CRITERIA FOR THE INTERNAL MEDICINE 4TH YEAR STUDENT SUBINTERNSHIP

1. Goals of this rotation are to:
   1. Provide greater responsibilities for the students
   2. Encourage and develop independent thinking.
   3. Provide better preparation for the student's PG-1 year.
2. On Call Nights at the CSC:
   All students (M4's) will be required to:
   
   1. Alternate new admissions with the Intern (PG-1) on call
   2. Cover all after hours calls from the nurses regarding patients on his/her own service. The on call intern will cross cover other services.
      A limit of 15-20 minutes will be allowed for the student to formulate a diagnosis and plan. The student will then call the resident on call for approval of plans and signing of orders.
   3. The Intern (PG-1) should not be involved in the M4's new admissions or calls for coverage unless it is an emergency. The resident on call should be the supervisor.
3. On Call Nights at the VAH:
   
   1. Alternate daytime admissions with the intern as above. When on call: the first night on call, the M4 does all the admits and the intern does all the cross cover. Reverse this every other night on call.
4. Daytime admissions:

   Work up every other new admission and call the resident for approval of orders and plans.

FOURTH YEAR STUDENT REQUIRED MEDICINE ROTATION

1. INTRODUCTION: 4th year students are expected to spend the majority of their time on the wards, taking as much responsibility for patients as their abilities permit.
2. GOALS:
   
   1. Learn the elements of patient care
   2. Improve problem solving and diagnostic skills
   3. Increase knowledge by reading about patient problems
   4. Perfect written skills i.e. histories, physicals, progress notes and orders
   5. Improve efficiency
3. STUDENT ACADEMIC MISCONDUCT POLICY AND PROCEDURES
   Examples of academic misconduct include, but are not limited to: submitting a paper or assignment (for example: H&Ps and progress notes) as one's own work when a part or all of the paper or assignment is the work of another; submitting a paper or assignment that contains ideas or research of others without appropriately identifying the sources of these ideas. If plagiarism is identified, disciplinary sanctions will be taken in accordance with the University Student Academic Misconduct Policy and Procedures. At a minimum this will include a lower grade for the course. Sanctions can include expulsion from the University.
4. DAILY SCHEDULE
   Everyone will pre-round on your patients prior to morning work rounds.
   Please follow the same schedule as your intern which will include all required weekly conferences.




5. CALL SCHEDULES
   
   1. Students must have one weekend day off each week.
   2. Students will take night call with their own PG-I/cross cover intern/resident.
   3. Beepers are assigned for the month if available.
   4. Students will follow the same post call duties as your intern
6. ABSENCE:
   
   1. If you are ill, you must call the Education Office at the site you are working with to notify them that you will not be coming into work. See List of Coordinators on OASIS for phone numbers. Also call your ward team by 7:30 am.
   2. You may not leave the rotation for any other reason unless you receive written permission to do so from Drs. Chheda or McKown. (The Standard Request for Absence Form on OASIS must be submitted to UW DOM Education Office). Housestaff, Ward Attendings or Site Directors cannot grant permissions for absences. Failure to obtain proper permission could result in failure of the clerkship.
   3. Please see note the UWSMPH clinical years attendance policy guidelines on OASIS.
7. WARD RESPONSIBILITIES
   
   1. ADMISSIONS/WORKUPS
      
      1. At All Sites, Work up and follow at least 4-5 new patients weekly. It is anticipated that each sub-I will complete 16 write-ups by the end of the rotation. Only three of these can use the "On-Service" format. The minimum number of write-ups, is 12. The intern will not be working up these patients. Supervision will be by the resident.
      2. At the CSC, alternate admissions with the intern including nighttime on-call admissions. Cover your service at night. The intern will cross over.
      3. At the VA: Alternate daytime admissions with the intern as above. When on call: the first on call night, the M4 does all the admits and the intern does all the cross cover. Reverse this every other call night.
      4. The 4th year student and 3rd year student should not be assigned to the same patient if at all possible.
   2. WRITE-UPS
      
      1. Write up patients using the standard write-up format. (See attached)
      2. The write-up must be on the chart the day the patient is admitted. It must be countersigned by the resident and the attending physician.
      3. These patient write-ups should be logged on the OASIS Fourth Year Experience Requirements checklist. These must be logged on OASIS by the last Thursday of the rotation before you are eligible to take the Sub-I exam.
   3. ORDERS

      Write admitting and daily orders after consultation with the house staff. These must be countersigned immediately or the nurse will not carry them out.

   4. PROGRESS NOTES

      Write daily progress notes with an assessment and plan for each active problem. These must be countersigned by the resident.

   5. PATIENT MANAGEMENT

      Always consult with the house staff before you make any significant changes in the patient's care.

   6. STUDENT SAFETY

      Do not draw blood, start IVS or have contact with body fluids from HIV positive, Hepatitis C positive patients. Take similar precautions with Hepatitis B antigen positive patients if you have not had the vaccine.

   7. PROCEDURES
      
      1. Venipunctures, peripheral IVs and blood gases may be done by the student once he/she becomes experienced.
      2. Lumbar punctures, paracenteses, thoracenteses etc must be closely supervised by the house staff or staff physician.
8. FINAL EXAM

   There will be a final on-line exam at the end of this rotation for all students at all sites. This exam will be 1 hour in length. This is a competency-based examination which must be passed in order to pass this required rotation.

   Directions:

   1. Review the Fourth Year Medicine Sub-I Pass/Fail Final Exam handout
   2. Complete the exam on the last day of the rotation at your site. Please check with the administrator as to where the exam will be given. All exams will begin at 2:00 P.M.

   The exam will be graded on a pass/remediate/fail basis. Students who are required to complete a remediation assignment must do so within 30 days. Failure to do so will result in a grade of BC for the course.

   Students who fail the exam will complete a remediation assignment, and will also be required to pass another written examination. If more than two attempts are required to pass the exam, the sub-internship grade will be lowered by one-half grade point.

9. EVALUATIONS
   
   1. The attending physician, after consultation with the resident, will evaluate and grade each student at the end of the month. This will be discussed with the student.
   2. The student will evaluate the resident, the attending physician and the conferences. This evaluation must be returned to the education office before the end of the rotation. The grade for the rotation will not be forwarded to the Medical School until the student's evaluation of the rotation and patient list have been received, and your exam has been taken and passed.

We hope you enjoy the month. If any problems arise please let one of us know promptly.