MDC7203
Senior Medicine Acting Internship

Syllabus for the Medicine Sub-Internship
2025-2026

Responsibilities and Expectations

General Philosophy: Strive to function like an intern on the team.
The sub-Internship is more than just a required rotation or a refresher on the wards. Residency program directors across the country expect the sub-Internship to be the definitive testing ground to make sure you are ready for internship. As such, it is critical that you seize this opportunity to function just like the other interns on your team – forming your own independent assessments, developing your own plans, and taking full ownership of the care of your patients (with help from the literature and your team, as needed).

At this point in your education, you should be proficient in performing H&P’s and coming up with an initial differential diagnosis and assessment. Now it’s time to develop your problem solving abilities, improve your efficiency, hone your presentations, and gain comfort designing your own treatment plans. We want to give you as much autonomy as possible.

Course Logistics
You will be assigned to a ward team typically with one resident and two to three interns. For the general medicine teams, admissions are distributed across an Early Call day, a Mid Call day, and a Late Call day, followed by a day of no admissions. The subspecialty teams admit every day.

As a Sub-I, you report directly to the resident, not the interns and you should follow patients directly with her or him. Your attending should co-sign your H&P’s in order to give you feedback, but your resident should co-sign all progress notes and orders. When your resident is off, your attending is your supervising physician, although the interns may co-sign orders to help expedite patient care.

Workload and Clinical Expectations

• You will be on the same call schedule and have the same number of days off as the other interns.
• You should attempt to admit a patient on every admission day just like the interns, aiming to carry a patient max of 4-5 at a time.
• You should put your own orders in whenever possible.
• You should sign-out your own patients to the cross-cover resident every day and receive sign-out back every morning at 7am.
• You will gain further experience with sign-out and cross-cover working two nights with the night team (more below).

Write-Ups and Charting

• Every patient you admit needs an H&P and daily progress note.
• Unlike as a third year, H&P’s should be on the chart the day of the admission
• H&P’s should be co-signed by the attending
• Progress notes should be on the chart everyday (ideally by noon).
• Progress notes should be co-signed by your resident.
• Copying and pasting portions of other providers’ notes constitutes fraud and is not permitted.

Conferences

• Attendance is expected at any conference that includes interns unless patient care requires your presence.
  • Morning Report is on Wednesdays at 7-7:30am in the Medicine Library.
  • Noon Conference is at 12pm every day except for Thursday.
  • Grand Rounds is 11am on Thursday

“Night Shift” Cross-Cover
Each of you will select one of your “Long-call” days over the course of the rotation where you will stay until 11:00pm and assist with cross-cover. Doing the cross-cover on your Long-call day will ensure that you are not doing it at the same time as another Sub-I. Students on Cardiology and Heme-Onc will do cross-cover on their own unique clinical location, and therefore may select any one night during the rotation. This is a requirement of the rotation. Notify Dr. Hood at to let him know which night you will cover.

Days Off
This is a mandatory rotation. If an emergency occurs such that you need to be away from the rotation more than your allotted one day per week, you must obtain prior approval from Dr. Hood. Failure to do so could result in an unsatisfactory or incomplete grade. You must also notify your resident and attending. If the absence occurs while in Jacksonville on a clinical rotation, you must also notify Lavetta Jones in the Office of Student Affairs by email or by phone (904)244-8314.

• Just like the interns, you will receive one day off per week, on average.
• You may pool your days off together if you need to take a weekend off.
• The last day of the rotation is the final Saturday, which most students typically take as their final day off.
• Holidays are not extra days off during the Sub-Internship, although they may be taken as your day off for the week.
• If the first Monday of the rotation is a federal holiday, the rotation and orientation will begin on Tuesday.
• See Policies and Procedures for more information about planned and unplanned absences.

Patient Logs
You must continue to maintain patient logs as a requirement for College of Medicine graduation requirement, even during the Sub-Internship. Failure to demonstrate a reasonable effort to maintain logs (defined as less than 10 presentations logged or logging all entries the last week of the clerkship) may result in a lowered Professionalism competency score or an “Incomplete” grade.

Policies and Procedures

The University of Florida Honor Code
“We, the members of the University of Florida community, pledge to hold ourselves and our peers to the highest standards of honesty and integrity by abiding by the Honor Code.”
Honor Code

Professional Behavior

• You should dress professionally at all times.
• You should be polite and respectful to your patients and colleagues at all times.
• Never falsify information. If you do not know, simply say “I don’t know.”
• Cutting and pasting anything other than online medication lists and lab data is fraud.
• You are expected to do your own work, regardless of what you may observe others do.
• All patient information is confidential and should be discussed only with those involved in the patient’s care. Do not talk about patients in public places, no matter how softly you think you speak.
• It is strictly forbidden to access any patient records outside of the hospital. Doing so will result in all students losing all computer privileges.
• You may not use USB ports to transfer patient information.
• If you need to work on a write-up at home, de-identify it and you may email it using ONLY your ufl.edu email account.
• Cell phones with cameras must have the camera disabled if they are to be taken in patient care areas.
• If you wish to take a picture of a patient for medical/educational reasons, discuss the proper procedure and consent form with your resident or Chief Resident.
• Unprofessional behavior will result in a lowered Professionalism competency score and potentially an unsatisfactory evaluation for the Sub-Internship.

Unplanned absences

• In the event of a single-day, unexpected absence due to illness, you MUST notify the Medicine Clerkship office preferably by email as soon as physically possible.
• You must also contact both the Sub-internship Director and your resident.
• If the absence occurs while in Jacksonville on a clinical rotation, you must also notify Lavetta Jones in the Office of Student Affairs by email or by phone (904)244-8314.
• If you are absent from the rotation and do not communicate with the office and cannot be reached, the office of Medical Education and Dr. Harrell will be notified that we have been unable to contact you and a search for you will be initiated.

Planned/excused absences

• Planned absences discussed in advance with Dr. Hood must be made up at the beginning or end of the rotation in order to ensure adequate clinical experience. This may require an extra call or weekend experience.
• Missed days which cannot be completed before Sub-internship end date result in an “Incomplete” grade.
• Failure to adhere to these policies and procedures will result in a lowered Professionalism competency score.

The official COM policy can be viewed at:
COM Policies and Procedures

Reporting problems
Problems with your resident, an attending, intern, or a general concern should be reported to Dr. Hood as soon as possible. The Sub-Internship should be a great experience and all concerns will be addressed appropriately.

Email is the predominant source of communication regarding updates in the clerkship. It is expected you will check your email daily. Email is also the primary means of communicating with us. Our department is committed to an excellent student experience and we believe good communication is the principle foundation to achieving this goal.

Student and Course Evaluations

Student Evaluations
Your final grade is derived from the competency-based evaluation forms submitted by your team members. You are strongly encouraged to regularly review your performance with your resident and attending, in particular mid-rotation using the written Formative Evaluation Form for the Medicine Sub-Internship. This will minimize surprises on the summative evaluation.
Successful completion of the course requires participation in the night rotation and in all mandatory Sub-Intern Conferences (unless absence is excused in advance by Dr. Hood).

Sub-Internship Evaluation
There is an anonymous, online clerkship evaluation that must be completed in order for your grade to be released. This evaluation form can be accessed through New Innovations under the Required Medicine evaluations. These evaluations are vital to the success of the Sub-Internship by ensuring adequate levels of teaching. This feedback is also helpful in resident/faculty evaluations and award nominations.

FORMATIVE EVALUATION FOR MEDICINE SUB-INTERNSHIP

PROFESSIONALISM

• Respectfulness
  • Always respectful
  • Minor lapse in respectfulness
  • Area of concern
• Work Ethic/ Dependability
  • Consistently takes initiative and follows through
  • Sometimes requires prompting but always follows through
  • Area of concern
• Motivation/Excellence
  • Actively strove for excellence
  • No problem with motivation
  • Area of concern
• Honesty
  • Honest even when it entails personal risk (e.g. readily admitting a mistake, giving due credit to someone else, etc)
  • There were no concerns
  • Area of concern
    

Goals and Objectives

The Department’s expectations of your performance are aligned with the College of Medicine’s competency-based curriculum. You will be evaluated specifically according to these competencies:

Competencies

• Professionalism
• Patient Care
• Medical Knowledge
• Practice Based Learning
• Interpersonal and Communication
• Systems Based Practice

Your performance in these competencies is determined by your proficiency in the goals below. Specific objectives are listed to guide you toward successful achievement of these goals.

Goal 1: Evaluate and manage patients hospitalized with an acute illness.
(Patient Care, Medical Knowledge)

Objectives:
1. Independently obtain and record patient histories in an efficient, organized, and thorough manner.
2. Refine physical examination skills by performing and recording a physical examination in a logical, organized, and thorough manner incorporating advanced and disease-specific physical examination maneuvers when appropriate.
3. Understand and be able to communicate the reason for a patient’s admission and learn admission criteria for common illnesses.
4. Formulate a comprehensive but concise problem list with differential diagnosis as appropriate, based on the history, physical examination, and diagnostic tests obtained.
5. Generate and communicate thoughtful assessments and plans for evaluation and management.
6. Initiate and enter patient orders for admission, inpatient management, and discharge, understanding the rationale for each order.
7. Provide interpretation of test ordered, including CBC, chemistries, urinalyses, coagulation studies, cultures, ECGs, telemetry, and x-rays.
8. Recognize variations in common laboratory findings and vital signs, with particular attention to blood pressure, heart rate, and glucose monitoring.
9. Develop familiarity with drugs of choice for common medical conditions (such as cardiac disease, diabetes, COPD, pneumonia, cellulitis), including the rationale for their use, contraindications, and proper adjustment according to age and renal function.
10. Determine proper routes, rates, and choice of agent for electrolyte correction and fluid replacement.
11. Modify the primary diagnosis and its management based on diagnostic information.
12. Continuously reassess the patient throughout the day and hospital course.
13. Recognize when a patient has met criteria for discharge, and secure the necessary paperwork, orders, medications, and post-discharge follow-up.

Assessment methods:

• Observation by resident and attending physician during concurrent evaluation of patients.
• Review by resident of all electronic orders.
• Daily participation in rounds, including independent oral presentation of all patients.
• Review of patient write-ups by attending physician and resident.
• Successful generation and entry of patient orders as monitored by resident.
• Self-recruitment of focused feedback from attending and resident utilizing the Formative Feedback form.
• Summative feedback from the team using a standardized evaluation tool.

Goal 2: Work effectively as part of an inpatient team to care for patients but with more independence in preparation for residency training.
(Professionalism, Patient Care, Interpersonal and Communication, Systems Based Practice)

Objectives:
1. Present all new patients on rounds including focused history, physical examination, laboratory data, assessment, and plan in a concise, organized manner.
2. Present concise and well-organized follow-up presentations on established patients with particular attention to the plans development and rationale.
3. Weigh risks, benefits, evidence, and costs when recommending diagnostic and therapeutic plans.
4. Write daily progress notes that thoughtfully, concisely, and legibly communicate to other members of the team the patient’s current status regarding the diagnostic work up and therapeutic plans.
5. Establish excellent rapport with patients as their primary caregiver (without misrepresentation of student status), including addressing the emotional and social needs of the patient and appropriate family members.
6. Effectively communicate with other members of the health care team including nurses, social workers, consultants, physical therapists, and ancillary staff.
7. Consistently demonstrate respect, reliability, helpfulness and initiative modeling the highest degree of professional behavior.
8. Identify patient discharge needs throughout the hospital course, incorporating team members early to overcome obstacles to discharge.
9. Coordinate all activities surrounding discharge planning insuring that the patient and/or caregiver clearly understands the plan, how to take all discharge medications and their risks, any new safety concerns, follow up arrangements, and any other needs specific to the patient.

Assessment methods:

• Daily participation in rounds, including independent oral presentation of all patients.
• Review of patient write-ups by resident and attending physician.
• Successful generation and entry of patient orders as monitored by resident.
• Self-recruitment of focused feedback from attending and resident utilizing the Formative Feedback form.
• Summative feedback from the team using a standardized evaluation tool.

Goal 3: Initiate a management plan for the important inpatient medical problems that were introduced during the 3rd year clerkship. In addition, be able to evaluate and initiate management for important inpatient medical emergencies.
(Patient Care, Medical Knowledge, Practice Based Learning, Interpersonal and Communication, Systems Based Practice)

Objectives:
1. Accurately recognize and development appropriate management plans for common medical conditions that require hospitalization, including the following:

• Abdominal pain
• Altered mental status
• Arrhythmias
• Drug and alcohol withdrawal
• Electrolyte abnormalities
• Gastrointestinal bleeding
• Hyperglycemia, DKA, or hyperosmolar syndromes
• Hypertensive emergency
• Hypotension
• Musculoskeletal pain or swelling
• Nausea and vomiting
• Renal failure
• Seizure
• Shock/Systemic Inflammatory Response Syndrome (SIRS)
• Shortness of Breath
• Syncope

2. Apply an evidenced-based approach to problems and questions that arise in the clinical setting.
3. Recognize when consultation from another service is required and initiate it in timely and respectful fashion to the consultant.
4. Recognize potential sources of medical errors and be able to differentiate between individual vs. systems problems that can lead to adverse outcomes.
5. Assess unforeseen patient emergencies and initiate appropriate evaluation and treatment.
6. Recognize patients requiring immediate attention by a supervising physician and communicate appropriately.
7. Identify objective criteria and findings that necessitate relocation to a higher level of inpatient care.

Assessment methods:

• Daily participation in rounds, including independent oral presentation of all patients.
• Participation in mandatory weekly Sub-Internship conferences focused on common medical conditions and identification of need for escalation of care.
• Participation in mandatory simulation sessions focused on shortness of breath, chest pain, arrhythmias, and cardiac conditions.
• Successful generation and entry of patient orders as monitored by resident.
• Successful communication of changes in status to resident and attending physician.
• Self-recruitment of focused feedback from attending and resident utilizing the Formative Feedback form.
• Summative feedback from the team using a standardized evaluation tool.

Goal 4: Increase and refine procedural skills.
(Patient Care, Medical Knowledge)

Objectives:
1. Develop clinical comfort in phlebotomy, inserting intravenous catheters, urinary catheterization, and CPR as the opportunities arise.
2. Perform rectal exam for stool testing as clinically indicated.
3. Develop skill through patient simulations in performing EKG’s, delivering oxygen, bag-mask ventilation, AED and defibrillator use, and delivery of emergency IV medications.
4. Describe the elements of informed consent, including indications, contraindications, risks, and benefits of the following procedures (and observe/assist whenever possible):

• Lumbar puncture
• Paracentesis
• Thoracentesis
• Central line or peripherally inserted central catheter (PICC) placement

Assessment methods:

• Participation in a Clinical Skills Examination (CSE) at the beginning of the rotation to assess phlebotomy.
• Participation in mandatory simulation sessions focused on shortness of breath, chest pain, arrhythmias, and cardiac conditions.

Goal 5: Demonstrate interpersonal and written communication skills that result in effective information exchange and collaboration with patients, their families, and all members of the health care team
(Professionalism, Practice Based Learning, Interpersonal and Communication)

Objectives:
1. Communicate effectively with patients and families across a broad range of socio-economic and cultural backgrounds.
2. Demonstrate relationship building skills in each clinical encounter and inter-professional exchange.
3. Elicit and recognize the perspectives and needs of families and provide care for patients within their social and cultural context.
4. Include the patient and family in the decision-making process to the extent they desire.
5. Recognize when interpreter services are needed and demonstrate how to use these services effectively.
6. Provide education and patient instructions to patients and families, using written or visual methods, taking into account their health literacy level.
7. Write organized, appropriately focused, and accurate patient notes, including admission, progress, cross-cover, and discharge notes and summaries.
8. Perform safe hand-offs of patient information using electronic shift hand-off tools.

Assessment methods:

• Observation by resident and attending physician during concurrent evaluation and discharge planning of patients.
• Review of patient write-ups and discharge materials by resident and attending physician.
• Review of clinical hand-off materials by resident.
• Self-recruitment of focused feedback from attending and resident utilizing the Formative Feedback form.
• Summative feedback from the team using a standardized evaluation tool.

Objectives:
1. Recognize limits and deficits in knowledge, skills, and attitudes and initiate a plan to obtain help from faculty, colleagues, and other informational resources.
2. Read daily about issues that affect patient care.
3. Always place the needs of the patient first and act as the patient’s advocate.
4. Recognize limits and deficits in knowledge, skills, and attitudes and initiate a plan to obtain help from faculty, colleagues, and other informational resources.
5. Demonstrate personal accountability to patients, colleagues, and staff in order to provide the best patient care.
6. Demonstrate integrity, compassion, respect, altruism, and empathy when interacting with all members of the health care team, patients, and their families.
7. Demonstrate culturally effective care by understanding the important role of culture in the care of each patient, recognizing how one’s own beliefs affect patient care, and eliciting the cultural factors that may influence the care of the patient.
8. Recognize the impact of stress, fatigue, and illness on learning and performance.
9. Maintain appropriate professional boundaries with patients, families, and staff.
10. Identify strengths, deficiencies, and limits in one’s knowledge and clinical skills through self-evaluation.

Assessment methods:

• Observation by resident and attending physician during concurrent evaluation of patients.
• Daily participation in rounds, including independent oral presentation of all patients.
• Successful entry of patient orders, communication with consultants, and implementation of patient care plan as monitored by resident.
• Self-recruitment of focused feedback from attending and resident utilizing the Formative Feedback form.
• Summative feedback from the team using a standardized evaluation tool.

MDC7203 Medicine Sub-I Student Schedule

Monday through Sunday – round in the morning and see patients in the afternoon with one day off a week
Attend Intern conferences at noon every day, except Thursday. And morning report on Wednesday morning
Attend Grand Rounds every Thursday
Complete a Night Shift Cross-cover
Attend one “night-on-call” Sub-I Conference