Geisel School Sub-Internship Policy

  1. Policy
    1. All students are required to perform a 4-week sub-internship during their fourth year at the Geisel School of Medicine at Dartmouth. Sub-internships can be done only by 4th year students.
    2. The sub-internship experience is intended to give students a more advanced level of direct patient care responsibility, greater than that required during a third-year or fourth-year clerkship or elective, and comparable to the level of clinical responsibility assumed by an intern (although often with less pressure and volume). The key concept is that the student assumes direct responsibility for management of patient care, reporting directly to a resident or attending physician, assuming the place or responsibilities of an intern.
  2. Operation
    1. During their third year, students will design a fourth-year schedule consisting of required clerkships, required courses, and electives in consultation with the Assistant Dean of Medical Education, and with advice from their Advising Dean and/or departmental internship/ residency advisor if desired. Students will identify and schedule a four-week sub-internship as part of this fourth-year schedule.
    2. A faculty supervisor (or director of the subinternship for that month) must be identified on the service where the sub-internship will be performed who will be responsible for submitting a written evaluation and grade.
    3. The Assistant Dean of Medical Education will approve all sub-internship choices in the context of approving all fourth-year schedules.
  3. Rules for Choosing a Sub-Internship
    1. Sub-internships may be chosen in any clinical area in which the student previously has performed a clerkship, such as medicine, surgery, psychiatry, pediatrics, obstetrics and gynecology, neurology, and family practice.
    2. Students can choose any clinical field which offers an appropriate experience in which to perform a sub-internship, and are not restricted to the field in which the student plans to apply for post-graduate training.
    3. Sub-specialties of the major fields may be chosen (eg, urology, orthopedics, cardiology, etc.) if the institution in which the subinternship is performed has interns rotating on these services from the major clinical fields (eg, medicine, surgery), and if the rotation fulfills the requirements of a sub-internship rather than an elective. Again, the key criterion is that the fourth-year student is operating at a level of direct patient-care responsibility comparable to that of an intern.
    4. Students should perform their sub-internships on an inpatient service or on a service with at least some inpatient responsibilities whenever possible.
    5. Students performing sub-internships will work under the direct supervision of a resident or attending physician, in parallel with other interns on the service.
    6. The sub-internship may be performed at any teaching hospital of the student's choice. Students choosing sub-internships at non-Geisel School-affiliated institutions should follow the Geisel School rules and procedures established for choosing electives at outside institutions.
    7. Students may, if they wish, consider scheduling a subinternship at an institution to which they plan to apply for a residency position. Such students should seriously consider the advantages and disadvantages of such a choice and discuss them with an advisor.

      Commentary: The advantages are that students may learn much about that institution, and if they perform well, may derive an advantage in internship or residency selection. However, students in the past have observed that it may be difficult for sub-interns to "shine" because so much of internship success requires efficiency, and most efficiency is learned in the first month at a new institution. Students may prefer to perform an elective rotation (e.g. in which students work as consultants rather than as subinterns) at such institutions where knowledge of the workings of the institutions is not such a critical element of perceived performance. Our faculty can advise students in this regard, but the ultimate choice is the student's.

  4. Grading
    1. The attending faculty supervisor will submit a written evaluation and grade to the Registrar for the student sub-internship. As with all other Year 3 and Year 4 clinical rotations, grades will be Honors; High Pass; Pass; and Fail.

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