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J Gen Intern Med. 2010 May;25(5):403-7. doi: 10.1007/s11606-010-1263-7. Epub 2010 Mar 13.

The impact of the internal medicine sub-internship on medical student career choice.

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  • 1University of Pennsylvania School of Medicine, Suite 640, Philadelphia, PA 19104, USA.



Medical student interest in internal medicine is decreasing. Whether the internal medicine sub-internship affects intent to pursue internal medicine is unknown.


Determine the immediate and longer-term effect of the medicine sub-internship on students' decision to pursue internal medicine residency.


Mixed method, single institution, prospective cohort study.


Ninety-two students completing an internal medicine sub-internship in 2006.


Survey administered prior to and immediately after the sub-internship and prior to the match. Questions included likelihood of applying in internal medicine and perceived impact of the sub-internship on career choice.


Seventy-seven percent of students (N = 63) completed the first two surveys; 63% (N = 58) completed the second and third. Immediately post sub-internship, 21% (N = 13) were less likely to apply in internal medicine and 11% (N = 7) were more likely to apply (net change in plans was not significant, p = 0.38). There was a significant relationship between the perceived impact of the sub-internship and likelihood of applying in medicine (ANOVA comparison across means, p < 0.001). Compared to the second survey, on the third survey more students (41%, N = 24) believed the sub-internship positively impacted their decision to apply in medicine, though overall shifting was not significant (p = 0.39). Key themes describing sub-internship impact included the intense workload, value of experiencing internship, rewards of assuming the physician role, and education received (30%, 25%, 20% and 16% of comments, respectively).


Overall, there was not a significant effect of the sub-internship on students' decision to apply in internal medicine. Additional research about the relative impact of the sub-internship in relationship to other career choice predictors is needed to better address factors that may encourage or dissuade students from pursuing internal medicine.

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