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. Proof of passing score of USMLE Step 1 or COMLEX 1 is required, and documentation of a scheduled USMLE Step 2 or COMLEX 2 date is strongly encouraged if a Step 2 score is not yet available to submit. If available, please upload your USMLE Step 2 or COMLEX 2 score or scheduled test date with your Step 1 or COMLEX 1 score report as part of your application materials.

Description

The subinternship is designed to prepare students for their future roles as first-year residents.  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 they admit 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.

Medical students choosing this elective will be based at Mayo Clinic hospital. Students pre-round in the morning, then attend daily morning report, and make rounds with I-MED teaching service. They also attend scheduled noon conferences in Internal Medicine. 

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 manage acute and chronic medical problems, including by utilizing consultative services.
6. 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 attending and other members of the team.
6. Write / pend 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. "Sign out" to the on-call intern when leaving the hospital.
11. Observe procedures on assigned cases.
12. Attend medical grand rounds, morning report, and noon conferences with the internal medicine residents.
13. Absences should not be scheduled during the subinternship.

Method of evaluation

All supervising consultants provide a written description of their students' performance. The program coordinator then writes a single summary letter.

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.