Intern year in residency can be daunting. It is extremely difficult to adapt the basic sciences and experiences learned during clinical years to be able to perform efficiently or even adequately on day one of your residency. Quite often, the majority of students match into Internal Medicine (which has the highest # of residencies in the USA) and are placed on the inpatient floor unit (“the wards”) often on Day 1. They then do up to a total of 7-8 months of wards rotations over the course of their intern year.
Wards are unlike anything else. They’re BUSY and BUSIER depending on what residency program and in WHICH CITY you are located in the country, for example: suburban vs. city hospitals. Often residencies are in charity systems that care for the public, Medicare, Medicaid, and often the Uninsured.
In most hospitals, it can comprise of taking care of patients in the hospital and admitting sick patients from multiple sources to the hospital: the ER, the clinics, outpatient physicians, etc. Options within the hospital you must decide where to admit to:
1) The Medical Floor/Unit (mild to moderately sick patients)
2) Telemetry (moderately sick patients or anyone that needs closer monitoring):
– Cardiac patients that need heart monitoring and vital signs
– CVA/Stroke patients that need frequent neurological checks
3) The ICU (severely sick and high level care needed)
– High Risk Post Operative patients
– Diabetic KetoAcidosis (DKA) requiring IV insulin
– Cardiac patients on nitro drips, cardizem (diltiazem) drips for a.fib, etc
– A. Fib patients on Cardizem (diltiazem) drips
– Hypertensive emergency patients on IV titrations
– Upper or Lower GI Bleeds
Sources to always have on you for how to determine admission or not? Where do these patients go within the hospital?
- Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine
- UpToDate.com (hospitals usually give you a subscription but, if not, it is well worth it)
- Consult Medicine