DESCRIPTION:
The four-week senior experience in Family Medicine will provide an educational experience for M4 clinical clerks that offers graduates supervised responsibility for inpatient care in the area of Family Medicine.   This sub internship will allow students to synthesize knowledge and skills learned in the M3 clerkship, and gain an awareness of the knowledge, skills, values and attitudes that doctors that practice Family Medicine strive to acquire and maintain throughout their professional lives. You will not have the 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. Students will have the opportunity to participate in the care of newborns, children, prenatal / laboring patients, and adults.

GOALS & OBJECTIVES:

• To utilize medical knowledge and clinical reasoning to form hypotheses related to patient problems in the breadth of Family Medicine.
  • Evaluate, discuss, observe the progress of and be responsible (with supervision) for the care of approximately six new patients a week.
  • Attend and participate in morning report and Quality / M&M meetings.
• To acquire a basic knowledge of Family Medicine and a greater knowledge of medical conditions of your assigned patients.
  • Use electronic resources and major texts to obtain evidence based medicine to apply in the management of your assigned patients.
  • Demonstrate the ability to research a clinical problem in the primary medical literature.
  • Show the use of following a line of reasoning, critical thinking, and the hypothetical deductive reasoning model in the care of your patients.
• To obtain an accurate and pertinent medical history from all appropriate available resources and to record it in a complete, concise, and literate manner.
  • Record data in the electronic medical record in a preliminary format and obtain feedback from your supervising senior resident and attending.
  • Document each new patient or transferred patient, in the approved format, with a thorough assessment (differential diagnosis and reasoning that dictates the diagnostic and management approach) and plan for each problem.
  • Work up approximately six patients a week.
• To perform and record a thorough physical examination and review the physical findings with the supervising senior resident and attending.
  • Perform examinations on approximately six new patients a week and record the findings in the approved format.
  • Review abnormal or uncertain findings with your supervising senior resident and attending.
  • Improve physical exam skills by reviewing the literature on appropriate examination techniques.
• To use the clinical laboratory, radiology department, and other testing procedures in an appropriate and cost-effective manner
  • Compose the initial orders for the work-up of your assigned patients and discuss the management (diagnostic options based on current literature) with your supervising senior resident and attending.
  • Follow the results of this work-up and discuss additional future orders with your supervising senior resident and attending.
  • Understand the methods and limitations of commonly performed diagnostic tests.
  • Understand potential complications of the tests that you are considering to order.
• To utilize medical knowledge and clinical reasoning skills to develop complete and accurate problem lists for approximately six new patients a week.
  • Develop a problem list in the expected institutional format.
  • Discuss this list and the assessment of each problem with the supervising senior resident and attending.
  • Use this problem list as a framework for daily progress notes.
  • Students will need to revise and update problem list as appropriate.
• To effectively utilize evidence based literature in order to research the problem lists while demonstrating proficiency with critical reading skills.
  • Search and read about the clinical problems for each patient assigned and apply evidence based medicine based on literature review.
  • Identify quality articles that address the problems of your assigned patients.
  • Critically analyze the methods and conclusions of relevant articles and apply the results appropriately to your assigned patients.
• To become skillful at formal rounding and case presentations.
  • Present at least one of your assigned patients at morning report.
  • Be prepared with all relevant data when presenting your patients at formal rounds.
  • Before formal rounding you will be expected to have seen and examined your patients. In addition, you are expected to have reviewed events from overnight, recent test results, as well as consultant recommendations.
• To develop an understanding of the psychosocial, educational, economic, cultural, and religious backgrounds of patients that underlies their diverse belief systems and demonstrate this understanding in the approach to the management of the individual patient.
  • Work on taking a complete history as it relates to the patient’s background since it may affect management.
  • Demonstrate insight into diverse backgrounds during rounds, presentations, and in chart documentation.
• To develop sensitivity to and an understanding of the ethical dimensions of patient care while demonstrating this approach in the management of individual patients.
  • Demonstrate sensitivity to ethical issues during rounds, presentations, and in chart documentation.
  • Use the medical literature and appropriate consultations when ethical dilemmas arise.
• Modeling continuity of care and appropriate hand offs from the inpatient setting to the outpatient arena by working with Care Coordinator RN’s.
• Students are expected to manage chronic and acute conditions as noted below, if the student is exposed to, during their Family Medicine Sub-Internship.
  • Altered mental status
  • Abdominal pain
  • Chest pain
  • Asthma
  • COPD
  • Arrhythmias
  • Allergic reactions
  • Pulmonary embolism
  • DVT
  • Fever
  • Cellulitis
  • Osteomyelitis
  • Pain
  • Seizures
  • Hyperglycemia / Hypoglycemia
  • Fluids and Electrolytes
  • Hypertensive Urgencies / Emergencies
  • GI Bleeds
  • Renal Insufficiency / Acute Kidney Injury
  • CHF
• In the event the following procedures arise during their rotation, the student will need to understand the risks, benefits, and proper technique prior to performing the procedure under the supervision of trained physician.
  • Circumcision
  • Venipuncture
  • ABG
  • Placement of intravenous catheter
  • Placement of nasogastric tube
  • 12 lead Electrocardiogram
  • Catheterization of bladder of male / female
  • Assisting in the delivery of normal vaginal delivery
  • Lumbar puncture
  • Thoracentesis
  • Paracentesis
  • Aspiration of joint
  • Central line placement
• Students receive an end of rotation assessment based on compiled faculty and resident evaluation of student performance
• Students on the FMS1 team will work on Saturdays and students on the FMS2 team will work on Sundays.

DESCRIPTION:
This four-week sub internship in Gynecology is intended for fourth year medical students who are interested in a career in OB/GYN. During the experience, students will gain the knowledge and skills to evaluate and manage various gynecologic conditions in a multitude of settings: inpatient, outpatient, emergency room and operating room. Students will be closely supervised as they take on clinical responsibilities and demonstrate knowledge and values expected of an intern. During the sub internship, students are responsible for hospital rounds, hospitalized and outpatient patients, preoperative workups, surgeries, involvement in gynecologic ultrasound and colposcopy,  family planning services and procedures, and weekend call. This elective expects attendance at all service and departmental rounds and conferences to further knowledge and experience in OB/GYN.

Two 12 hour on call shifts will be expected over the course of the rotation. List of required reading is provided on the first day of the rotation on a jump drive. Anywhere from 0-4 hours of independent study time will be assigned weekly. 80% of all instruction will be directly supervised by faculty and 20% will be directly supervised by the senior resident on service.

GOALS & OBJECTIVES

• Evaluate, discuss and care for 4-6 new gynecology inpatient patients every week. Gynecology patients can include postoperative patients and patients with complex gynecologic conditions.
• Obtain an accurate and succinct history in the initial evaluation of a patient by accessing all appropriate and available sources.
• Document and present your patient to the senior resident and GYN attending. Present the patient’s information in the recommended format and provide an assessment which includes a differential diagnosis and reasoning and initial management approach. Documentation will be reviewed by the gynecology attending of the day.
• Perform all indicated pelvic examinations under the supervision of senior resident or attending.
• Write management plan and initial orders for the work-up of 4-6 gynecologic patients every week. Orders must be discussed with supervising senior resident and faculty.
• Follow the results of orders, and order further studies as indicated. Review results with the senior resident. Follow up with the progress of assigned patients throughout the day.
• Prior to OR days, review anticipated surgical cases. Students are expected to scrub into surgical cases and will hone their procedural skills in the operating room under the close supervision of faculty.
• Demonstrate skill in the performance of essential technical skills in gynecology and will perform under supervision or view the following:
  • Pelvic examination
  • Catheterization of the bladder
  • Positioning the surgical patient
  • Prepping the surgical patient
  • Draping the surgical patient
  • IUD insertion
  • Endometrial biopsy
  • Colposcopy and colposcopic biopsy
  • Suturing and knot tying
  • Intraoperative placement of the uterine manipulator
  • Perform transvaginal ultrasound

Learning activities:

1. Daily morning rounds: 5 hour/week with the gynecology team and attending
2. Case review- 1 hour/week. Active participation in preoperative conference held once a week on Wednesdays. The Sub-I will present cases that are scheduled for the operating room in this conference staffed by the gynecology attending.
3. Departmental Conference- 3 hours/week
4. Outpatient clinic- 10 hours/week
5. Simulation workshops- Two sessions during the rotation. Simulation sessions are scheduled for the sub-I to work one on one with supervising faculty on procedural skills: knot tying and suturing, pelvic exam and pap smear, endometrial biopsy, IUD insertion, laparoscopy skills and GYN ultrasound.
6. On call- students will complete two 12 hour in house call shifts during the weekend where they will actively manage gynecologic and obstetric patients under the supervision of the on call attending and the on call second or third year resident.

Mandatory assignments to be completed on rotation:

1. Prepare a 10-15 minute talk for your supervising attending and gynecology team based on your investigation of the literature as it pertains to a clinical question based on a patient encounter(s).  For example: Instead of a presentation on pelvic pain, dig deeper and present on new emerging therapies in the treatment of endometriosis. Ask for assistance if you are unable to identify a clinical question.
2. Complete Simulation Workshops- scheduled for two Friday afternoons each rotation to work on procedural skills: Knot tying and suturing, pelvic exam and pap smear, endometrial biopsy, IUD insertion, basic GYN ultrasound.
3. Schedule a time to meet with the OB/GYN Residency Program Director once during the rotation: Abigail Litwiller, MD.  Email: ablit21@uic.edu
4. Complete the gynecology multiple choice final exam.

ASSESSMENT

1. The student will receive an evaluation from the supervising residents and faculty preceptors based on fund of knowledge, patient care, procedural skills and interpersonal skills: 90% of grade
2. The student’s end of rotation presentation will be evaluated based on topic understanding, level of complexity of discussion and practical use of the knowledge: 5% of grade
3. End of rotation multiple choice examination PASS/FAIL with pass rate of 70%:  5% of grade
4. The student will receive midterm feedback with written feedback by the Sub I Director at the midpoint of the rotation.

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:
The Department of Internal Medicine will provide a 4-week educational experience for senior (Phase3) students offering graduated supervised responsibility for patient care in the area of general internal medicine.  During the Sub-I each student will gain an awareness of the knowledge, skills, values and attitudes that internists strive to acquire and maintain throughout their professional lives. Students will have graduated, supervised responsibility for patient care, learning to integrate clinical knowledge with practical experience. During the course of the clerkship, the students will gain competencies in 8 core areas: Patient care, medical knowledge, interpersonal and communication skills, professionalism, practice based learning and improvement and systems based practice, interprofessional collaboration and personal and professional development.

OBJECTIVES:
At the end of the sub-internship, the student should be able to demonstrate competencies in each of the competency domains as outlined below:

Medical Knowledge:

• Explain the pathophysiology of each of the diagnoses or clinical conditions as outlined by the AAIM Core Medicine Clerkship Curriculum Guide & SUB-I Curriculum Guide.
• Describe how biomedical, ethical, and psychosocial-behavioral factors apply to the clinical presentation of the disease in their patients
• List the indications, contraindications and benefits of the following common procedures: ABGs, thoracentesis, paracentesis, and lumbar puncture
• Describe the indications for the following tests: complete blood count, comprehensive metabolic panel, coagulation studies, chest Xray, abdominal x-rays, EKG, PFTs, and interpret results of these tests for their patients

Patient Care: 

• Obtain an accurate, pertinent history from all appropriate available sources, perform a thorough and accurate physical examination, and record all findings in a complete and well-organized manner (EPA: 1 and 5)
• Based on history and physical examination findings as well as any laboratory or diagnostic tests done, develop an appropriately prioritized and detailed problem list for each patient
• Utilize clinical reasoning to develop appropriate differential diagnoses to assess the patients’ problems (EPA 2)
• Select a working diagnosis and formulate a diagnostic and therapeutic plan for their patient(s) based on gathered clinical information and laboratory data (EPA: 2 and 3)
• Write admit orders and enter/discuss daily orders/prescriptions with supervising resident(s) and faculty. (EPA 4)
• Pre-round on assigned patients & follow-up on tests and consultation notes and updates
• Prioritize patients’ clinical problems and daily patient care task list according to degree of importance/urgency.
• Organize a daily patient care task list for each patient in a structured and systematic way so that required tasks (e.g., daily notes, orders) are not overlooked.
• If indicated, place an EKG, perform BLS, venipuncture and insert an i.v. with supervision (EPA 12)
• Recognize a patient requiring urgent or emergent care and initiate evaluation and management and recognize one’s own limitations and call on other team members to help. (EPA 10)

Interpersonal and Communication Skills:

• Document & deliver oral case presentations on new admissions (full H&P) and document and present daily progress notes (SOAP notes) that are generally accurate, concise, organized, and complete. (EPA: 5 and 6)
• Write transfer/accept notes for patients who transfer to/from different service(s)
• Write cross-cover notes and discharge summaries
• Give and receive patient handoffs (both in writing and verbally) to transition care responsibility (EPA 8)
• Communicate with patients and their families in a clear, respectful manner, responding to verbal and non-verbal cues.
• Demonstrate respect and courtesy when communicating with all members of the health care team, including staff, nurses, residents and faculty
• Describe the key components of informed consent, and when, applicable, participate in obtaining informed consent prior to performing procedures in their patients (EPA 11)
• Demonstrate ability to actively engage with patients, families and other members of the health care team to coordinate care (EPA 9)
• Demonstrate ability to discuss management plan with their patient and explain pathophysiology to them without using medical jargon

Professionalism:

• Discuss how psychosocial, educational, economic and religious backgrounds of patients may underlie their diverse belief systems, and demonstrate this understanding in the approach to the management of individual patients
• Demonstrate sensitivity to, and an understanding of, the ethical dimensions of patient care, and demonstrate this sensitivity in the approach to the management of individual patients
• Develop professional relationship based on trust, mutual-respect, empathy and conscientiousness with patients, peers and other health care members at all times
• Demonstrate ability to work hard, accept patient responsibility and respond appropriately to feedback provided
• Demonstrate respect, compassion, integrity, and honesty at all times

Practice Based Learning and Improvement:

• Develop and research clinical questions that arise during patient care and management, using evidence-based resources. (EPA 7)
• Demonstrate critical reading skills by analyzing selected journal articles, and identify characteristics of effective medical articles (EPA 7)
• Choose pertinent issues related to the care of their patients and research them independently. (EPA 7)

System Based Practice:

• Participate, whenever possible, in coordination of care and in the provision of continuity of care including transfer and discharge.
• With supervision, students should be able to identify system failures and contribute to a culture of safety and improvement (EPA13)

Interprofessional Collaboration:

• Describe the roles of other health care professionals in the care of patients in internal medicine.
• Collaborate with other health professionals to establish and maintain a climate of mutual respect, dignity, diversity, ethical integrity, and trust (EPA-9)
• Speak with specialist/subspecialist colleagues to request consultation
• Communicate collaboratively and effectively with nursing, pharmacy, outpatient care providers, nutritionists, occupational/physical therapists, social workers, discharge planners, and case managers to enhance patient care and to facilitate discharge planning

Personal and Professional Development:

• Develop the ability to use self-awareness of knowledge, skills, and emotional limitations to engage in appropriate help-seeking behaviors
• Demonstrate healthy coping mechanisms to respond to stress
• Manage conflict between personal and professional responsibilities
• Practice flexibility and maturity in adjusting to change with the capacity to alter one’s behavior
• Demonstrate trustworthiness that makes colleagues feel secure when one is responsible for the care of patients
• Recognize that ambiguity is part of clinical health care and respond by utilizing appropriate resources in dealing with uncertainty

Year 4 Sub-I: Role & Responsibilities

The Sub-I experience is to be four continuous weeks spent on an inpatient general medicine service. This may include time on night shift if that opportunity is made available. Students will act in the role of an intern, reporting directly to supervising residents and taking cases in rotation with PGY-1s on the service.  They should take first call for de novo problems arising on their own hospitalized patients and limited number of calls on other patients on the team at the discretion of the supervising resident. Generally, interns should not be assigned to the cases to which a sub-intern is assigned.

Patient Care Responsibilities

• Obtain a thorough history and physical exam at the time of patient admission
• Write & present full H&P(s) on new admissions and daily progress notes (SOAP notes) on the patients they are following
• Write transfer/accept notes for patients who transfer to/from different service(s)
• Write cross-cover notes and discharge summaries
• Pre-round on assigned patients & follow-up on tests and consultation notes and updates
• If feasible, accompany patients to tests (e.g., colonoscopy, stress test)
• Participate in family meetings and multidisciplinary rounds
• Participate in sign-out rounds (give or receive a patient handover to transition care responsibility) (EPA 8)
• Actively practice EBM & read and bring in articles or other educational materials related to your own or team patients (EPA 7)
• Assist residents with the care of any patient with supervision commensurate with their level of training and particular skill i.e., calling a consultant about a case.
• Ask for feedback about write-ups, presentations, participation, etc. consistently and especially at midpoint
• Organize a daily patient care task list for each patient in a structured and systematic way so that required tasks (e.g., daily notes, orders) are not overlooked.
• Prioritize patients’ clinical problems and daily patient care task list according to degree of clinical importance/urgency.
• Recognize a patient requiring urgent or emergent care and seeks and initiates evaluation and management with assistance – recognizing one’s own limitations and calls on other team members to help. (EPA 10)
• Speak with specialist/subspecialist colleagues to request consultation
• Communicate collaboratively with nursing and pharmacy staff to enhance patient care
• Communicate effectively with team case manager, social worker, and outpatient care providers to facilitate discharge planning
• Students should seek opportunities to perform (under supervision) procedures on their patients commensurate with their level of training (e.g., BLS, EKG placement, venipuncture, insertion of an i.v.). (EPA 12)
• With supervision, students should be able to identify system failures and contribute to a culture of safety and improvement (EPA13)

Call Responsibilities:

• The students are expected to be on call with their team for the duration of the call.
• Students will work with their teams on weekends, and on average will get 1 day off per week.
• Sub-I students are guaranteed, on average, one day off per week (at the discretion of the team), and these are typically weekend days, unless the team is on or post call. Days off for special circumstances or interviews must be requested in advance with the Sub-I Director and Coordinator.  Days off may be required to be made up at the discretion of the Sub-I and Site Director.  The supervising resident, attending and team must also be notified in advance.
• Students should not exceed work hour rules set by UI COM.
• Students should respond to the blue alerts/Code Blue as part of the code team.

Floor Responsibilities:

• Students are expected to participate in pre-rounds and sign-outs and follow patients with their Residents. Sub-I’s should admit ~3-4 new patients a week (no >2 on a given call day) and follow ~3-6 patients daily depending on complexity.
• Students are expected to pre-round on their patients and follow up on (and inform the team) all test results and consultant recommendations
• Students are expected to write daily progress notes on their assigned patients. Exception is made for following patients daily and writing progress notes if doing a week of night duty
• Students should write transfer/accept notes, cross-cover notes, procedure notes and discharge summaries with appropriate guidance.
• The students are expected to participate with the medical team in the “sign-out” of patients at the end of the day-(the student should sign-out all of their patients to the covering intern or covering Sub-I).
• Sub-I student is responsible for appropriately discharging their patients in conjunction with the senior resident, including medication reconciliation and arrangements of  follow-up and generating a discharge summary with supervision.
• Sub-I student is responsible for beginning discharge planning from admission, speaking with the discharge planner and case management, and assisting in the process of obtaining the resources and referrals needed for a safe discharge.
• Sub-I student is responsible for contacting the PCP at discharge with the supervision of their senior resident to inform them of the follow-up plans.
• Student is expected to participate fully with supervision in family meetings, end of life and code discussions, and emergent bedside management of their patients when needed.

Mandatory Requirements

• Students are expected to attend all mandatory student didactics/meetings as assigned by the Sub-internship director.
• Students must complete all the required assignments designated by the Sub-I director(s)
• Students should seek and incorporate ongoing feedback.
• Students should complete Qualtrics surveys & Evaluation of the Sub-I rotation

UI COM Student Work Hour Policy 

1. The maximum number of required hours at clinical sites (hospital, clinic, nursing home, etc.) should not exceed 80 hours per week.
2. There should be no required consecutive call.
3. Night call should be assigned no more than an average of every fourth day (Q4) over the duration of the experience.
4. Night call should not be required the day before administration of the end of clerkship examination.
5. Students should have an average of at least one day (24 hours) each week free of clinical responsibilities (including lectures, seminars, clinic, and rounds).
6. Any time off including getting off early on scheduled work days must be approved by the Clerkship office/Director.
7. Students may be required to do a week of night shifts as per the sub-internship director’s discretion. Total time in that should not exceed 80 hours per week. Student should not do more than 5 consecutive nights.

The above restrictions do not include independent study time apart from clinical duties or optional activities in which the student voluntarily participates.

The Association of American Medical Colleges (AAMC) 13 Core EPAs:

• EPA 1: Gather a history and perform a physical examination
• EPA 2: Prioritize a differential diagnosis following a clinical encounter
• EPA 3: Recommend and interpret common diagnostic and screening tests
• EPA 4: Enter and discuss orders and prescriptions
• EPA 5: Document a clinical encounter in the patient record
• EPA 6: Provide an oral presentation of a clinical encounter
• EPA 7: Form clinical questions and retrieve evidence to advance patient care
• EPA 8: Give or receive a patient handover to transition care responsibility
• EPA 9: Collaborate as a member of an interprofessional team
• EPA 10: Recognize a patient requiring urgent or emergent care and initiate evaluation and management
• EPA 11: Obtain informed consent for tests and/or procedures
• EPA 12: Perform general procedures of a physician
• EPA 13: Identify system failures and contribute to a culture of safety and improvement

SCHEDULING

• For UIC students scheduling:
  • To inquire about scheduling , please contact Angie Fanuke, Internal Medicine Sub-I/Elective Coordinator at abevel2@uic.edu.
• For Visiting Students from LCME accredited institutions:
  • IM Sub I is NOT offered, but for availability of other IM elective opportunities, please apply through VSLO.
• For International Students:
  • IM Sub I is NOT offered, but for availability of other opportunities: contact Kay Spreitzer (kspreitz@uic.edu) in The Office of International Education or visit their website at:  https://medicine.uic.edu/education/international-education/

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

Day 1 of Rotation: All students will have general orientation at UIH with the sub-I director (dr. Khan). Students should report to their sites after orientation.

• UI Health: Angie Fanuke (abevel2@uic.edu)
• Jesse Brown VA: Marci Laragh, MD (Marci.Laragh@va.gov), Ambareen Khan (Ambareen.Khan@va.gov) & Michael Kolozsvary-Kiss (Michael.Kolozsvary-kiss@va.gov)
• Advocate Lutheran Medical Center Hospital: Marisol Hernandez-Martinez (marisol.hernandez-martinez@aah.org)
• Advocate Christ Medical Center Hospital: Lucia Ontiveros (Lucia.Ontiveros@aah.org)
• Advocate Illinois Masonic Medical Center DeBorah Anderson (deborah-w.anderson@aah.org)
• St. Francis: Catherine Clark (catherine.clark@ascension.org)
• St. Joseph: Juanita Walker (juanita.walker2@ascension.org)

PREREQUISITES AND PLACEMENT IN THE CURRICULUM: Students must have completed all M3 Core Clerkships.

PURPOSE:
To provide students with a pediatric-focused sub-internship, where they will work in a busy academic community-based institution. Students will have near intern level responsibility in the care of neonates requiring critical and stepdown care.  Students will round with attending, and residents; attend didactics, independently manage patients with either senior resident/faculty supervision.  They will attend deliveries and assist with initial resuscitation efforts and also provide all subsequent care for neonates in the unit: including management of medical, nutritional, pre/post-operative, and disposition issues that affect preterm and term infants who require NICE level care. This should serve as an excellent barometer for students to determine their readiness for pediatric internship.

OBJECTIVES:

• Obtain a prenatal and birth history from consultation of chart and family
• Recognize and report any change in patient status, while also independently providing suggestions for next steps in management
• Communicate effectively with multidisciplinary team, including nurses, as well family of the patients
• Arrange for timely subspecialty consultation
• Appropriately document the clinical course and findings
• Present updates and suggests plans for patients during rounds
• 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 obtaining a neonatal and birth/pregnancy history and physical examination
2. A moderate level of competency in the complete work-up and management of issues that affect neonates, such as prematurity, necrotizing enterocolitis, respiratory distress, hyaline membrane disease, meningitis, pneumonia, feeding intolerance, intraventricular hemorrhage, genetic disorders
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, arterial blood gas sampling, ventilation, umbilical cathetar placement.

Patient care

• As part of being the primary care provider for critically ill infants in the ICU – the student will need to demonstrate competency in all patient care graduation competencies listed below

Medical knowledge

• Perform a search and utilize resources to answer clinical questions
• Disposition plans will need to account for socio-economic and other possible barriers to care as a child’s guardian assumes full care responsibilities
• Provide patient education on discharge regarding a child’s diagnosis, ongoing treatment plan, and follow-up, while also addressing any concerns or questions caretakers may have

Practice-based learning

• Identify clinical uncertainties and knowledge gaps and address them by consulting the literature and asking questions of other members of the care team

Communication

• Communicate effectively with other care providers and family off and on rounds
• Provide clear and accurate chart documentation
• Navigate stressful and difficult conversations with families whose newborns are critically ill

Professionalism

• Be timely, report accurate information, and seek appropriate help

System-based practice

• Work with and incorporate the input of a multidisciplinary team
• Effectively refer patients to appropriate community resources

INSTRUCTIONAL FEATURES:

• Learning activities – Lectures, case reviews, conferences, ward-round, literature reviews, group work
• Students will see a variety of critically ill children from diverse socioeconomic backgrounds
• 2 night on-call shifts per month
• 2 weekend shifts per month
• How much clinical independence/supervision can students expect? Will work directly with senior resident or attending
• 10 percent of the education is independent
• 100 percent of instruction is directly supervised by residents
• 60 percent of instruction is directly supervised by the attendings

ASSESSMENT:
The student will receive direct in-person feedback midterm and at end of rotation

SCHEDULE & ORIENTATION:
The coordinator will contact students with reporting instructions the week before the elective begins.

• Location: Advocate Children’s Hospital – Oak LawnFaculty
• Director: Richard Kampanatkodol, DO (richard.kampanatkosol@aah.org)
• Sub-I Coordinator: Tammi Bauske (tammi.bauske@aah.org)

Updated: 7/27/20

PREREQUISITES AND PLACEMENT IN THE CURRICULUM: Students must have completed all M3 Core Clerkships.

PURPOSE:
Students will have near intern level responsibility in the care of neonates requiring critical and stepdown care. Students will round with attending, fellows, and residents; attend didactics, independently manage patients with either hospitalist/fellow/senior resident supervision. They will attend deliveries and assist with initial resuscitation efforts and also provide all subsequent care for neonates in the unit: including management of medical, nutritional, pre/post-operative, and disposition issues that affect preterm and term infants who require NICU level care. This should serve as excellent barometer for students to determine their readiness for pediatric internship.

OBJECTIVES:

•  Obtain a prenatal and birth history from consultation of chart and family
• Recognize and report any change in patient status, while also independently providing suggestions for next steps in management
• Communicate effectively with multidisciplinary team, including nurses, as well as family of the patients
• Arrange for timely subspecialty consultation
• Appropriately document the clinical course and findings
• Present updates and suggests plans for patients during rounds
• Develop an appropriate discharge plan, including outpatient follow-up
• Shadow a nurse doing discharge teaching, learn how to take a temperature, and how to give a bath/cleanse a baby with cord attached.
• Be able to understand and interpret growth curves, fluid management, calorie calculations, and temperature management.
• Observe a lactation consultation session

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 obtaining a neonatal and birth/pregnancy history and physical examination
2. A moderate level of competency in the complete work-up and management of issues that affect neonates, such as prematurity, necrotizing enterocolitis, respiratory distress, meningitis, pneumonia, feeding intolerance, intraventricular hemorrhage, genetic disorders
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, arterial blood gas sampling, ventilation, umbilical catheter placement.

Patient care

• As part of being the primary care provider for critically ill infants in the ICU – the student will need to demonstrate competency in all patient care graduation competencies listed below

Medical knowledge

• Perform a search and utilize resources to answer clinical questions
• Disposition plans will need to account for socio-economic and other possible barriers to care as a child’s guardian assumes full care responsibilities
• Provide patient education on discharge regarding a child’s diagnosis, ongoing treatment plan, and follow-up, while also addressing any concerns or questions caretakers may have

Practice-based learning

• Identify clinical uncertainties and knowledge gaps and address them by consulting the literature and asking questions of other members of the care team

Communication

• Communicate effectively with other care providers and family off and on rounds
• Provide clear and accurate chart documentation
• Navigate stressful and difficult conversations with families whose newborns are critically ill

Professionalism

• Be timely, report accurate information, and seek appropriate help

System-based practice

• Work with and incorporate the input of a multidisciplinary team
• Effectively refer patients to appropriate community resources

INSTRUCTIONAL FEATURES:

• Learning activities – Lectures, case reviews, NICU-rounds
  • NICU sign-out and pre-round 3 hours per day
  • NICU Rounds – 2-6 hours per day
  • Lectures are 1-5 hours per week
  • Case Reviews and literature searches as needed – maybe 1-3 hours per week
• Students will see a variety of critically ill children from diverse socioeconomic backgrounds

ASSESSMENT:
Evaluation form will be co-written by NICU staff and reviewed with student by rotation director

SCHEDULE & ORIENTATION:
Students will receive verbal midterm feedback from the attending, hospitalist, and fellow on service at the end of the second week of the elective. The coordinator will contact students with reporting instructions the week before the elective begins.

• Location: UIH
• Faculty Director: Shannon Murphy, MD
  Email: shannomu@uic.edu
• Sub-I Coordinator: Lupe Medina
  Email: gmedina@uic.edu

Updated: 6/21/21

PURPOSE:
This course provides a unique opportunity for students who have decided on a career in otolaryngology to have exposure to the unique aspects of caring for the otolaryngology patient. It will allow the medical student to function like an intern with continuity of care of otolaryngology inpatients, inpatient consults and ER consults. The sub-I will be under the supervision of a senior resident and attending.

Due to the surgical nature of our field, the student will have the opportunity to have hands on experience involving the admission of a patient after surgery, care for the patient through recovery, then discharge. Though the duration of stay is low, we expect the student to care for a high number of patients due to our high volume of surgery. This is in contrast to the usual patient experience of caring for the same number of patients with gradual clinical progression. We expect the student to have the opportunity to care for approximately 20 patients for short periods during the course of the rotation.

OBJECTIVES:

• Clinical and surgical knowledge: Students will have framework to categorize information into the different subspecialties of otolaryngology . Students will have diverse exposure to various operations so they know the objective and relevant anatomy
• Collaboration: Students will understand how to work as a sub-intern on an otolaryngology service covering in patients, inpatient and outpatient surgery, inpatient consults and ER consults.
• Care of the otolaryngology patients with complex needs: Students will directly manage a variety of inpatients including: the post-tracheostomy patient, the post head and neck resection and free flap reconstructing patient, the patient requiring airway monitoring, the post skull base surgery patient, the post lateral skull base surgery, care of the post-operative obstructive sleep apnea patient with and without airway surgery.  The student will be under direct supervision of a senior resident, attending or both. Activities include: taking direct responsibility of a patient and providing continuity of care, daily patient assessment formulation of an evidence-based cost-effective and ethical plan, follow up of investigation and communication with the patient, patient family and the patient care team.
• Care of the otolaryngology consult: Students will have the opportunity to evaluate and work up otolaryngology consults from inpatient services, and the emergency room. This will include both otolaryngology emergencies and stable patients.

INSTRUCTIONAL METHOD:

• Weekly grand rounds (1-3 hour per week)
  • Grand rounds include – radiology, topics in otolaryngology, guest lecturers, quality improvement, journal club
• Conference: Morbidity and mortality, multi-disciplinary head and neck tumor board, multi-disciplinary skull base tumor board, multidisciplinary cochlear implant conference and multidisciplinary vestibular conference
• Sub-I conference (2 30-minute sessions/week)
• Case reviews available (10 hours)
• Ward rounds (17 hours)
• Rounds with attending or senior resident reviewing the care of inpatients (2.5 hours)
• Outpatient evaluation (8 hours)
• Literature reviews available (10 hours)
• Surgery with postoperative admission (19.5 hours)

ASSESSMENT:
Student performance is evaluated by house staff and attending faculty with exposure to the student using the College of Medicine Clerkship Evaluation form. Knowledge and skills are rated during patient care situations and throughout the course of students’ didactic discussions with various faculty members. during the last week of the rotation, the student and PD will meet to discuss the rotation feedback and evaluation scores.

Update: 10/10/19

PREREQUISITES AND PLACEMENT IN THE CURRICULUM: Students must have completed all M3 Core Clerkships.

PURPOSE:
To provide students with a pediatric-focused sub-internship, where they will work in a busy academic community-based institution. Students will have near intern level responsibility in the care of children requiring critical and stepdown care.  Students will round with attending, fellows, and residents; attend didactics, independently manage patients with either senior resident/faculty supervision.  Student will take care of children with acute single or multisystem organ dysfunction due to an acute illness/incident, exacerbation or complication of a chronic illness, requiring intensive care perioperatively, and/or any combination of the above.  This should serve as excellent barometer for students to determine their readiness for pediatric internship.

OBJECTIVES:

• Obtain an age and developmentally appropriate history and physical exam
• Recognize and report any change in patient status, while also independently providing suggestions for next steps in management
• Communicate effectively with multidisciplinary team, including nurses, as well family of the patients
• Arrange for timely subspecialty consultation
• Appropriately document the clinical course and findings
• Present updates and suggests plans for patients during rounds
• 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 obtaining a pediatric history and physical examination
2. A moderate level of competency in the complete work-up and management of issues that affect critically ill children, such as sepsis, respiratory failure, acute complication that occur in blood or solid organ malignancies, diabetic ketoacidosis, toxic ingestion, trauma, acute presentation or progression of neurologic/neurodegenerative/genetic conditions, and other organ failure
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, arterial blood gas sampling, ventilation, lumbar puncture, central line placement.

Patient care

• As part of being the primary care provider for critically ill children in the ICU – the student will need to demonstrate competency in all patient care graduation competencies listed below

Medical knowledge

• Perform a search and utilize resources to answer clinical questions
• Disposition plans will need to account for socio-economic and other possible barriers to care as a child’s guardian assumes full care responsibilities
• Provide patient education on discharge regarding a child’s diagnosis, ongoing treatment plan, and follow-up, while also addressing any concerns or questions caretakers may have

Practice-based learning

• Identify clinical uncertainties and knowledge gaps and address them by consulting the literature and asking questions of other members of the care team

Communication

• Communicate effectively with other care providers and family off and on rounds
• Provide clear and accurate chart documentation
• Navigate stressful and difficulty conversations with families whose children are critically ill

Professionalism

• Be timely, report accurate information, and seek appropriate help

System-based practice

• Work with and incorporate the input of a multidisciplinary team
• Effectively refer patients to appropriate community resources (esp on discharge – e.g. early intervention)

INSTRUCTIONAL FEATURES:

• Learning activities – Lectures, case reviews, conferences, ward-round, literature reviews, oral presentations
• Students will see a variety of critically ill children from diverse socioeconomic backgrounds
• 2 night on-call shifts per month
• 2 weekend shifts per month
• How much clinical independence/supervision can students expect? Full supervision
• 10 percent of the education is independent
• 100 percent of instruction is directly supervised by residents
• 50 percent of instruction is directly supervised by the attendings

ASSESSMENT:
The student will receive oral feedback midway through the rotation along with written and oral feedback at the end of rotation

SCHEDULE & ORIENTATION:
The coordinator will contact students with reporting instructions the week before the elective begins.

• Location: Advocate Children’s Hospital – Oak Lawn
• Faculty Director: Ronald Kampanatkodol, DO (ronald.kampanatkosol1@aah.org)
• Sub-I Coordinator: Tammi Bauske (tammi.bauske@aah.org)

Updated: 7/27/20

PREREQUISITES AND PLACEMENT IN THE CURRICULUM:
Students must have completed all third yearCore 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, Advocate Children’s Hospital – Oak Lawn, 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 fourth year sub-intern differs significantly from that of the third year. 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: Lupe Medina (gmedina@uic.edu)
• Lutheran – Advocate Children’s Hospital: Tara Murphy (tara.murphy@aah.org)
• Oak Lawn – Advocate Children’s Hospital: Tammi Bauske (tammi.bauske@aah.org)

Updated: 4/24/2023

PURPOSE:
This elective will help the fourth year student prepare for inpatient care during their internship. In addition, the student will further develop and synthesize the responsibilities, knowledge, skills, and values learned from the M3 Clerkship and which are necessary to become an effective and a professional psychiatrist. This will be accomplished largely by allowing the student to take on an intern-level responsibility for patients.

OBJECTIVES:

• To utilize medical knowledge and clinical reasoning and judgement to assess patient needs, put patients first, form diagnostic hypotheses, and formulate evidence-based, cost effective, and ethical management decisions.
• To improve patient interviewing skills and order to obtain the most accurate, sensitive history possible.
• To actively take responsibility for their patients, recognize the need for consultative assistance, and follow-up on all relevant clinical information.
• To effectively communicate issues to parties involved, i.e. patient care team, patient, and family.

INSTRUCTIONAL METHOD:
The student will act in the role of a sub-intern for approximately 40 hours per week as part of an interdisciplinary inpatient team. In general, the student will carry 4-5 patients at a time and follow them throughout their hospital stay. The sub-intern will interview patients, attend group therapy, present on rounds, write admitting histories, perform physicals as appropriate, write daily progress notes and mental status exams, and input orders, which will be reviewed and co-signed by a senior resident or attending. In addition. the sub-intern will work with consulting services, provide handoffs to short-call/night float residents, and write complete discharge summaries. There are no weekend or on-call requirements. The student should attend the weekly Grand Rounds in the Department of Psychiatry. The student will be supervised and evaluated by the supervising attending or senior resident. The supervision will include direct observation of their patient interviews. The sub-intern will also prepare several small or one large presentation on a topic of psychiatry of their choice, which he/she will present to the treatment team.

ASSESSMENT:
The student will receive informal mid-term feedback and an end of rotation assessment based on compiled faculty and senior resident evaluation(s) of student performance.

Update: 9/6/18

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

1. Students may seek out external 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. Emergency Medicine Sub-Internships are not approved due to a lack of continuity in the experience.

 Approved, 9/1/10, Updated 3/6/19

Students interested in pursuing an external Sub-Internship should consult the Registrar’s web page for the appropriate paperwork and submit a scheduling request.

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, OBGYN, 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 a scheduling request.

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:
3. Admission notes and orders
   • Daily notes and orders
   • Working with consulting services
   • Discharge summaries
   • Handoffs
   • Pre- & Post-operative notes (if applicable)
4. Students have continuity with patients during the course of the rotation.
5. 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
  • 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
  • Focus on intern-readiness skills
  • 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
  • Could include encounters on disclosure of medical error, placing a medical consult, delivering bad news, discharge planning.
  • 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