Internal Medicine clerkship schedule at PSL

Presbyterian St. Lukes Medical Center

Call: When your team admits new patients.

Call is every fourth day ("call q4") at PSL. Residents and sub-interns (fourth-year medical students) are there for the full 30 hours; the two interns per team split the call day in two 12-hour shifts; third-year medical students stay until they get their 2-3 patients, but no later than midnight.

Rounds: When your team talks to the attending physician about current patients.

Rounds can be a bit confusing because they're held at different times depending on the day in the call cycle. Post-call rounds are usually at 7:30am, and the attending usually invites the team to eat breakfast in the physicians' cafeteria. Rounds are held at 8:00 and 8:30 on the second and third days after call, and they're held at 9:00 on call days.

Pre-round: When you visit with your patients in the morning and collect all new information (e.g. labs, studies, significant overnight events, physical exam).

I usually gave myself around 2 hours to pre-round on 2-3 patients. The earliest I got to the hospital over the past month was at 5am, and that was on a post-call day when I had 3 patients to pre-round on before rounds at 7:30.

My pre-round looks something like this:
1) Talk to the night nurse about overnight events.
2) Look in the patient's chart (both physical and electronic) to check for new orders or follow-up notes.
3) Start filling in my own follow-up note with the information I got from the overnight nurse and objective data like morning labs or any studies done since the previous morning's rounds.
4) Visit with my patient: get their perspective on how they did overnight.
5) Do a targeted physical exam.
6) Finish writing my follow-up note before rounds.

Classroom learning

In addition to clinical duties, I also had to attend various lectures and seminars. We had Morning Report every day from 10:30-11:30 and Noon Conference every day from noon-1pm. On Thursday afternoons, we also had to attend the Chief Resident Lecture Series from 2:30-4:00.

The end of the day

I got lucky that both of the residents who I worked with over the past month were laid-back and considerate of my time. They usually told me to go home rather early in the afternoon, sometimes even as early as 2pm. I didn't really know what to think about this, at first, especially given all of the horror stories I've heard about Internal Medicine being one of the hardest clerkships.

Typically, when my resident told me to go home earlier than 4-5ish, I would go find one or both of my interns and see if there was anything I could do to make their life easier. This amounted to scutwork, yes, but these were the kinds of tasks and chores that I'll have to be doing myself when I'm an intern. Plus, I know that both of my interns appreciated my scutwork services because it helped them get out of the hospital earlier. If both of my interns sent me home, too, I'd either study for the shelf exam in the hospital's library (I'm not exactly a procrastinator) or I'd actually go home and relax or go for a run.

Overall, I had a few 18-hour days and a few 8-hour days, with most of my days falling somewhere around 10-12 hours. It'll be interesting to see how my schedule at Denver Health compares.