Sub-Internships 2017-08-08T12:33:15+00:00

During the M4 year, students are required to take a four-week Sub-Internship in Medicine or Pediatrics within the UIC system, or an external Sub-Internship that strictly adheres to the UIC-COM Sub-Internship Rotation Criteria.

PREREQUISITES AND PLACEMENT IN THE CURRICULUM:

Year Four; Completion of all Core Clerkships.

M4 Director:

Asra Khan, MD

E-mail:

arkhan@uic.edu

Phone:

312-413-2863

DESCRIPTION:

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.

GOALS AND OBJECTIVES:

  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, subinterns are strongly encouraged to attend and review the findings of the autopsy.
  6. To utitlize 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 meember.
    • 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 deomonstrate 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

PREREQUISITES AND PLACEMENT IN THE CURRICULUM:

Students must have completed all M3 Core Clerkships. The Pediatric sub-internship may replace the Medicine sub-internship.  It is intended for students who are applying for residency match in Pediatrics, Med-Peds, Child Psych, and Family Medicine.

GOAL:

To facilitate the professional and clinical development of the senior student in the area of inpatient pediatrics.

SITES:

Advocate Lutheran General Hospital, Hope Children’s Hospital, University of Illinois at Chicago

PURPOSE:

The purpose of the pediatric sub-internship is to provide the M4 student an intense, broad-based pediatric learning experience at the level of a PL1, utilizing direct patient care as the primary learning forum.

OBJECTIVES:

  • Work towards developing history-taking and physical examination skills at the level of a PL1
  • Recognize and manage common, high-acuity pediatric clinical presentations
  • Recognize and manage significant changes in the medical status of pediatric inpatients
  • Recognize the need and arrange for timely subspecialty consultation
  • Develop an appropriate discharge plan, including outpatient follow-up

 

COMPETENCIES:

It is expected that by the end of the four-week experience, the sub-intern will have achieved the following:

  1. An advanced level of competency in performance of the age-appropriate pediatric history and physical examination.
  2. A moderate level of competency in the complete work-up and management of children with common diagnoses such as status asthma, dehydration, neonatal fever, BRUE, pneumonia, bronchiolitis, and epilepsy.
  3. A beginner’s level of competency in procedural skills, which may include, but are not limited to, phlebotomy, IV insertion, lumbar puncture, bladder catheterization, and arterial blood gas sampling.

 

PROCEDURES/TASKS/RESPONSIBILITIES:

  1. A maximum of one M4 student will be assigned to a site per four-week period.
  2. The pediatric sub-intern will work up an average of four-six new patients per week, all of whom will be presented either at morning report or during team rounds. The team senior and attending will be responsible for providing feedback on sub-intern write-ups.
  3. The M4 student will function in the role of a PL1 (intern) and therefore report directly to the senior resident, be first contact for issues pertaining to their patients, place orders, and take the lead for communicating about their patients during team sign-out.
  4. The sub-intern will be expected to participate (where appropriate) in all procedures performed on their patients.
  5. All patients must be seen prior to resident/student work rounds.
  6. Active participation in work rounds, morning report, attending rounds and conferences is an expectation. Participation is facilitated by reading on one’s patients’ problems and developing clinical questions prior to the rounds or conferences.
  7. Ongoing feedback of the pediatric sub-intern is the joint responsibility of the senior resident, the team attending, the site director, and sub-intern.  Feedback should be actively pursued by the pediatric sub-intern.

 

INSTRUCTIONAL FEATURES:

The Pediatrics Department at UIH is committed to providing comprehensive primary and tertiary care to the children of metropolitan Chicago. This translates into a very rich patient experience for the M4 sub-intern interested in pediatrics as a career.  There are 3 sites for this sub-internship: UIH, Hope Children’s Hospital, and Lutheran General Hospital. The M4 sub-internship is an inpatient experience. On the inpatient wards, the children are cared for by medical teams, headed by an attending physician and consisting of senior residents, interns, clerkship medical students and one or more sub-interns (if assigned). These teams work closely with pediatric nurses, pharmacists, and social workers, as well as consulting subspecialists.  The subi-intern functions as a PL1.  The experience of the M4 sub-intern differs significantly from that of the M3. The sub-intern is given the privilege of first line responsibility for all patient-care matters relating to their patients. This includes work-up of inpatient admissions, writing orders, performing procedures, coordinating patient care, and developing appropriate discharge/follow-up plans. Methods of instruction vary from active discussion on rounds, resident conferences, and an NBME exam (for self-assessment only).

UI HEALTH ONLY:

Pediatrics E&M Conference (E&M = evaluation and management): This is a an educational enhancement specifically designed for the M4 student in Pediatrics – case-based learning sessions designed to focus on issues that you likely will face as residents.  The schedule for these sessions will be provided at the beginning of the rotation.

Additionally, sub-interns will participate in an intern clinical judgment exam prior to completion of the rotation, primarily for self-assessment purposes.

ASSESSMENT:

The team attending(s) is responsible for providing feedback informally on a frequent basis and formally at the end of the four-week rotation. A composite evaluation is submitted in writing with input from the senior residents as well.

SCHEDULE & ORIENTATION:

The medical school coordinator for your site will contact students with reporting instructions the week before the elective begins.

UI Health Sub-I Coordinator:

Chris Hansen (chanse6@uic.edu)

Lutheran – Advocate Children’s Hospital:

Tara Murphy (tara.murphy@advocatehealth.com)

Christ – Advocate Children’s Hospital:

Ellen Metzger (ellen.metzger@advocatehealth.com)

Updated: 8/9/16

The College Committee on Instruction and Appraisal (CCIA)  approved the following motions regarding external sub-internships:

  1. Students may seek out external Medicine and Pediatrics Sub-Internships already approved at other LCME institutions to fulfill the sub-internship rotation requirement. These will be reviewed and approved by the Assistant/Associate Dean of Curriculum and must meet the approved Sub-Internship Rotation Criteria. It is the students’ responsibility to provide supplemental material of the pre-existing Sub-I for review. These cannot be self-designed experiences.
  2. Students may seek out existing external Sub-Internships in General Surgery, Ob/Gyne and Family Medicine at other LCME institutions if they meet the approved Sub-Internship Rotation Criteria. It is the students’ responsibility to provide supplemental material of the pre-existing Sub I’s for review and approval by the Assistant/Associate Dean of Curriculum. It is the students’ responsibility to provide supplemental material of the pre-existing Sub-I for review. These cannot be self-designed experiences.

 Approved, 9/1/10

 

Students interested in pursuing an external Sub-Internship should consult the Registrar’s web page for the appropriate paperwork and submit to medsched@listserv.uic.edu .

The College of Medicine at Chicago has deemed that a clinical experience must meet the following criteria to be considered a sub-internship.

An external sub-internship in Medicine, Pediatrics, Ob/Gyne, Surgery and Family Medicine that has already been approved as a sub-internship at an LCME accredited school, may be submitted for review and approval to insure that it meets the criteria. Students interested in pursuing an external Sub-Internship should consult the Registrar’s web page for the appropriate paperwork and submit to medsched@listserv.uic.edu for approval.

Goals:

  • To prepare the student for inpatient care during their internship.
  • To synthesize knowledge and skills learned in the M3 Clerkship.

 

Objectives:

By the end of the rotation, students will be able to do the following:

  • Put patients first
  • Actively take responsibility for their patients
  • Assess patient needs
  • Formulate evidence based, cost effective, and ethical management decisions
  • Follow-ups on all information
  • Effectively communicate issues to parties involved, i.e. patient care team, patient, and family
  • Recognize the need for consultative assistance


The following criteria are required for a rotation to be approved as a sub-internship:

 

1)    Consists of a 4-week inpatient rotation.

2)    Students report directly to a senior resident or attending physician, with appropriate autonomy and ownership of the following responsibilities for their patients:

o    Admission notes and orders
o    Daily notes and orders
o    Working with consulting services
o    Discharge summaries
o    Handoffs
o    Pre- & Post-operative notes (if applicable)

3)    Students have continuity with patients during the course of the rotation.

4)    Students receive an end of rotation assessment based on compiled faculty and resident evaluation of student performance.

 

Other Recommendations for Inclusion in the Sub-Internship:

 

•    Safe Discharge & Patient Follow-Up Activity

•    Patient Safety & Quality Improvement Project
o    Students identify potential & actual errors, and participate in methods of systems-error reporting.

•    Lists of suggested diagnosis and procedures for the specialty.

•    Sub-internship didactics
o    Focus on intern-readiness skills
o    Done separately from resident lectures.  Faculty and residents participate by  leading these sessions, and students are expected to present a case discussion as well.

    End of rotation OSCE
o    Could include encounters on disclosure of medical error, placing a medical consult, delivering bad news, discharge planning.
o    Could also consider cases involving handoffs, cross-cover, and advance directives.  Note that these cases currently rely on faculty involvement.

Approved by the Chicago Curriculum Committee, 1/23/17

M3/M4 Clinical Absence Policy