This past week I wrapped up my Family medicine Sub-I (a rotation you do as a fourth year med student usually in your chosen specialty where you’re expected to act like an intern resident)! It was 4 weeks of inpatient medicine with long hours and a lot of hard work but I honestly loved it. Before I started it I thought I hated hospital medicine, but by the time it was over, I realized that I had grown to really like it. I don’t think I could be a hospitalist full time or anything, but I’m not opposed to seeing patients in that setting. I’m writing this post to pass along some advice that I’ve learned along the way of what makes a good SUB-I whether at your home institution or at an away/audition site.
Your attitude is so important when it comes to a 4th year rotation. Always be alert and engaged. In order to do this consistently you have to make sure you’re sleeping at night. The worse thing you want to do is fall asleep during someone’s presentation (like me lol). Especially when it comes to picking up patients, or seeing a new patient, always volunteer yourself. If you have another sub-I with you, then you guys will alternate patients and you don’t need to jump at every opportunity before then you look too eager. Take initiative when it comes to your patients. Examples: set up their discharge follow up appts, call their nurse to make sure they saw the order you put in, call the lab to check the status of your AM labs if they haven’t resulted in time. All of these things are what an intern would do so you want to go ahead and step your game up now!
Know your patients
Know them backward and forward. Take extra time to get more social history from them (where do they live, what support do they have) because that’s usually the area the resident may be lacking in due to time. The more you know, the more you shine!
Take note of any questions that come up on rounds and as soon as you can, look up the answer on a credible source and report it to the attending/resident who asked. For extra brownie points, let the whole team know: “We brought up X on rounds today and I found on UpToDate that __.” You can even to a 3-5 min presentation of the topic. This will make you stand out and highlight your curiosity. To excel, do research on other patients that aren’t yours. For example, if there’s a tricky patient that no one really knows what’s going on with, take some time to formulate 1 or 2 new things to add to the differential. Another great tip is to print out a research article on any topic concerning one of your patients and present the article to the team.
Be attentive on rounds
Pay attention to the discussion for each patient. At minimum, try know the plan for each of the patients. Try not to fixate too much on getting your presetnations ready that you miss details. You exceed expectations when your chief resident is running through the list trying to remember what they were supposed to order for a certain patient and you can remind them when it’s not even your patient. On rounds, you also just don’t want to look uninterested, because you’re still a part of the team that’s managing each patient. I would suggest staying off of your phone, even if you want to look something up–or just be wise about it. Definitely no side conversations during rounds unless a resident addresses you.
Ask for feedback
All attending and residents are different when it comes to feedback. I had a great group of residents who offered feedback on a pretty regular basis. But with my attending, I had to make a point to actively seek feedback. Once I asked they would give it and I knew moving forward how to improve. I know from past experience that attending like students who actively ask for feedback because it shows a constant desire to improve.
Implement the feedback
Self explanatory but don’t take feedback and not implement it. Because you’re wasting the resident/attending’s time that they took to try and help you. And they notice. It’s a sure fire way to get some strikes against you. You don’t want to be getting the same feedback 3 times.
Hope this advice helps you excel!! For more advice feel free to contact me!