A second year medical student reader asked me to comment on what rotations to take in medical school to prepare for an internal medicine or hospitalist medicine career.

I am a second year medical student, very interested it practicing the art of Hospital Medicine, and I was wondering if you had any advice/comments on any specific electives to consider to help prepare me for an Internal Medicine residency.

Great question.  As is standard in most medical schools, your third year will be defined for you with a nice healthy serving of clinical rotations in bloodless surgery, pediatrics, internal medicine, obstetrics and gynecology, family medicine and psychiatry.   If your education was anything like mine, you will have some limited elective options within each core curriculum clinical rotation.   They are first come first serve as spots will be limited.  Don’t stress too much about these options.  Anything will do.

But your fourth year is filled with electives of your choosing.  What is my advice for picking clinical rotations in your 4th year if you are planning on doing an internal medicine residency in preparation for a career in hospitalist medicine?

1. Radiology.  It was a “posh” rotation in my day.  But you still get to see some crazy stuff like the tortuous aorta,  severe scoliosis and  bilateral hydrophrosis, from a foley catheter.    Plus, you’ll get pretty good at reading chest x-rays.   You won’t read your own CTs and MRIs in the real world, but you can get a good sense of what you’re looking at on rounds and you can impress all the nurses who will think you’re smarter than you are as you scroll  up and down through the images while consuming food and drink at the nurses station.  Image is everything.  Right?
2. Electrophysiology cardiology.  Why EP cardiology?  At my institution, as a fourth year medical student, I got to “read” every EKG in the entire hospital for an entire month.  I saw some pretty unusual EKG/ECG patterns during that month.  To this day, I still remember nuggets of info that I carried past my internal medicine residency into my life as a hospitalist. For example, sinus tachycardia does not need a beta blocker.  Ever.
3. Gross anatomy.  This had to be one of the hardest educational experiences of my life, as a first year.   Nothing can prepare you for the incredible  onslaught of information you have to pack into your brain in that first week of medical school.  As a fourth year medical student, deeply inflicted with medical student syndrome, our 4th year elective gross anatomy rotation consisted of looking at a cadaver for three days and then writing a paper about the experience.  Come to think of it, I never did get that paper written.  To this day, I still can’t figure out how I got an A that month.  Oh, yeah.  Everybody got an A.  Now I remember why I played golf that month.
4. Rheumatology.  It helped that Happy’s rheumatologists were pretty smart.  I gained a new perspective on horses and zebras.  I learned to never ask for an inpatient rheumatology consult because, as you’ll soon discover,  the answer is never lupus.  I discovered fibromyalgia is all in your head.  Oh wait, that was from my family medicine rotation.  All the rheumatologists make it very clear that fibro is outside their scope of practice.  Systemic fibromyallergia?  Now that’s a disease  for the hospitalist to tackle.
5. Anything outpatient.  Doesn’t matter what you do.  At all costs, avoid lengthy inpatient rotations where you’re in the hospital until midnight every night.  Why?  Because all your fiends did and they’re at the bar hanging out eating chicken wings while the ID doctor finds great joy in pimping you about the appropriate treatment for a UTI at 9 pm on a Saturday night.  Stupid Happy.  Stupid Happy.  Stupid Happy.  What were you thinking?  If that happens to you, feel free to suggest choramphenicol as the appropriate treatment, but only after you’ve matched in your residency slot.  Now that your residency work hours are restricted to banker’s hours, there’s no need to abuse yourself.  If you want to abuse yourself, volunteer to shadow a surgical intern and offer to do all their grunt work when you’re done by noon on your Mon-Thurs dermatology rotation.
6. Dermatology.  Speaking of dermatology, I know of no other field where you only have to remember two medications: a steroid cream and an antibiotic cream.  If you remember this advice, you’ll get an A+.  Plus, if you become a hospitalist, you’ll understand why any inpatient dermatology consult will alway’s result in the same answer.  If it’s wet, make it dry.  If it’s dry, make it wet.  In either case, they’ll get an order for a  steroid cream and an antibiotic.
7. Research.   Remember, you’re paying tens of thousands of dollars in tuition to play golf that month.  Make every round your best round ever.  You might even be able to deduct your new golf clubs as an educational expense.  Though I’d talk to your accountant about that first.  This is not tax advice.  But it is medical education advice.
8. Do a second month of research.  Your handicap has a few more strokes to go before the big spring scramble.
9. Take a month of sick leave, or get pregnant and take a month off for maternity leave.  I think both, if they aren’t already, will be available to you by the time you become a fourth year medical student.  Because you’ve been working too hard for two years and America thinks it isn’t fair.

“Happy Hospitalist” is a physician who blogs at at his self-titled site, The Happy Hospitalist.

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