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Advice for your internal medicine sub-internship

Are you getting ready to start your medicine sub-internship? Rest assured you will have a great introduction to what life will be like for you as an intern, especially if you plan to go into medicine. It is your opportunity to take full ownership of your patients, unlike in third year, where you probably co-followed a patient with an intern.

Click here to read about how to prepare for your internal medicine sub-internship.

First, I will start out with the comments I received from attendings who often evaluate students on their medicine subI.

Attending comment #1
“When I think about my sub-I’s performance, mostly it is about working hard and keeping track of your patients.  Hopefully you have a system for keeping track of all of the data about your patients, as well as a “To Do” list that you update throughout the day.  Mostly, the attendings and residents want you to know as much detail about your patients as you can so that you can help anticipate and solve problems that arise.  You should be ready to present your patients on work and attending rounds, as well as at other times (eg to consultants, when you are reviewing studies with the radiologists, etc).

Patient presentations during the sub-I should be complete but not as expansive as they are for the MS3s.  The focus here is on the practical: what data goes the team need to hear, what do you think is going on, what do you want to do with him/her.
Make a point of spending a few minutes with both the new attending and resident to discuss rotation expectations and to let them know that you would like feedback whenever possible.  Then, I would make a point of touching base with each of them every week to check in about your performance.”
Attending Comment #2
Most important thing — know your patient.  Really know everything, as soon as possible. Labs, imaging, etc results, and get a really good history going back when you have to do so. (If I as the sub-I how many children the patient has — not directly relevant question – -and they don’t know, it makes me feel that they are not really paying attention to the patient as a human being. )   And, really understand why you are treating as you are.  Ask, ask, ask.   Ask the attending if you feel comfortable but really talk with your resident.   Finally,  don’t complain.   Always help out the resident and the ms-3, etc.   That stuff really helps your grade and is a silent behavior.
Attending Comment #3
Even if it’s boring, hang around, be available, help out.  If they need labs checked, check them.  Help your intern and residents, and they will usually respond by including you.  Also, know your patients inside and out.  Take charge but also ask questions… don’t be a dare devil, but also don’t look like a wimp.  Look stuff up and be ready to give very brief presentations, but if there’s not enought time, don’t feel disappointed.  It’s pretty much about being really nice, upbeat, competent, reliable, and willing to do the boring stuff in order to also do the good stuff.  Try to really connect with at least one person on the team and ask them for feedback early on.
In other words, just be you!

Below are some additional tips:
1) Know everything there is to possibly know about your patient.

2) Read to prepare for possible problems you might encounter the next day, or to understand and interpret any upcoming lab results.

3) Read ahead of time to make sure that you can interpret whatever labs you order. You have to approach each situation with this question. What do I need to know about this patient to treat this disease? Every test you order should answer a question. Do I need to replete electrolytes? Your chem 7 should tell you this. Do I need to treat this patient with antibiotics? a temperature, CBC, and other vitals, other labs should give you the answer to this.

Stay tuned!

Click here to read about how to prepare for your internal medicine sub-internship.

 

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