Category Archive: All Rotations

Best Books and Resources for the Internal Medicine Rotation

 

This post is part of our series on the best books and resources to help you perform well on your third year rotations and shelf exams. Also check out our lists for clerkships in Internal Medicine, Family Medicine, OB/GYN, General Surgery, Neurology, Psychiatry, Pediatrics, and Emergency Medicine. You can also check out our complete list of "Best Books" lists for medical students here

Background: Clerkship Grades

At the beginning of each of these clerkship lists there are a few things I must say. First, your grade on clinical rotations will depend on both your clinical performance and your performance on a shelf exam at the end of the rotation. While it is true that how you work with your teams and patients will play into your evaluation, there is no denying that your knowledge of the subject matter is, by far, the most important part of your final grade because it directly affects both of these two areas of evaluation. As a resident, I currently find myself filling out medical student evaluations every week. There are very few 'incredible' medical students and very few 'terrible' medical students. The vast majority of you (~95%) fit into the "good and easy to work with" group; the only thing you have to set you apart from others is your knowledge base. You have no alternative but to study! First Aid for the Wards is a great resource to understand the dynamics of your clinical rotations, I highly recommend it.

Essential Resources

The resources I will describe in the clerkship lists are books and online question banks. From the onset let me point out two indespesible resources that I will not list for each rotation individually.

  • First, I consider a great online question bank essential. Both Kaplan and USMLE World are very good products. I highly recommend purchasing a one year subscription to one of these USMLE Step 2 question banks. As you complete your third year rotations, these question banks will prepare you for 1- your clinical duties, 2- your rotation shelf exam, and 3- the USMLE Step 2 during your fourth year.  
  • Second, online review materials (e.g. Medscape, UpToDate, etc.) are essential resources to prepare for your patients in the hospital. The books and question banks can never provide the type of in-depth detail about disease processes that you will need to learn how to properly take care of your specific patients. To be a great medical student, you must prepare more profoundly for the diseases you are encountering personally in the hospital.

Book Series for Third Year

Medical students are not all made the same; we are all very different learners. There are a number of companies producing review materials for third year medical students, each with a slightly different focus. Each of these companies produce a different book for each clerkship. Interestingly, some companies' books are rated higher in some clerkships than others. If you find a product that works for you, consider sticking with it during your third year even if that product is not 'rated' as highly for a specific clerkship. Below are a few of the review products and their features.

  1. The Case Files Series: A unique teaching model; the Case Files series introduces a number of important clinical cases and follows them up with clinical pearls and important concepts. For students who need vivid clinical situations to remember factoids and concepts, this is a great series. (Case Files Internal Medicine)
  2. The PreTest Series: The PreTest series is a classic question bank format with questions and detailed explanations. As I previously mentioned, I believe there is no substitute for a great question bank. While an online resource (USMLE World or Kaplan) can be more robust and mobile, a good question book is still a great option. The PreTest series produces a couple fantastic question banks (PreTest Medicine).
  3. The BluePrints Series:  The BluePrints series has a beautiful format that is very easy to read. The text is laid out in a bulleted lists, but with more details and descriptions than the First Aid series with which most students are familiar. I think very highly of these review books. (Blueprints Medicine).
  4. First Aid Clerkship Series: The First Aid series well known to most students also produces review books for third year clerkships. The content is similar to what students are used to, bulleted lists of high yield information. While I highly recommend many of the First Aid review books for USMLE Step preparation, the books are not quite as widely read and recommended for clerkships. (First Aid for the Medicine Clerkship).

Best Books for Internal Medicine Rotation

So, we agree that books are not sufficient for success on your clerkships, but they are still an incredible resource that you should tap into. Lets review the best books and resources for your Internal Medicine rotation. These lists come from both my experience and also from one medical school's annual survey of its 250 graduating medical students who try to detail which resources were the most useful on their rotations.

There are actually a number of great resources to help you prepare for the internal medicine rotation and shelf exam. The exam will focus heavily on inpatient internal medicine but you can not completely disregard the outpatient material.

 

1. Step-Up to Medicine:

The reputation of the Step-Up series for the medicine rotation is tried an true. It has been a stable of medical student study lists for decades and continues to produce a well-recieved review manual that I consider as close to a 'must-have' as there is in the third year of medical school.

 


 

2. MKSAP Book or Online Q-Bank:

These questions are produced by the Internal Medicine governing body, the American College of Physicians (ACP). The MKSAP Book is a well known resource, but recently the ACP released a digital edition of the MKSAP questions that can be used any of your electronic devices or computers.

3. Internal Medicine Essentials for Students:

This book was a collaboration of the American College of Physicians in conjunction with the Internal Medicine clerkship directors from across the country. The clerkship directors lay out a plan to succeed while on your medicine rotation. As you might expect, the content is very relevant and is generally ranked very highly by students.

 


 

4. Case Files Internal Medicine:

Most students agree that the case-based CaseFiles series is very good for the medicine shelf exam. I would rate this book very highly and feel like it was specifically responsible for a few correct answers on my shelf exam.

 


 

Is the Patient’s Device Safe for MRI?

MRIsatety.com is a great resource for medical students, residents, and all medical personnel.  We all know that when a patient has a pacemaker from 2004 that they can not get a thoracic MRI. However, what if the patient had a recent shoulder replacement? What if the patient has a port for chemotherapy? What if the patient had recent spinal surgery? No matter what the circumstance, you can search this website for the patient’s device and find out if it is safe for an MRI.

The main website is…
http://www.mrisafety.com

Or, the searchable list of implantable devices can be found directly at…
http://www.mrisafety.com/list_search.asp

The list of all searchable products includes:

  • Pumps
  • Aneurysm clips
  • Bone and Nerve stimulators
  • Cardiac Pacemakers and AICDs (defibrillators)
  • Breast and other soft tissue implants
  • Coils, Filters, Stents, Grafts
  • Dental Implants and Devices
  • Catheters
  • Clips
  • Foreign Bodies
  • Ocular Implants, lens
  • Sutures
  • Etc.

 

American College of Radiology: Appropriateness Criteria

Have you ever wondered what imaging test should be ordered for your patient? What radiologic test would be most beneficial in this situation? What imaging test should I order first? If a patient comes in with a painful knee, should I get an x-ray or go straight to MRI?  If a woman comes in with a non-tender breast mass should I get an ultrasound before the mammogram?  These are difficult questions; luckily The American College of Radiology (ACR) has our back! The ACR publishes a fantastic online resource they call the “Appropriateness Criteria” which details the best imaging tests for nearly every presentation.

http://www.acr.org/ac

They website allows the user to choose between a variety of organ systems (e.g. women’s health, urology, gastrointestinal).  In each organ system the user can then choose a specific complaint (e.g. breast mass, hematuria, dysphagia). For each complaint, the ACR then allows the user to choose what specific patient presentation is occuring (e.g. 35 year old woman with a new breast mass vs. 35 year old woman with a mass seen on mammogram vs. 70 year old woman with a new breast mass). In each circumstance, the ‘Appropriateness Criteria” explains what is the best radiologic test to help diagnose the patient’s problem.  They explain in detail the advantages and disadvantages of each test (MRI, CT scan, ultrasound, x-ray, etc) for each specific problem.

The criteria are updated every few years, the most recent data comes from 2009. One of the best parts about the ACR Appropriateness Criteria can be found at the end of each section. Not only do they make suggestions about which tests will be most useful in diagnosis, they also provide a literature review for EVERY SINGLE patient complaint which outlines what research and studies they are using when making their suggestions.

I HIGHLY RECOMMEND this website. In fact, there are few resources that I can recommend higher. I have used this many times and they intricacies and precision of the criteria still surprise me.  There is NO BETTER RESOURCE available to determine which imaging tests are indicated for a specific patient presentation.

 

Epocrates: Your brain in your hand

Did anyone actually enjoy studying pharmacology during the 1st and 2nd year of medical school?  One of the best resources you can have during your 3rd year rotations and into 4th year, internship, residency, and beyond is solid pocket medication and prescription reference.  Epocrates is the most widely used pocket reference and I can say from personal experience, it is a MUST HAVE.  There are many other apps, and some are good (LexiComp) but none are as good as Epocrates.

Set up is simple, download the app to your hand held device and the rest is self explanatory.  There is a free version and a pay version.  Even the free version is very good. However, your school likely has a tie in with Epocrates which will allow you to obtain the full version for free while you are in school.  Ask your administrators to provide this service if they do not already do so.

The Epocrates site provides the free download for Apple, Blackberry, Palm, Android, and Windows Mobile devices
http://www.epocrates.com/products/rx/

Medscape: The Most Downloaded Medical App

Medscape (now part of webmd.com) has produced the most widely used medical apps on the market.  The best part is, they are all free.  The main app links you to a database of review articles, disease definitions/physiology/pathology, and management guidelines.  It provides very quick access to important information: you could look up first line medications for community acquired pneumonia in the 15 seconds before you get pimped!

Their main site provides free app downloads for Apple, Blackberry, and Android users.  I have to admit, I use this ALL THE TIME right now during internship.  It is amazingly useful and user friendly

http://www.medscape.com/public/mobileapp

In order to download the app you will need to register with the website (here).  This will not only open the door to all their free apps, but also to all their online resources including free articles, text books, and reviews.  It will also allow you to view their annual physician compensation survey, one of the best ways to learn about how much physicians in each specialty earn.  See my dedicated post on this subject.

 

 

 

 

 

Uptodate: How to impress on rounds

Throughout your third and fourth year of medical school you will frequently be told to “read about your patients.” Uptodate.com is one of your best resources for succinct, up to date, and easy to manage medical information.  The site contains  review articles written by experts in the field and covers nearly all important topics in medicine.  Most large hospitals and medical centers have access to the database through their network.  There is a useful app too, but you may not be able to access it through wi-fi even within the hospital, due to some site restrictions.  But, DON’T PAY for it.  More than likely, there is a way to access it through your medical school.

http://www.uptodate.com/index

How to Use:

Read about your patient before rounds or at night.  Learn the ins and outs of the disease process well to better treat your patient and to better answer questions when you are pimped.  See if your team is doing everything suggested by the review article.  If you find something to add, mention this on rounds or to your residents and mention where you learned it (uptodate).  Everyone in medicine respects the review articles on uptodate.  If you mention that your information comes from uptodate, everyone will now it is reliable.  In the same vein, NEVER admit you learned something from wikipedia…even if it is a great resource sometimes.