4th year schedule question

[quickfeet]

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If I am planning to apply for I.M., should I keep my E.M. away rotation? It 's the first one I have scheduled for the year and will appear on my transcript.

Reason I scheduled it: did it a few months ago when I was sure I wanted to do E.M.

Now I am worried if it appears on my application, it will look like I am applying to more than one specialty or not committed to E.M. or something.

 

[Amygdarya]

Can you still schedule an IM sub-I or IM elective for that month at your school? (I'm assuming it's too late to schedule an IM away at a program you may be interested in.)
I don't know what IM programs are going to think of your EM away, I'm more concerned about you wasting your money and valuable pre-application time which you could use to show what an awesome IM doc you're going to be.

 

[alpinism]

No.

Why would you waste all that time and money on an EM away rotation if you're not going into EM?

Do an IM subI rotation or IM subspecialty rotation before applying in September.

 

[quickfeet]

Can you still schedule an IM sub-I or IM elective for that month at your school? (I'm assuming it's too late to schedule an IM away at a program you may be interested in.)

My school doesn't have an IM Sub-I.
I applied for 3 away Sub-Is for the same time period, got rejecterino'd from all of them. I sent in the apps like 3 weeks ago, so I think I did so too late.

No.

Why would you waste all that time and money on an EM away rotation if you're not going into EM?

Well, our school does require us to get 4 weeks of "Procedure"-based experience, and counts EM towards this requirement. That's one reason I haven't dropped it yet, because its just easier to keep it and complete the credit.
The other reason is that the rotation is literally 30 minutes from my house, so its not like I have to spend money to stay somewhere for 4 weeks.

 

[J ROD]

If it were later in the year, it would look like an extra elective or to fulfill something like you mentioned. However, with it being first, it looks like you want to EM. Why else would you have it first except to audition for EM? Hence, I see this as an IM doc looking over your stuff. I think you are an EM app with IM as a backup.

I would move it. I think it will almost flag you as a dual agent.

 

[Crayola227]

My school doesn't have an IM Sub-I.
I applied for 3 away Sub-Is for the same time period, got rejecterino'd from all of them. I sent in the apps like 3 weeks ago, so I think I did so too late.


Well, our school does require us to get 4 weeks of "Procedure"-based experience, and counts EM towards this requirement. That's one reason I haven't dropped it yet, because its just easier to keep it and complete the credit.
The other reason is that the rotation is literally 30 minutes from my house, so its not like I have to spend money to stay somewhere for 4 weeks.

I know some people who planned for both IM & EM because they decided right before ERAS

however, while their transcript showed EM subIs they did get at least one IM subI in before ERAS
and while they didn't get a subI letter, and even had an EM letter, they had excellent IM letters
so I don't think the harm comes from having EM on there, it's more if you don't have IM subI or GOOD IM letters

if you don't have an IM subI, it might hurt the invites you would get
(luckily IM is a core clerkship so you've had exposure - I hope you did really well)
you could minimizing how much that hurts you by addressing the change of heart in your PS, and in general you need to address why IM anyway
as far as why your app looks the way it does and how you feel about EM vs IM, it will sort of depend on all your particulars of your app the best way to talk about this in your PS

and try to get an IM subI or even ICU subI before ERAS
line up some IM subIs before rank lists go in so you can mention that in your interviews maybe if all else fails

TLDR
you don't get faulted for having had some interest in EM, the IM/EM decision split is more common than you think
that itself doesn't concern PDs as much - it would be a perceived lack of interest/commitment in IM that would hurt you
you need to turn around your schedule to show via transcript, write a convincing PS, good solid IM letters, spin your activities
try to get that EM --> IM subI, if you can't, you can still apply IM but need to be convincing in your statement

 

[Crayola227]

Add on to the TLDR:
that person had plenty of invites and was only asked a few times about having the EM rotations, to which they were able to talk about how the rotation only served to strengthen their opinion that IM RULED, and had no problems in the match whatsoever

n=hearsay above

 

[quickfeet]

I know some people who planned for both IM & EM because they decided right before ERAS

however, while their transcript showed EM subIs they did get at least one IM subI in before ERAS
and while they didn't get a subI letter, and even had an EM letter, they had excellent IM letters
so I don't think the harm comes from having EM on there, it's more if you don't have IM subI or GOOD IM letters

if you don't have an IM subI, it might hurt the invites you would get
(luckily IM is a core clerkship so you've had exposure - I hope you did really well)
you could minimizing how much that hurts you by addressing the change of heart in your PS, and in general you need to address why IM anyway
as far as why your app looks the way it does and how you feel about EM vs IM, it will sort of depend on all your particulars of your app the best way to talk about this in your PS

and try to get an IM subI or even ICU subI before ERAS
line up some IM subIs before rank lists go in so you can mention that in your interviews maybe if all else fails

TLDR
you don't get faulted for having had some interest in EM, the IM/EM decision split is more common than you think
that itself doesn't concern PDs as much - it would be a perceived lack of interest/commitment in IM that would hurt you
you need to turn around your schedule to show via transcript, write a convincing PS, good solid IM letters, spin your activities
try to get that EM --> IM subI, if you can't, you can still apply IM but need to be convincing in your statement

I have an IM sub-I scheduled for the beginning of October. Sadly that probably won't be in-time to be of use for interviews.

I will cancel this EM away if I have to... I know the program won't mind bc they have a waiting list of people trying to get it. I mean do you really think it will hurt my app to have an EM away rotation on my transcript applying for I.M.?

My worry is that I won't be able to schedule anything of value in its place, and like I said, at least keeping it will allow me to fulfill a credit requirement for our 4th year curriculum.

 

[Amygdarya]

Try scheduling an IM elective at your program during the time of your EM away. If that works out, cancel the EM away as soon as you have that, so that someone else can have the away. If you can't schedule an IM elective during that time, proceed with the EM away, so you don't waste your time and fulfill your school's "procedural rotation" elective; explain it in your PS as Crayola said suggested.

 

[mvenus929]

My school doesn't have an IM Sub-I.

What kind of school doesn't have an IM sub-I rotation? Can you get an IM subspecialty rotation? Preferably one where you'll be working with the attendings rather than fellows?

 

[TheFutureFatMan]

What is SubI? A sub-specialty under internal medicine? (Sorry everyone, didn't know the terminology)

 

[Amygdarya]

What is SubI? A sub-specialty under internal medicine? (Sorry everyone, didn't know the terminology)

SubI = sub-internship, in some places called acting internship. It's an early 4th year rotation in your specialty of choice*, in which you're supposed to perform the job of an intern (with fewer patients) and which is the best approximation of what kind of resident you're going to be. You want to do your subI before you submit your residency application because you want to include your subI grade and - very important! - hopefully a strong letter of recommendation from one (or more) of the attendings you did your subI with. Many (most?) MD schools now have subIs as part of graduation requirement.

* - it depends on the school in how many specialties subIs are offered. Eg., Medicine and Surgery are offered by all schools requiring subIs, some schools also offer subIs in Pediatrics, Neurolobgy, Emergency Medicine etc. If you're applying for a specialty your school doesn't offer a subI in, you do an advanced elective in your specialty of choice that will hopefully confirm your suitability for the specialty before submitting your residency application + do one of the officially approved subIs whenever is convenient for you and before the school's deadline. (Eg., I'm going into Psychiatry, but my school doesn't accept Psychiatry subIs to fulfill subI requirement, so I'm going to do an advanced Psychiatry elective + a Medicine subI.)

 

[TheFutureFatMan]

SubI = sub-internship, in some places called acting internship. It's an early 4th year rotation in your specialty of choice*, in which you're supposed to perform the job of an intern (with fewer patients) and which is the best approximation of what kind of resident you're going to be. You want to do your subI before you submit your residency application because you want to include your subI grade and - very important! - hopefully a strong letter of recommendation from one (or more) of the attendings you did your subI with. Many (most?) MD schools now have subIs as part of graduation requirement.

* - it depends on the school in how many specialties subIs are offered. Eg., Medicine and Surgery are offered by all schools requiring subIs, some schools also offer subIs in Pediatrics, Neurolobgy, Emergency Medicine etc. If you're applying for a specialty your school doesn't offer a subI in, you do an advanced elective in your specialty of choice that will hopefully confirm your suitability for the specialty before submitting your residency application + do one of the officially approved subIs whenever is convenient for you and before the school's deadline. (Eg., I'm going into Psychiatry, but my school doesn't accept Psychiatry subIs to fulfill subI requirement, so I'm going to do an advanced Psychiatry elective + a Medicine subI.)

Thank you so much. That was incredibly helpful.

 

[quickfeet]

If it were later in the year, it would look like an extra elective or to fulfill something like you mentioned. However, with it being first, it looks like you want to EM. Why else would you have it first except to audition for EM? Hence, I see this as an IM doc looking over your stuff. I think you are an EM app with IM as a backup.

I would move it. I think it will almost flag you as a dual agent.

I know some people who planned for both IM & EM because they decided right before ERAS

however, while their transcript showed EM subIs they did get at least one IM subI in before ERAS
and while they didn't get a subI letter, and even had an EM letter, they had excellent IM letters
so I don't think the harm comes from having EM on there, it's more if you don't have IM subI or GOOD IM letters

if you don't have an IM subI, it might hurt the invites you would get
(luckily IM is a core clerkship so you've had exposure - I hope you did really well)
you could minimizing how much that hurts you by addressing the change of heart in your PS, and in general you need to address why IM anyway
as far as why your app looks the way it does and how you feel about EM vs IM, it will sort of depend on all your particulars of your app the best way to talk about this in your PS

and try to get an IM subI or even ICU subI before ERAS
line up some IM subIs before rank lists go in so you can mention that in your interviews maybe if all else fails

TLDR
you don't get faulted for having had some interest in EM, the IM/EM decision split is more common than you think
that itself doesn't concern PDs as much - it would be a perceived lack of interest/commitment in IM that would hurt you
you need to turn around your schedule to show via transcript, write a convincing PS, good solid IM letters, spin your activities
try to get that EM --> IM subI, if you can't, you can still apply IM but need to be convincing in your statement

Try scheduling an IM elective at your program during the time of your EM away. If that works out, cancel the EM away as soon as you have that, so that someone else can have the away. If you can't schedule an IM elective during that time, proceed with the EM away, so you don't waste your time and fulfill your school's "procedural rotation" elective; explain it in your PS as Crayola said suggested.

What kind of school doesn't have an IM sub-I rotation? Can you get an IM subspecialty rotation? Preferably one where you'll be working with the attendings rather than fellows?

Ok, so I decided to cancel the EM rotation for beginning of M4. In its place, the best I could get was a 4-week Pulmonary/ICU rotation at my own school. Do you think this is a good idea? TBH I am relatively mid-to-weak applicant for I.M. (224 on Step I). So I started to really worry about PDs getting my transcript and seeing that the first rotation of M4 I did was an EM Sub-I and making them think I wasn't really committed to I.M.

 

[J ROD]

Ok, so I decided to cancel the EM rotation for beginning of M4. In its place, the best I could get was a 4-week Pulmonary/ICU rotation at my own school. Do you think this is a good idea? TBH I am relatively mid-to-weak applicant for I.M. (224 on Step I). So I started to really worry about PDs getting my transcript and seeing that the first rotation of M4 I did was an EM Sub-I and making them think I wasn't really committed to I.M.

I know several folks that matched internal this year with lesser. Bust your ass on that rotation get a good letter. I think it was a wise move.

 

[quickfeet]

I know several folks that matched internal this year with lesser. Bust your ass on that rotation get a good letter. I think it was a wise move.

Do you think that PDs will really care much about a letter if its from the intensivist at my own school? Our faculty aren't well known in the residency world either since its a community hospital with no residents. Regardless I will work as hard as possible

 

[mvenus929]

Do you think that PDs will really care much about a letter if its from the intensivist at my own school? Our faculty aren't well known in the residency world either since its a community hospital with no residents. Regardless I will work as hard as possible

The letter is designed to let them know how good of a resident you would be outside of numbers and Evals from rotations. Name is only important if it is known in the community, which is going to be rare in a specialty as large as IM. Far better for you to get a letter from someone you worked with closely who can comment on your work ethic and knowledge base.

 

[Crayola227]

Do you think that PDs will really care much about a letter if its from the intensivist at my own school? Our faculty aren't well known in the residency world either since its a community hospital with no residents. Regardless I will work as hard as possible

many intensivists are IM trained (many not) but the sort of medicine you will be doing as a subI in the ICU, let's say that an intensivist will absolutely be seen as someone qualified to evaluate your suitability for IM.

now it is a question of the content of the letter

 

[lakeofirefun]

To the OP, the ICU rotation is way better than the EM away. Yes a medicine sub-I would have been preferred for an IM candidate (I've never heard of a school not requiring a medicine sub-I for everyone during fourth year much less not offering one!) but pulm/ICU will be fine. Most of my fellow IM classmates did both a sub-I and ICU rotation. I couldn't get an ICU month and it's freaking me out a little going into residency. I did an EM rotation instead but well after ERAS was said and done so not applicable to your situation. Another elective in an IM subspecialty prior to interview time might be a good idea depending on your schedule--think endo, rheum, cards, etc. All were IM trained and could write you a letter. One of my strongest letters was from an IM subspecialist.

 

[mvenus929]

(I've never heard of a school not requiring a medicine sub-I for everyone during fourth year much less not offering one!)

My school (UVA) did not require a medicine sub-I for everyone. You had to have an approved sub-I, but if you were going into peds, you could do a Peds Sub-I, or if you were going into Surgery, you could do a surgery sub-I. EM didn't have one, so those people had to do an EM month early, then pick a sub-I to do later, but trauma surgery was an option for surgery, so they often did that one. I don't remember if the surgical subspecialties had sub-Is, or if those people had to do something else too.

We did have to do some medicine, but they were subspecialties that were usually pretty chill.

 

[lakeofirefun]

My school (UVA) did not require a medicine sub-I for everyone. You had to have an approved sub-I, but if you were going into peds, you could do a Peds Sub-I, or if you were going into Surgery, you could do a surgery sub-I. EM didn't have one, so those people had to do an EM month early, then pick a sub-I to do later, but trauma surgery was an option for surgery, so they often did that one. I don't remember if the surgical subspecialties had sub-Is, or if those people had to do something else too.

We did have to do some medicine, but they were subspecialties that were usually pretty chill.

Interesting. My program required a minimum of 2 sub-Is, one in medicine and the other typically in your area of interest, or whatever you ended up with in the lottery. Friends at other programs also had the med requirement but I'm only familiar with a couple others so hardly representative of the apparent variability out there.

You make a good point about the potential "chillness" of IM subspecialty rotations. They can be a good opportunity to shine, depending on how much you mesh with the faculty and how much enthusiasm you bring, while having a fairly cush schedule.