Tips to Shine on a General Surgery Sub-I
Written by Elizabeth Bashian
Sub-internships, also called acting internships or audition rotations, usually happen during the summer of your fourth year and are an opportunity to act at the level of an intern in your chosen specialty, impress your attending physicians and residents, and prepare yourself for intern year. A lot is riding on a 4-week rotation, so how do you succeed? To some degree, the same advice for succeeding on third-year rotations applies: know your patients, ask good questions, be on time, helpful, and eager to learn. Surgery sub-internships have an extra layer of complexity because you must succeed on the floor and in the OR. You must impress attending physicians and residents with whom you may only work with briefly.
1: Get a great letter of recommendation. Surgery is a small world, so a strong letter from a well-known attending can carry a lot of weight with interviewers. During the first couple of days of your rotation, talk to your senior residents about getting a letter—they will be able to recommend faculty who are well-known in the field and like working with medical students. Let the attending know early that you are hoping to receive a letter at the end of the rotation, then maximize your time with them. Scrub all their cases and be prepared with questions; follow their patients on the floor; go to their clinic if possible. However, don’t stress if you only spend a few days with them because they’ll talk to residents to learn more about your performance (see #2). At the end of the rotation, schedule a meeting and ask them if they can write a strong letter.
2: Find ways to help your residents as much as possible. As an M3, you perfected the phrase “Anything else I can help with?”. As a sub-I, take the initiative and pay attention during rounds to find ways to help without being asked. Residents will appreciate completed hospital courses, calling outside hospitals/pharmacies/consults, pulling drains (ask first), getting supplies for procedures, and teaching M3s how to pre-round, tie knots, or about shelf topics. In the OR, you can help with moving the bed, getting your residents gloves, updating handoffs, and getting blankets. The general goal is to help the team function so that they notice when you’re not there.
3: Remember why you’re there. On every rotation, you should work hard and be professional, but at the end of the day, an audition rotation is designed to see how well you fit at a program and how well it fits you. It’s also a fantastic time to determine if this specialty is truly right for you. If the other residents all have completely different personalities or senses of humor, there may be other programs where you would be happier. If they are all focused on pursuing academic fellowships and you want to practice rural general surgery, this may not be the right place for you. If you realize you hate waking up at 4:30am every day, avoiding the OR by week 3, and you keep focusing on non-surgical aspects of the patient’s care, this may not be the right specialty for you –and that’s ok. It’s much easier to change dream program or dream specialty now than it will be in a year, so be honest with yourself.
