Away rotations/AI's/Sub-I's

[khadija]

I'm planning out my 4th yr electives. I was interested in doing some away rotations (aka AI's or sub-I's). But they are expensive (the fee for the rotation, plus travel and lodging). So I was wondering how important is it to do an away rotation and how many should I do?

Also, I'm not sure what type of programs to apply to do for an away rotation. That is, should I do a general peds inpatient program? outpatient peds? or try to do some type of peds subspecialty to enhance my learning?

Any advice abut doing away rotations (or applying to peds in general) will be greatly appreciated.

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[CrazyPeds527]

I wouldn't plan on doing more than 1 - it is fairly cost prohibitive, and frankly, you don't need to do an away to match somewhere.

In order to get the best experience, if you are looking to do a true AI, best to do a general inpatient month; it will give you the best look at the day-to-day stuff of a residency. An outpatient month will likely leave you fairly disconnected from the residents, while an elective is hit and miss depending on the elective - some are wonderful, others, not so much.

Lastly - work hard. Don't do an away elective and plan on coasting; nothing will leave you black-balled from a resident's perspective than not working hard. Knowledge gaps can be addressed, and frankly are expected in med students (and interns/residents). Laziness is not well tolerated.

Do a search of these forums from last year around summer time and you will find some good stuff on this topic.

Good luck!
~MD

 

[bubabugster]

I agree- just do one away rotation. I also recommend doing inpatient as your AI.

 

[Allergy]

My advice is do an away rotation where you would like to go but don't think you have a great chance of getting an interview ie. reach programs. If you go there and do a great job which I know you will just because of the nature of doing an away and wanting to do well. You may get an interview you may have not have otherwise gotten. I know some programs automatically interview candidates that do aways at their institutions.

Hope this helps

 

[michigangirl]

I have posted multiple times on both the anesthesiology and pediatric board so do a search. In a nutshell-- away rotations are absolutely not a necessity unless you have a specific program or region that you feel you must match in (i.e. you've always dreamed of going to CHOP, or you absolutely must match in Baltimore because your spouse/S.O. is there). If you are a reasonable candidate with good grades and scores and did well 3rd year in your clerkships, you will not have a problem matching at a good program. If you are just average, didn't do great in your peds rotation or a lot of your 3rd year clerkships, and want to go to a particular "top" program, then an away might be the best chance you have to go to that "reach" program.

The issue is-- you have to ROCK the rotation. Meaning, work harder than you ever have, go above and beyond, and show the people there that you are the bees knees. Don't try doing more than one away-- it's not worth it. If you're better on paper than in person, don't even bother with aways-- let the paper do it's job and do your best in interviews and you're set.

From your post it doesn't sound like you have a particular burning desire for one program or region. For me-- I HAD to match in the D.C./Baltimore area to be with my husband. So I did aways at both CNMC and Hopkins to see which I would rather match at and hopefully impress someone in the process to rank me highly. Just one example of why I did an away. Otherwise, I wouldn't have bothered. Good luck.

 

[BigRedBeta]

While I think doing an AI/Sub I does represent the best case opportunity, it should be noted at many programs - especially those that are popular with their own students - getting an AI in an advantageous timeframe may be difficult. I wouldn't rule out the possibility of doing a PICU or CVICU month. Even an outpatient specialty month in a specialty where you know residents rotate through (look at their websites) can be worthwhile.

 

[DickyV]

In a nutshell-- away rotations are absolutely not a necessity unless you have a specific program or region that you feel you must match in (i.e. you've always dreamed of going to CHOP, or you absolutely must match in Baltimore because your spouse/S.O. is there).

I have to pretty much agree with this, an away at CHOP or Boston Children's is probably worth it; lesser-known peds programs, probably not so much.

That said, I did an away at a place I assumed was going to be ranked #1, but disliked it so much that I left it off of my ROL. If there's a place in which you're truly interested, an away month is worth WAY more than an interview and a second look.

 

[lockjaw]

I have to pretty much agree with this, an away at CHOP or Boston Children's is probably worth it; lesser-known peds programs, probably not so much.

That said, I did an away at a place I assumed was going to be ranked #1, but disliked it so much that I left it off of my ROL. If there's a place in which you're truly interested, an away month is worth WAY more than an interview and a second look.

Exactly - I didn't do aways in order to improve my chances of matching (since in general it's less crucial in pediatrics than in many other specialties, except at maybe the top programs), I did them to help me get a feel for what I was looking for in a residency program. Both programs associated with my school are small, so I wanted a chance to see some medium/large programs. Two of the programs I rotated at ended up being numbers 1 & 2 on my list; the third program ended up last. I'm not sure I would have made the same ranking choices based only on a short interview day, so I'm glad I had the opportunity to do these away rotations. One of those months was an AI and the other two were electives, but there was enough integration with the residents/teaching conferences/etc. during those electives that I still felt I was able to get a solid idea of what the program was like.

 

[goinginpeds2011]

I also did an away rotation somewhere that I thought would be my #1 with my original reasoning to check out the area to live in and ended up disliking the program so much that I didn't even apply there. That experience made me much more careful when applying to programs - and even though I was really disappointed it was good I found out I hated it there and it made me realize what was important to me (and that some things my home program did which I thought were givens are not).

I was given the advice not to do an AI because you will be new and it will be especially difficult to shine when you are the only one learning a new computer system, trying to find your way around the hospital, in a new and less stable living situation, etc. Their 4th year students likely did their 3rd year clerkship at the same site and know the drill. I did my AI at my home program when the new interns started and even with them being a year wiser they had a hard time the first week or so. For my away rotation, I did a consult service that had lots of interactions with the general teams and therefore the residents. I also made sure to go to all the conferences. I think this was good as you don't want to be on an isolated rotation.

I wouldn't waste your time on programs you are not very interested in and won't be at or near the top of your list.

 

[Powdermonkey]

What if you don't have a home institution, a home residency program at your school, and only one class that has graduated in front on you? I have 6 elective months starting in June and I plan on doing a bunch of away rotations at places I'm interested in going to residency. Why would I not go out and explore and see if I even like those places if I have the chance? Why stay somewhere thats easy and comfortable to me when I could go out and challenge myself and learn new stuff and meet new people?

I think that NOT doing as many away rotations as possible is silly. But what do I know...

 

[greenbottleblue]

What if you don't have a home institution, a home residency program at your school, and only one class that has graduated in front on you?

I think that NOT doing as many away rotations as possible is silly. But what do I know...

Sure, but that's not the case for the majority of people here. Like the factors mentioned above (cost, etc.) there are plenty of reasons to do none/few.

 

[michigangirl]

Your situation is unique. The question asked by the original poster was geared toward how aways related to residency applications as well as learning experiences. Feel free to do as many aways as you want since you don't have a home residency or a home institution-- obviously aways are almost the only way to go for you. But most of us come from an institution affiliated with either a peds residency and/or a pediatrics service/floor . It is VERY expensive-- but if that's the only way for you to get a broad peds experience and you have the resources, go for it.

if your institution is affilated with a pediatrics service and you KNOW you want to do peds, then letters from your home school and faculty should be sufficient as long as you're willing to match all over the country. If you have any limits, though, things get more complicated. Also, I can only speak from the MD school perspective, I have no knowledge about the DO school perspective.

What if you don't have a home institution, a home residency program at your school, and only one class that has graduated in front on you? I have 6 elective months starting in June and I plan on doing a bunch of away rotations at places I'm interested in going to residency. Why would I not go out and explore and see if I even like those places if I have the chance? Why stay somewhere thats easy and comfortable to me when I could go out and challenge myself and learn new stuff and meet new people?

I think that NOT doing as many away rotations as possible is silly. But what do I know...

 

[Powdermonkey]

Sure, but that's not the case for the majority of people here. Like the factors mentioned above (cost, etc.) there are plenty of reasons to do none/few.

And I have every one of them. So what do I do?

 

[Powdermonkey]

Your situation is unique. The question asked by the original poster was geared toward how aways related to residency applications as well as learning experiences. Feel free to do as many aways as you want since you don't have a home residency or a home institution-- obviously aways are almost the only way to go for you. But most of us come from an institution affiliated with either a peds residency and/or a pediatrics service/floor . It is VERY expensive-- but if that's the only way for you to get a broad peds experience and you have the resources, go for it.

if your institution is affilated with a pediatrics service and you KNOW you want to do peds, then letters from your home school and faculty should be sufficient as long as you're willing to match all over the country. If you have any limits, though, things get more complicated. Also, I can only speak from the MD school perspective, I have no knowledge about the DO school perspective.

Mmk.

 

[deleted311769]

I think that NOT doing as many away rotations as possible is silly. But what do I know...

Most allopathic programs won't give you credit for more than 2-3 months of away rotations in your chosen specialty.

 

[khadija]

Thanks everyone for your responses. And to clarify, my school actually doesn't have an associated peds residency. So I know I want to do at least one away. In fact, I would like to do 2 (the max my school will allow in one specialty). The only things restricting me are the cost and the risk of looking bad.

As someone mentioned, you don't want to do an AI/Sub-I and not do your best. That ends up hurting you a lot. So I was planning on doing an away at one of the top children's hospital. But I'm not sure if I should do an away first at a less competitive program to sort of prepare first. (Since my own school doesn't have a residency program, I can't do a home rotation first.)

 

[Allergy]

you should do a peds elective at your school I suggest ID which is great prep since you will see a lot and learn those all important antibiotics. i got pimped a lot on "what antibiotic should we use" during my AI etc and a lot of things you see in peds during the fall/winter time require antibiotics so i think its a great elective to take prior to an AI. I did 2 electives early on ( ID being one). A/f electives I did AI so I looked like a star as a result of doing peds 2 months prior and attendings were very impressed with my knowledge. Do these early in 4th year so that when Aug, Sep or Oct come around u can use on of these months for an away. The only thing is you have to be really on your stuff in terms of yours ERAS essay etc. and if you do your aways early you can possibly get a rec from favorable rec from a away attending to use for that particular program.

 

[fleetgoddess]

you should do a peds elective at your school I suggest ID which is great prep since you will see a lot and learn those all important antibiotics. i got pimped a lot on "what antibiotic should we use" during my AI etc and a lot of things you see in peds during the fall/winter time require antibiotics so i think its a great elective to take prior to an AI. I did 2 electives early on ( ID being one). A/f electives I did AI so I looked like a star as a result of doing peds 2 months prior and attendings were very impressed with my knowledge. Do these early in 4th year so that when Aug, Sep or Oct come around u can use on of these months for an away. The only thing is you have to be really on your stuff in terms of yours ERAS essay etc. and if you do your aways early you can possibly get a rec from favorable rec from a away attending to use for that particular program.

Interesting this was not at all my Peds ID experience. Except for maybe some malaria, erlichia, and RMSF which is pretty easy to rock. Otherwise it was a lot of open chest heart kids growing out weird bugs I've never heard of before the rotation, kids in lawnmower accidents/ traumatic amputations growing out weird bugs I've never heard of + some that I did. Some TB meningitis from across the border ( I actually live no where near the border but the kid had just been there). Some Fungal Osteomyeltitis. + the normal osteo kids and a one or two pneumonia consults that were in the PICU and not doing so well. More often than not it was weird things than normal things. The good thing is there is a website with guidelines on everything so I just read it all the time I forget what it was called now.

Our ID team is a consult service only though which may be the difference the normal pneumonias, uncomplicated infections just don't get consults.
Don't get me wrong I enjoyed ID but I felt like I learned nothing practical about most infections I'll actually be seeing frequently.

My fav rotation was the PICU we did the cardiac ICU and PICU which was fun.

 

[michigangirl]

Fleetgoddess is on the money about what the usual academic children's center ID service is like. I disagree with ID as a good service to do an away. You need a rotation where the patients are all in the same area (i.e. NICU, PICU, oncology, general peds floor) and you have the opportunity to showcase that you are a hard worker, efficient, intelligent, resourceful, energetic, and an overall awesome person to work with. Consult services will not give you that opportunity.

For example, as a med student in the PICU/peds onc/NICU/general peds floor you will have the opportunity to follow 1-2 patients with a resident-- but if you play your cards right do the majority of management, patient care, presenting on rounds, making recommendations, and teaching your team about specifics related to your patient(s). The residents are there to make sure orders get written, you do things right, and know when to ask a higher up. You also get direct exposure to fellows and/or attendings who will be instrumental in writing you letters that will help you get an interview/land a match spot. Consult services are useless for medical students who can't go do a consult themselves because of a lack of clinical knowledge base. you don't get to show people how you individually manage hospital systems, people, nurses, colleagues. It's an important difference.

Good luck.

 

[khadija]

Fleetgoddess is on the money about what the usual academic children's center ID service is like. I disagree with ID as a good service to do an away. You need a rotation where the patients are all in the same area (i.e. NICU, PICU, oncology, general peds floor) and you have the opportunity to showcase that you are a hard worker, efficient, intelligent, resourceful, energetic, and an overall awesome person to work with. Consult services will not give you that opportunity.

For example, as a med student in the PICU/peds onc/NICU/general peds floor you will have the opportunity to follow 1-2 patients with a resident-- but if you play your cards right do the majority of management, patient care, presenting on rounds, making recommendations, and teaching your team about specifics related to your patient(s). The residents are there to make sure orders get written, you do things right, and know when to ask a higher up. You also get direct exposure to fellows and/or attendings who will be instrumental in writing you letters that will help you get an interview/land a match spot. Consult services are useless for medical students who can't go do a consult themselves because of a lack of clinical knowledge base. you don't get to show people how you individually manage hospital systems, people, nurses, colleagues. It's an important difference.

Good luck.

So u r saying consult is not a good away elective b/c u don't really get a chance to shine. what about outpatient aways?

and also, is there a difference between a AI/Sub-I and doing a regular 4th year away elective? i'm on vsas and i see both types of electives being offered and am a bit confused about the benefits of each type.

 

[michigangirl]

Precisely. Unless you know that the outpatient elective attending is the residency program director or chairman of the dept., not really of any benefit. The key is-- "sub-I" = acting as a 'sub-intern'-- you are expected to operate at the level of an intern, carry patients, and do everything you can except write orders since you're not an md. gives you ample opportunity to shine.

A "regular away elective" could encompass things like peds onc or consult services like peds ID. So it's important to clarify.

 

[fleetgoddess]

I totally agree with MichiganGirl in her advice. I felt bad for the away students who got consult services as they were sometimes overlooked and not as involved. On my peds ID rotation (which was at home) I didn't get much autonomy as even the first year fellow I was working with was still learning how to manage all the strange things. I really was just reading to stay afloat.

I'd only do an away rotation if I could do a Sub I. I actually did two home sub I's. I'd really recommend PICU if you could.

 

[Superman DO]

I'm resurrecting this thread because I have a similar question about sub-i's, and just wondering if there were any new thoughts about them. I applied to quite a few away rotations to residency programs I was very interested in attending through VSAS; however, I was denied from all programs because there were no spots available. Currently, there is no rotations I can apply for that seem to fit my schedule, so I have pretty much given up on the possibility of being able to do an away sub-i. My adviser is pressuring me to find some kind of an away rotation as she says it posts a big red flag on my application, even if it is at a residency program I'm not even applying to. On paper, I think that I am a decently competitive applicant, and I do not plan on applying to the most competitive peds programs. . .so, how much will not doing an away sub-i hurt me in getting interviews and the match? Thanks!

 

[michigangirl]

Doing an away rotation at a residency program you may match at is generally the exception and not the rule. I'm not sure how anyone can tell you its a "red flag" if you dont do any aways. The only reason I did an away is because I only had 1-2 options where I would be happy- I had to do everything in my power to get noticed at the 1 place I really wanted to match so I could live with my husband. If you have several choices, away electives are by no means required, or expected.

 

[GraceEuphoria]

I think this just gets back to the difference in expectations for allo vs osteo programs. DO programs place a big emphasis on audition rotations generally speaking. There are even some that go so far as only considering those who rotate through their service. That might be why a DO advisor brought this up. I'm personally doing 3 auditions.

 

[Superman DO]

I think this just gets back to the difference in expectations for allo vs osteo programs. DO programs place a big emphasis on audition rotations generally speaking. There are even some that go so far as only considering those who rotate through their service. That might be why a DO advisor brought this up. I'm personally doing 3 auditions.

I have an MD adviser though, and only applying to MD programs.

 

[Superman DO]

Doing an away rotation at a residency program you may match at is generally the exception and not the rule. I'm not sure how anyone can tell you its a "red flag" if you dont do any aways. The only reason I did an away is because I only had 1-2 options where I would be happy- I had to do everything in my power to get noticed at the 1 place I really wanted to match so I could live with my husband. If you have several choices, away electives are by no means required, or expected.

Thank you for your answer. =)

 

[GraceEuphoria]

I have an MD adviser though, and only applying to MD programs.

Whoops I didn't know that based on your post and I made some assumptions. If you're competitive on paper, matching allopathic peds without an away rotation seems more than feasible. Like the others said, it seems to be the norm. I'm sure you'll be fine.

 

[Superman DO]

Whoops I didn't know that based on your post and I made some assumptions. If you're competitive on paper, matching allopathic peds without an away rotation seems more than feasible. Like the others said, it seems to be the norm. I'm sure you'll be fine.

lol, thanks. I wish there were more osteopathic peds residencies in the Southeast. It is a shame there are so few DO programs. Nonetheless, there are some great acgme peds residencies in the South that I would love to attend. Ready to finally submit my application tomorrow! =D

 

[GoSpursGo]

Just going to echo that it's silly for anyone to say that you need an audition rotation to match in peds. The vast majority of applicants don't do one

 

[GraceEuphoria]

lol, thanks. I wish there were more osteopathic peds residencies in the Southeast. It is a shame there are so few DO programs. Nonetheless, there are some great acgme peds residencies in the South that I would love to attend. Ready to finally submit my application tomorrow! =D

I wish my circumstances allowed me to apply ACGME, strictly because of how limiting locations are with the AOA match. Between the quality of my application + couples matching, AOA match is my fate it seems. Here's to hoping it all works out...I'd really like to avoid scrambling when only try to match osteo peds