Why Medical Rotations Matter

General medicine rotations are the backbone of training for virtually every specialty. They build your clinical reasoning, your systems for managing complex patients, and your ability to recognise and manage acute deterioration. Invest in them — the skills transfer everywhere.

The Ward Round

Prepare for the ward round the night before or early in the morning:

  • Review overnight observations, escalations and nursing notes for each patient
  • Check all outstanding bloods, imaging and cultures
  • Have a prepared summary for each patient: diagnosis, day of admission, current status, outstanding issues, plan
  • Know which patients are being considered for discharge — have the paperwork started

Clerking a New Admission

  1. Presenting complaint: In the patient's own words
  2. History of presenting complaint: Systematic; timelines matter in medicine
  3. PMH, medications, allergies: Medication reconciliation — cross-reference with pharmacy, GP summary
  4. Family history, social history: Smoking, alcohol, occupation, living situation
  5. Systems review: Brief; don't miss something not volunteered
  6. Examination: Focused to the presentation; always include a set of observations
  7. Investigations: Bloods, ECG, urine, imaging — ordered with a reason
  8. Assessment and plan: Your differential, most likely diagnosis, management plan — even as a junior, formulate one before presenting

Handover

Safe handover is the most important communication skill in hospital medicine. Use a structured format:

  • SBAR: Situation, Background, Assessment, Recommendation — widely used across all countries
  • Handover every patient you are concerned about — never assume the on-call team will check
  • Document handover in the notes when clinically relevant
  • The ISBAR format adds Identification at the start — useful for telephone handover

Recognising and Managing Acute Deterioration

  • Know your early warning score system (NEWS2 in UK, MEWS, BETWEEN, state-specific in other countries)
  • A nursing call about a patient who "doesn't look right" should be taken seriously — this is a validated observation
  • ABCDE approach for any deteriorating patient before calling for help
  • Know your escalation pathway: registrar → consultant → rapid response / MET team
  • Never be afraid to call for help early — delayed escalation is a major contributor to adverse events

Common Conditions to Know Thoroughly

  • Acute coronary syndromes (NSTEMI, STEMI, unstable angina)
  • Acute decompensated heart failure
  • Community-acquired pneumonia (CURB-65 severity scoring)
  • Acute kidney injury (AKI stages, commonest causes, management)
  • Diabetic ketoacidosis and hyperosmolar hyperglycaemic state
  • Pulmonary embolism (Wells score, imaging, anticoagulation)
  • Sepsis (source identification, bundle management)
  • Stroke (FAST, imaging, thrombolysis eligibility, secondary prevention)