4th year aways

[ED50]

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Hey all, I was hoping I could get a bit of advise. I am heading into my fourth year and prior to turning in my application I will have done 4 PM&R rotations, 1 outpt musculoskeletal, 1 inpt peds, 1 outpatient pain, and one general inpt. The problem is only one of those is an away rotation affiliated with a residency program. My question is, do I need to do some rearranging and set up another away rotation or should I be good? I know common consensus is 2-3 aways, but what I'm unclear on is are those recommended more for exposure and LOR's or are they more for networking and getting yourself seen by PD's. I ask since there are no real residencies around where I live so it requires me to move somewhere for a month. I feel like I will have enough exposure and LOR's come the application deadline, but I am concerned about if it is going to be considered adequate.

Also, are PM&R LOR's from Dr.'s affiliated with a residency program potentially worth more then other PM&R LOR's?

I know these are not easy questions and they probably don't have a definitive right or wrong answer, but any input or advise would be appreciated, Thanks!

 

[RangerBob]

My personal opinion is to do a total of 2-3 PM&R rotations max, including aways. Some people only do one PM&R rotations--that's the minimum anyone should do, but I don't see anything wrong with doing just one. But, I think 4 is quite a bit, especially since only one is an away. Can you try to combine a few of those to get a more thorough intro to PM&R? Many schools let you design an elective, so that you could say, spend a week on peds, a week on inpatient, a week on MSK, and a week doing pain. It's enough to get you a general intro to parts of the field.

Honestly paying a month or two for rent to do an away is part of the away rotation gig. I paid two months of rent plus cross-country travel. If you have a top choice program (and if you come across well on rounds/clinic--many don't, and these people get hurt on away rotations) then you should do a rotation with that program. That's how I thought about my aways-- (1) which program do I want to get my foot in the door and try and impress them, and (2) which program do I want to "interview" more thoroughly? People tend to forget that second part, but you only get to know a program so much during the structured interview day, whereas over the course of a month-long rotation you'll get to know a lot more ins and outs and gripes/complaints of the residents, whether you really want to work with those attendings for three years, etc.

Anyway, keep in mind that you will have all of residency to learn PM&R, but you only have one 4th year of medical school. Take rotations that interest you that you'll never get a chance to get exposure to, and take rotations that are known at your school for being really great learning rotations/great prep for internship. Do at least 1-2 sub-I's. I did a general medical floor sub-I and an ICU sub-I, and I'm very glad I did them. If your school doesn't require a neuro rotation, definitely do neuro. I could go on and on, but those would be may main recommendations--do a few rotations to prep for intern year, a few for fun, a few for PM&R, and a few for laziness (so you can interview without hassle in Dec/Jan!).

I do think a PM&R letter from an academic physiatrist will potentially be worth more because someone reading the letter might know that physiatrist or put more stock in what they say. But ultimately what is far more important is how well that physiatrist knows you and how good of a letter they write--I'd prefer a very well-written community physiatrist letter over a decent academic physiatrist's letter.

 

[lejeunesage]

Dude, here's my advice: take a chill pill.

You've already done way, way, way more than enough. I had interviews at Harvard and Mayo and I hadn't done a single away rotation. You'll be fine. This is PM&R, not derm. All you need is to get one letter from an academic physiatrist. My guess is that you'll have more interview offers than you'll know what to do with.

 

[Paddington]

While I've echoed the sentiment that PM&R is not Dermatology, the fact is that the match for PM&R has become much tighter. Before applying you need to take a brutally realistic assessment of yourself as a candidate. If you are an average to below average candidate, even as a U.S. graduate you may not match, simply because of how the numbers work and the element of randomness. If you should doubt this, check some prior threads here. As such, I would focus on using away rotations to maximize your chances of matching somewhere, rather than doing a rotation at RIC "because that's what everyone does" as was the case some years ago.

If you're an average candidate, of two away rotations do one safety and maybe one reach program. If you're below average (and that means any single black mark on your application, like a repeat of a clerkship, Step exam failure or low score, or even time taken off that you might need to explain) then cultivate 2 away safeties, in addition to your home program.

If you want to know what a "safety" is, it's the 50% (or more) of PM&R programs that barely get any attention here on these forums.

 

[The JockDoc]

With your schedule, how did you have time to learn about other fields in medicine besides PM&R during your 3rd year?

 

[colourmebadd]

Fail.

 

[ED50]

Hey all, thanks so much for the replies. I felt like I was in a pretty good spot but my school and some classmates were giving me mixed signals about aways and total number of rotations needed. I just wanted some advise from people who had already done it and knew more then me.

@RangerBob, thanks for the thoughtful insight. I might try to combine a few of those experiences or shorten them a bit. I'm currently doing a neuro rotation and am planning on doing another. At your suggestion I will set up another IM rotation which should be helpful during intern year (plus I love IM).

@Paddington Thanks for the thoughts, I consider myself a pretty average applicant, no black marks, but nothing too special about my app. I guess I'm just trying to ensure I have my ducks in a row since as you noted the competition has increased a bit this year. Not really worried about matching, just aware that it is a possibility.

@ The JockDoc, I think you misinterpreted my post. During third year I only did one PM&R rotation, the other three I have planned are this summer and early fall.

I know posting this makes me seem a bit neurotic, but once again just looking for some advise from people who have done it.

 

[The JockDoc]

I'd focus more on quality instead of quantity. Do 1-2 (max) more PM&R rotations where you'll have the most in-depth experience. Yes, connections for LORs can matter, like everything in the real world, so it's a consideration. During applications, expressing cogent reasoning from past experiences about why you want to do rehab is the best way to show you want to join the field and can fit in.

Use the other 1-2 rotations that you would have otherwise spent on PM&R to explore other fields. You'll be surprised with what arcane knowledge or experience can come in handy in the future.

 

[ED50]

Thanks for the insight everyone. I'm planning on condensing a few pm&r rotations so I can obtain a bit more breadth prior to starting residency! Quality > quantity