1. UH Sub-Internship 2016 DHM Best Practices L Noronha, MD Assoc Clerkship Director April 20, 2016

2. Objectives Review timing and purpose of UNM sub- internship Reflect on personal experiences Share planned 2016 Sub-I activities Confirm attending role

3. Session Outline UNM SOM Calendar – 5 min TPS – 10 min Sub-I role – 10 min HVC – 3 min Discussion – until 12:55pm

4. “…the main purpose students have for the fourth year and the sub-i are to get ready for residency and apply for and obtain a residency.” -Dr. Deepti Rao WGEA LEAD fellow Outlook email 4/19/16

5. SOM Calendar for CO’17 Phase I Phase II Phase III – Required: Sub-I, ICU, CAC, Med in NM – Electives Submit requests in March after meeting with match advisor

9. A Comparison of Medical Students’ and Internal Medicine Program Directors’ Perceived Skill Needs for Internship * L Noronha, MD, * S Mayasy MD, § B Liston MD, * D Rao MD *University of New Mexico School of Medicine § Ohio State University Discussion Stakeholders in the training of sub interns have varying perspectives on priorities for this important clinical experience. Existing assessments of student goals and internal medicine residency program directors opinions on expectations for readiness to function as an intern have not been compared. Introduction Results Students’ and program directors’ goals for their sub internship rotation provides useful information about perceived gaps and areas of growth potential. Data gathered in 2013 suggests students mainly want to increase medical knowledge and develop skills in patient management, including operational tasks. Program directors ranked development of recognizing situations and communication skills as the most important domains for new internal medicine interns. These responses may reflect experience with problems borne from lack of these skills. Not surprisingly, both groups surveyed gave a moderate to high level of importance to efficiency. Methods Students starting internal medicine subinternship at the University of New Mexico between April 2010 and April 2012 and at Ohio State University between July 2012 and July 2013 were surveyed regarding their goals for the rotation. In 2010, the Clerkship Directors in Internal Medicine (CDIM) subinternship task force performed a survey of internal medicine clerkship directors to identify skills expected in new interns. 36 items were scored to reflect perceived level of priority. Additionally, “free text” responses could be entered. These were compiled into a separate list of common themes. In both surveys respondents were allowed to select more than one item. 40 students completed the survey at the University of New Mexico and 175 at Ohio State University. 282 of 377 program directors completed the 2010 CDIM sub internship task force survey. References Lyss-Lerman, P, etal. “What training is needed in the fourth year of medical school? Views of residency program directors.” Academic Medicine. 2009. Vol 84, 823-829. Langdale, LA, etal. “Preparing graduates for the first year of residency: are medical schools meeting the need?” Academic Medicine. 2003. Vol 78, 39-44. Sidlow, S, etal. “The internal medicine subinternship, a curriculum needs assessment.” J Gen Int Med. 2002. Vol 17, 561-564.

10. Survey of 20,484 IM residents at time of 2013-2014 ITE Asked to rate which of the following would have been most important to learn prior to internship? [very important – somewhat – not – unsure]

11. 2015 Sub-I Feedback “I had several attendings communicate with me primarily about my patients, which I also appreciated because it made me feel like I was being trusted with my patients and their care. I felt like a more functional member of the team this way.”

12. Surgeon General calls for culture of ‘emotional well-being’ “We’re not just talking about trying to build a couple of intervention programs where people meet in small groups once a week. This is about shifting perspective in culture, recognizing that emotional well-being is an essential tool for clinicians to be able to do their jobs well.”

13. Think-Pair-Share (10 min) What do you remember about your IM Sub-I (or equivalent experience)? – Where – Role – What emotions does this provoke – Impact on career Confidence Passion Path

14. Rotation Routines Welcome email 2 weeks in advance Day 1: Sub-I Orientation Day 2: 11 am Intern orientation (Chief Resident) 2 nd Tuesday: Attending evaluation 2 nd Friday: Mid-point feedback (from me) 3 rd - 4 th Tuesdays: Attending evaluations Final Friday-Sunday: review feedback/grade

15. Team Assignments By resident > attending – Role model, patience, teaching Try to avoid 2 Phase II students with Sub-I – Space, computers, crowd

16. UNM Sub-I Role Schedule/duration 4 weeks Includes last weekend 1 day off/week Morning report GR/Thurs School BATCAVE* HVC Curriculum* Duties # patients Oral presentations Notesᶲ – HP – PN – DC Team pager Teaching team/patients *optionalᶲ to be discussed

17. Role, Part II Should do admissions, MICU accepts Should not see same patients as Phase II students May have continuity clinic

18. HVC Curriculum Optional, formative 4 sessions 45 minutes afternoons

19. Evaluation Individual goals Same attending form as Phase II Midpoint meeting Performance over month

20. Comment on LOR Offer/request Timeline Department LOR

21. DHM Faculty Expectations (next 5 slides) PRIME feedback Documentation review Career advice/support Offer to write LOR

22. PRIME Feedback Advance notice from Office of Education Scale If you work with them on serial weeks Quotes will go into Dept Letter

23. Documentation Review – decide now HP (see handout) – Attending note below with billing requirements vs Resident HP for billing – Review within 48hours Progress note – IPPN (not “medical student note”), attending note below DC Summary – Format – Review within 48hours

24. Discussion