Student sub-internship and Electives
Internal Medicine Subinternship
The Internal Medicine Subinternship offers medical students the opportunity to function in the role of an intern on an Internal Medicine inpatient team. Subinternship opportunities are available throughout the academic year at Yale New Haven Hospital's (YNHH) York Street and Saint Raphael campuses and the VA Medical Center (West Haven, Conn.). Subinterns 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 Subinternship 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 Subinternship, 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 at barbara.wanciak@yale.edu.
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 Subinternship 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 subintern 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 Subinternship 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 subintern 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 subinterns 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 Subinternship is that the bulk of knowledge acquired will be learned at the bedside attending to the needs of patients admitted by the subintern 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 subintern 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 4-week ward rotation at our Subinternship sites, the subintern 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 subintern 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 subintern as and when a patient to whom that subintern is providing care requires that procedure. In each case the subintern will also be tutored about informed consent. The types of procedures involved include diagnostic thoracenteses and paracenteses, joint aspirations, and lumbar puncture. The subintern 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 Subinternship prepares a student for), and that is the skill of interpersonal communication.
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.
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 Linda Limauro in Student Affairs.
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 West Haven VAMC with Dr. M. Remetz (Yale) or Dr. Steven Pfau (VAMC)
Students electing this course will attend the weekly arthritis Clinic at the West Haven VA Medical Center on Tuesday afternoons, and at Yale New Haven Hospital (YNHH) on Thursday afternoons, preceded by a Rheumatology Teaching Conference. Additionally, students will attend the weekly Allergy and Clinical 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/Clinical Immunology Services at both the West Haven VA Medical Center and YNHH. This elective is limited to one student. Dr. P. W. Askenase
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 4th year students. Dr. D. Proctor
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.
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. Dr. Silvio Inzucchi
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. Dr. T. Duffy
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. Dr. Edward Chu
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. Dr. G. Friedland
