Fourth Year Surgery Sub-Internship

The fourth-year sub-internship rotation in surgery is an opportunity for medical students to function as an integral member of the surgery team with responsibilities commensurate with a surgical intern.  Sub-interns are expected to participate in patient rounds, outpatient clinics, daily operations and other surgical procedures.  You will have primary responsibility of patients, with appropriate resident and staff supervision.  Faculty preceptors within the specialty are assigned to each sub-intern to enhance the educational experience and oversee the rotation. A course description and outline will be provided to the preceptor as a means for guiding clinical activities. Sub-interns are expected to participate in all teaching conferences and Grand Rounds while on the surgical service.

Surgery sub-internship credit can be obtained by rotating on an inpatient general surgical service or surgical subspecialty service. In an effort to improve the ease and clarity with which students select a surgical experience that qualifies for sub-internship credit, the following experiences are acceptable.

• Hepatobiliary
• Surgical Oncology
• Colorectal Surgery
• Acute Care/Trauma Surgery
• Thoracic/Foregut Surgery
• Burn Trauma Intensive Care Unit
• Plastic Surgery
• Burn Surgery
• Cardiothoracic Surgery
• Vascular Surgery
• Transplant Surgery
• Pediatric Surgery

These rotations are deemed acceptable due to the intensity of the surgical experience in the hospital setting with responsibility that is on par with that of a surgical intern.  Any exceptions to these must be presented to the surgery sub-internship director (Dr. Stassen) for acceptability and approval by the individual Advisory Dean.

All sub-internship rotations require registration through the registrar’s office.  Rotations on the general surgery and subspecialty services are scheduled through the office of Dr. Nicole Stassen in the Department of Surgery.  A letter will be sent to participants in advance of the sub-internship asking for their site preferences.  All reasonable attempts will be made to accommodate the requests.  At the completion of the rotation, an exit interview is arranged to review course evaluations and obtain feedback of the rotation.

At the completion of the rotation, the sub-intern is expected to be able to organize data (laboratory, radiologic & pathologic) in a concise and coherent manner. The individual should be able to perform an efficient and thorough history and physical examination.  Based on the findings of the history and physical exam, the sub-intern should be able to define and initiate an appropriate care plan.  They should be comfortable with the preparation of a patient for surgery and the routine management of post-operative care.  During the rotation the sub-intern should expect to perform (under direct supervision) suturing of incisions, suture and drain removal, abscess drainage and dressing changes.  Competency based evaluations will offer an excellent basis on which to assess the medical student’s progress. 

I. Patient Care

• be reliable, keep track of all clinical events and participate on daily rounds, be primarily responsible for 2-3 patients at a time
• work closely with interns, residents and fellows
• perform detailed and thorough history and physical examinations
• devise patient care plans and participate in decision making process for patients
• learn to write medically appropriate, error-free orders
• maintain thorough medical records

II. Medical Knowledge

• develop a general knowledge of fundamental clinical principles and decision making process of basic surgical problems
• learn relevant anatomy & physiology to aid in patient care
• understand the fundamentals of evaluating surgical risk in both elective and emergent settings
• analyze available data relevant to your patient care
• read about each surgical problem you encounter and be prepared to discuss this with your preceptor

III. Practice-based Learning

• learn basic laboratory evaluation of emergent and elective patients
• understand basic indications for various radiologic studies
• reinforce basic concepts of tissue handling, suturing techniques and operating room procedures
• use instruments appropriately
• while scrubbed in the operating room, learn various exposure techniques, and become facile with suctioning, cutting and retraction techniques
• participate in daily rounds and all service related conferences
• plan to attend an outpatient clinic 1 day/week with a designated faulty member

IV. Professionalism

• be responsible and dependable
• understand the importance of honesty in the doctor-patient relationship
• learn about ethical issues such as informed consent and end of life issues
• learn how to participate in discussions and becomes an effective part of the surgical team
• maintain a presentable appearance that sets the standard for others

V. Systems-Based Practice

• pay attention to and learn from the assessment of patient care as discussed during rounds and the weekly M&M conferences
• be introduced to outcomes analysis, quality improvement and cost-benefit considerations of patient care
• begin to practice evidence based medicine though the use of practice guidelines and clinical pathways

VI. Research

• develop a basic understanding of and participate in the evaluation of surgical literature for credibility and applicability

Overall Goals and Objectives

The month long intensive surgical immersion in one of the surgical services provides the student with an opportunity to function as an integral part of the surgical team as an advanced surgical sub-intern. At the completion of the rotation, the sub-intern is expected to be able to:

1. Organize data (laboratory, radiologic & pathologic) in a concise and coherent manner.
2. Perform an efficient and thorough history and physical examination.
3. Define and initiate an appropriate care plan, based on the findings of the history and physical exam.
4. Display comfort with the preparation of a patient for surgery and the routine management of post-operative care.
5. Perform (under direct supervision) suturing of incisions, suture and drain removal, abscess drainage and dressing changes.

Competency based evaluations will offer an excellent basis on which to assess the medical student's progress.

Available sub-internship rotations may be viewed through the Visiting Student Application Service (VSAS)

• 2017 VSAS Student Handout
• 2017 VSAS Student Presentation

All sub-internship rotations require registration through the Registrar's office. Rotations on the general surgery and subspecialty services are scheduled through the Office of Surgical Education.  Please contact Julie Burkhart (585) 273-1712 (Julie_Burkhart@URMC.Rochester.edu) for further information.  

Nicole Stassen, MD
Associate Professor of Surgery
Director of Sub-Internship Program
Phone: (585) 275-5100
Email: Nicole_Stassen@urmc.rochester.edu