Welcome to the Johns Hopkins Hospital sub-intern elective on the Hospitalist service. The hospitalist service consists of eight full-time faculty members who care for patients on a 17-bed unit on Halsted 6. We are ready and eager to teach. Dr. Lenny Feldman is the course director, and is happy to answer any questions (lennyf@jhmi.edu).
The rotation is an advanced medicine clerkship for medical students who have already completed their basic clinical rotation in medicine. The four-week rotation provides training in the care of hospitalized patients in a tertiary-care setting. We accept sub-interns year-round.
Note: All medical students who want to apply for a sub-internship spot on the Osler Firms, the Nelson 4 Service, or the Polk Unit should refer to the Advanced Clerkship website: http://deptmed.med.som.jhmi.edu/advclerk/.
Contact Information and Requirements
Objectives
- Expansion of skills needed to accurately and efficiently assess, diagnose, and treat general medical conditions requiring hospitalization
- Acquisition of procedural skills necessary for immediate provision of care
- Development of problem-solving skills needed to facilitate future medical care/compliance in a patient population frequently without prior medical care
Students will work under the direct supervision of attending hospitalist physicians on a service without third-year medical students or interns. There may occasionally be resident rotators from other institutions. Given the team structure, students interact one-on-one with their supervising attendings allowing for teaching to occur when the opportunity arises. Much of the teaching you will receive on this rotation will occur as “teaching moments” present themselves, rather than through formal didactic sessions. There are, however, ample opportunities for sub-interns to attend conferences.
Patient Care Experience
Students serving as sub-interns will admit their own patients and will assume primary responsibility for their complete care, including: writing admission, progress, and discharge notes; developing and implementing diagnostic, therapeutic, and discharge plans; performing all routine procedures; inputting all of their patients’ orders; and communicating with family members, consultants, and primary care physicians. In addition, they will spend a portion of their on-call time carrying the hospitalist pager and cross-covering the hospitalist service with in-house attending supervision. Students will be expected to discuss their patients in detail at daily attending rounds and multidisciplinary rounds.
Students will follow 3-4 patients daily, preferably cases that they have worked-up on admission. If a sub-intern has fewer than 3 patients at the beginning of a non-call day, he/she will follow one of the new patients admitted in the last 24-hours.
There is no overnight call. Each call day, the sub-intern will be expected to admit two patients. Students take call from 7am-10pm three times a week. Call days will either be Monday, Wednesday, and Friday or Tuesday, Thursday, and Saturday from 7am-10pm. Please alternate the call schedule weekly. Two students should not take call on the same day. This schedule provides each sub-intern with at least one day off each week, but students will be expected to round on patients on two Saturdays from 8am-8pm during the rotation. The on-call sub-intern will hold the hospitalist pager after sign-out each call day and will take care of cross-cover patient issues.
Teaching/Formal Didactic Experience
Teaching occurs throughout the day with the on-service attending. In addition, formal conferences and didactics include: 1) noon conferences with the Johns Hopkins medicine residents Monday-Thursday 2) bi-monthly case-based didactics led by Dr. Bimal Ashar of the Division of General Internal Medicine 3) conferences on clinical genetics led by Dr. George Sack of the Division of General Internal Medicine 4) monthly sub-I noon conferences by a hospitalist attending 5) weekly intern report 6) twice-weekly hospitalist teaching rounds
Students will also prepare one (20 minute) presentation incorporating evidence-based medicine resources to answer a focused clinical question pertinent to a patient that the sub-intern has followed. These presentations are typically given in a PowerPoint format, and all the hospitalists make an effort to attend. Lunch will be provided. Please discuss the topic with Dr. Feldman.
Feedback
Feedback occurs at least two times during the rotation, once at a mid-point and once at the end of the rotation. In addition, feedback from students is always appreciated in an effort to provide the most rewarding experience possible.
Evaluation
Students will receive a written evaluation from the hospitalist attendings upon completion of the elective. Students are asked to provide a written assessment of the elective as well.
