I. Purpose Statement
As the first post graduate year of training, the internship year forms the backbone of graduate medical education. With increasing administrative burdens and training time restrictions, the preparation for this year during undergraduate education is increasingly important. The sub-internship experience is one which allows in-depth participation in diagnosis and treatment within a discipline. As such, it provides opportunities distinctly different than the third year clerkship or fourth year electives. The sub-intern will assume a first contact patient care role that includes increased patient care autonomy, increased responsibility, and more direct interaction with the attending. The sub-intern will demonstrate diagnostic, procedural and technical skills related to patient care. He or she will have on-call responsibilities that typify the internship experience relevant to an area of career interest. Finally, the sub-intern will participate in didactic conferences and educational exercises specific to the chosen rotation.
- Completion of third year core internal medicine clerkship.
- Promotion to fourth-year status, of no failures in third year core clerkship (visiting students).
Description: The subinternship is designed to prepare students for their role as house officers. During the subinternship the student should function as a PGY-1 resident under the supervision of the Senior Medical Resident (SMR). The subintern will assume primary responsibility for the patients he/she admits to the service. The number of patients assigned to the subintern will be determined by the SMR and attending on the service and will depend on the complexity of the cases, the number of patients on the students' service, and the clinical skills of the student.
- To learn to participate as an integral member of a medical team in the management of adult patients.
- To refine history-taking and physical examination skills.
- To learn to formulate a problem list and prioritize medical problems.
- To learn the judicious selection of laboratory and ancillary tests.
- To learn to institute drug and supportive therapy.
- To learn to manage acute and chronic medical problems including the utilization of consultative services.
- To learn to develop definitive plans for ongoing care and follow-up of dismissed patients.
- Perform a comprehensive history and physical examination on patients admitted to his/her service.
- Formulate a complete patient problem list emphasizing differential diagnosis for active problems.
- Formulate a diagnostic and therapeutic plan for active problems.
- Discuss the management of each new case with the SMR.
- Present each new admission to the attending and other members of the service.
- Write all orders for assigned patients. All orders must be co-signed by the SMR or a resident on the service.
- Write progress notes at least once daily on all patients.
- Visit each patient at least twice daily (before morning rounds and again in the afternoon or evening).
- Prepare discharge (including writing or typing the summary for review by your senior resident) and off-service summaries on all patients and help arrange for follow-up care.
- Take in-house call at least once per week during the rotation. Call and days off should be coordinated with the call schedule of the SMR on the service whenever possible. The rotation begins on Monday and ends on Friday. Students are expected to work holidays.
- "Sign out" to the on-call resident when leaving the hospital to inform the on-call resident about the status of the patients on his/her service.
- Perform procedures on assigned cases.
- Attend medical grand rounds (Wednesday mornings at 8am in 3015 Sudler), morning report (4050 Wescoe every morning except Wednesday) and noon conference (3015 Sudler).
- The subintern should wear a nametag at all times.
- Absences should be avoided during the subinternship. If an absence is necessary (i.e., interview), the student will make-up this time as discussed with their senior resident.
II. Symptom Complexes
Sub-internship selective will provide exposure to a number of core symptom complexes considered critical to preparation for intern year regardless of the chosen discipline. These items are as follows:
- Abdominal Pain
- Altered Mental Status
- Chest Pain
- Dyspnea / Respiratory Distress
- Syncope / Loss of Consciousness
- Uncontrolled Pain
III. Sub-Internship Course Objectives
Patient Care - The demonstration of compassionate, appropriate and effective care for the treatment of health problems and the promotion of health
- Patient Presentation - In addition to the performance of a complete and appropriate history and physical exam with development of a patient problem list, the sub-intern will synthesize and present a plan of care for his or her patients.
- Increased Autonomy in Patient Care - The sub-intern will assume the care of a list of patients not covered by an intern. The sub-intern will be supervised directly by senior residents and/or attending's.
- On Call and Emergency Issues - The sub-intern will have on call experiences that allow exposure to the urgent and emergent issues that are the on call responsibilities of an intern.
- Procedural Opportunities - With the foundation of third year clerkship in place, the sub-intern will learn the indications, contraindications, risks and mechanics behind procedures pertinent to the discipline of the sub-internship.
- Order Writing - The sub-intern will have responsibilities in the task of order writing with guidance and supervision of the senior residents and attending's
Medical Knowledge - The demonstration of establishing and evolving scientific knowledge and applying this knowledge to patient care
- Medical Knowledge - The sub-intern will demonstrate understanding of the "Core" conditions as identified in the summative competencies of the KUSOM, Appendices A, B, and C.
- Medical Data Interpretation - The sub-intern will perform interpretation of clinical information including pharmacologic, radiographic and laboratory data.
- Didactics - The sub-intern will participate in didactic conferences and exercises specific to the discipline and demonstrate an attitude of leadership in working with third year medical students if any are on the rotation.
Practice Based Learning and Improvement - The investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care
- •Evidence-Based Practice - The sub-intern will incorporate relevant medical literature into his or her presentation of the patient assessment and plan of care.
Interpersonal and Communication Skills - The demonstration of effective information exchange and teaming with patients, their families, and other health professionals
- Transitions of Care - The sub-intern will participate in the pass-off and communication of patient care information.
Professionalism - The commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population
- Professionalism - The sub-intern will be dependable, trustworthy, and considerate and demonstrate an attitude of prioritizing the needs of his/her patients above his/her own needs. The sub-intern will demonstrate effective interaction with all members of the multi-disciplinary care team.
Systems-Based Practice - The demonstration of the awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value
- Discharge Coordination - The sub-intern will have responsibilities in the discharge process to include things such as practice with discharge summaries, medication reconciliation, and medical follow-up coordination.