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Harborview Medical Center
Clerkship Director & Faculty Contact:
Andrew M. Luks, MD
Fourth year medical students will function at the sub-intern level on the Medical Intensive Care Unit (MICU) service at Harborview Medical Center. During the rotation, they will have direct patient care responsibilities through which they will learn about various forms of critical illness and how to apply different therapeutic and diagnostic modalities commonly used in critical care medicine.
The primary goals of this rotation are as follows:
At the end of this rotation, students should be able to:
The sub-internship will be open to 4th year medical students by departmental permission.
The rotation will be offered from September until May of each year.
The MICU service at Harborview Medical Center consists of an attending physician, pulmonary and critical care fellow, 4 senior residents and 4 interns. The sub-intern will be paired up with one of the senior residents and will take call with that resident and their corresponding intern on an every 4th night basis.
The sub-intern will work an average of less than 80 hours per week during the rotation and will have a total of 4 days off per month. The specific days off will be determined at the start of the rotation. On workdays, the sub-intern will be expected to arrive at a time that will allow them to adequately pre-round on all of their patients before the morning didactic sessions. The workday will conclude when they have completed their work on all of their patients and have signed out with the pulmonary fellow and/or attending physician. Sub-interns may be asked to assist with the care of other patients as part of the team’s work covering for residents and interns who have the day off or as part of an effort to get the post-call team out of the hospital but all such requests are at the discretion of the attending or fellow on the service. On call nights, the sub-intern will adhere to the same work-hour requirements as the resident and intern and will not work more than 30 consecutive hours at a time.
Working under the supervision of the pulmonary and critical care fellow and their senior resident, the sub-intern will be responsible for all aspects of care for their patients. They will be expected to write all admission and daily progress on their patients and to communicate with consultants and other providers that are part of the multidisciplinary MICU team.
At the start of the rotation, the sub-intern will admit one patient per night but as the rotation progresses this total may be increased to 2 patients per call night at the discretion of the supervising resident, fellow or attending physician based on the sub-intern’s demonstrated skills and current patient load. Sub-interns may be responsible for up to 4 patients at any one time.
During the course of their work on the service, sub-interns may also gain experience in certain procedures including central venous catheter or arterial line placement. However, priority for all therapeutic and diagnostic procedures goes to the interns and residents on the service and the sub-intern may have to defer to these individuals in certain situations, even when such procedures are being performed on their patients. In the era of work-hour requirements and caps on admissions, it has become increasingly difficult to ensure that the resident staff get adequate procedural experience. It is for this reason that priority for all procedures goes to the resident staff. If they have done an adequate number of the procedure in question or are too busy with other work to complete the procedure, then the sub-intern will have an opportunity to do the procedures.
Several different teaching modalities are employed on this service:
The weekly schedule for the rotation is as follows:
* X-ray rounds take place in the MICU workroom
There is no required reading for the clerkship. Sub-interns are, however, expected to read materials relevant to the care of their patients and other patients on the service as time permits during their rotation. Available sources of reading materials include:
At the end of the rotation, the student’s performance will be evaluated by the attending physician, pulmonary and critical care fellow and senior resident using the current Evaluation of Student Performance in the Clinical Curriculum form. This evaluation is completed on-line but the sub-intern will also receive feedback in person from each of their evaluators.
Students will be graded on an Honors / High Pass / Pass / Fail Basis. There are no examinations or required assignments for this rotation. In order to pass the rotation, students must be present for all assigned workdays and must demonstrate the ability to adequately execute patient care responsibilities.
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