IMED661CM.01 (Reno)
Internal Medicine Sub-I

Office of Medical Education

  • Course Name: Internal Medicine Sub-I
  • Short Name: Internal Medicine Sub-I
  • Course Number: IMED661CM.01
  • Location: Reno
  • Department Contact: Dawn Younie
  • Type: Clinical
  • Length: 2 weeks only
  • Preceptors:
    • Darryl Patterson, M.D.
    • Timothy Baker, M.D.

Please contact the department to verify elective availability.

Description of Rotation

Student Learning Outcomes:

  • Gather a history and perform a physical examination
  • Prioritize a differential diagnosis following a clinical encounter
  • Recommend and interpret common diagnostic and screening tests
  • Enter and discuss orders and prescriptions
  • Document a clinical encounter in the patient record
  • Provide an oral presentation of a clinical encounter
  • Form clinical questions and retrieve evidence to advance patient care
  • Give or receive a patient handover to transition care responsibility
  • Collaborate as a member of an interprofessional team
  • Recognize a patient requiring urgent or emergent care and initiate evaluation and management
  • Obtain informed consent for tests and/or procedures
  • Perform general procedures of a physician
  • Identify system failures and contribute to a culture of safety and improvement

Description:

The progression from medical student to resident intern involves a significant transformation involving increased responsibility and workload. The sub-internship (also known as acting internship) is commonly viewed as one of the most important clinical experiences in helping senior medical students prepare for internship [1-3]. This course provides fourth-year medical students an opportunity to assume the role of an acting internal medicine intern in an outpatient setting with responsibilities in accordance with the Alliance for Academic Internal Medicine (AAIM) and the Association of American Medical Colleges (AAMC) guidelines for optimizing preparation for internship [4]

Course objectives follow the AAMC thirteen core entrustable professional activities (EPA) that define a set of foundational skills and behaviors expected of all medical school graduates entering residency. As an outpatient sub-intern, students will predominantly be evaluated under EPA 1 - EPA 7 and EPA 9 

References/Materials

  1. Vu, T. Robert, Allison H. Ferris, Michelle L. Sweet, Steven V. Angus, Nadia J. Ismail, Emily Stewart, Jonathan S. Appelbaum, and Brian Kwan. "The New Internal Medicine Subinternship Curriculum Guide: a Report from the Alliance for Academic Internal Medicine." Journal of general internal medicine 34, no. 7 (2019): 1342-1347.
  2. Elnicki, D. M., Gallagher, S., Willett, L., Kane, G., Muntz, M., Henry, D., ... & Salvit, C. (2015). Course offerings in the fourth year of medical school: how US medical schools are preparing students for internship. Academic Medicine, 90(10), 1324-1330.
  3. Elnicki, D. Michael, Meenakshy K. Aiyer, Maria L. Cannarozzi, Alexander Carbo, Paul R. Chelminski, Shobhina G. Chheda, Saumil M. Chudgar et al. "An entrustable professional activity (EPA)-based framework to prepare fourth-year medical students for internal medicine careers." Journal of general internal medicine 32, no. 11 (2017): 1255-1260.
  4. Elnicki DM, Aiyer MK, Cannarozzi ML, Carbo A, Chelminski PR, Chheda SG, Chudgar SM, Harrell HE, Hood LC, Horn M, Johl K, Kane GC, McNeill DB, Muntz MD, Pereira AG, Stewart E, Tarantino H, Vu TR. An Entrustable Professional Activity (EPA)-Based Framework to Prepare Fourth-Year Medical Students for Internal Medicine Careers. J Gen Intern Med. 2017
  5. Elkins, M. Y. (2010). Using PICO and the brief report to answer clinical questions. Nursing2019, 40(4), 59-60.
  6. Slawson DC, Shaughnessy AF, Ebell MH, Barry HC. Mastering medical information and the role of POEMs--Patient-Oriented Evidence that Matters. J Fam Pract. 1997;45(3):195-6.
  7. Chatterjee, D., & Corral, J. (2017). How to write well-defined learning objectives. The journal of education in perioperative medicine: JEPM, 19(4).
  8. Ryan, M. S., Lee, B., Richards, A., Perera, R. A., Haley, K., Rigby, F. B., ... & Santen, S. A. (2020). Evaluating the Reliability and Validity Evidence of the RIME (Reporter-Interpreter-Manager-Educator) Framework for Summative Assessments Across Clerkships. Academic Medicine.
  9. Chretien, K. C., Raj, J. M., Abraham, R. A., Aronowitz, P., Astiz, D. J., Chheda, S. G., ... & McLaughlin, S. E. (2020). AAIM Recommendations for the 2020-2021 Internal Medicine

Evaluation Method

This course follows AAIM recommendations for prospective internal medicine residency applicants to be formally assessed using the RIME (reporter-interpreter-manager-educator)-based schema. The RIME-based grading system is associated with a more robust and balanced grading practice [8].

• Reporter: Obtains thorough information from H&P but often asks question in a checklist format; rarely misses pertinent history details; consistently reports findings in organized SOAP format.
• Interpreter: Asks questions and performs physical exam reflective of potential diagnoses; formulates an appropriately broad and prioritized differential; provides appropriate clinical reasoning for current treatment plan; independently evaluates new data to modify their differential
• Manager: Formulates a diagnostic and therapeutic plan independently on common medical problems based on standraized guidelines and evidence-based medicine; able to counsel patients appropriately on the plan of care
• Educator: Has the insight to define important questions to research in more depth and the drive to seek out and scrutinize the quality of evidence behind clinical practice. Identifies knowledge gaps in others and effectively fills those gaps. Transition to educator is usually completed during residency.

The mini-CEX is method of clinical skills assessment developed by the American Board of Internal Medicine for graduate medical education. The mini-CEX allows for direct observation and evaluation of medical students by faculty.

Grading

You will receive a final evaluation of pass, high pass, or honors. This evaluation will be completed by one of the outpatient faculty physicians after input is obtained from those faculty and residents with whom you worked most closely. A breakdown of the grading criteria are as follows:


Honors: Students receiving Honors are considered to be outstanding fourth year students demonstrating the ability to evaluate patients independently and develop compressive care plans. Students receiving Honors are functioning at the level of a PGY 1 resident

High Pass: Students receiving High-Pass are considered to be very good fourth year students demonstrating the ability to evaluate patients and develop compressive care plans that exceed expectations of an average, competent. Students receiving High-Pass are well on their way to functioning at the level of a PGY 1 resident, however, still have some limited additional development to achieve before reaching this goal.

Pass: Students receiving Pass are considered to be competent fourth year students demonstrating the ability to evaluate patients and develop care plans with the guidance of faculty or residents. Students receiving Pass are in need of significant additional development to function at the level of a PGY 1 resident

Fail: Students receiving Fail do not demonstrate competencies appropriate to the level of a fourth-year medical student. Students who fail to meet the professionalism standards* will receive a grade of Fail, regardless of their academic/clinical performance in the elective.

* Professionalism Standards - Students are expected to conduct themselves according to the policies and procedures outlined in the student handbook or any other applicable policies of the school of medicine. Additionally, students are expected to
1) communicate clearly and effectively with their supervising faculty and residents
2) Be timely in the performance of clinical and academic duties, including arriving to clinic on-time and staying until the day is complete.
3) Treat their colleagues, the faculty, residents and staff with respect

Grade

  • Honors: An exceptional performance which exceeds all course objectives
  • High Pass: A performance which exceeds most course objectives
  • Pass: A performance which meets the course objectives
  • Fail: A performance which does not meet the course objectives

Special Notes

A maximum of six students may be admitted to this course.

Open to one 4th year at a time. May or may not be paired with a clerkship student.