Medicine - Sub-Internship

Year Four; Completion of all Core Clerkships.
M4 Director: Asra Khan, MD


Phone: 312-413-2863


The four-week senior experience in internal medicine will provide an educational experience for M4 clinical clerks that offers graduates supervised responsibility for patient care in the area of general internal medicine.

During this clerkship each student will gain an awareness of the knowledge, skills, values and attitudes that internists strive to acquire and maintain throughout their professional lives. You will not have time to acquire all of these attributes yourself during the rotation, but you will understand the professional responsibilities and student-centered learning process that permits the gradual acquisition of these attributes over longer periods of time.

1. To utilize medical knowledge and clinical reasoning to form hypotheses related to patient problems in general internal medicine.

  • Evaluate, discuss, observe the progress of ad be responsible (with supervision) for the care of approximately six new patients per week.
  • Attend and participate in housestaff and departmental conferences.


2. To acquire a basic knowledge of internal medicine and a greater knowledge of the medical conditions of assigned patients. Tasks:

  • Attend and participate in housestaff and departmental conferences.
  • Read in detail from major texts and the current literature about the medical problems of assigned patients and of other patients of interest on the service.
  • Demonstrate the ability to research a clinical problem in the primary medical literature. 


3. To obtain an accurate and pertinent medical history from all appropriate available sources and to record it in a complete, concise and literate manner.

  • Work-up approximately six new patients per week.
  • Write up each new or transferred patient, presenting patient data in the approved format and including an assessment (differential diagnosis and the reasoning that dictates the diagnostic and management approach) and plan for each problem.
  • Turn in write-ups for review and correction by the service attending.
  • Receive feedback on write-ups from the supervising resident and service attending.


4. To perform and record a thorough physical examination and review the physical findings with the faculty. Tasks:

  • Perform examinations on approximately six new patients per week and record the findings in the approved format.
  • Review abnormal or uncertain findings with the appropriate housestaff and faculty.


5. To use the clinical laboratory, x-ray, and other testing procedures in an appropriate and cost-effective manner. Tasks:

  • Write the initial orders for the work-up of approximately six new patients per week, discussing the orders with the supervising resident and faculty.
  • Follow the results of this work-up and order further studies as indicated.
  • Understand the methods and limitations of commonly performed diagnostic tests.
  • Discuss diagnostic options with the supervising resident and faculty member. Complement this discussion with appropriate reading in major texts and current literature.
  • In the event of the death of a patient, sub-interns are strongly encouraged to attend and review the findings of the autopsy.


6. To utilize medical knowledge and clinical reasoning skills to develop a complete and accurate problem list for approximately six new patients per week. Tasks:

  • Develop an initial problem list in the expected institutional format.
  • Discuss this list and the assessment of each problem with the supervising resident and faculty member.
  • Use this problem list as a framework for daily progress notes.
  • Revise and update problem lists as appropriate.


7. To effectively utilize the library and electronic resources to research the problem list and to demonstrate proficiency with critical reading skills. Tasks:

  • Search and read about the clinical problems of each assigned patient in major texts and current literature.
  • Do literature searches of clinical problems of assigned or other interesting patients.
  • Identify quality articles that address the problems presented by such patients.
  • Critically analyze the methods and conclusions of relevant articles and apply the results appropriately to patient care.


8. To become skillful at bedside, formal rounding and conference presentations. Tasks:

  • Present patients to supervising residents, faculty and peers during rounds and at conferences, becoming skilled at both impromptu and more formal presentations.


9. To develop an understanding of the psychosocial, educational, economic, cultural and religious backgrounds of patients that underlie their diverse belief systems and demonstrate this understanding in the approach to the management of individual patient. Tasks:

  • Undertake to know about the patient's background as it pertains to the patient's medical problems.
  • Demonstrate an insight into diverse backgrounds during rounds, in presentations and in write-ups.


10. To develop a sensitivity to and an understanding of the ethical dimensions of patients care, and demonstrate this in the approach to the management of individual patients. Tasks:

  • Demonstrate sensitivity to ethical issues during rounds, in presentations and in write-ups.
  • Use the literature and appropriate consultation to reseach ethical issues in the same way as clinical problems are studied.


11. To demonstrate skill in the performance of essential technical tasks in internal medicine. Tasks:

  • Perform under supervision or view, the following:
    • Venipuncture
    • Arterial puncture
    • Placement of an indwelling intravenous catheter
    • Placement of a nasogastric tube
    • 12-lead electrocardiogram
    • Catheterization of the bladder (male and female)
  • If the opportunity presents, perform, under supervision, the following:
    • Dipstick and microscopic urinalysis
    • Periperal blood smear interpretation
    • Gram or other appropriate stain of sputum and other body fluids
    • Lumbar puncture
    • Thoracentesis
    • Paracentesis
    • Aspiration of joint fluid
    • Flexible sigmoidoscopy
    • Cardiopulmonary resuscitation
    • Central line placement