Sub-I on IM getting only 1 patient at a time but being praised. Should I be worried?

[Latteandaprayer]

To me actions speak louder than words, but I have a constant fear that I’m incompetent but no one is telling me.

I have been on my sub-I for two weeks. I’ve made mistakes here and there (like paging PT instead of putting in an order, not wrong meds or anything like that), and I certainly slow down my senior because he has to sign all my orders and my notes.

I’ve asked for feedback and my senior and attending praise me. But when I only have 1-2 patients at a time, while the interns take 6, I’m not so sure I’m actually doing well. Sub-I’s max at 4. I usually literally only end up with 1 patient, and if they go home then I don’t come in the next day if it’s a non-call day. I feel useless.

How can I gauge how I’m doing? Do I just take what they say at face value? I’ve said multiple times I’d love to get up to 3-4. The senior assigns us so there’s no room for me to say “I’ll take this new one” or whatever.

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[blameitonbaby]

To me actions speak louder than words, but I have a constant fear that I’m incompetent but no one is telling me.

I have been on my sub-I for two weeks. I’ve made mistakes here and there (like paging PT instead of putting in an order, not wrong meds or anything like that), and I certainly slow down my senior because he has to sign all my orders and my notes.

I’ve asked for feedback and my senior and attending praise me. But when I only have 1-2 patients at a time, while the interns take 6, I’m not so sure I’m actually doing well. Sub-I’s max at 4. I usually literally only end up with 1 patient, and if they go home then I don’t come in the next day if it’s a non-call day. I feel useless.

How can I gauge how I’m doing? Do I just take what they say at face value? I’ve said multiple times I’d love to get up to 3-4. The senior assigns us so there’s no room for me to say “I’ll take this new one” or whatever.

Don't be so hard on yourself. Also, don't keep continuously asking for feedback or some of it may be sarcastic. People are very busy and you are low on the totem pole.

Do you know why you are usually only assigned one patient?? Do you have another way to gain feedback, i.e. asking the attending?

 

[Latteandaprayer]

Don't be so hard on yourself. Also, don't keep continuously asking for feedback or some of it may be sarcastic. People are very busy and you are low on the totem pole.

Do you know why you are usually only assigned one patient?? Do you have another way to gain feedback, i.e. asking the attending?

I don’t continuously, I asked after the end of week 1 and then they offered feedback at the end of week 2.

No I don’t know why only 1. I’ve said my goal is to carry 3-4 though

 

[mrbreakfast]

Directly ask if you can take the next admission that comes up. If the answer is no, tell the senior something along the lines that you don't feel like you are filling the role of the sub-intern and ask how you can get from where you are now to a point at which you are filling that role. If you get a vague answer, you may need to email the clerkship director.

People may be busy (though if they're capping interns at 6, it can't be that busy) but that doesn't matter. Medical student education is part of the paid responsibilities of residents, and if they are doing a poor job at that, it is a deficiency in their duties as a resident. If you go to a halfway decent medical school, people will absolutely care about that.

The other answer, unfortunately, is that you might be terrible. It's hard to say. Either way, putting a bit of pressure on the senior to give you more patients will either result in more patients, or more frank feedback on your performance.

 

[operaman]

What’s the makeup of your team? Are you the only student or are there others? If multiple students and a slow time/short list, could easily happen.

Are your residents weak? I know I definitely teach better when I’m confident and when I’m feeling overwhelmed then teaching is often the first thing to go. This seems to be a fairly universal pattern. If your residents and interns seem to be treading water themselves, then they may be in survival mode and giving you the bare minimum so there’s no extra work for them.

Do your best to feel out the issues but there may not be much you can do about it. If it’s weak residents then going over their head is just going to make their lives harder and make them dislike you. Best to err on the side of staying in everyone’s good graces.

Not sure about the vibe and workflow on your team, but on my sub-I I would follow the entire service and keep a list just like the interns. Even if I wasn’t presenting on a patient I would still follow them and make sure to know what was happening and figure out what things I could do to advance their care. It’s hard as a student because you’re locked out of so much, but do your best to find ways to contribute. Even small things like getting supplies for procedures or calling for outside records to be faxed can be a big help to some tired overwhelmed interns.

If you have more junior students on service with you, you can help them out as well. I had 2 M3s on with me during my subI and I always made sure to help them prepare for rounds and cases so they could shine. Both of them are now attending ENTs too!

 

[GritsNGuts]

Are your residents weak? I know I definitely teach better when I’m confident and when I’m feeling overwhelmed then teaching is often the first thing to go. This seems to be a fairly universal pattern. If your residents and interns seem to be treading water themselves, then they may be in survival mode and giving you the bare minimum so there’s no extra work for them.

This happened to me. Wouldn't call them weak, I felt like the interns were pretty good and the senior appreciated them. The problem is that our service was getting SMASHED. I tried very hard to be proactive (in a non-annoying way) and pick up more patients, take over the care for my patients, etc. But I came in at a time where the list was extremely packed, they had just hit their stride, and it was just impossible. They didn't know me or if I was capable, so it was safe to limit my responsibilities.

Plus, tons of other barriers that make it very difficult (impossible, tbh) for a student to fully assume the role of an intern at my school...won't get into those lol. For a while, I was struggling to get even 2 patients.

Then, the residents switched services and I was the only person left who knew the patients. The new interns depended on me very heavily for management, plans, patient communication, calling consults, writing discharge summaries, etc. And I was able to get up to 4/5 patients. Finally felt mostly like an intern by that point lol

 

[mistafab]

You need to pump those numbers up asap.

Its an unspoken rule that a sub I should be able to take 4 patients.

Yes, take them as they come. But at least average closer to 2-3 than to 1-2. The number is closer to MS3 level and you have to show more capability especially for letter writing ammo on a ref letter, If you have 2 on a day, pick up an old for the next day. You can always drop an old to take a new if you hit 4.

 

[DarkBluMage]

Why don’t you just tell the resident your concerns? You’re on a sub-I so the stakes are higher. You have to advocate for yourself. Go directly to the senior assigning patients and have a frank conversation about your concerns and that if possible you’d like to increase your patient load going forward because you don’t want to function as an M3 on a sub-I rotation.

 

[esob]

You need to pump those numbers up asap.

Its an unspoken rule that a sub I should be able to take 4 patients.

Yes, take them as they come. But at least average closer to 2-3 than to 1-2. The number is closer to MS3 level and you have to show more capability especially for letter writing ammo on a ref letter, If you have 2 on a day, pick up an old for the next day. You can always drop an old to take a new if you hit 4.

I tend to agree with this. I let the AI's take as much as they were willing to handle (while also providing appropriate supervision). Carrying an appropriate pt load contributed to my positive view of those applicants during the cycle.