Swedish Family Medicine Sub-Internship Student Guidelines

This experience is intended to allow you to function as an intern on the Inpatient Service under the supervision and guidance of residents and faculty.

Goals for Students in the SFMR Subinternship

GOALS

1. Participate and develop skill in clinical practice in Family Medicine by:

  • practicing interview techniques and physical examination skills
  • identifying patient problems encountered in family practice
  • developing problem-solving and decision-making skills
  • diagnosing and managing common illnesses encountered
  • participating in patient education and behavior modification
  • performing appropriate record keeping/charting duties

2. Acquire competence in office operations by:

  • describing the organization and operation of an ambulatory Family Medicine office
  • identifying office staff roles and their duties or responsibilities

3. Stimulate intellectual growth by:

  • cultivating questions/inquiry habits
  • initiating reading and investigative routines to facilitate independent learning
  • acquiring an understanding of the principles of Family Medicine

4. Develop interpersonal skills and build relationships by:

  • developing an active, working relationship with preceptors and staff
  • effectively interacting with patients utilizing effective doctor/patient communication skills

5. Become acquainted with the Swedish Family Medicine Residency training program, its residents and faculty.

Supervision Guidelines

SUPERVISION

While participating in patient care at Swedish Medical Center and the residency office, the student will be supervised by a resident and clinical attending faculty. The role of preceptors in this course includes:

  1. Serving as a personal and professional advisor
  2. Providing guidance in understanding principles and philosophy of family medicine
  3. Linking the student to other departmental activities
  4. Functioning as a clinical teacher

Final student evaluations and grades will be compiled by the Course Directors from evaluations completed by residents and faculty who worked with the student.

 

Student Expectations for SFMR Subinternship

Welcome to Swedish!

We hope your sub-internship here will be a positive experience. If you have any questions, please do not hesitate to ask any of the residents (or Codie or Laurie), and we will be happy to help. Below are the expectations we have of you as a sub-intern:

1.     IPS (Inpatient Service):

  • Plan to arrive by 7:15. You should then “computer-round” on your patients in which you should review labs, vitals, and important diagnostic to be able to report important new findings on your patient when we review all the patients at Morning Report.  This can all be accessed in Meditech.
  • Morning report starts promptly at 7:30. Feel free to bring coffee/breakfast in with you to munch on as we talk, all available in the doctor’s lounge.  Morning report begins with an educational talk (usually about 10 minutes) given by one of the residents, pharmacy students, or medical students.
  • Plan on signing up for two talks during your rotation here. This should be on a clinically relevant topic (often we present something that a patient or clinical experience has prompted you to look up). You will orally teach the service for the first 10min; no PowerPoint or handouts necessary and plan to spend ~1-2 hours to research/prepare. Eg. Clinical overview of Hypertensive Emergency.
  • Dress Code: Business casual—nice, clean, closed-toed shoes; slacks or conservative length skirt or dress; dress shirt; tie (encouraged for men; no sleeveless tops for females).  If you are on all-day call (or are post-long-call) you can wear blue scrubs – available on the 5th floor in L&D. Ask a resident for help locating them.
  • Each day you will round on 2-4 patients. The first 2 weeks you will start with 2 patients and for your last two weeks you should round on 3-4.  These ideally will be patients that you have admitted or can be interesting patients you would like to follow and learn from. You are expected to touch base with the rounding resident after morning report and let them know when you plan to see your patients and then contact the resident after you see the patients to discuss your assessment and plan for the patient. You can reach the resident by cell phone text or text page. You are expected to write a full SOAP note. You should think of and suggest what orders you think are appropriate for the patient for the day and discuss these with the resident. You should complete your rounding (including having discussed your patients with the supervising resident) by 12:00.
  • On-call: You will have various call shifts during your month. Please follow your schedule and communicate your scheduled shifts with the resident with whom you are working. When on-call, you will work with the on-call resident to do hospital admissions, labor deck triage, and cross-coverage of hospital patients. Your day call shifts will start the same as your hospital half days with morning report and rounding, yet this may be interrupted by an admission. The on-call resident will communicate with you regarding admissions as they come-in. You will document your admission on an H&P form. Push yourself to develop a complete assessment and plan for the patient. Often your resident will work alongside you while doing your H&P, yet you should run the interview and discussion of assessment and plan.  Each week you are expected to type-up and submit one complete H&P in which you should have a more in-depth assessment and plan detailing why you have made said diagnoses and any EBM (evidenced based medicine) you used to guide your treatment plan. You should submit this to the on-service attending on Mondays and receive feedback by Wednesday. You should submit a total of 4 formal H&P’s.
  • Computer Access: You should have access to Meditech and PACs. If you have issues please call IT&S Services 303-788-8710 and if they do not know who you are then call Codie right away (303-788-3153).
  • Hospital Access: Students do not have badge access 5th floor (L&D/Peds/NICU) or the Doctor’s Lounge. You are permitted to be in both places but will have to gain access via a resident’s badge. Let one of us know if you need to get into either place.
  • For questions on any issues that come up while you are on-service, please feel free to approach the service chief or faculty. You should receive weekly or biweekly feedback from the service chief.
  • Please set goals for yourself at the beginning of your month and discuss these with your service chief. These will be reviewed during your feedback times.
  • We expect you to conduct yourself in a professional manner while at Swedish.
  • Have fun and push yourself to learn what your patients have to teach!

 

2.     Clinic:

  • You will be working with either a resident or faculty member for each half-day of clinic. When in morning clinic, plan to arrive by 8:00, and for afternoon clinic, come straight over from noon conference. You will meet your resident or faculty in the upstairs resident/preceptor room on 3rd floor of Clinic building.
  • Depending on your learning style and the resident or attending with whom you are working, you may see the patient ahead of time and present the patient to the resident afterwards, who will then go in with you to see the patient; OR you may go in together and talk with the patient.
  • Be ready to present pertinent history, exam, diagnostic data, and plan to the attending (preceptor) after discussing with the resident.  Goal presentation = 2 minutes or less.
  • You will be trained to access patient records in eCW (the clinic electronic medical record), however, you will document your soap notes in a Microsoft word document and submit them for preceptor review. Feedback will be provided in person and via email.
  • If the patients need pelvic exams, pap smears, knee injections, wart cryotherapy and you want to be involved, don’t hesitate to ask the resident if you can do it! Sometimes we get busy and forget to offer, but we want this to be a good learning experience for you so be proactive.
  • Attire: see above.
  • You will receive basic orientation on how to use eCW (our EMR). If questions arise please ask and do not hesitate to ask the same question multiple times. It takes a little while to get accustomed to the system, and we understand!
Sample Sub-internship Schedule

Subinternship Sample Schedule

Required Documentation

Required Rotation Documentation

(Documents initiate by SFMR)

  • Executed Teaching Practitioner Agreement (TPA)
  • Executed Attestation Statement
    • Documents required by TPA and/or Attestation Statement
      • Signed consent for school to provide documentation listed below ( provided by program)
        • Immunizations
          • Negative PPD, time or chest xray
          • MMR
          • Varicella
          • Hepatitis B
          • Tdap (within last 10 years)
          • Flu immunizations (October-March)
        • Negative drug screen (9-panel w/ opiates within 1 year of rotation)
        • Background check with no adverse information during the time the student has been enrolled as a student at school
        • Student will sign confidentiality forms (provided by program)
      • School must provide malpractice insurance certificate
      • Colorado medical schools must provide Worker’s Compensation certificate
      • American Heart Association BLS card
      • All students have received education on HIPAA and TJC/OSHA standards and evidence of their education is on file in the office
      • School attests the program participants do have any physical or mental disabilities which renders them unable to perform services or duties with reasonable skill and safety and which may endanger the health and safety of persons under their care.
Thanks for checking out SFMR! I’m a year into residency and I still feel incredibly lucky to be a part of this program. The residents, faculty, and staff here are intelligent, caring, funny, hard-working, and generally awesome human beings. I would make the decision to come here again in a heartbeat. Megan Gorzalski

Resident, Class of 2016