Sub-i’s in Family Medicine || Our wedding
We’re double married! We finally had our backyard with the love and support of our friends. It’s true. 95% of the day was a blur. I feel like I only remember the really awesome and not so awesome parts, but I think I can laugh about it. Imagine this, it’s the reception. We’re having a great time, dancing with these awesome glowsticks. I have curated a reception playlist. Painstakingly made the playlist during my sleepless nights on the 3rd year grind. Then our planner decides instead of just pressing play, she is now the DJ. She starts picking her own songs. Pangs of dead silence keep interrupting the night as she decides to skip songs in the middle. Giiiiirl.
Anyways, I think the timing was perfect in terms of my medical school timeline. We got married in October. It was stressful towards the end when I was doing the ERAS application and audition rotations. Then obsessively checking my email hoping for interview invites. But the wedding itself was in this nice little lull before the interviews.
I took about 3 weeks off for the wedding and also our honeymoon! With credit card points, we were able to book 5 days in Cabo at an all-inclusive resort. I absolutely love this type of vacation. Potating around and leaving a couple times to do activities like scuba or ride camels. This guy’s name is Hercules. His only job is to take pictures and eat carrots. We loved him!
It was a much-needed break before interview season. You know some schools actually build in a rotation break during interview season or have virtual electives? That’s amazing.
You know I had to have boba at the wedding!
My dried bouquet and our invitation
My Sub-i Experiences
A sub-internship (sub-i) is a type of clinical rotation where you attempt to work like an intern in a hospital/clinic where you are interested in matching. I call it an audition rotation or some say away rotation. It’s usually completed during the fourth year. Timing-wise, I completed mine in July, August, and November. You submit your residency application in September. Some Redditors say they gained an interview by rotating there, but of course, it’s not guaranteed. I am applying for Family Medicine. Many told me that doing audition/sub-i rotations is not as critical for gaining an interview as in other specialties. I’m glad I did the ones I did because it was especially helpful I knew the staff who interviewed me.
My experience: The rotations themselves were not incredibly different than my core FM/IM rotations. They varied in setting. One audition was completely outpatient, one was completely inpatient, and the last audition was 3 weeks inpatient and 1-week outpatient. During some rotations, I had limited access to the EHR and could see the patients with/before residents. In another sub-i, there were no residents and I did the notes, pended orders, called consults, and talked to case managers. There was another rotation, I did a mix. I would see patients with residents or I would see on my own and chief to the attendings. So the experience will depend on how the site runs things.
My tasks were mostly the same as in my core rotations. However, I tried to take on more by seeing more patients, speaking up more during rounds, and asking more questions about the program. As an introvert, I think it was helpful to tell my residents and attendings that it was an audition rotation for me. I also liked asking for feedback halfway through my time with them and at the end. I would ask at the end of the rounds when we’re all going our separate ways if I could ask them for any feedback. It was helpful both to get more time with the attendings, improve my letters of recommendation, and just know I was on the same page.
Comfort food during audition rotations tastes so much better (:
Tips I have for inpatient medicine sub-i’s
Make a routine: It was helpful to have a systematic approach to the day and to how I saw patients. I usually chart checked first for any changes (Event log in Epic), I&O’s, medications taken, any new notes, and what the plan was for today so I could keep the patient informed when I say them as appropriate of course
Try to save residents time. I think this is hard as a medical student. I felt like I was often in the way or I took up a lot of time. A lot of attendings have emphasized that we pay to be here. One calculated how much per hour, it was like +$200/hr. So I try to get the most out of your rotations but also try to be part of the team. I would offer to do things like:
Call families
Offer to counsel patients
Offer to run errands like if they needed to get a form from another floor or something like that
Ask for feedback. One attending told me to come up with 1-3 measurable things that she could give me feedback on. She mentioned it was helpful for attendings to know what you’re working on and what your goals are because a lot of time students come in with different perspectives about the rotation.
Look for ways to save yourself time, especially in the EHR: Especially Epic, there are ways to make your workflow easier. So look out for good dot phrases or reports (like the handoffs!) you can print that will save you time.
Take a good social history. An attending I loved working with emphasized this and had us ask every patient who they lived with, what they did for a living, their activity level at home (ADLs), what they enjoyed, and what made them the most anxious. Honestly, it felt a little strange at first. But I enjoyed this because you got to know your patient. Help motivate them to make changes based on knowing what they loved or help ease anxiety by addressing something simple like getting them earplugs because they didn’t love the noise of the hospital. On the practical side, it made discharge planning easier when you the barriers they have.
Ideas to talk about during rounds for those who find it hard to jump in:
Talk about something your patient said when you saw them during pre-rounds
Ask more questions
Something you learned from reading about the patient’s condition
Plan suggestions, especially in 4th year I feel like many attendings are looking for this
For my fellow introverts, take care of yourself! My social battery does run low during auditions so take time at home to fill your cup. Even if it’s just scheduling a face mask or listening to music. Doing at least one thing with the purpose of only refilling my cup every day was so helpful because this is a long journey!
In one of my interviews, the interviewer told me what my letters of recommendation said. Based on that, these were the things that my attendings found notable:
Communication with attending: asking for feedback
Communication with patients
Working at the level of an intern
Taking initiative
Writing notes
Talking to nurses
Working well with the residents
Professionalism
A point that was told to me many times: you’re interviewing the program as much as they are you. I think as an IMG, I had this mindset that I’d be lucky to get anything. So I went into the process very open. However, it’s also important to decide what kind of physician you want to be and what kind of training you want. It came up a lot in my interviews. All of the programs I interviewed with seemed to have robust education, but there were smaller details that would change the experience. Like there’s more OB here, more community medicine here, they do a little more inpatient here, or they have this certain electives/fellowships here.
Warmly, Rainee
Can’t wait to tell you about interviews!