How to be a Stellar Sub-Intern (Surgery)

• Generally, students spend $2k to $5k on each away rotation (including flights/transportation, housing, and food costs) 

• Try to find ways to save money!

  • Live with friends/family to save on costs

  • Housing closer to your clinical assignment so you can save money on daily travel

  • Some programs will offer meal credits, so make use of them at the hospital

  • See housing/transportation tab below for more ideas

• Try to put some money aside for fun activities to see the city and get to know the community

• Contact the financial aid office (mayofinaid@mayo.edu) if you need help making a personalized financial plan for fourth year. 

• Generally the most expensive part of an away rotation is housing :(

• You want to ensure you’ve confirmed safe+secure housing so that you don’t have to worry about that after a long day at the hospital 

• Housing closer to the hospital can be more expensive, but that means you may be able to save on daily transportation costs by walking/using public transport 

• Use your network! Reach out to friends/family for free housing (and maybe food)!

• Ask past rotators/residents for housing recommendations 

  • Might be able to connect you with where they stayed/what they recommend

  • Check out our student bios in order to contact MCASOM AZ alumni

• Check out airbnb/vrbo for temporary housing

• Check out rotatingroom.com 

  • Need to make an account and upload proof of being a medical student, so set aside time to get this done earlier rather than later 

• Ask past rotators/residents if it’s helpful or difficult to rent a car

  • Might be annoying to figure out parking in a more urban hospital setting  

  • Might be necessary if you’re required to be at multiple sites around the city 

• Consider renting a car through turo or other budget rental companies 

• 4-5 pairs of scrubs (fewer if you’re doing a surgical sub-i as you’ll be wearing hospital scrubs most of the time)

• 3 clinic outfits (business to business casual)

  • At least one formal suit/professional look 

• Sneakers (or clogs) for the hospital 

• Flat shoes

• White coat (if you have one) 

• Jacket for the hospital 

• Work out clothes

• Pajamas 

• Fun clothes to see the city, hangout, attend program social events 

• Laptop, phone, chargers, etc. 

• Battery pack (optional) 

• Fanny pack (optional) 

• Backpack

• Toiletries (toothbrush, toothpaste, soap, shampoo, conditioner, SPF, etc.)

• Generally, Mon-Sat from 6 AM to 6 PM

  • One day off a week

  • 6-6 is the official shift, you may be required to come in earlier to pre-round 

• Generally, outpatient clinic days are shorter, but you still have patients on the floor to take care of. 

• Some programs may expect you to do a few overnight shifts. They may or may not offer a post-call day, so just be prepared

• Have a ~15 second presentation ready 

  • Who’s the patient, what's the problem, why are you telling me about this person

  • Presentation, exam, plan

  • You will be asked f/u questions, that’s when you fill in the details

• ALWAYS make double sure your patient was truly NPO overnight or else…

• In the morning: get numbers (vitals, ins/outs, and labs), what happened yesterday/overnight (check images, talk to nurses, check nursing and consult notes), and come up with a tentative plan for the day

  • Extra points if you keep a disposition plan in mind. 

  • Help your residents out by keeping the hospital course updated

• Read up on every single case. DO NOT go into an OR without having read up on the patient. That’s a sure-fire way to not get invited back and/or be HEAVILY pimped the next time you're in the OR because they can’t trust you to read up beforehand. 

  • Know the patient - name, age, relevant PMH, allergies, Caprini score

  • Read about the steps of the procedure 

• Know your anatomy. Easiest questions to be pimped on.

• Anticipate what the surgeons/team is doing. This will take some time at first, but if you have gloves or supplies ready, they’ll know you've been paying attention.  

• That being said - Gloves on immediately! You can’t be the first to help unless you’re gloved up. 

• In the OR: 

  • Introduce yourself to the entire team (scrub techs, nurses, etc.) and write your name on the white board 

  • Grab your own gown and gloves and for extra points- grab the residents’ gloves too (ask for their size)  

• Have extra dressing supplies in your white coat pockets OR wear a fanny pack. Some students will carry a little basket around, but a fanny pack will leave you hands free. 

  • Top tip: while you can carry supplies around to have on hand immediately, you could also leave extra supplies in the patients’ rooms if you know you’re going to be back the next day to re-dress something that’s been examined. 

  • Always have trauma shears on hand!

  • For dressing changes - grab the same things that they're taking off because they'll probably put the same dressing back on

  • If you’re doing a medicine sub-i, try to have the necessary tools handy such as your stethoscope, pen light, neuro tools, etc. 

• Watch the intern

  • See what they help with, figure out what you can do to help them do their job

• Start learning the dressings - Tegederm, telfa, curlex, etc.

• Extra tasks that may be appropriate at certain sites: draft the consent for the interns, write notes for floor patients, have brief post-op notes drafted, have the post-op team text drafted, etc. 

• The goal for your away rotation (or sub-internship) is to function as an intern and demonstrate that you’d fit well into the team at that institution. It really is a month-long interview, which means you need to be as prepared and engaged as possible at all times. Expect to work longer hours than you likely have on your home rotations, including weekends and/or in-house or home call. 

• Ways to be prepared:

  • Review the common diagnoses and treatments for your specialty. Know the can’t miss and emergent diagnoses. 

  • Know the common clinical decision rules and pathways. 

  • Common medications, doses, and side effects/contraindications. 

  • Ask yourself - what interests me the most? Where am I deficient or less strong? What are my goals for the rotation?

• During the rotation: 

  • BE. ON. TIME. (this means 15 min EARLY). 

  • Don’t ask to leave early. If there’s nothing going on - read, demonstrate that you’re continuing to learn. 

    • They often won’t dismiss you on sub-Is… you’re treated more like an adult with autonomy. Read the room and don’t be overbearing, but also don’t ask to leave early or hurry out of the rotation.

  • Don’t lie. If you’ve never done it or seen it before, be honest. They expect and understand that rotations are different at different hospitals. 

    • Tip: you can always say “I’ve never done/seen this, but I’d like to learn if you’ve got a second to walk me through it” 

  • Own your patients - and know them really well. Talk to nursing, case management, etc. to know as much as you can about what’s going on in their care. 

    • See them in the morning AND tuck them in before you leave to have a better idea of how they looked at the end of the day. 

  • Interact with your team. Have some personality! It’s okay to be yourself, but also remember that you’re there to work and learn. 

  • Have some fun! Do something local-ish (ask the residents what to do). Exercise, sleep, and rest too. That’s important to ensuring you can wake up and perform your best during the work week. 

  • Meet with faculty and residents before the rotation is over - ask for feedback, advice about applying, and ways you can communicate interest to the program. 

  • Request a departmental SLOE or letter of recommendation during the last week (if you’ve worked with the faculty member and know them well).

    • Ask the residents who is best to obtain a letter from! Often this is the department chair, but there are others that are well known in the field that may be of more benefit. Only ask for a letter if you really know them!

By Megan Campany, Class of '24

Here are some helpful slides from the Jan 2024 VSLO webinar. You can find the full webinar PPT here.

Goals for Pursuing Away Rotations: students use away rotations to...

• Explore a residency program

• Secure a letter of recommendation

• Meet specialty or degree requirements

• Consider a specialty not offered at their Home institution

• Explore a specialty other than their intended specialty

Before you start your Sub-I: 

• Know the differential diagnoses for common complaints

• Can’t miss diagnoses

• Common clinical decision rules

• Common treatments

• Presentation skills

• Ask yourself: 

  • What interests me the most? 

  • Where am I deficient or less strong? 

During the Rotation: 

• Be on time

• Be enthusiastic

• Be prepared

• Never lie

• Own your patients

• Ask questions

• Interact with your team

• Adhere with administrative requirements

• Be humble

• Have some fun!

• Exercise, sleep, rest

• Do something “local-ish” - great thing to ask residents/attendings! 

• Meet with faculty & residents

• Interview with us

• Request a Departmental SLOE

• Interviews

  • Rotation serves as an interview, some institutions may offer a built-in interview at the end of the rotation OR you may be invited back for a formal interview 

• Most sub-i's will offer committee LoR

  • Usually not as strong as someone who actually knows you but programs may expect at least one LoR from a sub-internship rotation 

  • If you end up working closely and often with one attending, that would be an appropriate person to ask for a letter. If you’ve worked with someone for 2 days, that probably won’t be a strong letter.

• Check out this PPT for more Surgical Sub-I Preparation Tips

• Check out this blog post by Tito Onyekweli M.D.

• https://blog.blueprintprep.com/medical/five-tips-for-sub-internship-success/

• https://blog.womensurgeons.org/training/sub-internship-success-a-how-to-guide/

• https://medschoolinsiders.com/medical-student/how-to-ace-the-sub-internship/