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Internal Medicine, Subinternship (Arizona)

Prerequisites

  1. Completion of third year core internal medicine clerkship.
  2. Completion of ACLS course.
  3. 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 G-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 consultant 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.

Specific goals

  1. To learn to participate as an integral member of a medical team in the management of adult patients.
  2. To refine history-taking and physical examination skills.
  3. To learn to formulate a problem list and prioritize medical problems.
  4. To learn the judicious selection of laboratory and ancillary tests.
  5. To learn to institute drug and supportive therapy.
  6. To learn to manage acute and chronic medical problems including the utilization of consultative services.
  7. To learn to develop definitive plans for ongoing care and follow-up of dismissed patients.

Activity outline

  1. Perform a comprehensive history and physical examination on patients admitted to his/her service.
  2. Formulate a complete patient problem list emphasizing differential diagnosis for active problems.
  3. Formulate a diagnostic and therapeutic plan for active problems.
  4. Discuss the management of each new case with the SMR.
  5. Present each new admission to the attending and other members of the service.
  6. Write all orders for assigned patients. All orders must be co-signed by the SMR or a resident on the service.
  7. Write progress notes at least once daily on all patients.
  8. Visit each patient at least twice daily (before morning rounds and again in the afternoon or evening).
  9. Prepare discharge and off-service summaries on all patients and arrange for follow-up care.
  10. Assume the care of two or three patients at the beginning of the hospital rotation if a student or resident is rotating off the service at the time.
  11. Take in-house call every fourth night. Call and days off should be coordinated with the call schedule of the SMR on the service whenever possible. The rotation begins on Saturday and ends on Friday. Students are expected to work holidays.
  12. Admit the first two patients assigned to the service and then alternate admissions with one of the residents on the service (assignment of patients is at the discretion of the SMR).
  13. Carry the service pager during call nights until 11 p.m. The subintern will review problems that arise on the service with either the on-call resident or the SMR. For urgent problems, the subintern should immediately contact the on-call resident or SMR. After 11 p.m., the on-call resident will carry the service pager. If problems that require patient assessment arise on the service after 11 p.m., the on-call resident should contact the subintern to participate in the evaluation.
  14. "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.
  15. Perform procedures on assigned cases.
  16. Attend medical grand rounds and conferences and seminars outlined in the Orientation Booklet for the General Internal Medicine rotation.
  17. The subintern should wear a nametag at all times.
  18. Absences should not be scheduled during the subinternship.

Method of evaluation

Students are evaluated by the supervising staff consultant, the senior medical resident assigned to the service and other residents assigned to the service.

  • ART003334