Are sub-interships really necessary for IM?
Started by sozme
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Not sure where you're getting your information but I most programs expect you to have done a subI at your home institution (and done very well in it) by the time you apply for IM residency.
I'm going to presume OP meant away rotation sub-Is, which, as I'm told, aren't necessary for IM unless you're trying to target a specific program.
At least that's what our home dept tells everyone.
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this is true regarding away rotations
I go to a state MD school. We do not have an IM sub-I rotation. What to do then?
This seems unusual - what rotations do fourth year students interested in IM typically take? What sub-I options do you have? A Medical or Cardiac ICU rotation would be valuable, as would spending a month doing general inpatient IM and taking on the responsibilities of an intern (or as much as your attending/resident will allow).
We have some of the subspecialty rotations, but nothing that is "advanced IM" or a subinternship for IM. But we also do not have an IM residency here either.
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I can tell you with absolute certainty with you can interview at stellar IM programs without (yet) having done a sub-I - at least if your M3 and Step scores are high enough.
What MD state school doesn't have an IM program?
I'm also curious about this as my school is getting rid of IM AIs and quite possibly surg AIs after this year (we have IM and Surg residencies fwiw). I know a number of the details behind it, but admin is pretty vague when pushed for more info. I'm pretty much dead set on IM and this makes me wonder if I should seriously consider doing away subIs/AIs come 4th year. My class is the first one this will impact so I won't be able to consult recent grads for advice.
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To clairfy, we're a satellite campus of a larger school, which does have an IM residency program. This program does not have an IM sub I though.
Maybe they aren't necessary. I've been told they just end up hurting you and killing your chances at the place you do the sub-I. Not sure why though... unless their expectations of a 4th year are way overblown.
This was the experience at my med school. Depends on how competitive the app overall is. People I knew who were highly competitive actively avoided Sub-Is because it could only hurt them. On the flip side, if you're a mediocre app and want to land somewhere competitive, well... you best be doing things to upgrade your stock.
Cheers,
Chris
+1. Would also like to here some advice about this.
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What do people who have applied and matched IM have to say? You have to have run into someone who can answer that question at some point. Reach out. Sucks if you're the first year that this has happened to, but again reach out - coordinators, advisors, even your deans and home prog director.
What your school has done seems pretty nonsensical. That said, here's what I would consider:
- Do an ICU rotation at home (and of course, rock it - which could be a little difficult but definitely manageable). This is probably the only one that could be considered somewhat equivalent to a sub-i in the eyes of selection committees.
- Do an away at a reasonable program. Things to consider - will you work with one attending the entire time? Be shuffled around every day? Are you competitive for that program? Also consider the opportunity cost of relocating for a month and all that it entails. Your goal is to Honor this and get a fantastic letter. If you're not that good, and it shows, or if you're drowned in a sea of other rotators or constantly shuffled between people, you could come out of this month with not much to show for it or tank your chances at that program. That said, as long as it's somewhere you didn't have your heart set on, there are lots of fish in the sea in terms of IM programs. Do your research here on what places put effort into their aways.
- Do an away at a reach program. The idea is that you work with a big name, happen to impress them, and get a letter from a big wig that helps you at other programs (but not necessarily improve your chances at that program). The risk here is that you could waste a whole month. The potential upshot could be great if you're willing to stomach that - ie great letter and a chance a highly regarded program you would not have had otherwise.
Throw in a possible elective (heme onc, GI, cards, whatever) and you've rounded out your schedule. You can do two aways at reasonable programs. You can substitute the reach away with another home ICU elective if you'd like as well. I've known people who have matched doing only Aways and no home rotation. Best of luck!
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I would caution against thinking that an ICU rotation can mimick or substitute for a subI. Speaking as a resident who has supervised med students in the ICU the environment doesn't lend itself to allowing us to treat you like an intern. Some patients will be too complex for you to adequately conceptualize, a lot will happen without you, the nurses won't see you as the point person and will routinely go to the intern or resident. Not the kind of environment where a 4th year student can shine.
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