Tag: internal medicine

Internal Medicine Shelf

Sup ya’ll!

So you are looking into taking your internal medicine shelf or COMAT for your third year of medical school. Well, I didn’t do terribly on it but I am definitely a middle of the road type of student. So if you need some advice on just passing, then this is the place for you!

Your internal medicine shelf will be like a mini level 1 or step 1 exam. Internal medicine spans MANY different specialties and is the actual base of the medicine stepping stool. You need to know a lot about a lot for this shelf. So pace yourself a bit because it is a lot of information. Topics they like (at least on my shelf):

  • Screening. Know the different indications for this. I.e. colonoscopy, breast cancer screening, AAA screening, vaccinations for adults, etc.
  • Cardiac basics. I.e. ACS vs MI vs NSTEMI. How do you diagnose it. What do you order vs next steps. How do you treat?
  • Cardiac continued: there are several classifications. I.e. Diamond classification for ACS, CHADS2VASC score for anticoagulation, NYHA for CHF. They will ask questions about these. So will your preceptors, so just be familiar with them.
  • INFECTIONS. Oh man I was so mad about this. I’m terrible with infections and antibiotics. They will ask.
  • Sepsis is hit or miss. I had a lot of sepsis practice questions but didn’t feel like I had that many on my shelf personally. But either way, it is a big hitter in medicine in general and patients die from it, so understand it and how to treat it.

How I prepped:

My internal medicine rotations were back to back. So I started studying during my first rotation a little bit throughout regardless of if I was in clinic or not to try to get through some of this.

  • Online med ED videos and questions. There is a lot, and it can be difficult to get through all of it. I started with one topic and tried to dive into it. Some of it will come back from your first two years. The rest you will see for the first time (or at least your brain will think it has). You will be exposing yourself to a lot, so take it chunk by chunk.
  • Case X. Yes, very helpful!
  • Aquifer cases: more helpful for screening and outpatient medicine guidelines. Less helpful I thought for inpatient medicine.
  • Anki Dorian deck: oh yes. Wish I would have been able to get through more.
  • U world and Truelearn questions. Even if I only did 10 at a time, I tried to go through all those incorrect answers. I would pick the topics I was studying from the videos I was on at the time to really drive in the content home in my brain.
  • Case files. Helpful, just couldn’t get through that much. A good quick way to see high-yield or common presentations and how to assess them.

On my off days, weekends, or weeks where I was off to do my assignments as I am a hybrid student I tried to do a good mix of my assignments and the above. Weirdly enough my school didn’t require me to watch the OME (online med ed) videos/do questions for internal medicine which I thought was just whack. But I did it anyways, because it was a good source of information/study material for me.

My shelf exams were 125 questions. I think it is around 2 hours for a time limit? For the most part I was able to pace myself. The ending there I was a little peeved because I was worried I would run out of time. Just try not to spend too much time on one question. You can always guess, flag it, and if you have time go back and try to glean a better answer.

Anywho, good luck and cheers!

Scribe Series: Full Chart Examples!

Hello hello!

I decided I was in a very giving mood and wanted to give some examples of full SOAP notes. Since a chunk of you who show up to my site are here for the scribing practice and explanations, I figured I’d try to give you some more resources.

I have added a blank or a general SOAP note template here. This full out SOAP note is pretty in-depth. It would likely be used more for general wellness exams at a family practice office, internal medicine visit, or possibly a pre-operative full H&P. Many other specialties do take the same format as this note, they just don’t necessarily have as much information or as detailed of information.

Here is an example of an ER note.  I based this one off of my posts *scribe series: HPI practice case 2*. Which you can check out by clicking the link.

Here is an example of an ENT focused note. It is not quite as in depth as the charts I used to write were simply because I can’t remember every detail of how I did those notes. The pathology for them as well is getting hazy too. I used to work in several ENT subspecialties and I have to tell you, this was one of the hardest scribing jobs I had. Each specialty was so incredibly specific yet all in the same small area of the body. I chose to do a hearing related one as neuro-otology was one of my favorite subspecialties. Rhinology/sinus was my second favorite, only because I then spent the most time here. It took me forever to cross train scribes as their providers also usually only worked 1-2 days a week. [Insert your favorite eye rolling emoji here].

Here is an example of an ortho follow up note.  This one is a little more rough (I know). It’s been a hot minute since I did an ortho note so take it with a grain of salt. But basically the first paragraph you want to summarize all the previous history/surgeries and the second HPI paragraph you want to give an update for how they are doing in the office the day you are seeing them. The goal is to continue to add on to the first paragraph with pertinent information from the last visit so you have it all in one note.

Here is an example of an urgent visit note . Say from a level 3 ER case, an urgent visit at the family/internal medicine office, or possibly at an urgent care.

What are some differences that you notice between these charting types? What are some similarities? Do you notice how the more focused notes don’t have as many ROS and PE systems as a full generalized well exam would?

Look at how I tend to word my HPI’s or how I might put things in the physical exam. There are definitely some findings that can go under multiple systems on the PE; pick one for that chart or try to pick one system that you would generally put it under.

I personally liked to bold the abnormal findings when doing charts in programs that do not automatically bold them or highlight them in red. As a scribe, this is a nice touch to help your provider or other medical staff see the abnormal findings more quickly. But by all means, this is not necessary to have in your chart.

*As a side note, these will be read only. You may feel free to print them off and mark them up. Or make a copy on your own drive and mess around with them.

Cheers!