Multi-institutional Development and Implementation of an Internal Medicine-Pediatrics Acting Sub-internship

Medical students interested in combined Internal Medicine-Pediatrics (Med-Peds) training traditionally complete separate sub-internships in Internal Medicine and Pediatrics. This fragmented approach often limits access to Med-Peds-specific mentorship, integrated clinical training, and specialty-aligned letters of recommendation.

To describe the development, implementation, feasibility, and preliminary outcomes of two institution-specific integrated Med-Peds sub-internships.

The University of North Carolina (UNC) and the University of Utah independently developed four-week Med-Peds sub-internships led by Med-Peds-trained faculty. UNC implemented a Med-Peds hospitalist acting internship, whereas Utah developed a core sub-internship consisting of two-week inpatient rotations on internal medicine and pediatrics services, both supervised by Med-Peds attendings. Educational outcomes, student evaluations, access to letters of recommendation, and residency match data were assessed.

At UNC, 182 students completed the Med-Peds sub-internship. Following implementation, the UNC Med-Peds match rate among the entire graduating class increased from 3.3% to 4.6% (P = 0.005). UNC course evaluations were consistently high (mean overall rating 4.68/5; faculty effectiveness 3.92/4). At the University of Utah, 10 students completed the course, and all rated the experience as excellent, citing autonomy within a supportive learning environment. Additionally, access to Med-Peds-specific letters of recommendation increased from 33% to 100%, exceeding national averages (approximately 60%).

Integrated Med-Peds sub-internships address a longstanding curricular gap by providing cohesive clinical exposure, dedicated mentorship, and specialty-specific career development. These models are feasible, adaptable, and may positively influence student satisfaction and Med-Peds match outcomes at institutions with dedicated Med-Peds faculty.