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Northwestern University Feinberg School of Medicine
MD Education

Medicine Subinternship

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.

Summary

Responsibilities during the subinternship include:

  • Order writing
  • Cross coverage
  • Procedures
  • 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
  • Delirium
  • Fever
  • Acute renal failure
  • Acute gastrointestinal bleeding
  • Electrolyte imbalance
  • Hypertensive urgency
  • Pain management
  • Hyperglycemia
  • Management of the complex medical patient

 Assessment and EPAs

EPAs

Medicine SubInternship CPA form

Mobile Observation Forms (eMerg)

GradingProcedure for Senior Medicine at NMH/VA:

Your final clerkship grade will be based on demonstration of competence in the objectives set out in the curriculum (see page 4 of the course book). Your performance will be judged by your attending physicians and your residents. The pgy-1 interns on your team are not part of the formal evaluation process since they have less ability to directly observe your orders/exams/assessments/notes/etc.  We encourage you to view them more as your colleagues rather than your evaluators. Your clerkship director, based on conference performance and review of your class assignments, will also evaluate you. The allied health professionals may also evaluate you on your floor (nurses, social workers, discharge planners) as part of interdisciplinary rounds.

 

Your final “score” will be used to determine your grade (Honors, High Pass, Pass and Fail). However- regardless of the final numerical “score”- students may still receive a failing grade and require remediation if they do not demonstrate a minimum proficiency             in each of the individual core competencies. Individual comments/verbal feedback will be taken into consideration when determining the final grade.

Core Competencies:
How this will be evaluated:
Contribution to final grade:
Professional

Average of attending & resident CPA evaluation forms

Directly observed patient encounter forms

 
Communication & Interpersonal Skills

Average of attending & resident CPA evaluation forms

Directly observed patient encounter forms

Conference participation evaluated by clerkship director

 
Advocacy

Average of attending & resident CPA evaluation forms

Clinical reasoning skills evidenced during case discussions

 
EPA10: Urgent/Not Urgent

Average of attending & resident CPA evaluation forms

Appropriately assesses the patient, calls for help, and initiates treatment

 
EPA2: Clinical Reasoning

Average of attending & resident CPA evaluation forms

Meaningful completion of web-based handoff cases

 
EPA3: Recommend and interpret diagnostic And screening tests

Average of attending & resident CPA evaluation forms

Recommends & interprets studies for common conditions and routine tests/studies

 
EPA4: Orders and Prescriptions

Average of attending & resident CPA evaluation forms

Enters orders and writes prescriptions correctly 

 
EPA9: Team

Average of attending & resident CPA evaluation forms

Independently communicates with team to convey accurate and updated information to the patient

 
EPA7: Medical Decision Making

Average of attending & resident CPA evaluation forms

Devises appropriate clinical questions and identifies, applies and correctly applies primary literature

 
EPA8: Handoffs

Average of attending & resident CPA evaluation forms

Gives and receives patient handoffs, prioritize patients in terms Of acuity and complexity

 
 
 
 
 
 
90% 
EPA completion
Completion of four EPA based assessments 
2%
Required 
Direct observation (EPA1), clerk log, canvas cases, handoff forms (3), mid- Clerkship feedback form (2), H&P, site director conference 
8%
Total score:
 
100%

 Required Clerkship Clinical Experiences (Clerklog) and additional tools

Download the subinternship clerklog

Access the Clerklog Online(requires NetID)

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)

Contacts

Michael Angarone, DO
Director
Pager: 312-695-3492

Ami Desai, MD
VA Director
Pager: 312-925-5933

Bridget Murdoch
Coordinator
Phone: 312-926-0858
Fax: 312-926-6905