Strengthening the Away Sub-Internship Experience: Practical Skills and Strategies for Transition to Internship

This article aims to provide practical strategies for students on away surgical sub-internships (sub-Is) to enhance preparation, help navigate team dynamics, develop skills necessary for residency, and demystify the hidden curriculum.

Author group consensus for this perspective piece was developed through review of published literature and guidelines (e.g., Association for Surgical Education (ASE) guidelines and recent Delphi consensus), identification of gaps from the sub-I viewpoint, and integration of educator insights to address gaps.

The provided guidance is applicable to surgical away sub-interns at U.S. medical centers.

We provide specific recommendations and examples for rotation preparation, patient care on the floor and in clinic, operating room conduct, and professionalism. Before the rotation, sub-Is should set clear goals, review service-specific knowledge, and clarify expectations with their team. During rotations, sub-Is are encouraged to take ownership of patient care, contribute actively in clinic and the operating room, consistently grow and incorporate feedback, and practice both technical and communication skills. Our specific recommendations address the hidden curriculum of rotations and emphasize professionalism as humility, respect, and dependable teamwork. Lastly, we provide strategies for sub-Is to evaluate program culture, teaching, and resident interactions to assess program fit.

Aligning sub-I expectations/roles with ACGME competencies and Delphi consensus domains promotes equitable, high-quality training and improves readiness for internship. By approaching the away sub-I with preparation, initiative, and reflection, students can optimize learning while simultaneously evaluating residency programs' alignment with their goals.