By Sarah Wesley
The sub-internship (sub-I) is a 3-4 week period during which final-year medical students work as unpaid interns, often with a much lighter patient load but with all the responsibilities and tasks of an intern. Many competitive residency institutions require that IMG applicant have completed a minimum of 1-2 sub-Is in the U.S. in order to be considered for a spot. Some applicants will have the finances and time to complete many more than the required number of sub-Is, and you should specifically research the requirements on the websites of the programs and specialties you are interested in.
Sub-internships are available in:
- Psychiatry
- Internal Medicine
- Family Medicine
- Radiology
- General Surgery
- Cardiology
- Gastroenterology
- Dermatology
- Neurology
- Sports Medicine
- Emergency Medicine.
Some programs have an unspoken policy to accept only those individuals who have done an elective with them, and it is to your benefit to inquire as to what proportion of residents did a sub-I with the department before residency.
The goal of all of these sub-Is is to show residency programs that you are competent to practice at the standard expected in American hospitals – academically, culturally, and linguistically. Furthermore, the majority of your letters of recommendation will come from these sub-Is, so it is important to be academically prepared and treat the internship as a “four-week-long job interview.”
In terms of where to go, you should consider the following criteria:
- Where you hope to match
- Where your connections are, and
- What your budget looks like
Many programs will have extensive fees in the thousands of dollars for a four-week sub-I. On top of the sub-I fees, you’ll need to factor in living costs, traveler’s insurance, malpractice insurance, visas, and plane flights. If money is an issue at a particular institution of choice, the next best option is to work at a hospital affiliated with the program, or at the very least, in the same region. That way, when it comes time for interviews and you are asked “Why this hospital?” or “Why this city?”, you can give a good answer. For example, you can get by paying nothing more than application fees if you go a university-affiliated hospital and not the main one. You will still make a lot of connections, get good letters of recommendation, and gain valuable clinical experience, perhaps more so than if you had been at the main teaching hospital and lost in a sea of observers, medical students, and residents.
Another caveat: if there is a program you really like, and that program indicates that they take only American-trained medical applicants, it never hurts to call the program administrators directly. When you speak to them and give them your information, they might be inclined to make an exception. Who knows, the chief of the department could be an alum of your school. Also, connect with alumni from your school who are practicing in the U.S. to see where they are working.
As I mentioned in a previous post, observerships are useful for the personal benefit of experiencing an institution or certain subspecialty, but they will not be regarded as work experience in an American hospital on your application.