Fourth Year Aways

[TurtleyReady4Med]

Hello everyone!! I am excited to be applying to psych this year and was wondering how important fourth year aways are for placement? My PD seems vehemently against them and financially it would be a lot easier for me to skip an away, but some residents I have talked to have said they are mandatory. I have average stats for a psych applicant. Any thoughts?

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[rjs2131]

I didn't do any aways and did just fine - I think it really depends on your interpersonal strengths. Do you think spending an extended period of time at a program will increase your chances (can you be "on" for an entire month during an away rotation) or are you better suited to just making a solid impression on your interview day?

I'd say if you have a program you really want to match at that's a reach, it may be worth doing an away (if you can get one) to increase your chances. Other than that, probably better off saving your money. Definitely heard of people shooting themselves in the foot by doing an away and being "average", so at the end of the day you need to evaluate your strengths/weaknesses (maybe look at your evals from MS3?) and play to your strengths. If you're the introverted med student that doesn't socialize much, aways probably won't do you any favors (especially in psychiatry where interpersonal ability/finesse is a huge asset).

 

[TexasPhysician]

I started residency a decade ago and left academics a few years ago. I may not be up to date.

I did 0 aways and was an average US med student. I interviewed everywhere I wanted and matched #1. In my residency, we had few away students join us and it generally didn’t benefit them.

if you are going to do aways, I’d recommend doing it at places you don’t believe that you could match otherwise.

 

[Psychresy]

Current resident here. I did an away at a program I likely would not have matched at. Later ranked them number one and matched. Just another perspective.

 

[notamindreader]

I think it can go either way as has been stated above. I know several people who did aways at reach programs and were able to secure a spot there and also folks who rotated at top programs and ultimately found the program to be a poor fit for their professional and personal interests. I would advise caution if you don't shine interpersonally. I met someone who had done an away rotation and had had some friction with an attending and was effectively told they would never match there.

 

[MacDonaldTriad]

Familiarity can breed contempt or admiration depending upon how you do. Given two applications one of which might be 10% stronger on paper than someone who did a reasonable job on a sub-I and has proven to be able to do the work, the sub-I wins every time. We don't have any expectation that the best candidates do Sub-Is because you can only do one or two at most so not doing one isn't a bad mark. I don't suggest doing two at the same program. One is enough of a sign of interest. I have seen sub-Is get a good review on their first rotation and then upset the residents on the second. Doing poorly on the first attempt will never be erased by a good performance on the second, but the inverse will black ball you most times. I have said this before, but it is also true that undergraduate medical education doesn't always have strong communication with graduate medical education. Good programs will look at sub-I performances, but with grade inflation and the vagaries of medical school performance evaluations, this takes some energy and research to get the honest picture.

 

[frizzyhair]

I have also been struggling to decide whether I should do an away rotation. Although many here have advised to do an away rotation at a reach program, I would definitely be anxious doing an away rotation at program that seemed out of my league, and I'm sure that would affect my performance. On the other hand, an away rotation would be a great learning experience, even if it did not result in an interview.

 

[MacDonaldTriad]

I have also been struggling to decide whether I should do an away rotation. Although many here have advised to do an away rotation at a reach program, I would definitely be anxious doing an away rotation at program that seemed out of my league, and I'm sure that would affect my performance. On the other hand, an away rotation would be a great learning experience, even if it did not result in an interview.

Thank you for saying this. Doing a sub-I doesn't equal being granted an interview, and If you think it does and ask why are you working here if you are not being considered, the answer should be for the high quality of training and learning you are being offered. If you don't see this as enough, you are welcome to rotate somewhere else. There will always be some difference of agreement between graduate medical education and undergraduate medical education so one doesn't tell the other one what to do or how to behave in a concerted fashion. We didn't agree to adopt or even support the expression "audition rotation". It does help to work at a program in terms of knowing what you are buying, but it isn't a guarantee.

 

[solitarius]

Don't do an away unless you have a really good reason and are willing to take a gamble.

 

[nexus73]

I like the idea of doing away rotations at places you otherwise think you would not have a chance to match, then it's not a gamble since you have nothing to lose.

 

[EmilKraepelin55]

Would doing an away at programs you really want which are also in your home state be a good enough reason?

 

[splik]

aways are not mandatory. However I think they can be invaluable. You will get a much better sense of the program for doing an away rotation. Some institutions (including where I am and where i did residency) only offer away rotations to students they would offer an interview to (and they may not otherwise offer an interview). Others are completely unrelated. If you do an away, it also matters what rotation you do and with whom. If it's not with people connected with the residency program in a meaningful way then it's not going to have an impact. Or worse, if you're rotating with an attending that the program director hates, they aren't going to put much stock in their opinion (yes, this stuff happens at some programs).

Prioritize doing aways in inpatient, C-L or emergency psychiatry. You aren't going to be able to demonstrate your skills sufficiently enough if youre just shadowing in some outpatient clinic or doing some random rotation. Make sure you did a 4th yr psychiatry rotation at home before doing an away.

For DO students, doing aways are very important. I believe they were particularly disadvantaged by the limitations in away rotations this past cycle. This is a good way of getting letters from faculty who are part of a residency program (other letters don't carry much weight) when applying to other programs as well as a way to get a foot in the door for specific program.

Yes, some students don't do well on their away rotations. But that means that program was not a good fit for you.

 

[nexus73]

If you do an away I'd suggest offering to give a brief presentation later in the rotation. If you have a chance to give a lunchtime talk for example to the C/L service or ED service, that is good I think. An outside medical student teaching residents and/or attendings leaves an impression if you do a good job. Especially helpful if the attending is supposed to teach and you can take that burden off them for one day.

 

[MacDonaldTriad]

I think aways make the whole process much less like on line dating. Both sides get to know each other a lot better than an online profile and a one day of superficial interviews where everyone is well behaved. If you don't like us, we are glad not to match you. If we don't like you, both sides are better off not creating a marriage for the next 4 years. It is all win win if it ends up not being a bachelor reality TV show like process. I did miss the ability to have outside people during the pandemic and it did disadvantage both sides significantly. Given the relatively static numbers, I'm not sure it was a disaster, but where we usually had about half of our matches do aways with us, it was only a quarter this match. Interestingly, we had many more local medical students work with us who were not interested in psychiatry, but needed to find rotations and we were open. They did a good job and seemed to appreciate the experience. I wouldn't be surprised if this didn't bear some kind of fruit in terms of more appreciation for psychiatry as a specialty that doesn't deserve the scorn we put up with historically. Maybe some day I will stop being asked if I ever regret deciding not to be a real doctor. No, that is asking too much and will never happen.