Strong vs. weak APPE rotations and its impact on residency prospects

SDN Members don't see this ad. (About Ads)

Hey everyone,

I am hoping some of you guys can give me some advice on this issue I'm having.

I had no luck in the APPE lottery and I am stuck with only one inpatient hospital rotation by the time residency interviews come around. I will have a specialty rotation at a psych hospital but it will be after interviews.

I talked to a transplant/TICU pharmacist and he said that he will take me as a student (I know him personally, I work with him). However, my school has a policy to where I am not allowed to contact preceptors so they refused changes to my APPE's.

I am very frustrated with this situation.

Should I schedule a meeting with the APPE office and push the issue?

Thanks!

It's your future, fight for it but stay respectful and keep in mind you are not entitled to anything. Good luck

I think its worth a try, the worst thing that could happen is a "no"

Its okay if you get only one acute care experience prior to interviews, you can have great experiences in your ambulatory care APPE or even institutional APPE. When you're rotating through, work on projects, be proactive and volunteer to do things. Let your preceptor know you're interested in residency. I had two acute care rotations prior to Midyear but the projects I did on my am care and hospital APPEs stood out b/c they were unique. So even if you have only 1 acute care rotation, make the best of all of them... you never know which preceptors you click with the best.

If you can't get a change on your APPE, see if you can still get that extra experience. If you get a block off, work voluntarily in an acute setting to get more experience. See if anyone will take you on a series of weekends over a month. If you're at an amb care clinic associated with a hospital, see if you could spend a few days on the inpatient side of things. These are all things that you can comment on during the application/interview process to show that you have clinical experience AND that you're proactive about your learning. Good luck!

You should try to get another inpatient, but as long as your inpatient rotation is a more clinical rotation, you should be OK. I also had only one acute care before applying and I matched. I also had 1 ambulatory care before interviews and 1 during interviews, so I talked about those experiences extensively (even for my interview at a program that only had 1 am care rotation + 1 longitudinal clinic), as you are still using your clinical pharmacy skills in those rotations.

Originally Posted by Hendlefe

Should I schedule a meeting with the APPE office and push the issue?

I see nothing wrong with asking as long as you're polite about it. My school was pretty rigid about changes, but maybe yours is a little more open-minded. It sounds like you work at a hospital, though, so I wouldn't get too upset if you're not allowed to change. A person who has a few years of hospital work experience may be more desirable to some programs than a person whose only experience in acute care comes from rotations.

Aside from a rotation being acute care vs retail or something, how does one know if a rotation was challenging/hard?

Is it the name of the place? The preceptor? Does it really matter if you're at the UMC versus a smaller community hospital or critical access hospital?

Since so many people at my school apply for residency, they all want to front load. It's a lottery, though. If I went for the less competitive rotations (in rural communities or at smaller institutions) will it make a difference? I've been told I need to try and front load but if I pick smaller hospitals, I have a better chance at getting acute care early on. I've been told, though, that if you want residency, it's big institution or name or bust. Is that total bull**** or true?

Originally Posted by rxlea

Aside from a rotation being acute care vs retail or something, how does one know if a rotation was challenging/hard?

Is it the name of the place? The preceptor? Does it really matter if you're at the UMC versus a smaller community hospital or critical access hospital?

Since so many people at my school apply for residency, they all want to front load. It's a lottery, though. If I went for the less competitive rotations (in rural communities or at smaller institutions) will it make a difference? I've been told I need to try and front load but if I pick smaller hospitals, I have a better chance at getting acute care early on. I've been told, though, that if you want residency, it's big institution or name or bust. Is that total bull**** or true?

It's BS. There are no hard and fast rules. I wish people would stop promoting the idea that there is only one path that's acceptable for those who want a residency.

And there's no way to tell in advance if a rotation will be challenging or suck, or both. Ask other students about their experiences. That will be more helpful than trying to guess based on the "name" of the facility.

That said, there is a difference between acute care rotations at teaching hospitals and community hospitals. Many community hospitals don't have traditional rounds, with an interdisciplinary team. Some do. It just depends. That doesn't mean you won't learn anything, but it will be a different kind of learning experience. You should go for an acute care at a traditional teaching hospital for the learning experience, and to see if you like that environment. I thought I wanted that kind of residency (academic medical center) until I realized I hated everything about it. I liked my community clinic and amb care rotations a whole lot better, and ended up going in a completely different direction.

Originally Posted by All4MyDaughter

It's BS. There are no hard and fast rules. I wish people would stop promoting the idea that there is only one path that's acceptable for those who want a residency.

And there's no way to tell in advance if a rotation will be challenging or suck, or both. Ask other students about their experiences. That will be more helpful than trying to guess based on the "name" of the facility.

That said, there is a difference between acute care rotations at teaching hospitals and community hospitals. Many community hospitals don't have traditional rounds, with an interdisciplinary team. Some do. It just depends. That doesn't mean you won't learn anything, but it will be a different kind of learning experience. You should go for an acute care at a traditional teaching hospital for the learning experience, and to see if you like that environment. I thought I wanted that kind of residency (academic medical center) until I realized I hated everything about it. I liked my community clinic and amb care rotations a whole lot better, and ended up going in a completely different direction.

Thanks They love to push residency and large academic teaching hospitals here, which I guess is ok, but when I tell people I want some community hospital/rural rotations, they are like, "Aren't you applying for residencies? You should pick UMC." and they go all blah blah about how residency directors look at whether or not you had a lot of "hard" rotations and rotations at large institutions. I just wonder..how can a residency director know how "hard" a rotation is. It's so subjective, ya know?

Originally Posted by rxlea

Thanks They love to push residency and large academic teaching hospitals here, which I guess is ok, but when I tell people I want some community hospital/rural rotations, they are like, "Aren't you applying for residencies? You should pick UMC." and they go all blah blah about how residency directors look at whether or not you had a lot of "hard" rotations and rotations at large institutions. I just wonder..how can a residency director know how "hard" a rotation is. It's so subjective, ya know?

Depends on your area but word of mouth travels far so people are aware of how different preceptors are. One of my preceptor is well known in the area as a hard ass and works his students hard, students know it and fellow preceptors do too. I also interviewed at places where they personally knew my preceptors (former resident of the program) so they have a good idea of how that preceptor practices. Plus you can have specialty acute care rotations... I would say medical oncology or solid organ transplant is a different level than internal medicine acute care. Generally the preceptors request that students do one general acute care rotation before they do the specialty for good reason. Not all acute care rotations are the same and you'll see that when you describe those activities you had on your CV.

Originally Posted by ADN1226

Depends on your area but word of mouth travels far so people are aware of how different preceptors are. One of my preceptor is well known in the area as a hard ass and works his students hard, students know it and fellow preceptors do too. I also interviewed at places where they personally knew my preceptors (former resident of the program) so they have a good idea of how that preceptor practices. Plus you can have specialty acute care rotations... I would say medical oncology or solid organ transplant is a different level than internal medicine acute care. Generally the preceptors request that students do one general acute care rotation before they do the specialty for good reason. Not all acute care rotations are the same and you'll see that when you describe those activities you had on your CV.

I actually have a specialty rotation already set up at a large hospital (hem/onc). This particular preceptor doesn't normally take students from my school but the person knows me from when we worked together. I just have to figure out where to slot it. They hand slot the ones we set up and then run a lottery on the rest. So you think I should do general acute care before that?

I would recommend everyone to do general acute care first but its not always an option. If you can I think it'll definitely help to have it first b/c gen med will cover common disease states that heme/onc patients may have so it'll make life easier and you can focus on learning heme/onc issues. But I didn't have gen med before heme/onc so I had to "double" up with reviewing common dz states ie: PNA, DM, HTN, pain management, anticoags, and also all the heme/onc specific problems ie: neutropenic fever, onc emergencies, chemo toxicities etc.

You seem like the type of student that will step up to the challenge of having difficult rotations and will prep accordingly so I wouldn't worry TOO much but I definitely think it helps with the rest of your rotations to cover the common disease states early whether it'll be in am care or your gen med rotation so once you get to rotations where the disease states are more "difficult" treating DM, HTN, DVT will be a breeze.

I think when it comes to residency, its a lot of who you know, sucks, but true. Pick your preceptors brains... see where they trained, who they know ...if you can do a rotation at a site you're interested in thats HUGE. The program I matched at... I didn't think I had a chance at an interview but I did and i'm 100% sure having a dean that spent years at the program, and having 2 professors (1 of which wrote my LOR) as former residents helped me get the opportunity to "wow" them. They mentioned all 3 people's names during my interview so i'm sure that was a major factor when they looked at my application.

Originally Posted by rxlea

I actually have a specialty rotation already set up at a large hospital (hem/onc). This particular preceptor doesn't normally take students from my school but the person knows me from when we worked together. I just have to figure out where to slot it. They hand slot the ones we set up and then run a lottery on the rest. So you think I should do general acute care before that?

Don't underestimate the name of the institution and preceptors carries. You will also likely be requesting 1 or more letter of recommendation from these preceptors. If you are interested in acute care residency, try use these opportunities to to your maximum advantage.

As for rotation line up, I would save the specialty fields for later, so you can first get the basics in internal med, ID and ICU will make a lot more sense to you after that, then even more specialized ones like hem/onc. Don't be afraid to go to the office of whoever is setting up your rotation. The squeaky wheel gets the grease.

I wouldn't worry too much about landing an academic acute care rotation over others. When I applied to residency, the only acute care rotation I had completed was at an Indian hospital (like 30 beds...) and I matched (to a community hospital). As has already been stated, sometimes it's about knowing the right people. My preceptor knew the RD at the hospital I matched to so his LOR likely helped.

From what I've seen, rotations are a total crapshoot. You can have a great learning experience at a small hospital and vice-versa. You will always be able to talk about your acute care experience during your interview and explain how it made you a better candidate regardless of the size of the institution. Sometimes it's better to be a big fish in a small pond, so to speak.

rxlea, I see you attend U of A. If you are considering rotations in the Phoenix area I would be happy to share any information I have about specific sites; just send me a PM.

I agree that you shouldn't worry about it too much. I know plenty of people who did acute care rotations at big name hospitals and due to the number of highly specialized providers and expertise, there were less opportunities for pharmacy interventions. Definitely just make the best out of your situation and ask your preceptor for additional responsibilities if you feel it isn't reaching your expectations or goals.
Regarding APPEs, I was also concerned with my university only doing 6 APPEs (6 weeks each), but my residency interviewers did not bring it up as a weakness (and I matched). I think there are +/-s to doing less rotations for a longer duration each, and doing more rotations for shorter periods.

What about "block" rotations? the large teaching hospital associated with my COP has a "block" where all the rotations are in either the inpatient or outpatient settings here. downside: you only get to experience one institution (ie: we also have a VA) but upside: less traveling, the students who have completed this rave about how clinically relevant the majority of the rotations are. students actually have to apply for this and I think they take about 20 total.

Originally Posted by tungsten87

What about "block" rotations? the large teaching hospital associated with my COP has a "block" where all the rotations are in either the inpatient or outpatient settings here. downside: you only get to experience one institution (ie: we also have a VA) but upside: less traveling, the students who have completed this rave about how clinically relevant the majority of the rotations are. students actually have to apply for this and I think they take about 20 total.

We have this option at several hospitals. The people that did these have mixed feelings about them, and some say that they wish they'd rather have more variety to see how things are done in different institutions. Of course the upside is that you know that you won't get rotations where you're sitting around and doing nothing. Looking at the people I know that did these, how well they matched isn't really different from how similar candidates that didn't do this type of rotations matched, so I wouldn't say that a block rotation is positive or negative in terms of your chances of matching.