Sub-Internship

Clerkship Objectives Index | Ambulatory |  Emergency Med | Family Med | Internal Med | Neurology | Ob/Gyn | Peds | Psych | Surgery | Sub-I
 

CURRENT LEARNING GOALS & OBJECTIVES

• Subinternship Internal Medicine Curriculum
• Primer to the Internal Medicine Subinternship

1. Communication

• Rationale
  • Interns play a key role in communicating aspects of patient care to patients, families, and healthcare providers, often in diverse clinical settings.
• Prerequisites
  • Communication and rapport/relationship development with patients, families, and colleagues consistent with Year III curriculum.

Specific Learning Objectives:

1.1: Knowledge - Subinterns should demonstrate knowledge of:

• Local and national ethical and legal guidelines governing patient confidentiality with specific attention to
  • Written documentation
  • Verbal communication with the patient and family members
  • Electronic transmission
• Recognition and management of denial, grief, noncompliance, depression, and psychosis.
• The importance of cultural issues governing health care decision-making by patients and their families.
• Appropriate resources available in the inpatient and outpatient setting for the coordination of mental and physical health care

1.2: Skills - Subinterns should demonstrate the ability to:

• Communicate effectively with patients and family members
  • Utilize lay terms appropriate to the patient's or patient's family's level of education and be able to explain scientific terminology.
  • Communicate abnormal results and/or "bad news" to patients or their families in a sensitive manner.
  • Discuss end-of-life issues with patients and family members
  • Provide concise daily updates for patients and family members regarding hospital course and rationale for ongoing or new treatment plans.
  • Consider cultural sensitivities and patient wishes when providing information.
• Recognize verbal and non-verbal clues of a patient's mental and physical health.
• Clearly summarize for the patient and/or family the reason for admission and rationale for the clinical plan.
• Initiate a conversation with a patient about advance directives.
• Demonstrate the ability to clearly and concisely present oral and written summaries of patients to members of the health care team.
  • Recognition and synthesis of relevant information
  • Communication of clinical information to the primary care physician

1.3: Attitudes and professional behavior - Subinterns should:

• Demonstrate an understanding of the value of effective communication with physician and non-physician members of the health care team and consultants.
• Demonstrate an understanding of the importance of communicating with the patient's primary care physician.
• Understand cultural sensitivities and patient wishes with regard to health care and incorporate this knowledge into discussions with the patient and family.

2. Coordination of Care

• Rationale
  • Interns play a central role in coordinating patient care; both during hospitalization and upon transition from the inpatient to outpatient setting. This involves communication between the patient and his/her family, colleagues, consultants, members of the health care team, and other hospital personnel. Appropriate; management and coordination are essential to ensure optimal patient care.
• Prerequisites
  • Communication skills as outlined above
  • Community health care skills consistent with Continuity of Care Clerkship
  • Coordination of Care consistent with Year III curriculum

Specific Learning Objectives:

2.1: Knowledge - Subinterns should demonstrate knowledge of:

• How to contact members of the health care team, consultants, and other hospital personnel.
• How to properly transfer care throughout a patient's hospitalization including end of the day and end of service coverage.
• Availability of community resources.

2.2: Skills - Subinterns should be able to:

• Prioritize tasks for daily patient care in order to effectively utilize time.
• Appropriately utilize consultants
  • Define a consultant's role in the care of a patient.
  • Identify appropriate issues for the consultant referral.
  • Discuss a consultant's recommendation with members of the healthcare team.
  • Effectively coordinate with physician and non-physician members of the health care team including:
  • Nursing staff
  • Physician assistants and nurse practitioners
  • Social Workers
  • Therapists (occupational, physical, speech, art...)
  • Pharmacists
  • Nutrition support staff
  • Discharge planners
  • Respiratory therapists
• Identify house staff on-call and cross-coverage schedules among house staff.
• Communicate oral and written transfer of patient care responsibilities to other house staff (e.g. at sign-out)
  • On call days
  • Upon transfer of the patient between services.
• Demonstrate proficiency in coordinating a comprehensive and longitudinal patient care plan.
• Communicate the plan with outpatient health care provider; arranging for follow-up when appropriate
• Enter orders and write prescriptions.
• Document clinical encounters that are accurate, focused and well-organized, and appropriate to the clinical setting (e.g. comprehensive new patient, abbreviated follow-up), documenting the patient's status and progress.
• Coordinate care plan utilizing community resources when necessary.

2.3: Attitudes and professional behavior - Subinterns should demonstrate:

• Respect for all members of the health care team.
• A willingness to assist other members of the health care team.
• Altruistic behavior.

3. Information Management

• Rationale
  • Interns face an extraordinary challenge in managing large amounts of clinical information relevant to a patient's hospital admission. Accurate and timely acquisition, documentation, and transfer of clinical information are necessary for safe and efficient hospital practice.
• Prerequisites
  • History acquisition and physical examination skills as per year III curriculum.
  • Test interpretation as per Year III curriculum.

Specific Learning Objectives:

3.1: Knowledge - Subinterns should demonstrate knowledge of:

• How to access the clinical information system in use at their hospital
• How panic values are communicated from the hospital laboratory to the responsible team member
• A systematic method to track clinical/laboratory/radiologic data.
• Patient confidentiality regulations governing medical records and clinical information.
• The importance of precision and clarity when prescribing medications.

3.2: Skills - Subinterns should demonstrate the ability to:

• Document the following in an organized and efficient manner:
  • Admissions notes; including the History and Physical Exam
  • Daily progress notes
  • Transfer notes iv. On-call emergency notes
  • Discharge summaries
• Use of electronic or paper references to access evidence-based medicine to solve clinical problems.

3.3: Attitudes and professional behavior - Subinterns should demonstrate:

• A respect for patient confidentiality rights.
• A respect for the patient's medical record as a medico-legal document.

4. Procedures

• Rationale
  • For fourth-year medical students, the subinternship presents an opportunity to gain experience with procedures that are commonly performed by interns and residents.
• Prerequisites
  • Basic and advanced procedures per School of Medicine Curriculum
• Collaborate with patients, families, and health professionals in a manner that optimizes safe effective patient-centered care.

Specific Learning Objectives:

4.1: Knowledge - Subinterns should demonstrate knowledge of:

• Indications, contraindications, risks, and benefits of each of the following procedures:
  • Venipuncture
  • Intravenous catheter insertion
  • Arterial blood sampling
  • Nasogastric tube placement
  • Lumbar puncture
  • Urethral catheter insertion
  • Intramuscular and subcutaneous injections
  • Bag and mask placement and utilization
  • Other procedures that are service-appropriate
• How the information obtained from these procedures will enhance the patient's care
• How to assess a patient's competence in order to provide informed consent for a procedure
• Potential procedure-related risks for the operator and the need for universal precautions.

4.2: Skills - Subinterns should demonstrate the ability to:

• Recognize clinical situations where one or more procedures are indicated
• Effectively explain the rationale, risks, and benefits of the procedure in language that is understandable by the patient and/or his/her family.
• Obtain and document informed consent, if necessary
• Recognize limitations of skill or proficiency in performing one of the above procedures.
• Personally perform, with direct supervision, the above procedures, when possible.
• Write a procedure note
• Ensure that samples obtained are properly prepared for laboratory processing.
• Teach procedure skills to a third-year medical student, when appropriate.

4.3: Attitudes and professional behavior - Subinterns should demonstrate:

• Respect for patient autonomy and the principles of informed consent.
• Concern for maximizing patient comfort and privacy.
• Commitment to learning how to perform procedures in an efficient and cost-efficient manner.