Prerequisites

1. Completion of third-year core internal medicine clerkship.
2. Completion of advanced cardiac life support (ACLS) course.
3. Promotion to fourth-year status, of no failures in third-year core clerkship (visiting students).
4. International students: Due to the significant patient care responsibilities involved in this rotation, we highly recommend that students have completed a previous United States clerkship, and preference will be given to those who have.

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 assumes primary responsibility for the patients he or she admits to the service.

The number of patients assigned to the subintern is determined by the SMR and consultant on the service and depends on the complexity of the cases, the number of patients on the students' service and the clinical skills of the student.

Over the four-week rotation, each subintern can expect to spend two weeks on a traditional teaching service, one week on the attending only service, and one week on nights.

Specific goals

1. Learn to participate as an integral member of a medical team in the management of adult patients
2. Refine history-taking and physical examination skills
3. Learn to formulate a problem list and prioritize medical problems
4. Learn the judicious selection of laboratory and ancillary tests
5. Learn to institute drug and supportive therapy
6. Learn to manage acute and chronic medical problems, including by utilizing consultative services
7. 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 or 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. "Sign out" to the on-call intern when leaving the hospital to inform them about the status of the patients on his or her service
12. Perform procedures on assigned cases
13. Attend Medical Grand Rounds and conferences and seminars outlined in the orientation booklet for the General Internal Medicine rotation
14. Wear a nametag at all times
15. 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.

Per Mayo Clinic institutional policy, faculty and residents/fellows will not complete any outside evaluations. You will be provided with an electronic performance evaluation via Mayo Clinic’s MedHub portal. A final summative evaluation will be sent to you and your school official upon completion of your clerkship.