View Full Version : BLHC - Internal Medicine

11-28-2011, 05:42 PM
Since nobody has done one, or rather I can't find one, I'll start with my input on how this rotation went, as I should be studying right now, but I am of course procrastinating.

3 Month rotation as you know separated into 4 week segments (although our first week was kind of short). 1st day the Chief Residents sequesters you into the meeting room and "teaches" you how to use Eclipsys (the EHR that they use at BLHC). They more like show you some simple tricks, you kind of learn a lot of other tricks as you play with the system. It's a good idea to get familiar with the system as you can become very efficient in doing your work. Anyways, they ask you to write and pick the specialties you want to rotate through, ICU is not an option at BLHC (one of the only programs in the nation that don't let first year residents through their ICU). The real choices are Cardio, Pulmonary, Renal, ID, and General, as those are specific floors of Medicine available. If you choose anything else, you'll more than likely put onto the general medicine floors. After you choose, the Chiefs will try to accommodate you onto the floors you have choosen, you will be sent in pairs to each floor.

The Floors are as following:
17th - Half Cardio/Telemetry, Half Pulmonary
15th - Pulmonary + PCU (progressive care unit - ICU step down)
10th - Renal
9th - Cardio/Telemetry
8th - General Medicine
7th - Infectious Disease

The residents rotate as well as the attendings, so you won't be with the same attending as your colleagues from month to month.

The set up on each floor usually, except for 17th and 9th, are 4 first year residents, with 2 second year residents and 1 attending. You are paired up with a certain resident. You are suppose to follow him/her through everything (and if they request to clinic as well, try to skip this if you've done clinic before). Usually the resident should assign you 1 - 3 patients (Depends on their workload) and you are suppose to follow up on these patients (the residents SHOULD check in on the patients as well), and you are suppose to do everything, including checking their labs, checking in on them in the morning, bedside physical, reporting them during rounds, writing their notes, basically what a first year does, but you can't do discharge, dictation, or orders. The residents may ask you do "scut" work every now and then (sometimes there is more of this on certain floors - 15th, 9th, than others, as the residents are sometimes overwhelmed with sheer number of patients).

Set up on the 17th and 9th floor is that you'll have 2 teams. On the 17th you'll have 1 team for pulmonary one team for telemetry/cardiology each with their own attending. So 3 first year per team, with 1 second year per team. On the 9th Floor you'll have 2 teams, as there is a high turnover rate on this floor. 2 First year residents 1 second year resident, and 1 floater which belongs to both teams and 1 attending.

Rounds really depends on the attendings, so far I've experienced all types of rounds, including standing rounds, where we gather all the charts and just stand outside in the hall and go through each patient in order then go and check out the patients (sometimes not even). I've done bedside rounds, where we go to each individual patient and present the labs, and as well as sitting rounds (best IMO) where we sit at a conference table and discuss each patient, their plans. The teaching also depends on the attending, I've for the most part have had good attendings. Some will lecture, some will do bedside teaching, some will make you do presentations, all forms really make you learn. Some rounds will go on FOREVER, some will be so rapid that you don't know what happened (lightning rounds). For the most part you'll get the feel of each attending and you need to adjust yourself according to him/her and the way they like things presented. It's okay to make a mistake the first or second day, but more than that is not excusable.

Teaching from the resident is a real hit or miss, some residents really love to teach and see you succeed in your career, and some are too busy to even look at you for a second except for looking over your progress note. If this happens, really need to take initiative and read up on your patients, sometimes you may have to do your residents job for them, as some residents appear to be so scatterbrained that they can't even get the labs right... But for the most part, the ones I've had so far have been okay.

We have daily lectures, at 1pm throughout the week, one Tuesday and Wednesday one of us are suppose to be picked by the Chief Residents and we are suppose to look up a case and present it to an attending of a certain field. The organization of this has been lacking at best and sometimes we get an attending from a total different field of a subject that is basically not in their specialty. On the other days a Third Year Resident presents a topic to us. Some have been good, some are just terrible, boring, and a waste of time. What makes a big difference is sometimes the accents are basically incomprehensible.

Procedure wise, you can do a lot of blood draws if you want. If you are on the Pulmonary floors you can get a lot of ABGs in because they tend to do them every Wednesday on the respirator patients (and there is a bunch of them). Otherwise than that, you'll every now and then see LPs and a Paracentesis. If you want to you can go and check out bronchoscopies when they do it bedside, usually on the 15th floor. I've seen a TEE bedside, and TTE you can always see on the 9th floor, the Echo tech is right there, she'll even explain about what is happening if you just ask her nicely. If you really interested you can follow some patients down as they do Endoscopy, but this gets really boring if you have no idea what is going on, and if you do your GI elective there I bet you'll get a lot of opportunities to watch a couple. From what I hear from other students, probably never do one as the fellows need to rack up their hours.

Lunch really happens after rounds, or whenever you have downtime before/after lecture, generally you can eat, but it depends on your attending. Just remember you aren't getting paid, you should go eat. The "cafeteria" is more of a diner and the food selection is as such, it's not great, but will get you through. The coffee is terrible.

Evaluations are by your Attending. Some will be very nice and give you a great evaluation, some will be pretty strong and critical on your performance, so far it seems everyone are doing fine.

I haven't taken the shelf yet, but getting to it. I say if you read up on Step-Up to Medicine as you do your rotation you'll be in good shape, along with some UWorld questions.

The rotation as a whole is what you make it to be, if you go and find work for yourself you'll get work, if you try to learn, you will learn A LOT. Especially in the population here you will see things that you can only dream of at some of more nicer areas in the US. The Bronx has one of the highest rates of asthma, and you'll see many different co-morbidity related to poverty here. Overall I'd say my experience has been "good". No REAL complaints, as students we are really free to do a lot, and some residents will be very enthusiastic about providing opportunities to do a lot. Try however not to neglect your duties to MEDICINE and don't just go their to float around onto other services :).

Copyright © 2003-2020 ValueMD, LLC. All rights reserved.