A recent editorial highlighted the changing role of the subinternship (SI) in the medical school curriculum.1 It has been argued that the SI should be viewed as the culmination of a coordinated 4-year program of study in clinical care, with an aim to prepare fourth-year students for the demanding experience of internship. Ideally, the educational goals of the SI should complement and expand upon those outlined in the third-year clerkship and ought to uniquely emphasize the knowledge and skills needed to independently treat and manage acutely ill inpatients. To facilitate these goals, it has been recommended that SI programs place fourth-year students in a role that completely replaces the intern, albeit under the supervision of senior house staff. In particular, it has been recommended that subinterns should 1) have a dedicated coordinator of educational activities, 2) be provided with an explicit set of learning objectives, 3) have separate conferences which stress patient management issues,4) be able to write medical orders that are cosigned by a physician, and 5) participate in supervised cross-coverage.
Despite the valuable and distinctive experience of the SI, it has been neglected by medical educators and researchers as an area needing development and standardization. At an organizational level, the SI currently lacks the clearly defined curricular goals and rigorous evaluation methodologies found in the third-year clerkship.2–4 Nevertheless, it is unclear to what extent individual medical schools have addressed the unique educational needs of the SI. In an attempt to clarify the structure and requirements of internal medicine SI programs throughout the United States, a survey study was undertaken.