r/InternalMedicine

As the title states, I'm making a deck based on the Mass General Hospital intern handbook (the whitebook). There are only like 55 notes covering 20 topics in there so far, but it is growing each week.

These are difficult cards that are topic-encompassing, with 4 to 7 click-to-review one-by-one answers. They are hard and meant for those already introduced to the topics! 4th year or graduated MD. Under each card in the lecture notes is a screenshot from the current MGH manual

https://app.ankihub.net/decks/b98718f7-9bcd-40a5-a1f1-3a4739173fdf

Give me feedback if you like! Examples shown below.

I am looking for collaborators if anyone is interested

https://preview.redd.it/ljd13lsoqcyg1.png?width=904&format=png&auto=webp&s=4db40142037f465fe9baacf9a821b02c38d56f27

https://preview.redd.it/9iszrvepqcyg1.png?width=893&format=png&auto=webp&s=4bfc1ea43c93ab0a3979b282d867559eeef946a7

https://preview.redd.it/knl7mctpqcyg1.png?width=904&format=png&auto=webp&s=cfb20f099a19edf415c56fb09051cf45977b052e

https://preview.redd.it/gf4igvmqqcyg1.png?width=899&format=png&auto=webp&s=af5a48765a0299adb749c1176775d73ab492ef47

Hi, anyone have a working link to download the book? Thanks in advance.

hii im a high school student and i've got an opportunity to observe a doctor in internal medicine. since im in high school, i dont know anything about internal medicine. so what the hell am i supposed to do when im observing the doctor? am i supposed to ask questions from the doctor or just stay silent and write in my notes?

Hey everyone,

Starting IM residency soon and just trying to get a better sense of how to stay organized and efficient early on. A few things I’m thinking about

How do you keep track of your patients (overnight events, labs, plans) without missing things?

How do you handle constant interruptions during the day without losing your place?

What makes an intern stand out (in a good way) on rounds?

Any small habits that made a big difference for you in the first month?

Appreciate any practical tips or systems that helped you early on, especially on efficiency and workload

I absolutely adore Neurology, love the diversity of cases and I am really passionate about it.

But as a Non US IMG , the recent match rates for Non US IMG as 17% this year ( in contrast to IM : 30%) really makes me wonder if I should go for it .

According to the NRMP data , roughly speaking 1 in 2 IMGs matched in IM while 1 in 4 matched in neurology.

I have already graduated and will be yog -2-3 by the time I apply ,so , I am already running late .

Every other neuro applicant or resident that I have spoken to gives me the same advice - That if I am passionate about it and if my CV is completely neuro oriented that I'll have a good chance in match .

But what did those 3 out of 4 people not do that they didn't match ? It can't be true for all the remaining people that they weren't passionate enough or their CV wasn't neuro oriented, maybe a small percentage of people yes but not all . So why didn't they match?

So I really want you guys to give me a raw and unfiltered truth. Is it really worth trying if I go all in neuro ? What is that sets you apart from others as neuro applicants? And what NOT to do if you plan to apply?

Thank you in advance, I would love it if you guys could give me some input!

Current oms-1 at school that doesn't provide the best research opportunities. How important is it to do research during med school?

Cirrhotic patients with ascites make me hell nervous. The window to act is generally narrow. And the albumin decision is sometimes confusing.

I have made a framework for myself (which is kind of WIP).

1. Tap anyone with cirrhosis + ascites + any clinical suspicion
2. PMN ≥ 250/mm³ → SBP. In this case, I don't wait for culture. Treat.
3. Blood-tinged fluid? Subtract 1 PMN per 250 RBCs (otherwise, it can be false positive)
4. Community-acquired → cefotaxime 2g q8h × 5 days
5. Healthcare-associated or unit has MDRO signal → skip to pip-tazo or carbapenem upfront
6. Albumin 1.5 g/kg day 1 + 1 g/kg day 3 if Cr > 1, BUN > 30, or bili > 4
7. Repeat tap at 48h. PMN fall < 25% → not responding, escalate and rule out secondary peritonitis
8. Discharge → secondary prophylaxis starts that day, every time

The part that trips me the most in practice is the albumin criteria. The Sort trial numbers (HRS 33% → 10%, mortality 29% → 10%) are hard to argue with.

Is my thought process an oversimplification? How are you making calls in real-life practice?

Have you all read about Rome V?

Rome IV required symptoms for at least 6 months before you could confidently diagnose IBS. Rome V (released recently) has formally introduced parallel "Clinical Criteria".

Qualitative symptom pattern is the same, but the 6-month requirement is gone. It is replaced by 8 weeks, with the real qualifying bar being whether the patient is bothered enough to seek care.

There's data showing ~25% of people with DGBI symptoms don't meet full Rome research criteria but still have meaningful quality-of-life impairment.

But here's a thing running in my mind. The 6-month threshold filtered out transient GI complaints. Shortening the window and leaning on "bothersome-ness" as the anchor NOW pushes more of that judgment back onto the clinician.

What do you think about this reform? Are you actually going to use 8 weeks as your threshold now? Or still defaulting to 6 months?

For those currently in/were in fellowship, what was your step 3 score and did you feel it mattered at all during applications?

Currently studying for step 3 and wondering how much effort I should be giving/what score range to strive for.

Thanks!

GBS, Rockall, AIMS65

These are the three scoring systems. They are all validated, and used interchangeably in most departments I've worked in.
It took me longer than I would like to admit to figure out they're actually asking different questions.

So, I am trying to simplify it for my own department:

• GBS → pre-endoscopy, admission vs. discharge decision. GBS ≤1 = strong case for sending home or outpatient scope
• Rockall → post-endoscopy, rebleeding and mortality risk. Needs the endoscopic findings to be meaningful. Rockall ≤2 = safe to discharge after scoping. Not to use the pre-scope version alone
• AIMS65 → in-hospital mortality prediction, not triage. Albumin, INR, mental status, BP, age >65. Useful for deciding who needs ICU-level monitoring, not great just for admissions

From what I understand is that if we use GBS to triage, then scope, then Rockall to decide disposition is actually a logical sequential workflow. The problem is most places are just picking one score.

AIMS65 ≥2 in a patient already admitted probably warrants a more senior conversation about their care.

Is this a reasonable way to frame it, or am I oversimplifying the overlap between GBS and Rockall?

I'm an M2 who was drawn to medicine thanks to a deep passion for immunology. I've been set on Rheumatology for the past 3 years now out of heart. I have a laundry list of autoimmune diseases in my family, and the immunological toolbox and space left uncharted is much more interesting to me.

if you're a rheumatologist

— are you practicing at an academic or community hospital? is it specialized (e.g. orthopedics)? private practice or something else? WHY did you pick it?

— do you own a business? work with pharma or startups?

— where did you train? (academic vs. community)

— is rheum research funded? are there grants for interested MD PIs?

— do you still moonlight? is it "enough"? do you get FOMO? the Medscape reports the median salary of a rheum to be lower than IM...

— I am not going into Rheum for the MSK/orthopedics... no thanks. I want to work on the systemic inflammatory diseases. will I be missing out on the only money in the field? is it lost for me? help!

I don't know what I don't know.

I am taking boards in August. I have uworld and mksap. Looking for a cardio loving resident who can tutor/go over uworld questions with me. I am in a tough fellowship and needs some extra help to get through this exam. Please DM if anyone is interested.

I am a med student looking for remote research opportunities in internal medicine

Special interest in Endocrinology/Neurology/Rheumatology

I can do literature review, data extraction and basic stats

APASL 2026 in Istanbul had a whole session on liver transplantation in the MAFLD era and the framing was blunt. Centers are still using BMI cutoffs as a soft exclusion.

The argument made there was that MAFLD transplant patients who go through formal pre-listing metabolic evaluation are showing outcomes comparable to non-MAFLD etiologies at experienced centers.
Obesity alone isn't the variable that drives poor outcomes. The primary variable is uncontrolled metabolic risk, which is addressable.

The worry I have here is that this makes listing decisions significantly more subjective and resource-dependent. Centers without a formal MAFLD transplant protocol will apply different thresholds than those with one. That variation is going to matter a lot for patients.

How are people actually navigating this at their center? Is there a formal protocol, or is it still attending-dependent?