A sub-internship (abbreviated ''sub-I'') or acting internship (AI) is a clinical rotation of a fourth-year medical student in the United States medical education system, which typically takes place at their home hospital but may also be done at a different hospital than the student's medical school affiliation.

Process

A student will generally select an elective "sub"-internship, where the student will perform the role of an

intern An internship is a period of work experience offered by an organization for a limited period of time. Once confined to medical graduates, internship is used to practice for a wide range of placements in businesses, non-profit organizations and g ...

or first year medical graduate, under the supervision of senior house staff and

attending physician In the United States and Canada, an attending physician (also known as a staff physician or supervising physician) is a physician (usually an M.D., or D.O. in the United States) who has completed residency and practices medicine in a clinic ...

s. The rotation is generally pursued in the field appropriate to career interest. For example, a sub-I can be taken in

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Surgery Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...

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, or

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. In this way, the student can experience a glimpse of their future career without the burden of full responsibility. Additionally, many medical students select sub-internships at institutions where they wish to apply for residency; such rotations are "auditions" for the student to demonstrate his or her commitment to the outside program.

Responsibilities

At the turn of the 21st century ninety-eight percent of US medical schools offered an internal medicine sub-I a.k.a. (AI) to medical students. In general the following responsibilities are given to a sub-I student: accept and give sign-out of all patients on the team, assess assigned patients before morning rounds, write problem oriented notes daily on all patients, admit patients on call days, act as information liaison between the medical team and hospital staff, communicating plan of care to

patient A patient is any recipient of health care services that are performed by Health professional, healthcare professionals. The patient is most often Disease, ill or Major trauma, injured and in need of therapy, treatment by a physician, nurse, op ...

. Responsibilities that are generally limited or withheld include: writing orders or prescriptions, performing major procedures, obtaining consent from patients for procedures or surgeries. A recent editorial highlighted the changing role of the subinternship (SI) in the medical school

curriculum In education, a curriculum (; : curriculums or curricula ) is the totality of student experiences that occur in an educational process. The term often refers specifically to a planned sequence of instruction, or to a view of the student's experi ...

. It has been argued that the SI should be viewed as the culmination of a coordinated 4-year program of study in clinical care, with an aim to prepare fourth-year students for the demanding experience of internship. Ideally, the educational goals of the SI should complement and expand upon those outlined in the third-year clerkship and ought to uniquely emphasize the knowledge and skills needed to independently treat and manage acutely ill inpatients. To facilitate these goals, it has been recommended that SI programs place fourth-year students in a role that completely replaces the intern, albeit under the supervision of senior house staff. In particular, it has been recommended that subinterns should *have a dedicated coordinator of educational activities *be provided with an explicit set of learning objectives *have separate conferences which focus on patient management issues *be able to write medical orders that are cosigned by a physician *participate in supervised cross-coverage

Evaluation

Despite the valuable and distinctive experience of the SI, it has been neglected by medical educators and researchers as an area needing development and standardization. At an organizational level, the SI currently lacks the clearly defined curricular goals and rigorous evaluation methodologies found in the third-year clerkship. Nevertheless, it is unclear to what extent individual medical schools have addressed the unique educational needs of the SI. In an attempt to clarify the structure and requirements of internal medicine SI programs throughout the United States, a survey study was undertaken.

References

External links

AI Internship
{{Medical education in the United States Medical education in the United States