings to do and review at least 25 practice questions daily. I would also do additional reading if necessary, prepare for the following day if I was assigned a topic to present on, and finish my Anki cards if I didn't already that morning. My school also gives a few assignments to be done during each rotation, so I would often work on writing up a case or preparing for an oral presentation that is a little more in-depth than what was typically expected day to day at the hospital. We also had modules to complete with associated quizzes to ensure we covered all the topics we needed for the COMAT.
I would typically do all my work by dinnertime when I spent time with my husband and had some free time after dinner before going to bed with enough time to get 8 hours of sleep. Medical school was the first time as an adult that I prioritized getting a full night's rest. I have noticed a significant improvement in my energy levels and concentration during the day. The only way this can be achieved without sacrificing academics is to plan on when you are doing what so that you don't fall behind and feel that you have to stay up to finish something. It helps that I use my days off to catch up on what I need to instead of taking up the evenings to do this and not doing anything on the weekends. This has just been what I found to work better for me, and if you are struggling, I recommend trying something else.