General Surgery Student Clerkship
M4 Surgical Sub-Internship Major Goals and Key Features

The surgical sub-internship, regardless of which department/division offers it, is designed to preview the responsibilities of an intern during the M4 year. Each student is required to complete a 1-month surgical sub-internship chosen from the list of CEC-approved rotations. These rotations may include any of the surgical specialties (including Obstetrics & Gynecology, anesthesiology and/or emergency medicine). Listed below are major goals for the sub-I and key features that constituent a Sub-Internship Experience.

Direct attending physician supervision is encouraged and preferable required as per LCME guidelines. All of the goals and key features will be accomplished with the appropriate supervision by senior residents and attending physicians.

Goals of Sub-Internship

  1. Independently complete an initial assessment of the patient and his/her problems (e.g., to distinguish the patient who needs intervention now from the "sick" patient with less acute needs).
  2. Manage the short-term needs of the acutely sick patient.
  3. Formulate a diagnosis and a plan of treatment
  4. After appropriate supervision, implement therapy based on assessment of risks/benefits of available therapies and monitor outcomes for the patients.

Key Features of the Sub-Internship

  1. Serve as the physician of first contact for assigned patients.
  2. Be the physician of first contact for patients presenting with a diversity of multi-system problems and varying levels of problem severity and chronicity.
  3. Have primary/initial responsibility for formulating:
    3.1 an H & P with differential diagnosis
    3.2 treatment plan
    3.3 monitoring effectiveness of treatment plan
    3.4 talking with patient about his/her condition
    3.5 talking with family about patient's condition
    3.6 daily follow-up (where applicable)
    3.7 progress, discharge, planning notes
  4. Experience the level of responsibility/autonomy similar to that of an early-year intern


  1. Primary responsibility for communication about patients to:
    1.1 team
    1.2 patient and family
    1.3 other health care professionals

Call (if applicable)

  1. Assume call at a frequency appropriate for the service but no more often than every 3rd night.
  2. Admitting new patients
  3. Provide cross coverage appropriate to service
  4. Supervision of "on call" experience provided by Attending or Senior Resident.


  1. Attendance expected except when it interferes with urgent patient care responsibilities (patient care takes precedence).