Can We Achieve The Ideal Internal Medicine Subinternship? 

subinternship   A joint task force of clerkship and residency program directors, Vu et al, developed (mostly) non-evidence-based guidelines for internal medicine subinternships, typically taken in the last year of medical school.  They recommend a rotation of at least 4 weeks with primary responsibility for 3-5 inpatients, as well as cross-coverage experience.  Specific experience with care transitions, order entry, evidence-based medicine, and documentation in electronic health records is recommended.  Alignment of subinternship objectives and residency expectations and with the new milestones/entrustable activities is encouraged.  It may be useful to require more than one subinternship given the importance of these core skills.

A study published in the same issues (Goren et al) points out how difficult achieving at least one of these aims might be.  Overnight subinternship experiences have declined from a near-universal requirement to having a presence in 41% of programs, presumably as a response to progressive duty-hours restrictions.  Overnight rotations have traditionally been where students have learned most of their cross-coverage skills

Vu TR, Angus SV, Aronowitz PB, Harrell HE, Levine MA, Carbo A, Whelton S, Ferris A, Appelbaum JS, McNeill DB, Ismail NJ, Elnicki DM; CDIM-APDIM Committee on Transitions to Internship (CACTI) Group. J Gen Intern Med. 2015 Sep;30(9):1369-75.
The Internal Medicine Subinternship-Now More Important than Ever : A Joint CDIM-APDIM Position Paper.

Link to Article

Goren EN, Leizman DS, La Rochelle J, Kogan JR.
Overnight Hospital Experiences for Medical Students: Results of the 2014 Clerkship Directors in Internal Medicine National Survey. J Gen Intern Med. 2015 Sep;30(9):1245-50.

Link To Article

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