Session 118 Where will you see the most variety of patients? Internal Medicine, of course! Dr. Hilary Ryder gives us a peek into subspecialties and the IM lifestyle. Hilary is the Internal Medicine program director at Dartmouth-Hitchcock Medical Center. She shares her internal medicine residency experience, how to pick a program, and how to stand out in your applications and rotations. If you haven’t yet, please do check out our other resources on Meded Media. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:13] Interest in Internal Medicine Hilary was initially unable to make a decision about what specialty she wanted to go into. Into her fourth year, she thought she wanted to be a dermatologist. What drew her to it was the lifestyle having no nights and weekends. It felt like a lifestyle specialty that she could get into. During her third year clerkship in medicine, she really loved what she was seeing but she wasn't sure if she could handle the 30-hour shifts they were doing. Eventually, she did a medicine sub-internship in hospital medicine that didn't have any overnight shifts. She ended up falling in love with her team and with how diverse the cases she was managing. She started to take on more ownership of patients. She found it so rewarding that she found the 30-hour shifts to be all worth it. The'res this idea of spending of 6-12 weeks on Internal Medicine doing some hospital medicine work, ambulatory care work, etc. Then you're going to figure out this is what you're going to do. And so a lot of people choose IM since they haven't really made their decision. But then when you're in your residency, you're stuck making another decision because there are so many different ways to be an internist. You have the breadth of opportunities all over again within internal medicine. [Related episode: What is Private Practice Internal Medicine-Pediatrics?] [05:45] Types of Patients Hilary explains that the types of cases an internist might manage basically depend on your geographic location. She's from New England and a lot of their primary care doctors are internists. If you travel more to the midwestern states, you're going to find that most of the primary care doctors are family medicine doctors. So you go into internal medicine planning to subspecialize. You can do an internal medicine residency and go into Sports Medicine, Allergy, Interventional Gastroenterology, Interventional Cardiology, Geriatrics, or Critical Care. If you go into Anesthesia or Psychiatry, you're going to do just a couple of months of medicine. If you're going into Neurology or Radiology, you're going to do a year of internal medicine. If you want to be an Endocrinologist, you're going to do a three-year IM residency. And then spend some more time in a fellowship subspecializing even more in terms of the types of patients you're going to take care of. Many of the mentors you're going to see in your second year are internists. In your preclinical years, a lot of the physiology and the pathophysiology are going to be taught by internists. In Nephrology, you're going to learn your acid-base. And you're going to learn your electrolyte disturbances from internist. They completed their three years of internal medicine and they went on to a Nephrology fellowship. [Related episode: 5 Traits Patients Want Their Doctors to Have] [09:30] Typical Day Their internal medicine residents rotate through a variety of different specialties within internal medicine. A third-year clerkship student rotates through a variety of different departments. In their program, they have residents in the intensive care unit for a month. They have residents on the interventional cardiology service. They have those taking care of bone marrow transplant patients. They have residents in clinic and residents doing home visits. In general, students know what the inpatient experience is, the interims of pre-rounding, then the r