A Day In The Life Of A Med Student: Nephrology Rotation (MS4)

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Have you ever wondered what it’s like to be a medical student ‘on rotations?’ As you probably already guessed, no two days are alike. All future physicians are busy, but let’s take a snapshot from Dr. Niklas Buscher, who completed his Nephrology rotation at Northwestern University, Feinberg School of Medicine

6:00 AM Shower, coffee, smoothie - gotta run. 

6:35 AM Took the bus to downtown Chicago and checked the day’s rotation schedule. Had a few moments to reply to some emails, read the news.

7:15 AM Grabbed a bagel on my way to the hospital.

7:30 AM Arrived at the Nephrology Fellow Room in time to review charts for my four patients. Additionally, I read the patient amendments made by my fellow and the attending from the previous day. I then printed out the current patient chart sum-ups, and briefly discussed the patients with my fellow (e.g., one patient with membranous glomerulonephritis, one with hypovolemic hypernatremia, one with post-op acute kidney injury, and one patient with HIV who developed urolithiasis while on atazanavir, a protease-inhibitor).  

8:00 AM Pre-rounding patients, then headed back to the Fellows’ Room.

9:00 AM Met with the resident, fellow, and attending - Chief of Nephrology and the Director of the Cardiovascular Research Institute - to round all patients on the service (total patient count: 18). During rounds, I presented 3-4 patients that I was taking care of to the fellow and the attending while the fellow’s pager kept buzzing for new consults. 

11:00 AM We split up to visit the new consults (4 total). The resident took care of one of them, I cared for another patient and the fellow visited the remaining two patients. While the fellow and the attending continued with rounds, I did a quick chart review on the new patient and called the primary team to get a first impression - hyperacute kidney injury with hematuria. Urinalysis had previously been ordered by the primary team that requested the consult (thanks to them!) and showed an active urinary sediment.

11:30 AM Visited the patient, took history and did a quick physical examination.

12:00 PM Electrolyte Conference and great lunch buffet! The entire Nephrology Department attended the conference. There was an awesome lecture on acid-base disturbances! At the end of the conference, my attending asked me if I would like to present a case at the next Electrolyte Conference. I literally started to panic and my mind was running wild with ideas on what case I could present, but I said ‘sure’ - (no better way to make a good impression than presenting a case in front of the entire department). The problem was, I wasn’t quite sure how to fit it into my schedule…

1:00 PM Met up again with the fellow and attending. We continued with rounds and I presented the last of my four original patients. Then, we went to visit the new patients and I presented my case. We decided that the patient needed a biopsy. It turned out she had rapidly-progressive glomerulonephritis, which was later diagnosed as anti-glomerular basement membrane disease without pulmonary involvement - a rare disease that every med students knows about!

3:00 PM Finished my rounds, went back to the Fellows’ Room to write patient notes, but had to grab a quick coffee beforehand! 

5:00 PM Finished my notes, headed to the bus - the traffic was terrible so it took me forever to get home! I spent my time thinking about the Electrolytes Conference and what to present. Nothing good came up, but then I remembered a patient with hyperammonemia due to abscess-formation after a C-section that we had seen the previous week. I figured there were probably some good teaching points on electrolytes in that case, so I started preparing the case mentally on the long bus ride back home.

6:00 PM Arrived at home. Made myself an avocado-hummus sandwich. Yum!  

6:15 PM My roommate, who was also an MS4 at the time, was rotating in Interventional Radiology. He was home, so we quickly chatted about our day.

6:45 PM Got ready for a Crossfit workout.

7:00 PM Crossfit workout (it was MAX week again, seriously?) Cindy was tough today!

8:15 PM Ordered pizza with my roommate, then started to practice for Step 2 CS that was coming up in 2 weeks. We went over cases together - one case each. We role played each case (one of us played the physician while the other posed as the patient). We timed the encounter and afterwards gave ourselves 10 minutes to write a patient note (there is an online matrix to type in the note on the NBME website). Pizza arrived right on time, in between cases.

9:45 PM Had two IPAs with roommate.

11:00 PM Watched an episodes of House of Cards.

12:00 AM Light’s out!

For Niklas, this was how a typical day looked, six days per week. Each day was different and had something new to teach. If you are just now beginning your rotations, Niklas recommends staying calm, studying hard and as early as possible, and always having something to look forward to (e.g., vacation, away-rotations, or a weekend off). He also suggests going through Qbank questions and devising a realistic study plan and sticking to it.