Tips from my Sub-Internship

After having my Sub-Internship experience, I would like to share some of my observations with you in the hopes that it will help you to avoid some of the pitfalls that I have seen.  From the beginning of medical school, people begin telling you about the magic of 4th year.  They tell you to hang in there with all the classroom time and late night studying during years 1 and 2. They say that it will be OK even though you are working 12+ hours a day during 3rd year. They tell you it will all be worth it when the 4th year comes along.  We build it up to the point that when it finally arrives, we feel entitled to take advantage of the relaxed schedule and improved hours.  But it's important to remember that while 4th year is (in fact) glorious, there is still some important work to do.  The Sub-Internship is a job interview.  Basically, you are sampling a residency program, and they are in turn sampling a potential resident (You!).  With that in mind, here are some tips to help you stay on track to impress. 

First, I made it a point to go in early and stay late every day.  If you are tired, suck it up. I guarantee that the intern that you are working with has already put in more hours than you have.  You want to show the program that you are a hard worker.  Volunteer to help even if its outside of your comfort zone.  I learned to dictate which is awkward if you've never done it before.  But it is a skill I will need, and it was a small thing that I could do to help out.

Second, jump in on procedures and other learning opportunities.  Be aggressive. This is not the time to be a fly-on-the-wall.  As a Sub-I, you can function like an intern without having ultimate responsibility.  You are first in line among the students for interesting cases and procedures.   The faculty are likely to let you do a procedure that you've only observed up until this point.  Seize that opportunity and show them that you are teachable.  They do not expect you to know how to do a circumcision by yourself, but they do want you to be willing to jump in and learn.

On my rotations, I watched as students stood out for less than desirable reasons. Once a student mentioned that he really wasn't interested in doing OB in his future practice.  Tailoring your practice to your interests is one of the great parts of Family Medicine, but when you are on your Sub-I is not the time to draw your line in the sand. You have a lot to learn and the least you can do is be helpful.  Don't stand around simply because it doesn't interest you.  Another student told me that I shouldn't work so hard because I'm a 4th year student.  Do NOT fall into this trap!  I think about the residents working with me. I want to try to work as hard as they are working. 

Be careful about your interactions. Use good judgment and conduct yourself as a professional at all times (even socially).  A good rule of thumb is don't order alcohol when you are with residents. Be careful about your social networking. You can add new resident friends on Facebook, but be sure that there is nothing on your profile that will make you look bad (drunken pictures at the bar, crude wall posts, etc.).  

Finally, write thank you cards to the people that you worked with, especially if you are interested in their program.  It shows that you are grateful for the time that they invested in you and you are a thoughtful person. Do this and you will make a great impression while having fun!         

The Last Week of My Sub-I

I spent a few days during the final week of my Sub-I working at a women's crisis clinic which offers free ultrasound, counseling, and prenatal care.  While I was there, I met a woman who came in at eleven weeks gestation for her first ultrasound.  She had one young child at home and lived with her long-time boyfriend. She was very nervous during the ultrasound and joked about how many babies we saw on the screen. At first we saw only one gestational sac, but as the ultrasound tech continued to look we noticed a second baby. When the patient started crying, I was not sure what to think. I initially thought they were tears of joy until she sobbed "this is not good". She started talking about how she did not think that she could handle twins. It would be too much. I tried to console her and just held her hand while the tech completed the ultrasound. 

Afterward, I had a chance to sit with her and talk about her concerns for this pregnancy.  Her support system really only consisted of a sister who lived in another state. Her boyfriend was not supportive. He had been pressuring her daily about getting  an abortion. Now, she was afraid to tell him she was having twins for fear that he would become angry and kick her out of the house. His reasoning was that now wasn't a good time for him. It was hard for me to believe what I was hearing.  This woman was genuinely afraid of the reaction of her boyfriend.  She denied any history of physical abuse, but she believed that he would put her out on the street if he knew she was having twins.  She had nowhere to go.

She stayed at the clinic while a social worker contacted a local women's shelter. By the time she was ready to leave, she had made the decision not to tell him about the ultrasound until she had an alternative housing plan. The tech gave the woman her cell phone and told her she could stay with her if anything bad happened before she could make other arrangements. When she walked out the door, the ultrasound tech and I shared a hug and a tear for our patient. I don't know how things turned out for her, but I think about her often. I hope she is safe.

The third and fourth year are so different. You leave behind hypothetical patients and standardized tests and begin spending your time with real patients who have real tragedies. It is very difficult, sometimes, to separate the emotions that you feel at work from your personal life.  I have cried a few times after a particularly difficult day, but I think that's healthy. Hopefully, we all went into this field because we are compassionate.  The important thing is to do as much for you patients as you possibly can, and take comfort in that when you fall asleep at night. 

The Sub I continues

I spent the third week of my sub-I with the medicine team. I am really impressed with the training opportunities that are available in their residency program. And the residents are really smart. The first year residents (interns) are bright and efficient-they always seem to know the next step. I hope to be half that good when I start residency! The staff in this program are all very approachable and ready to teach. I haven’t seen anyone talking down to the residents, nor have I seen any friction between the residents themselves.

I have been paying close attention to these interactions because I want a residency program that will encourage learning and be a relatively happy place to work. The residents at this program seem truly happy and satisfied with their program. There are a lot of different personalities, styles, and belief systems, but I think since people are generally content with the way they are treated by the program, it is easy for them to work together regardless of their differences. Each attending that I have worked with has made a point to learn my name. I have been writing progress notes and even orders (they have to be signed by a real doctor) which has been excellent training for me. Everything here has been in a paper chart, but I’m getting the hang of it now. (Of course, just in time to leave!)

Earlier in the week I joined a few of the girls for dinner. It was nice to sit down and relax with them outside of work. I thought it would be good for me to hear what my potential future colleagues are complaining about when they are on their off time. It could give me clues to the obstacles that I might face later on in my training. This group didn’t really have any complaints. In fact, we spent most of our time figuring out all of the things that we had in common. On Friday, one of the residents arranged for everyone to attend a baseball game. My husband, Matt, drove in so he could meet everyone. It was so much fun to spend time with the residents outside of the hospital.

I highly recommend that students rotating through their sub-internship go to these extra activities. There may be times when you are exhausted, but it is a wonderful opportunity for you to learn about the people you might be working with later on in residency. Plus, it gives them an opportunity to see you let your hair down (a little)!