Rotation | Internal Medicine/Hospital Medicine

I completed my rotation in internal medicine/hospital medicine, and wow, I didn't think I would fall in love with hospital medicine all over again. I had originally chosen the family nurse practitioner track after reading about how equipped they are to see patients of all ages, but I did not realize at the time that it would confine me to primary care. I have seen posts in forums of other FNP students who were able to complete an elective (or two) inpatient or in the emergency department. Me being me and being committed to learning, I believed that FNP was the "right" track for me since it would allow me to learn a bit of everything.

Let me preface this to say I was very lucky that I even had the opportunity to complete part of my internal medicine rotation in the inpatient setting. Thankfully, I had met the required outpatient hours up to that quarter and was able to have a bit of wiggle room for some inpatient time.

As I prepare to share some tips of things you'll need to know to be ready for your internal medicine/hospital medicine rotation, keep in mind that some of the disease processes will be different depending on the area and the size of the hospital. For example, if you're rotating through a trauma hospital that is comprehensive stroke certified, you'll see much different and more complex patients than at a smaller, community hospital that does not have these designations. It doesn't mean that you won't learn; it just means that you'll learn and see different things. It's harder to make generalizations of what you'll see.

For context, the hospital I rotated through was a smaller community hospital, which was not designated as a trauma center. The hospital only saw adult patients; pediatric patients had to receive care from the other hospitals that are part of the system. For this hospital, hospitalists did not have to do procedures and did not handle codes.

With all this in mind, here are the basics of what you should know to get ready for this rotation:

Conditions/Diagnoses/Symptoms

• Cellulitis
• Pneumonia
• Congestive Heart Failure
• Acute Cholecystitis/Cholelithiasis/Choledocolithiasis
• Acute Pancreatitis
• Diabetes
• Hypertension
• Hypothyroidism / Hyperthyroidism
• Cancer (You don't need to know the chemotherapy regimen, but do know how to consult the oncology team for patient management)
• Acute Deep Vein Thrombosis (DVT)
• Plasmapheresis (Indications for patients)
• Chronic Obstructive Pulmonary Disease (COPD)
• Stroke
• Transient Ischemic Attack (TIA)
• Alzheimer's Disease
• Dementia
• GI Bleed
• Nephrolithiasis
• Acute Renal Failure
• Chronic Renal Failure
• Syncope
• Peripheral Arterial Disease (PAD)
• Peripheral Venous Disease (PVD)
• Sepsis
• Fever (Workup)
• Abdominal Pain (Workup)
• Shortness of Breath (Workup)
• Antibiotic Stewardship - Including alternative treatments if the patient has antibiotic allergies

Tests/Diagnostics

• Urinalysis - How to do and interpretation of results
• Labs - How to order, how to interpret lab values, what labs to order
• Culture and Sensitivity - How to order, how to interpret, how to adjust antibiotic treatment regimen after receiving results
• Point of Care Glucose Check - Interpretation of results and how to change/adjust insulin sliding scale, if needed
• Point of Care A1C Check - How to do and interpretation of results
• Radiology (X-ray, MRI, CT) - How and when to order. If consulting other specialties, these may be ordered by the specialist or the specialist may prefer that these are ordered prior to consult. You'll also have a radiologist who will read imaging for you (but always try to learn if you get a chance!).
• Telemetry - Know how to read and interpret strips (especially for your telemetry or higher level of care patients).

Skills

• Consulting the specialists - If there is anything you'll learn, it is definitely when you need to get some specialists on board to help you manage the patient.
• Prescription Writing (Electronic and paper)
• Writing admission orders for the patient
• Doing medication reconciliation during admission, during the patient's stay, and for the patient's discharge
• Writing up/preparing discharge summaries
• Putting in inpatient orders

And that was my experience in internal medicine/hospital medicine! There are definitely more things that you'll get to experience, but these are probably good starting points as you review before your rotation.

Nicole's Clinical Tip: On your first or second day of the rotation, find out if the facility does procedures; and if so, what some of the most common procedures are. Go home and review the steps for the procedures. Even if you end up just watching, at least you'll have an idea of what's going on, and it won't be your first time learning about it!

Good luck and have fun! Feel free to leave a comment or contact me with any questions.

- Nicole G.
@nextwithnicole