How to present on internal medicine rounds
Internal medicine presentations are the longest on any rotation, and the ones where structure matters most. A new admission can run six to eight minutes; a follow-up on rounds should land in three to five. Either way, your attending is listening for one thing above all: whether you understand why this patient is sick and what to do about each problem.
- Target
- 3 to 5 minutes for a follow-up, 6 to 8 for a new admission
- Lead with
- Your reasoning, in a plan organized by problem
Here is the format most medicine teams expect, a word-for-word example from a fictional patient, and the pearls and pimp questions that come up on almost every service.
What your attending listens for
Medicine attendings are listening for your reasoning. They want you to pull data from several organ systems into one clear picture, then give a plan organized by problem and ordered by how sick each problem makes the patient. Never just read the labs. Say what they mean.
The structure
Step 1: One-liner
Age, sex, up to three relevant conditions, and why the patient is here: the symptom and how long it has been going on.
Step 2: Overnight and subjective
Overnight events (fevers, rapid responses, PRN medications given), then how the patient feels: pain, nausea, appetite, bowel movements.
Step 3: Objective
Current vitals with ranges, a focused exam by system, then labs grouped by what they mean (CBC, BMP, troponin or lactate) and the trend in new micro and imaging.
Step 4: Summary statement
One sentence that pulls it together with semantic qualifiers, such as "acute on chronic decompensated HFrEF triggered by dietary indiscretion."
Step 5: Assessment and plan by problem
Problems in order of acuity (#1 acute hypoxic respiratory failure, #2 AKI, #3 hypertension). For each: where it stands, the cause or differential, and a specific plan.
Step 6: Prophylaxis, lines and disposition
DVT and GI prophylaxis, whether every line and the Foley still need to be in, code status, and what stands between the patient and discharge.
A word-for-word example
Step 1: One-liner
Mr. Smith is a 68-year-old man with HFrEF with an ejection fraction of 30%, stage 3 CKD, and atrial fibrillation on apixaban, admitted for acute on chronic decompensated heart failure.
Step 2: Overnight and subjective
No events overnight. He says his breathing is better and he slept flat for the first time this week. He was net negative 1.8 liters on IV furosemide.
Step 3: Objective
He is afebrile at 98.2°F, heart rate 78, blood pressure 118/72, satting 96% on 2 liters nasal cannula, down from 4. JVP is 9 centimeters, his bibasilar crackles are improved, and he has 1+ pitting edema. Creatinine improved to 1.4 from 1.8, and potassium is 4.1.
Step 4: Summary statement
In summary, a 68-year-old man with acute on chronic HFrEF from volume overload, diuresing well with improving renal function.
Step 5: Assessment and plan by problem
#1, acute on chronic HFrEF: he is still about 2 liters above his dry weight. We will continue furosemide 40 milligrams IV twice daily, recheck a BMP and magnesium in the morning, switch to oral torsemide once he is euvolemic, and restart empagliflozin and sacubitril-valsartan once his creatinine is back to baseline.
Ward pearls
- Report 24-hour ins and outs and the net balance on every patient with heart failure, cirrhosis or AKI.
- Never list an abnormal lab in the objective without addressing it in your assessment and plan.
- Group chronic, stable problems at the bottom: "#5, type 2 diabetes, stable on basal insulin; home statin continued."
- Commit to your leading diagnosis first, then explain why it is not #2 or #3.
Classic pimp questions
- Light's criteria: exudative versus transudative effusion
- Corrected calcium, the anion gap and Winter's formula
- The four pillars of GDMT for HFrEF that lower mortality
- FENa versus FEUrea in AKI, and when to use which
Not sure how to field them? How to take the questions
Practice it out loud
A script you have read is not one you can say. Present a fictional patient to an AI attending who cuts in, asks why, and grades you on a rubric, then drills whatever you missed.
Try a free caseOne case, free. No signup, no card.
Other rotations
Educational content with fictional patients, not medical advice. Teams and institutions differ: follow your attending, your institution's protocols and current guidelines.