Sub-I evaluations

[lilkiwi]

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How are sub-I's, particularly those in internal medicine, evaluated by attendings and residents? Or, more fundamentally, what exactly are sub-Is supposed to be doing?

I started my medicine sub-I a few days ago, and I seem to occupy an awkward gap between the intern and MS3 on my team. I know marginally more than the MS3 and far less than the intern. In fact, I often feel as clueless as I was during my 3rd year. I find myself flipping furiously through Pocket Medicine on the wards while being expected to write orders, make sure they're actually carried out, call consults (I know a lot of people do these as 3rd years, but for some reason I rarely had to), and most stressful yet empowering of all, answer pages! By the time I get home, I'm so tired that I usually don't get to read very much on my patients.

For MS3s, learning takes precedence over work on the wards (at least in theory). But as a sub-I, is my main role to improve my fund of knowledge, or is it to gain experience in working more independently and "prove" to the attending and residents that I would make a good intern? Although doing both would be ideal, which matters more as far as evals and LORs go, eagerness to learn (by reading and asking lots of questions) or ability to get the job done efficiently?

By the way, I feel uncomfortable asking questions on rounds as an MS4 because they might be thought of as things I should have learned during 3rd year... Thoughts?

 

[ZagDoc]

I found I was graded much more leniently on my sub-i than I expected. Kind of an understanding that the department knows you now, knows you want to enter their field, and wants to help you get there. Trust me, your department knows and understands that a honors in your sub-i is kind of needed for the match.

Eagerness to learn definitely goes much further than efficiency at this stage in the game. Just be the first there and the last to leave and you'll be surprised how highly you're regarded. Remember, they WANT you to succeed and match at this stage of the game.

 

[cnlaphny]

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[sprinkibrio]

I would try to mirror the interns as closely as possible. I'm on my peds sub-I, and honestly, I know more or at least as much as the new interns who have only been on for a week. What my attending said he wanted is for me to take on up to 4 patients, present the plan well and in plain language to the family during rounds (independently), and to read and teach the group, specifically the MS3s about the dx of each of my patients. Basically, try to figure out everything you can by yourself including dosing, duration of dosing, diagnostics, or figure out how to find the answers to that information, and do orders, d/c summaries, discharge patients, order consults, write notes (obvs), etc. I spend a lot of time on the phone, yes. Just take ownership of your patient and feel complete responsibility for them (although I'm sure things would get done by your senior if you didn't do them). I'm loving pertending like I'm responsible and the intern!! Maybe you have taken on too many patients too early?