Order of EM Rotations

Join the circus. Just kidding. I am facing a similar situation so I am curious what the rec will be. Good question

I was in a similar boat. Here is what I did, your milage may vary...

I took a rotation at Resurrection Hospital in Chicago as the first rotation of M4. The program there is GREAT for students. It has a good pace for learning, lots of pathology, and good instructors. Plus, the SLOR has some weight as Res has an EM residency. Then, in Sept., I did an away rotation at Indiana. At the time Indy was far and away my first choice. The pace was rapid - I learned a lot more by doing rather than being taught. The experience was fantastic. In Dec., I did a toxicology rotation at UIC, which was good "PR" for my interview there.

Lessons to take: In my opinion, find a community based, medium pace, facility with an EM residency to do an away rotation at as early as possible. With a slower pace, and an early date (so the interns are clueless - lets you shine) you will get a decent SLOR, which starts you off well. It is less important that this be a facility you are really interested in, it is more important it be "learning friendly". Then do your second EM rotation at whatever program is your pre-application "first choice". That way, you are well known to a program you like. Use anesthesia, critical care, and/or toxicology electives to pick up needed skills and earn a good reputation at different facilities.

- H

Firebird said:

However, my school only gives pass/fail grades for rotations at other universities.

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FYI, most EM rotations have a SLOR (standardized letter) that ranks you and gives you honors, high pass, pass, etc. that is your grade for the rotation. if you do an away rotation and get honors, but your home insitiution changes it to a pass on your transcript, your SLOR will still say that you got honors since the SLOR is part of the letter of recommendation.

let me know if this doesn't make sense but in essence, you away rotation grade will show up.

Firebird said:

Ok, makes sense...but does a letter grade at your home institution carry more weight than the SLOR, or is it the other way around? Actually, I would imagine that the letter from the institutions you're APPLYING TO would be the most important.

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The letter grade from your home institution won't carry much weight since it's not from EM residency faculty.

EM is a young community and there are people at just about every residency program who are well known amongst program directors. The letters you will use for recommendations in EM need to be on the Standardized Letter of Recommendation (SLOR) form and will ask the person grading you how many people they see rotating each year and what percentage of each type of grade they give out. So an "A" from your school where you are the only one that's ever been graded by the doc from your school will be difficult to interpret. A letter from Joe Schmoe program director who evaluates 50 med students each year and gives you Honors and is a friend of the pd where you want to go (or even just someone she's heard of) will probably carry a lot more weight. I'd be more inclined to do 2 away EM electives and get letters from them. Tell them early on you're hoping to work with someone enough to get a lor and they will usually let you work the schedule out to get several shifts with one of the attendings who write most of the letters.

you can also switch shifts or do an extra one in order to work with someone more often or in order to work with the program director.
-andy