SubI

[vegas]

Hi Folks!
I'm just curious to know what a SubI is and what are the expectations? Also, Pros. and Cons.!

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[14022]

"SubI" is short for "subinternship" and it is exactly what its name suggests...you act just below an intern, with the only difference being that the intern has a medical school diploma. The subinternship is the time for you to learn the things that you will need to know to function as a resident that may or may not have been taught to you in other rotations, such as writing orders, discharge instructions, prescriptions. You generally will do procedures that interns and residents do such as central venous/arterial access, para-/thoracentesis, intubation, LP's etc. The difference between subI and other medical student rotations is that for other rotations, if you do some of the things I mentioned, you impress residents with your work ethic and enthusiasm. In your subI it is expected of you. If you dont write your orders, it is likely that they will not get done, unless your senior resident does it for you. If your work doesnt get done, it reflects poorly on the senior resident and you are likely to get a poor evaluation. Generally the expectations of you are the same as the intern; eg, you take call redularly, you carry multiple patients, you must know all aspects of your patient's care. Generally, the senior resident will be the only other person on the team who follows your patient. The intern/junior resident/medical students will not follow your patient so no one can bail you out if you dont know something about your pt when the attending asks. If you do a subI in surgery or OB, you may be first assist on some of the easier cases. (I know a subI who did an entire C-section on a patient while the attending watched.) It is supposed to be the most labor intenesive part of 4th year. Others have recommended doing a subI at your top choice for residency, because since it is such a tough 4 weeks, it shows that you are really interested in their program. Most people are aware of this so it is difficult to get a subI at competitive programs. On the other hand, it can easily expose weaknesses in your work ethic if lacking.

 

[double elle]

Just one piece of advice - before scheduling a subI in ANYTHING, be sure to talk to others who have done it at that institution/in that program.

I did an inpatient medicine subI this fall and it was a total disappointment. I was worried for months that I wasn't ready and I'd look like a fool. Well, guess who supervised me for everything....the INTERNS! They were a great bunch of people, but if I were an intern and supervising a medical student...and this was MY first year of a residency program....and MY neck was on the line...there is no way in hell I am letting a medical student do anything. Which is exactly what happened. The upper level residents only take back up call, so I was never on with them...only the interns. It was a total joke - actually less challenging than my other medicine rotations.

Just make sure you get to interact with the upper-level residents. They've been around more and are ready to be done...they will let you do more. It's not fair (for the intern) that an intern should be "responsible" for your actions, as you aren't far from eachother academically. I don't fault the interns at that program one bit....they are new....they aren't going to put their butts on the line (I know I wouldn't at that point).

Anyway - just my opinion based on my crummy subI waste-of-a-month.

 

[vacation]

Hi, I have a follow-up question

My 3rd year clinical grade in IM wasn't the best and i want to really do well as a 4th year since I've decided on IM. Does anyone have any tips?

Also, i wanted to know when the best time to do the sub-I is, is November too late or would sept be better?

Thanks for your help..........

 

[14022]

Hi, I have a follow-up question

My 3rd year clinical grade in IM wasn't the best and i want to really do well as a 4th year since I've decided on IM. Does anyone have any tips?

Also, i wanted to know when the best time to do the sub-I is, is November too late or would sept be better?

Thanks for your help..........

If you want to do IM at a competitive program and you did not do well in IM 3rd year, you will want to do IM sub I as early as possible. You want to honor your sub-I and get a letter of rec prior to when applications go out in September and October. Programs will want to see that you can function as an intern, which is more important than how you did during third year.

If you had honored third year and got a great letter of rec, it wouldnt be as important to do a sub-I early unless you are doing away rotations. You learn a ton during your sub I and you will know the most about general IM at the end of your sub I compared to any other part of the year so if you are planning on doing away rotations it is a good idea to sharpen up with a sub I prior to going away. This is another reason to take it early.

I would recommend taking an outpatient general IM rotation in July or August and spend the month with no call or weekend work and do some reading to sharpen your clinical IM knowledge. Take the sub I the month after that. After that, take step 2 since the majority of step 2 is IM. Take 2-3 weeks to review OB, psych, peds, surgery, etc and then take Step 2. You can take an easy radiology month or consult month like ID, endocrine, derm etc. while you review for step 2.