does sub-i prepare you for intern year?

[kat82]

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hey y'all!
so i am currently doing a sub-i in the icu (a 10 bed unit), and i must say, it hasnt been that challenging. i usually follow about 2 patients. i round in the morning, write notes on them, and present them. i'll do admissions for new patients (write an h+p, write orders, usually with help from the fellow). i'll help out with transfer orders. but i havent had to do any dictations (in our icu, the pcp from medicine does that stuff).

im a little worried that its too easy and when i start intern year, im going to be totally overwhelmed!! i am doing another sub-i in a few months, in internal medicine, so that might help prepare me a little more

just wanted to see what sub-i is supposed to be like and if im totally missing out. im worried that when i start intern year i'll be totally clueless and look stupid, but that may be the case no matter what.

i will say that i have learned a TON on this rotation- the teaching has been excellent and i feel much more comfortable in the icu now. ive done several presentations and i feel like ive gotten much better at literature reviews and ebm.

any thoughts?
thanks!
kat

 

[pillowhead]

hey y'all!
so i am currently doing a sub-i in the icu (a 10 bed unit), and i must say, it hasnt been that challenging. i usually follow about 2 patients. i round in the morning, write notes on them, and present them. i'll do admissions for new patients (write an h+p, write orders, usually with help from the fellow). i'll help out with transfer orders. but i havent had to do any dictations (in our icu, the pcp from medicine does that stuff).

im a little worried that its too easy and when i start intern year, im going to be totally overwhelmed!! i am doing another sub-i in a few months, in internal medicine, so that might help prepare me a little more

just wanted to see what sub-i is supposed to be like and if im totally missing out. im worried that when i start intern year i'll be totally clueless and look stupid, but that may be the case no matter what.

i will say that i have learned a TON on this rotation- the teaching has been excellent and i feel much more comfortable in the icu now. ive done several presentations and i feel like ive gotten much better at literature reviews and ebm.

any thoughts?
thanks!
kat

Having three weeks of intern year under my belt, I will say emphatically no, a sub-I (or 2 or 3) does not prepare you for intern year although it is a step up from 3rd year. That said, nothing can really prepare you for intern year. The first week will always be horribly painful no matter what you do to try and prepare, but after that, it comes pretty quickly and although you still need a lot of help, you do learn to start doing things on your own.

Do sub-Is because you need them for residency applications or because you really want to learn something (like ICU). don't do them because you think you need them to prepare for internship because you're wasting the last precious time of your life to just be a bum until you retire. (and i was by no means a slacker med student--i graduated with honors but i still believe in enjoying fourth year).

 

[kat82]

ok, that is somewhat reassuring. i am definitely loving 4th year so far and learning a ton. i just would like to have some more practice at multitasking, writing orders, discharge summaries, etc. am i a huge nerd? i just dont want to start intern year being the dumbest intern in the bunch!

 

[plastikosmd]

funny, my icu sub-i was probably the only valuable rotation that i did in 3rd/4th year. i started out my internship in the CT icu (postop CABG unit) just 2 interns and a day PA. (and some very knowledgeable nurses.) thank god for my icu sub-i. i was weeks ahead of my other intern. Vents, settings, weaning..etc. drips and rates. placement of lines (i am still amazed that those supervising me let me put in a-lines, IJ, fems etc as a med student..and thank god they did), re-intubation etc. in fact the only time i had to call over a 3rd year from the SICU for some help was setting up an oscillating vent and trying to figure out the settings on it. granted i had a very good icu sub-i experience, and leaped into a very difficult first rotation..but it worked out well for me.

 

[jennyboo]

kat82, a sub-I in the ICU and a sub-I in internal medicine will be more than enough to get you as capable as can be during your first month of internship.

These experiences are not needed and plenty of people do fine without them. I did have one intern colleague last year who had never done a sub-I in IM or ICU and he felt this set him back a little bit. I had done one in IM but not ICU as an MS-4 and, well, when I arrived I still had to ask everyone questions as basic as where the bathrooms are. But still, I didn't feel worse off than my peers -- which is perhaps the biggest benefit of doing your two rotations, just that it gives you a slight edge in having more confidence (though not, sadly, more knowledge).

What you will learn from your sub-I is how to manage 1-2 patients under supervision. That means you will become skilled enough to write notes without supervision, check labs mostly without supervision, order labs with supervision, and order meds and tests with supervision for 1-2 patients. Intern year is very similar, except for the fact that 8-10 patients is very different from 1-2 patients and you will change the order in which you did those things as a sub-I, in order to get through all of your patients in a smaller amount of time.

 

[kat82]

thanks jennyboo, thats very reassuring
im really glad ive done an icu sub-i, not for the "sub-i" part but for the icu part. ive learned alot about vents, pressors, prophylaxis, antibiotics, sepsis, glucose control, ards, abgs, etc. i would definitely recommend an icu rotation to anybody because you become a real pro at physiology and its really cool

all the practical stuff, like keeping track of lots of patients, dictating, doing discharge summaries, calling pcps, i havent gotten much of. but i guess i should be grateful b/c there will be plenty of that coming my way, huh? 🙂

 

[nutcancer]

I have a sub-I and a MICU month scheduled back to back RIGHT AT THE END of my 4th year for the sole purpose of being uber ready for my intern medicine year.

If someone thinks this is too stupid to do, please explain why I shouldn't. In the end, I want to enjoy 4th year and not look TOO stupid on my first days in internship. Also, I'm only doing 1 sub-I and 1 MICU month, the latter being an elective and the former a requirement.

 

[jennyboo]

I have a sub-I and a MICU month scheduled back to back RIGHT AT THE END of my 4th year for the sole purpose of being uber ready for my intern medicine year.

If someone thinks this is too stupid to do, please explain why I shouldn't. In the end, I want to enjoy 4th year and not look TOO stupid on my first days in internship. Also, I'm only doing 1 sub-I and 1 MICU month, the latter being an elective and the former a requirement.

Hmm -- it depends what you would be doing if you didn't do the subI and MICU. Would you be on vacation? Then yes, absolutely, doing the work is stupid -- go on vacation for heaven's sake. But if you still need to do two months of something by then, do something that interests you -- and if a subI and MICU are more interesting than, say, two months of radiology elective, then by all means do it.

You will not be uber ready for internship. Your residents and your attendings will be expecting to lead you by the nose for the first two months. You will be led by the nose whether you did the MICU/SubI or not, and most likely it will not feel any different whether you did the two months or not. So spend the time in a way that makes you happy, and don't suck up extra work with the hope of being more ready (you won't be).

 

[Hard24Get]

What you will learn from your sub-I is how to manage 1-2 patients under supervision. That means you will become skilled enough to write notes without supervision, check labs mostly without supervision, order labs with supervision, and order meds and tests with supervision for 1-2 patients. Intern year is very similar, except for the fact that 8-10 patients is very different from 1-2 patients and you will change the order in which you did those things as a sub-I, in order to get through all of your patients in a smaller amount of time.

This depends on your school. At mine, you actually replace an intern, so you have the same patient load (except they cap at 6 admissions, you cap at 5) and are actually carrying up to 10 patients at a time. The way to get honors in the rotation is to become as indistinguishable as you can from your co-intern. I feel more prepared for internship having done this.

 

[nutcancer]

Hmm -- it depends what you would be doing if you didn't do the subI and MICU. Would you be on vacation? Then yes, absolutely, doing the work is stupid -- go on vacation for heaven's sake. But if you still need to do two months of something by then, do something that interests you -- and if a subI and MICU are more interesting than, say, two months of radiology elective, then by all means do it.

You will not be uber ready for internship. Your residents and your attendings will be expecting to lead you by the nose for the first two months. You will be led by the nose whether you did the MICU/SubI or not, and most likely it will not feel any different whether you did the two months or not. So spend the time in a way that makes you happy, and don't suck up extra work with the hope of being more ready (you won't be).

yes, they're two months of something i need to do. i'm going into rads as a career but medicine was my favorite rotation in 3rd year. i would enjoy doing back to back medicine (especially the micu) month i'm hoping.

 

[plastikosmd]

" I feel more prepared for internship having done this."

you are...your first month will be much less stressful!