The Value of the Subinternship: A Survey of Fourth Year Medical Students.

Background: Although the subinternship is often regarded as an important part of many fourth year curricula it is rarely studied.

Purpose: We aimed to understand the how well the subinternship prepared medical students to perform core clinical skills.

Methods: Senior medical students at Boston University School of Medicine rated their perception of the effectiveness of the subinternship and "medical school overall" in preparing them to perform core clinical skills using a written survey.

Results: Overall, 69% (101) of students responded. Students believe that the subinternship prepares them to perform most key skills involved in day-to-day medical care. However, students feel less prepared by either their subinternship or overall medical school experience to carry out some complex patient communication skills including delivering "bad news" and discussing endof- life wishes.

Conclusions: The subinternship appears to be effective in preparing students for many of the challenges they will face as an intern and beyond. However, students identified several complex communication skills that could be addressed in part by the subinternship for which they felt unprepared. Student learning would likely be enhanced by creating a longitudinal program to teach these higher-level communication skills during medical school and by integrating practice and feedback of these skills into the subinternship.