LAUSR

Creating space for autonomy is not only critical for supporting the development of medical students into independent clinicians but is also an important component to fourth-year sub-intern satisfaction with the rotation. Challenges that limit this autonomy include close supervision that is required with these new responsibilities while incorporating these learners into pre-existing medical team structures. The sub-interns at our teaching hospitals get incorporated in a traditional medical team, consisting of one attending physician, one senior resident, two interns, two third-year medical students and one subintern. The sub-interns care for their own patients under resident's supervision, without any assistance from the interns. However, because of the difference in independence level between an intern and a sub-intern, supervising residents tend to preferentially assign new, and complex admissions to interns rather than sub-interns. Our sub-intern rotation evaluations, distributed by the medical school and identical across all training sites for students, consistently showed that sub-interns' greatest dissatisfaction with the rotation was competition for patients with other learners on the team.