Subinternship Guidelines for Chief Residents

1. The subintern should always be on call with his/her resident
2. The resident should preferably be a PGY3
3. Call should be avoided on the first day of the subinternship
4. A maximum of three patients can be given to an on call sub. If call is overnight then a maximum of three patients can be given to the sub.
5. The maximum number of patients that a sub can follow is 7
6. Avoid complicated transfers and unstable patients to the sub
7. A short call can be given to the sub if they are carrying less than three patients
8. If there is only one sub on a team, coverage should be limited to patients on the sub's own color team. If there are two subs to a team, let one sub cover his/her own team, and the other sub cover another color team. Make sure to switch subs back and forth for each call, to ensure equity. If subs ever need to do overnight coverage (rare), it should ABSOLUTELY be limited to their team color, regardless of the number of subs on the team.
9. If possible, a sub and intern or two subs from the same team should take call together, thereby enabling coverage to be split
10. When the resident goes to clinic another resident MUST be automatically identified to supervise the sub ( i.e. "the on call pgy3 will be responsible..")
11. The subs will cover their co-intern's patients during clinic only if both the intern and resident are in clinic on the same day. Otherwise the resident will cover the intern's board until the intern returns from clinic.
12. The Chief Residents will meet with the subs once a week to review the curriculum and discuss any problems with team dynamics and patient management. Any problems with team dynamics and or adequacy of teaching should be brought to the attention of the Chief Resident as early as possible in the rotation.

Sabbath Observant Subinterns

1. If the residency has a Sabbath program then the Sabbath observer should be assigned to the Sabbath resident if available that month
2. If there is no Sabbath program then the sub will be incorporated into the regular call schedule
3. Saturday call will begin after sundown and will always be overnight. Day coverage will be done by the co-intern or the co-sub. If coverage is being done by the co-sub then it will consist of his own color only. Any uncovered patients on other teams will be split amongst the interns. The co-sub will take overnight call with the Sabbath sub only if needed for ER throughput purposes or coverage purposes (Weiler). The Sabbath sub will always receive the "next" patient before the co-sub (for fairness- the Sabbath sub should receive more patients than the cosub if possible (ig. three vs two if 5 patients are to be admitted)
4. On Fridays only private patients should be assigned to the Sabbath sub. During the winter months the Sabbath sub will receive one patient before 11AM. It should preferably be a leftover patient from the prior evening. During the summer months two private patients can be given before 2 PM. A detailed signout should be given to the co-sub on Friday afternoon.

These rules can be abrogated at the discretion of the Chief Residents and Directors of Medical Service if patient care and hospital service requirements deem it necessary.

Updated: 11/23/01
Seth Sokol, M.D.-Chief Resident, Montefiore Medical Center
Robert Sidlow, M.D.- Subinternship Director, AECOM