Patients of all ages, of both sexes, and with diverse medical problems will be managed in this sub-internship. Emphasis will be given to the total management of the patient, beginning with the ambulatory presentation, continuing through hospitalization and following dismissal from the hospital-coordinated, comprehensive, continuing medical care. The student will be responsible for complete evaluation of the patient, including initial history and physical examination, cost effective utilization of laboratory, x-ray and other procedures and the formulation and pursuit of the management plan, including cogent utilization of consultation/referral services. Emphasis will also be given to participation in community resources, which provide ongoing care of the patient, including Hospice and community health centers. Experience is afforded in the Family Practice Center, the inpatient service of family medicine, certain area nursing homes, and on occasion, in the home of the patient. The student will function with Family Practice residents under the direction of the Family Medicine faculty member assigned to the inpatient service and other Family Medicine faculty members.

This rotation will replicate the role of an Intern on a very busy hospital medicine service where the reporting physician is not another resident, but an attending for one on one mentoring. A very broad exposure to the entire swath of inpatient within the Academic Teaching hospital will be experienced.

This ward-based, primary care sub-internship provides the student an individualized, case-oriented experience as a sub-intern on a general medicine ward service, designed to be the natural extension of the thirdyear clerkship. Each student will work closely with a senior resident, have primary patient responsibility, take night call with his/her team, have patient care responsibilities like an intern with close supervision by the senior resident, be assigned readings and give mini-lectures on selected subjects, and attend the regularly scheduled teaching conferences of the Department of Internal Medicine. This sub-internship is strongly recommended for students planning to pursue a career in Internal Medicine.

This four week Sub-Internship will provide the student the opportunity to function as a first year resident on the MFM service. The student will gain ample exposure on the rotation in order develop the skills to recognize the clinical and laboratory diagnosis of medical, surgical, and obstetric complications of the high-risk pregnancy. The student will review the literature on and develop the skills to manage the fetal/neonatal complications of post term pregnancy, including the indications for induction of labor, and review the evaluation and management of the following conditions which complicate pregnancy: preterm labor, hypertension, and diabetes. During ultrasound sessions the student will be expected to discuss the essential components of a genetic counseling session with the following indications: advanced maternal age and abnormal maternal serum screening. While managing patients in labor and delivery the student will learn to interpret fetal heart rate tracings in laboring and non-laboring patients, gain the skills necessary to succinctly communicate patient sign out and hand offs on the high risk patients that she/he is following, and effectively communicate with nursing ancillary staff in order to coordinate patient care. The student will also have the opportunity to perform/assist in vaginal and abdominal deliveries, including laceration recognition and repair and forcep assisted vaginal delivery. The student will also be given the opportunity to improve their basic knot tying skills with a self-directed suture curriculum. The student will prepare for and participate in Friday afternoon didactics.

This four week Sub Internship will provide the student the opportunity to function as a first year resident on the Gynecologic service. The student will evaluate, present, and manage patients that present to clinic and the EC with gynecologic complaints and participate in and care for patients that undergo gynecologic surgery. On days assigned to the operating room the students will be expected to: prepare for and perform as a surgical assistant for assigned gynecologic cases, communicate with operating room nursing and ancillary staff, and become proficient in preoperative 'time out', and illustrate proper aseptic technique, and patient positioning in the operating room. Prior to surgical cases the student will review the surgical steps for and complications of commonly performed gynecologic surgeries as well as recent literature in regard to surgical outcomes. The student will gain experience in eye-hand coordinated movements relevant to basic laparoscopy in the simulation lab and with knot tying using a self-directed suture curriculum. The student will demonstrate effective communication skills regarding patient sign out and hand off, recognize and participate in systems improvements, and communicate with nursing and ancillary staff to promote teamwork, and patient care. The student will prepare for and attend Friday afternoon didactics including the participation in preoperative surgical conference.

The Orthopaedic Surgery Sub-I offers fourth year medical students with a strong interest in the Orthopaedic Surgery subspecialty, an opportunity to acquire and assimilate advanced clinical responsibilities at an intern level, by exposure to orthopaedic patients in various clinical settings: inpatient, outpatient, and operating room. This four-week elective rotation will provide an educational curriculum that emphasizes teaching of fundamental concepts of total patient musculoskeletal care. The sub-intern will be assigned to a different faculty mentor each week in order to learn and apply information for a variety of musculoskeletal/medical disorders, based on the patient group for which he/she is responsible. This will assist in maximizing academic preparation for postgraduate clinical performance as an intern. The sub-intern will function as the primary point of contact, assisted by an Orthopaedic resident, and supervised by the attending for all care issues concerning specific patients on different services. The sub-intern will attend all Orthopaedic Department conferences, present lecture(s) specific for their team along with hospital rounds, morning trauma report, Journal Club, and all other didactic events. The sub-intern will take in-house calls at least once per week with the call day established by the orthopaedic staff, and discuss ER cases to further enhance the sub-intern’s educational experience. The sub-intern will strictly follow duty hours’ guidelines as mandated by the Accreditation Council of Graduate Medical Education's Common Program Requirements.

The student will work as a member of a team caring for patients admitted to the pediatric inpatient service. During this elective, the student will have an opportunity to learn to formulate problem lists, management, and follow-up plans for hospitalized pediatric patients. The student assumes the role of extern and takes call with the residents.

The student will serve as an extern on the surgical service and participate in the care of surgical patients in the emergency room, surgical wards, operating room, and clinic. Pre- and post-operative care and the management of patients in the Surgical Intensive Care units will be stressed. Assignments to selected clinical faculty preceptors are also available. Students will take in-house call.

The Neurological Surgery Sub-I offers fourth year medical students with a strong interest in the Neurological Surgery subspecialty, an opportunity to acquire and assimilate advanced clinical responsibilities at an intern level, by exposure to neurological patients in various clinical settings: inpatient, outpatient, and operating room. This four-week elective rotation will provide an educational curriculum that emphasizes teaching of fundamental concepts of total patient care. The sub-intern will be assigned to a faculty mentor each week in order to learn and apply information for a variety of neurological disorders, based on the patient group for which he/she is responsible. This will assist in maximizing academic preparation for postgraduate clinical performance as an intern. The sub-intern will present lecture(s) specific for their team along with hospital rounds and take call at least once per week with the call day established by the neurosurgical staff and discuss ER cases to further enhance the sub-interns educational experience.

The Otolaryngology Sub- Internship is designed for medical students interested in applying to an Otolaryngology Residency Program during the upcoming match year. The rotation provides an in depth 4-week experience in the Department of TTUHSC Otolaryngology. During this rotation, students will work on improving their foundational knowledge in Otolaryngology including pathophysiology, differential diagnosis, assessment, and plans. The students will play a vital role in the core resident group with responsibilities including rounding, patient presentations, and operating room experience. The student will also work in the Otolaryngology clinic as a key member in patient care with ability to improve on history taking, physical exam, and in office procedural skills. The student will be expected to give a Grand Round presentation at the end of the rotation. The goal is for the student to feel proficient at the end of the rotation to enter into a PGY-1 residency position.

This Sub-I is an advanced experience in the management of disorders of the urinary tract and is designed to provide the student with an understanding of the principles of urological diagnosis and treatment. Students will participate in a series of lectures, ward rounds, operating room and clinical experiences. The course is of value to a student interested in a career in urology, gynecology, or surgery.