Internal Medicine at Mount Vernon

Green book core
I was warned by a peer of mine beforehand that I should expect to be disappointed. Go in with low expectations he said, and everything will be fine. He was right.

When I first walked into Mount Vernon on that cold January morning all I saw was a run down hospital, with  30 beds. There are about 20+ internal medicine interns/residents and I had no idea how they could possibly split up so few patients between them. Turns out the first years (interns) are the ones who primarily care for those admitted in the hospital and the second and third years oversee and guide the interns in their management of the patients. As for medical school students... I spent a good many weeks trying to figure out what our role was in all this. This is what I walked away with:

Daily Schedule

Arrive by 7:30 a.m.- For those of you driving, med students get free parking in the garage. You have to ask the security guard at the front desk for a coin. For those taking the train, you've got to take the subway and then switch to the Metro North to get to the hospital.

7:30-8:00 a.m:  Listen to the head nurse discuss discharges for the day and then listen to the residents who were on night float discuss the new admits over night (usually anywhere from 2-5 patients). On Mondays and Fridays there may be a resident/med student presentation on an interesting case with Dr. R.

8:00~8:45 a.m.: Chase down an intern before they all disappear and ask to follow them for their morning rounds. Stand and listen silently as each intern does a quick interview of each of their patients. Each intern will have anywhere between 5-10 patients on any given day. If you're lucky the intern will voluntarily discuss the case with you, if not, it's fine to ask them questions since they are all friendly anyway. 

8:45-9:15/10:15: A number of things can happen during this time. If you know how to do blood draws and ABGs and the residents trust you, they will ask you to do the blood work for them. If you can't do either of those things then you probably just go back upstairs to the residents lounge on the 6 floor and hang out until cardio rounds.

9:15/10:15- an hour later: Depending on the day, cardio rounds with Dr. N will happen at either 9:15 or 10:15 on the 4th floor. This is the most useless hour of the day. Residents gather around Dr. N and they go through each patient in telemetry. As students you have to stand at the other side of the desk and you can neither hear nor understand what's going with each patient.This will take take 45 minutes and you just stand there silently. If time permits, Dr. N will pull up a couple of EKGs on a screen and teach the residents. You stand there still confused. You are never acknowledged. The session ends. 

10:15/11:15-Noon: Hang out or go get an early lunch. I usually go the cafeteria or the nearby Subway. The only things worth eating at the cafe is the soup and the chicken cutlet sandwich. People like getting food during this time because there's usually a noon conference. 

Noon-1:00 p.m.: Noon conference can be either a student presentation on a case/disease, an attending teaching the students/resident about something in their specific field, or a test prep/board review Q&A session with Dr. E.

1:00-Whenever: God knows what. You're probably safe to go home at this point, although officially we have to stay till 4 for no real reason. For the first few weeks I would go to clinic in the afternoons till about 3 and then head off. For some reason, I was the only one who would do this since there was an odd rumor going around that our malpractice insurance didn't cover the outpatient clinic, which literally makes no sense.
They have some interesting clinics at Mt. Vernon that are worth going to. In addition to the regular outpatient clinic, I've been to the HIV clinic and Methadone clinic, each providing its own unique experience on a very different patient population.
Also during this time, some people pick up a side project during the rotation so they may spend an hour or two in the afternoon to catch up on their work.
If you aren't going to the clinic or doing project work, there's really not much else to do. Every so often there might be "bedside rounds" where a student is selected to do a full interview of a patient as 15 residents and students look on, but that only happened 4-5 times out of the three months.

Overall, Mount Vernon was not a good place for patient interaction, but you are able to gain a few skills if you are willing to work for it. I walked away learning how to perfect ABGS (drawing arterial blood) and I'm somewhat proficient in blood draws. It's also great if you enjoy studying. You get ample time to study if you so choose.