Sub I suggestions

[Coleman]

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My school, in all their wisdom, has allowed sub-I rotation only in inpatient surgery, medicine, or pediatrics.

Any suggestions?

I've heard from EM residents at my program that inpt med and peds months are worthless and trauma surgery could be very helpful. Although, the thought of volunteering for that torture is horrible.

 

[ERMudPhud]

Inpatient medicine if it is on a fairly sick service -ICU, hepatology, tele could be useful. I assume you can still do an EM elective just not a sub I.

 

[edinOH]

One man's subI is another's elective. I don't know if the semantics are really important so I don't understand why your school would make the distinction. Regardless, schedule your EM "elective" either at your home school or at a program you would possibly like to match at. If the program makes a distinction between the elective and SubI experience, just tell the medical student coordinator or the physician in charge of the rotation that you are considering EM as your career choice and would like the SubI "experience".

 

[FoughtFyr]

Originally posted by edinOH
One man's subI is another's elective. I don't know if the semantics are really important so I don't understand why your school would make the distinction.

Coming from a school that does not make the distinction, I've got to ask the stupid question...

What is the difference between a Sub-I and a senior elective?

- H

 

[southerndoc]

Originally posted by FoughtFyr
What is the difference between a Sub-I and a senior elective?

With a sub-I (sub-internship), you essentially function as an intern. Meaning they give you patients to go see for admission or for following during the day, but besides presenting the patient to an intern, and intern isn't even involved in their care. Instead, you present the patient to your upper level resident as if you were the intern.

Most of our 4th year electives are structured like that, so basically all of them are sub-I's.

 

[Coleman]

No, actually at my school, this is something down from the Dean's office. Like others, most of my 4th year electives I will function like an intern.

I am already doing my EM month at my school and get no Sub-I credit. The Dean's office has defined a Sub-I as intern-level of patients on a continuity level (i.e. no EM, ICU, or other critical patients that you will not see "continually"). Now, I tried arguing that not only are some of our patients in the ED very regular, they consider the EP their primary physician, but many ICU patients are chronic.

I've arrange all my EM time, this is just my required Sub-I and I'm trying to pick the lesser of all evils. I'm honestly trying to talk myself out of a trauma surgery Sub-I at this point.

 

[Scrubbs]

My school didn't count EM as a Sub-I either... and we were required to do 2 months of either Med or Surg (or Peds/Family). I did medicine, and don't regret it in the least... I actually did it at the end of the year (aka Feb/March), which sucked b/c most people were done with "real rotations", but gave me the time to do 2 EM rotations, a research block, and enjoy interview time with blow-off stuff. Although Trauma surg would be good in theory, most students are more involved with babysitting the inpatients than they are with actual trauma (unless your school is different). Why work the hours required when you'll get plenty of trauma exposure during your residency? You'd be better served by a SICU rotation than a month of trauma surg...

Med sub-I, while painful, was good. I made my interests known to my team, and while still doing all the med stuff, people really tried to tailor my experience a bit. I got to do any procedures/lines on the floor, and all patients were talked about in a "what if this person showed up in the ED" fashion. Just my 2 cents... good luck with everything!

 

[ERMudPhud]

I'd pick medicine since even working in a trauma center many if not the majority of your sickest patients will still be medical patients so you might as well learn as much medicine as you can while you can. A trauma sub-I sounds like death by scut

 

[anonymousEM]

depends on if you have to do your sub=i at your home school. i did my required surg month away on trauma...would've been better probably learning wise if i'd done sicu, but trauma put me on a team with em interns and senior and got me the chance to see another dept, work my butt off and earn an interview at a place that otherwise wouldn't have looked at my application. in the end, 6 calls for my whole first year was worth it to be where i want to be now. and i got to do all of the "trauma center handshakes" i could handle!

 

[tonem]

Gotta love the ABC's of trauma for medical students:

A - finger in the Anus
B - Foley in the Bladder
C - go stand in the Corner

 

[jashanley]

Honestly, where you are going to learn the most is medicine. YOu are more likely to take care of the patients on your own, do procedures and feel more like an intern.
Trauma for a med student is scut and note writing. Fetch this......is heard a lot......even as an intern it is a lot of scut and almost no procedures.
I do recommend all 4th years do a critical care month. MICU/SICU/PICU it doesn't matter. You will see the sickest patients, do lots of procedures even as a student, and rehash some physiology. You get a picture in your head about what it means to look "sick". You'll be amazed at how rosy everyone else looks after a month in the ICU.

Doing the medicine Sub-I is your best option.

The 4th year students that rotate at my program with the medicine residents have a good amount of autonomy and I think they get a lot out of it in the end. I don't think it every over steps the boundaries of good patient care.

 

[Apollyon]

When I did my med sub-I (8 weeks), I did half on the general medical floor (<--- mega waste of horrible time - less than zero utility), and half in the combined ICU/CCU. That was where the money was at.

At that very time (ie, the end of my sub-I), my school changed it to 4 weeks of medicine, and "One of the following: an additional medicine subinternship, neurology, emergency medicine, radiology, geriatrics, ICU/CCU, dermatology" This shows how it can really work for you, or you can take it easy.

It's really school-dependent, though - when I was prelim IM last year, we had Mt. Sinai students as Sub-I's, and they worked hard (and we didn't even push them), but we also had a combined floor and step-down unit (without dedicated residents), and an overloaded SICU, CCU, and MICU, meaning it was easy to have a critical care service, without being in the unit.

So, after all that, I second what jashanley said.

 

[tonem]

Originally posted by Coleman
My school, in all their wisdom, has allowed sub-I rotation only in inpatient surgery, medicine, or pediatrics.

Any suggestions?

My school had the same requirement for our required A/I rotation. None of those options looked very appealing to me and I resigned myself to the fact that I was going to have to endure a month of torture until I noticed that there was a MICU rotation that satisfied the requirement. It was an awesome learning experience. I agree wholeheartedly with the previous posters that are endorsing the ICU experience.

My suggestion...look into the possibility of doing your Sub-I in the ICU. It's alot of work and stress at times but it is a great place to learn some of the most important skills necessary for emergency medicine.

 

[ckent]

I definitely agree with the MICU recc's. Just to give you another reason to do MICU, A good number of our MICU patients are actually transfers from other hospitals who can't handle critical patients. Well, when the MICU and CCU beds are all full (which does happen fairly often), these patients sit in the ER where the ER staff has to manage them. I've heard of these critical transfers sitting in the ER for so long that the ER staff had to write progress notes on them because they stayed there for more then one day.