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Getting the Most Out of Your Acting or Subinternship

If you are in your third year and considering internal medicine as a career, you will likely be planning to take an acting internship or subinternship in internal medicine (they are the same thing, but may be called different names at different institutions). The acting internship is a very exciting and important experience, but also one that can be fairly intimidating, so you should be well prepared before beginning your rotation.

The purpose of the acting internship is to provide you with a more advanced level of clinical training in internal medicine beyond the basic medicine clerkship. The third year medicine clerkship is one of the earliest clinical exposures most students have to internal medicine, and because of this, the rotation is heavily supervised for both teaching and patient care reasons.  The acting internship, however, provides an opportunity for much more autonomy and ability to learn and care for patients in a way that approximates early postgraduate (internship) training. It also serves several other functions, including helping you to work in the context of patient care teams, apply more advanced medical knowledge to patient care, learn how to actually manage patients from the perspective of having direct responsibility for their care, continue development of your clinical style as a physician as you take on increasing responsibility, and allows your supervisors to work with you in a more advanced role that will help them provide assessments of your performance when applying for residency. Here are some things to know about and to help you prepare for your acting internship:

  • Find out the practical details of what your acting internship will be like. Because fewer students perform acting internships than the third year medicine clerkship, the settings in which acting internships may be available can differ significantly. For example, some acting internships take place on general medicine services, while others may occur in intensive care units or on subspecialty services. Each of these rotations may differ markedly from each other, and it is important to know what will be involved in your own experience.
  • Take a look at the CDIM Primer for the Acting Internship before you start your rotation. CDIM is the Clerkship Directors in Internal Medicine, the national group of internal medicine student educators across the US, and the Primer was created specifically to help you understand how to approach the rotation and what is considered important. This is extremely helpful information to have before you begin the clerkship. 
  • Talk to students who have already rotated through the acting internship you will be doing. There is probably no better way to find out what the daily experience is like, and they may be able to provide helpful advice about what you need to do to have an optimal experience.
  • Begin to work on changing the way you think about patients in your studying and current clinical rotations. The acting internship will be one of the first chances you will have to be directly in charge of patient care, and this is markedly different than many of your previous clinical experiences in which your role may have been more supervised. During your acting internship you will be asked what you want to do to manage your patients, and it will be expected that you take the lead in guiding patient care (supervised, of course!). However, this is a big change from what you may be used to, and starting to think this way in your current rotations is helpful in preparing you for your acting internship.
  • Remember that you know more than you think! Clinical training is structured to prepare you for increasing levels of responsibility with decreased supervision. Therefore, your previous clinical rotations have been designed to prepare you for well for this experience, and your supervisors also know what you are able to do.  So try to relax and make the most out of this clinical rotation.

The acting internship is a key clinical rotation that is an incredibly important next step in training.  Be prepared, and enjoy this opportunity to work on becoming the physician you want to be.