Importance of Sub-I? / UCLA Residency Question

[Effervescent]

Hi folks. I'm a 4th yr.

I would like to do some away rotations at UCLA (if they still have any space!) for a couple of reasons:
(1)They have some rotations my school doesn't offer.
(2)At least on paper, UCLA sounds like my "top choice" at this point. I'd like to check the program out in person & see if I think it would be a good fit.

Now for my questions.

My school neither offers, nor requires any rotations that are specifically designated as a "Sub-Internship". The deans said our (required) advanced Internal Medicine rotation is, for all practical purposes, a Sub-Internship, but some of the residents I've talked to (who trained elsewhere) said that it doesn't even come close. (These same residents seem to also find it very odd that Sub-Internships are neither offered nor required.)

The potential rotation I'm most interested in at UCLA is their Geriatric Psychiatry rotation. The have both an "advanced clerkship" and a "Sub-Internship" in Gero-Psych. I am thinking I should probably try for the Sub-Internship one so that I get the Sub-Internship "experience" for my application. Having said that, the Sub-Internship is all intpatient and the "advanced clerkship" is partly outpatient; I haven't had ANY outpatient Psych exposure and think it might be a good idea to "experience" outpatient. (Any thoughts?)

I guess my main concern (since I would't have any other Sub-Internship experience) - if I did the "advanced clerkship" (with the outpatient work) would UCLA look at my residency app & wonder why I *didn't* do the Sub-Internship instead when I rotated through their institution. (ie - will my application end up looking WEAKER in their eyes - as if I were trying to slack off & do an easier rotation when I came to their institution?)

What if the Gero-Psych "Sub-Internship" is FULL but there would still be space in the "Advanced Clerkship"? Does this change anything in relation to my previous paragraph?

My desire to have a Gero-Psych rotation is stronger than my desire to have a "Sub-Internship" just for the sake of the (generic) "Sub-Internship" experience. They do have other subinternships that would be of *some* interest to me if the Gero-Psych on is full, but my desire to do the "Advanced Clerkship" in Gero-Psych would be stronger than that to do a "random", "generic" Sub-Internship. But how would this be viewed? Would it be better to do the Sub-I (in the area I'm somewhat less interested in) than to do the "Advanced Clerkship" in an area I'm *very* interested in?

Thanks in advance for your thoughts on all of this.

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[atsai3]

My school neither offers, nor requires any rotations that are specifically designated as a "Sub-Internship". The deans said our (required) advanced Internal Medicine rotation is, for all practical purposes, a Sub-Internship, but some of the residents I've talked to (who trained elsewhere) said that it doesn't even come close. (These same residents seem to also find it very odd that Sub-Internships are neither offered nor required.)

It is possible to do very well in the psych Match without having done a psych sub-I. My medical school didn't even offer psych sub-I's. (Most programs probably will be looking for a medicine sub-I in your application, because they don't want you to embarrass them when you are rotating on the medicine half of your intern year.)

With the caveat that it is probably better for you to get specific feedback from a UCLA psych resident, here are some disjointed thoughts:

1. The primary use of a sub-I is to get a medical student as close to functioning as an intern but with plenty of supervision. The sub-I experience varies from school to school. At some schools, the sub-I is a true sub-I, having all of the autonomy and responsibility of an intern -- just with fewer patients (e.g., cap of 2 instead of 5). [Keep in mind that the autonomy of interns also varies considerably from institution to institution.] This is possible to do on an inpatient service, but it's kind of hard to have an outpatient sub-I. (At least, my school offered no such thing. There were only inpatient sub-I's.)

The reason why I bring this up is that in psych, the selection committees do not look at your application with the same lens of "autonomy" as a medicine residency selection committee (RSC) might. A medicine RSC is looking in the evaluation for the phrase "Johnny Smith rotated on my service as a sub-I, but he functioned essentially at the level of an intern in his approach to diagnosis and management of some very sick patients". Psych residents are heavily supervised throughout residency. True, there are some aspects of 'autonomy' that differentiate some residents from others (e.g., at UW the residents begin doing solo consult/evals for the ED/floor during their intern year; whereas at UCSF the residents do not do this until their second year), but by and large there is not the same emphasis on "autonomy" as you see during the medicine residency application process.

2. The best use of an away rotation is to give you an opportunity to see the program up close and determine whether you think it might be a good fit for you. Whether you're doing geropsych or consult or whatever, you should make use of the opportunity to attend resident didactics, take a morning or two to round with one of the other teams, etc.

3. If you take that as your primary aim, then it really doesn't matter if you do a sub-I vs. "advanced clerkship". (This holds with regards to matching in a psych residency. Medicine, peds, surg programs want you to do a sub-I, and some programs will not even grant you an interview unless you do a visiting sub-I with them.)

4. You're overthinking things with regards to the "will my application end up looking WEAKER in their eyes" stuff. Just pick the rotation that seems most interesting to you.

Cheers
-AT.

 

[watto]

Why don't you enroll in the inpatient sub-internship and just ask the attendings if you can spend a few afternoons in the clinics? I am sure they would love to have you doing as much as possible, and experience that which you're most interested in.

The geri psych rotation stands to improve a lot this year with the move to the new hospital and delineation of the inpatient wards to identify and treat dementia-related / difficult medical cases. Your application wouldn't be hurt per se by doing the advanced clerkship but your exposure to the inpatient ward would allow you to more fully experience what the residency here is like for the first two years. Also, the residents are strongly involved in the rank list process and sub-I performance is a data piece that is prized!

Bottom line, I don't think you need to really put yourself in an either / or situation, just ensure that you make your interest in outpatient known and see if an attending can help set you up.

 

[Thewonderer]

My general advise is: If you look really good on paper (awesome clerkship grades and high USMLE score), don't do an away rotation because you might turn out not as stellar in person as you seem on paper. However, if your stats are not good or only ok, then by all means do the away rotation, stay late and don't go home until all residents are gone. Your away rotation is essentially a 3-4 week long interview.

 

[strangeglove]

I'd recommend that you do a sub-I in internal medicine somewhere else if your own school doesn't offer this and indeed your advanced medicine clerkship is not comparable to sub-I's elsewhere. Many top psych programs are more interested in what you can do on a medicine sub-I than on an advanced psychiatry rotation (even if it's called a sub-I), as this will have more to say about your general fitness for residency and specifically your ability to handle a rigorous internship. There are some medical schools that don't consider psychiatry sub-I's to count towards their graduation requirements, which makes these more like advanced electives. Remember, the it's a sub-INTERNSHIP, i.e. it's supposed to be like intern year, which means less psych and more medicine/surgery/ICU/emergency medicine.