This the first rotation where students are held personally responsible for the daily care of their patients. The emphasis of this rotation is more about learning professionalism and responsibility, rather than just increasing knowledge base.
Subinterns are expected to work the entire four weeks (all 28 days) and get an average of one day off per week. Which day the subintern takes off depends on their team's call schedule, days off for their PGY1 colleagues, their resident's clinic conflicts and subinternship-related educational concerns. The specific days off for the month will be determined by their senior resident on the first day of the rotation. To accommodate for unforeseen circumstances, a student's grade will not be affected if a subintern misses one additional fifth day and provided there is a valid reason for the absence. Students who miss days due to family emergencies and/or illness will be handled on a case-by-case basis by the site director.
Students should make every effort to schedule the majority of their interviews either before or after their subinternship. Students will be allowed to use their "fifth floating day off" to accommodate interviews that might become available on short notice. Interviews that were scheduled prior to the start of the rotation should be discussed with the clerkship coordinator before the first day in order to help find the optimal team assignment and call schedule. If subinterns need to travel and miss two consecutive days, then one day will be considered their "fifth floating day off" and the second day will be their scheduled day off for the week. Students are not allowed to leave at noon the day before an interview or return at noon the day after an interview. We actively discourage more than 1 out-of-town interview since a flight cancelled due to bad weather could result in a student needing to remediate the clerkship if they have an unexcused absence.
Subinterns are expected to attend their own conference, VA conferences, Northwestern service conferences, morning report, noon conference and grand rounds.
Every attending and resident has individual ideas of how things should be run. There is no “right way” to run work rounds. The only way you know what they expect is if you ask them what they expect. Make your resident and attending go over expectations at the beginning of your rotation. Ask for regular feedback. Do not let the last day of the rotation become the first time you get feedback.
Goals & Objectives
Detailed Goals and Objectives
Find comprehensive Medicine Subinternship Goals and Objectives.
Responsibilities during the subinternship include:
- Order writing
- Cross coverage
- Daily ward responsibilities
- Delivering bad news
- Staffing services
- Histories and physicals
All intern physicians, regardless of eventual subspecialty, are expected to possess a basic fund of knowledge regarding common clinical scenarios encountered in the hospital. Upon completion of this rotation, all subinterns will be expected to demonstrate knowledge of the proper initial approach for these common inpatient medical scenarios:
- Chest pain
- Acute dyspnea
- Diffuse abdominal pain
- Acute renal failure
- Acute gastrointestinal bleeding
- Electrolyte imbalance
- Hypertensive urgency
- Pain management
- Management of the complex medical patient
Grading & Evaluation
The breakdown of grading is:
|Patient-centered medical care||30%|
|Professional behavior, moral reasoning, community engagement and service||20%|
|System awareness and team-based care||15%|
|Communication and interpersonal skills||10%|
|Medical knowledge and scholarship||10%|
|Continuous learning and improvement||10%|
|Personal awareness and self-care||5%|
Your performance will be judged by your attending physicians and your residents. The PGY1 interns on your team are not part of the formal evaluation process since they have less ability to directly observe your orders, exams, assessments and notes. We encourage you to view them more as your colleagues rather than your evaluators. You will also be evaluated by your clerkship director based on conference performance and a review of your class assignments. You may also be evaluated by the allied health professionals on your floor (nurses, social workers, discharge planners) as part of interdisciplinary rounds.
A failing grade is less than 55 points overall or less than 4 points on any individual competency; marginal pass is 56-59 points; pass is 60 points and higher; high pass is 72 points and higher; and honors is 80 points and higher.
Grading procedures for subinterns at the Jesse Brown VA may vary. Please check with your site director.
Tools & Readings
The main tool required for this subinternship is a professional wardrobe. Scrubs are acceptable for long call days when you may work late performing procedures. On all other days, you should be professionally dressed.
Attire guidelines include:
- Ties are expected for men
- Open-toed shoes are forbidden
- Patients should not be able to see your waistline
- Clean white coats are expected for daily activities
- Procedures are rare on night float admit days, so dress clothes are expected (not scrubs)
Michael Angarone, DO
Ami Desai, MD