Student Elective Information

Internal Medicine Sub-Internship

The Internal Medicine Sub-Internship offers medical students the opportunity to function in the role of an intern on an Internal Medicine inpatient team. Sub-internship opportunities are available throughout the academic year at Yale New Haven Hospital's (YNHH) York Street and Saint Raphael campuses and the VA Connecticut Healthcare System (West Haven, Conn.). Sub-interns will join a team consisting of an upper year medical resident and attending and will be responsible for admitting patients, writing admission and daily progress notes, presenting cases on rounds, communicating with consultants, ordering medications and tests, and serving as the front line physician for patients admitted to the hospital. Students will be responsible for managing approximately half the number of patients typically managed by an Internal Medicine intern. The Internal Medicine Sub-internship offers medical students an outstanding opportunity to prepare for internship, whether the student intends to pursue a career in Internal Medicine or another specialty.

Accepting Visiting Medical Students

No.

Requirements

To qualify for an Internal Medicine Sub-Internship, Yale medical students must have successfully completed their third-year Internal Medicine Clerkships.

Length of Rotation

4 weeks.

How Do I Apply?

Yale medical students may contact the Yale School of Medicine, Office of Student Affairs for information about applying for a future academic year. If the Yale medical student is interested in being scheduled during the current academic year and meet the requirements above, you may contact Barbara Wanciak.

Learning Objectives

History Skills

Students are allowed to do this rotation only if they have completed their Internal Medicine clerkship rotations both in the inpatient and outpatient arenas. Thus, by the time they begin the sub-internship there will be an expectation by supervising residents and Attending Physicians that students have acquired substantial skills in data gathering and in the writing of medical histories using accepted formats. Thus, the focus will be more on how the sub-intern is able to summarize the history succinctly during oral presentations, and is able to advance to the next phase from being a data gatherer to a data analyzer.

Physical Examination Skills

Students are allowed to do this rotation only if they have completed their Internal Medicine clerkship rotations both in the inpatient and outpatient arenas. Thus, by the time they begin the sub-internship there will be an expectation by supervising residents and attending physicians that students have acquired the rudiments of skills in physical diagnosis. Every patient whom the sub-intern examines is also examined by both the supervising resident and the attending physician, and therefore all discrepancies in physical findings are used as teaching opportunities at the bedside. Furthermore, attending physicians will also ensure that sub-interns are shown physical findings of interest on patients who are not their own but those of other interns or residents on the medical team

Knowledge/Diagnostic and Treatment Skills

It is our firm belief that the summum bonum of the Internal Medicine Sub-Internship is that the bulk of knowledge acquired will be learned at the bedside attending to the needs of patients admitted by the sub-intern and during call nights also from covering for the patients of colleagues on the medical team. Therefore, it being impossible to predict what kinds of patients will be admitted in a given month on the inpatient team on which the sub-intern serves, there is no strict qualitative definition of an exact mass of knowledge that should or needs to be acquired during this rotation. That having been said, based on the average experience acquired on a four-week ward rotation at our sub-internship sites, the sub-intern would have acquired the following skills in the approach to the diagnosis and management of: patients presenting with or having as a part of their illness

Procedural Skills

To anticipate a sub-intern to memorize the indications and risks of every procedure would be an unreasonable expectation and if required would be worthless expenditure of mental energy. Hence we do not very deliberately provide such a list. Instead, the indications, risks and individual benefits of procedures to patients will be discussed with the sub-intern as and when a patient to whom that sub-intern is providing care requires that procedure. In each case the sub-intern will also be tutored about informed consent. The types of procedures involved include diagnostic thoracenteses and paracenteses, joint aspirations, and lumbar puncture. The sub-intern may be taught to do such a procedure by a certified resident if it be a procedure such as the drawing blood for arterial blood gasses.

Professionalism and Interpersonal Communication

Demonstrate professional responsibility in working as a team member with other members of the Internal Medicine team, care coordinators, social workers, nurses, and consultants. Provide patient-centered care. Learn the skill so important to a medical resident, (which is what the sub-internship prepares a student for), and that is the skill of interpersonal communication.

Advanced Elective in the Medical Intensive Care Unit

This elective offers experience in the Medical Intensive Care Unit (MICU) at YNHH. Students are on call every fourth night with an intern and resident pair, assisting them in the admission of patients. Students follow patients in the MICU and assist in their care with their intern and resident. It provides the opportunity for participating in the acute management of common medical emergencies. The elective is offered for a period of two or four weeks.

Analytical Clinical Cardiology

The two- to four-week rotation emphasizes a rigorous history and physical exam to develop a differential diagnosis to guide the care of patients in the hospital and clinic. Supplementary reading on topics arising from the management of the patients is an important component of the experience. Interested students should discuss their goals prior to the rotation.

A maximum of one student can spend a minimum of two weeks on this rotation and share time between a private practice in New Haven, Conn. and Yale New Haven Hospital. This elective will not be offered in the summer months but will be available for students from September – May. Students interested in signing up for this elective should contact Student Affairs.

Cardiology Elective (Completed at YNHH or the VA Connecticut Healthcare System)

The student will participate in the daily activities of the cardiology service, including rounds, consultations, conferences, and special procedures such as cardiac catheterization, echocardiography, and electrocardiography. The training experience will emphasize the physiologic basis for clinical manifestations and therapy of cardiovascular diseases. The rotation is limited to two students every four weeks throughout the year at Yale New Haven Hospital or the VA Connecticut Healthcare System with Dr. M. Remetz (Yale) or Dr. Steven Pfau (VA).

Clinical Allergy, Clinical Immunobiology, and Arthritis Elective

Students electing this course will attend the weekly arthritis clinic at the VA Connecticut Healthcare System on Tuesday afternoons, and at YNHH on Thursday afternoons, preceded by a Rheumatology Teaching Conference. Additionally, students will attend the weekly Allergy and Immunology Clinic for adults held at YNHH on Tuesday mornings, followed by a one-hour conference at 10 a.m. Also, if they choose to, students can attend the Friday morning Pediatric Allergy Clinic from 8:30 - 9:30 a.m., Allergy/Clinical Immunology Journal Club Wednesday at 1 p.m., and a seminar Friday at 8:30 a.m. Students may also join in consultations with the Rheumatology and/or Allergy & Immunology Services at both the VA and YNHH. This elective is limited to one student.

Clinical Gastroenterology Elective (Completed at Yale New Haven Hospital)

This is an opportunity for students to see a wide variety of gastrointestinal problems and patients, with an opportunity for discussion and review. The student will be an integral part of the inpatient GI consult service, primarily working in an inpatient setting. The student should plan to attend this rotation on a full-time basis. It is offered to two students throughout the year every four weeks. This elective is recommended for fourth year students.

The Connecticut Hospice (Branford, Conn.)

This 52-bed inpatient program at the nation’s first hospice provides intensive palliative care for patients with terminal illness. The medical, psychological and spiritual needs of these patients and their families are met through the coordinated efforts of an Interdisciplinary Team (IDT) of physicians, nurses, social workers, pharmacists, clergy, art therapists and volunteers.

Students work one-on-one with an attending physician caring for patients approaching the end of life and their families. They participate fully in admissions, morning rounds, family conferences and IDT conferences. This elective offers students an opportunity to acquire advanced knowledge and skills in the management of symptoms (pain, anxiety, insomnia, etc.), which will benefit them in their future care of all patients, both those approaching the end-of-life as well as those who are acutely or chronically ill. It is the only elective in which symptom management receives a major focus.

We offer two- or four-week rotations. The four-week rotation allows for optional time spent with allied services and/or home care. The goal of this rotation for students are to learn to provide optimal symptom management and, as members of the IDT, to learn to care for patients approaching the end of life and to give support to their families. Contact: Louis Gonzalez, MA, MPH, at 203-315-7502.

Endocrinology Elective

The student will participate as an active member of the endocrine training program, making daily rounds with the metabolism fellows and residents and attending physicians. He or she will see inpatient consultations, participate in the endocrine clinics and participate in the regularly scheduled metabolism-endocrine conferences. The assignment will require students full-time for four weeks. Limited to one student per block throughout the year.

Hematology Elective

This clerkship is designed to provide intensive exposure to clinical hematology by direct participation in the activities of a regular clinical hematology service. Students will work up new patients and consults in rotation with the fellows and residents and will attend outpatient clinics. They will participate in daily hematology ward rounds and bone marrow readings and weekly inpatient/outpatient clinical reviews and clinical research conferences. The rotation is limited to one student for four weeks.

Hematology-Oncology Elective

This is an advanced clerkship offered to students who have completed the general in-patient medical clerkship. The elective is limited to three students for four weeks on a full-time basis throughout the year.

Externship in HIV/AIDS

Students desiring an intensive, more advanced in patient experience with the care of HIV infected persons may spend one month as a sub-intern on the Donaldson/Atkins Firm. The Firm offers a combined general internal medicine/HIV ward experience. Previously, Donaldson/Atkins admitted only HIV positive persons. However, with the advent of highly active antiretroviral therapy and effective opportunistic infection (OI) prophylaxis, the HIV inpatient census has decreased and both HIV positive and general medical patients are cared for. The firm practices a multidisciplinary HIV care approach. There are two teams, each comprised of an attending, two residents, two interns, and one third-year medical student. On average, 30-50 percent of the patients are HIV-positive. Students who elect an externship on Donaldson/Atkins function as an integral member of one of the two teams. However, the student does not substitute for, but works in tandem with one of the interns, essentially as a second intern. Activities include supervised initial evaluation and daily management of patients with HIV disease; daily rounds with the team; case presentations to the attending physician; and attendance of tri-weekly attending rounds, and weekly firm conference, during which various HIV related infections and non-infectious problems are discussed.

In addition, the students work closely with members from social work, nursing, pastoral care, and discharge planning to better appreciate the multidisciplinary nature of HIV care. Students can also attend one outpatient HIV clinic per week in the Nathan Smith Clinic (NSC) in order to supplement their inpatient experience with the ambulatory aspects of HIV disease. This elective accommodates one student per month and offers a unique opportunity to participate in comprehensive HIV care in the AIDS Care Program, preferably upon completion of all basic clinical clerkships. A previous medical or surgical sub-internship is useful preparation.

Infectious Disease Elective

Students participate as active members of the consultative and training program in Infectious Diseases at Yale New Haven Hospital and the VA Connecticut Healthcare System. This includes daily work rounds, daily attending rounds, microbiology rounds four times a week, two weekly clinical conferences and one didactic conference. In addition, residents may have the opportunity to evaluate patients in the outpatient HIV clinics.

Nephrology - Renal Elective (Yale New Haven Hospital & VA Connecticut Healthcare System)

This clerkship in clinical nephrology offers the student an opportunity for in-depth learning regarding problems in fluid and electrolyte disturbances, acute renal failure, chronic renal failure, and hypertension. Emphasis is placed on problem recognition, pathophysiologic diagnosis, evidence-based clinical judgment and management based on pathophysiologic principles. The primary activity involves the inpatient consultation service in which the student works up and follows several patients per week, and participates in daily rounds with the attending physicians, postdoctoral fellows and residents on service. An introduction to hemodialysis, peritoneal dialysis, renal transplantation, and renal biopsy histology is also provided. This elective requires full-time participation for four weeks and is limited to two students per block at Yale New Haven Hospital and one student per block at the VA Connecticut Healthcare System.

Occupational/Environmental Medicine Elective

This rotation is designed to provide senior students with an introduction to the principals and practice of occupational environmental medicine. The hope is to fill in gaps missing in most basic medical school curricula and to encourage especially interested students of opportunities for careers in this discipline. The experience is centered around the diagnostic clinic at 135 College Street, New Haven, Conn. In addition, students will have an opportunity to participate in ongoing didactic and research conferences as well as to visit factories and other environmentally contaminated sites which are being evaluated for their role in disease causation. The elective is limited to two students for a four-week block. It is available throughout the year.

Pulmonary and Critical Care Elective (YNHH & VA Connecticut Healthcare System)

Students will work closely with faculty and staff in the Pulmonary section and participate in daily consulting and intensive care rounds. Students will assist in the examination and treatment of patients with various cardiopulmonary diseases, including tuberculosis, chronic obstructive airway disease, asthma, lung cancer, bacterial and fungal lung infection, and other diagnostic problems. They will receive practical instruction in interpreting chest images and pulmonary function tests, clinical and laboratory methods in diagnosis and management, including intensive respiratory care and respiratory therapy, and an opportunity to observe fiberoptic bronchoscopy. Students will receive didactic lectures in a number of areas relating to airway pharmacology, lung cell biology and lung immunology (respiratory cells, immunologic reactions, etc). In addition, students may select one or more of five clinical sessions held weekly. A separate experience is available in intensive care medicine.

Rheumatology Elective

Students taking this elective will actively participate in the Rheumatology service both in the inpatient and outpatient settings and will work closely with the attending and fellow assigned for the month. They will work closely with the faculty member and fellow assigned to the inpatient consultative service at both Yale New Haven Hospital and the VA Connecticut Healthcare System. They are expected to attend rounds and evaluate patients with rheumatic conditions and other diseases with rheumatic manifestations. In addition they will participate in outpatient clinics including two VA Hospital arthritis clinics, and two general Rheumatology clinics at Yale New Haven Hospital. They are expected to attend two weekly conferences sponsored by the Section of Rheumatology. The elective is limited to one student every four weeks throughout the year.