Acting Internship Policy


  • Intensive, inpatient experiences featuring primary patient care responsibility and direct reporting relationships with faculty and upper level residents. (It should be noted that appropriately designed Emergency Room rotations represent an exception to the inpatient requirement).
  • Primary patient care responsibility includes interacting with patients and their families, writing patient notes and orders, helping direct management plans and having the opportunity to perform procedures as appropriate.

General Guidelines and Requirements

An Acting Internship is 4-weeks in length. Students are required to do a minimum of two. One is required to be held at an affiliate site in Cleveland (University Hospitals, MetroHealth or Cleveland Clinic), unless specifically approved by their program. 

The graduation requirement will be 2 A.I.s of any type.

  • It is suggested that students focus their first AI experience on their matching specialty and are encouraged to defer the second AI to later in the 4th year.
  • Intensive care unit (ICU) rotations can qualify as AI's as long as they are participatory and not observational experiences. Services may consider requiring a ward AI as a prerequisite for an ICU AI rotation.
  • Consult teams or observational experiences do not satisfy the criteria of acting internships.
  • Acting internships must comply with ACGME duty hour requirements.

Effective October 12, 2023: students will only receive AI credit for away rotations if the course is explicitly designated as an Acting Internship or Sub-internship in the course title or course description by the host institution. 

Learning Objectives

Student experiences should conform to the learning objectives for that service or discipline as they apply to the interns.

The AI is expected to participate in all the educational conferences attended by interns on the service. Patient care responsibilities take precedence over other medical school related programs (e.g. Friday medical student conferences, class meetings, etc.)

Basic Learning Goals

We expect students to be able to obtain these learning goals by the end of their internships.

  • To learn and apply principles of a hospital based medical care system.
  • To improve skills in physical examination and patient interviewing.
  • To improve skills in differential diagnosis.
  • To improve skills in formulating patient management plans.
  • To demonstrate appropriate interactions with patients, families and other health care providers.
  • To experience the role of primary physician for patients on a inpatient service (e.g. initial H&P, note and order writing, formulating and carrying out treatment plans, patient procedures, discharge planning and discharge summaries, etc.)


Where applicable, workload should correspond to approximately 1/2 of the patient-care responsibilities assigned to interns. Duty Hours should also correspond to an Interns experience on each respective service and comply with the ACGME duty hour requirements.


  • The acting intern should receive both midpoint and end of the rotation feedback from their attending physician of record; residents on the service are encouraged to participate in this activity as well.
  • The overall oversight for the acting interns experience rests with the AI course director, who will be named at each site for each rotation.
  • Final assessment for the AI rotation will be completed in CAS.

Update approved by JCOG on June 13, 2019 and CME June 27, 2019