Acting Internship

The Department of Internal Medicine requires fourth-year students applying to residency in Internal Medicine to complete at least one of the following Acting Intern experiences (each are 4-week duration):

  • a ward-based AI with the academic hospitalist service at VCU Health or the Richmond VA Medical Center
  • a critical care AI in the Medical Respiratory ICU (MRICU) at VCU Health or the Richmond VA Medical Center (MICU)

All students participate in an orientation day curriculum that focuses on practical clinical activities, including many of the AAMC Core Entrustable Professional Activities (EPA) for Entering Residency.  Topics covered include: (a) How to give and receive verbal patient handoffs, (b) Stepwise approach to calling consultations, (c) how to write admission orders, and (d) tips to providing effective cross-coverage.

In addition, students learn how to replete common electrolyte abnormalities and dose varying types of insulin through a flipped-classroom model by watching a short online video (micro-lecture) and applying newly obtained knowledge to case-based online questions.  Students then discuss their rationale and clinical decision making regarding which answers were selected during orientation.

 

Course Expectations

Students work one-on-one with an academic hospitalist and a nurse practitioner while on their Internal Medicine AI and they are the sole learner on each team.  They work a variety of different shifts, including the traditional rounding shift, evening, and/or night shifts, which involve admitting and cross-covering patients.  

  • When rounding, students are expected to follow at least 5 patients and fulfill all the duties of a typical intern, including writing notes, placing orders, calling consults and handing off patients.
  • On evenings and nights, students will complete all aspects of admitting patients, including placing admission orders, writing admission H&Ps, performing medical reconciliation, and signing out new patients to the ongoing team.  Furthermore, students will cross cover at least one clinical team by covering the functional pager, respond to nursing pages and patient issues under the supervision of a physician, and perform supervised patient handoffs.

While on the critical care AI, students are expected to follow at least 3 patients at a time given the higher patient acuity, work with residents and interns as a part of a traditional team structure, and are expected to perform all roles of a typical intern.

 

Course Objectives

The course objectives for the ward-based AI are in-line with the School-wide objectives that apply to all AIs across the school which are included in the following document:  (School of Medicine Universal AI Goals & Objectives)

For the Medical ICU AI rotation, please use the following objectives as a roadmap to what core concepts you should focus on during the rotation and what is expected of you by the end of the rotation. This is also the same as the School-wide ICU objectives.  (ICU AI Goals & Objectives)

 

Course Requirements

Students are required to have 2 observed clinical encounters for each of the following clinical activities:

  • Giving and receiving patient handoffs
  • Calling new consults
  • Placing daily orders
  • Obtaining informed consent

Students are expected to fulfill each one of the three clinical observed encounters during the first and second half of each rotation (for a total of 6 observations per rotation). The supervising clinician completes an online checklist of each observation and provides directed feedback to the student based on their performance.

 

Resources for Acting Internship

Please refer to the VCU School of Medicine e-curriculum website for additional resources and documents.  Textbooks of internal medicine are recommended as references. These include The ICU Book (3rd ed, Lippincott Williams & Wilkins) Marino, Paul L. and Harrison’s Principals of Internal Medicine (17th ed, McGraw Hill). AIs should review these texts as relevant to their cases, and as relevant to the materials covered in the AI/sub-internship syllabus.

Other materials such as UpToDate and JAMA Rational Clinical Exam series are useful for concise reviews of selected topics.

 

Resources for Supervising Faculty & Housestaff

Please see the following document for recommendations and expectations as a supervising clinician working with an AI.  (Faculty & Housestaff Guide to the Acting Interns - 2018)

 

Contacts

David Jessee, MD
Internal Medicine Acting Internship Director
Academic Hospitalist
Assistant Professor, Department of Internal Medicine
VCU School of Medicine
Email: david.jessee@vcuhealth.org