Advice for planning fourth year audition rotations

[RamblinRose]

I am an MS3 currently planning my fourth year with hopes of going into Internal Med. Facing a little trouble with how to schedule the first 5 months of fourth year and when to take Step 2, now that all my cores are practically done.

So far my fourth year plans include:
-Cardiology (last rotation of my third year, my elective) mid May- mid June
-Infectious Disease mid June - mid July ( Hopefully easy going b/c I want to take Step 2 by late June)
Followed by 4 internal medicine rotations each at a different university residency program I am interested in from mid July to mid Nov.

Concerns:
- Is four months of straight auditions likely to result in burn out and effect my audition performance OR is it normal to do it this way?
- Is it too early to take my Step 2 in June? If so, when is better? I'm a bit reluctant to take it later during my auditions.....
- Any suggestions on what rotation I should do while I try to study for and take Step 2?
- By what month do letters need to be into ERAS, (esp to be considered in the interview selection)?
- For IM auditions is it better to do a general IM vs a sub-speciality? If feel like by working on a primary care team, the residents and attending will get to see your skills so much more than being on a consult service.

Any other tips or helpful advice on how to plan IM auditions effectively would be much appreciated!!

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[gutonc]

I am an MS3 currently planning my fourth year with hopes of going into Internal Med. Facing a little trouble with how to schedule the first 5 months of fourth year and when to take Step 2, now that all my cores are practically done.

So far my fourth year plans include:
-Cardiology (last rotation of my third year, my elective) mid May- mid June
-Infectious Disease mid June - mid July ( Hopefully easy going b/c I want to take Step 2 by late June)
Followed by 4 internal medicine rotations each at a different university residency program I am interested in from mid July to mid Nov.

Concerns:
- Is four months of straight auditions likely to result in burn out and effect my audition performance OR is it normal to do it this way?
- Is it too early to take my Step 2 in June? If so, when is better? I'm a bit reluctant to take it later during my auditions.....
- Any suggestions on what rotation I should do while I try to study for and take Step 2?
- By what month do letters need to be into ERAS, (esp to be considered in the interview selection)?
- For IM auditions is it better to do a general IM vs a sub-speciality? If feel like by working on a primary care team, the residents and attending will get to see your skills so much more than being on a consult service.

Any other tips or helpful advice on how to plan IM auditions effectively would be much appreciated!!

I am of the opinion that for the vast majority of AMG applicants to IM, aways are unnecessary and may actually be harmful. But, with my bias out of the way, here's my advice (all of this assumes you are an AMG).

1. 4 aways is insane for IM. Do 1 or 2 at the most.
2. Do your IM SubI at home before you go traipsing around the country doing aways. Your SubI grade (and LOR...you NEED an LOR from your SubI) are going to be way more important than your away performance or a letter you get from there.
3. While it is better to do a General IM rotation as an away for the reasons you suggest, it is not common for good IM programs to offer these rotations to visiting students. So pick a specialty or two that you like and are good at so that you can shine.
4. Letters should be in ERAS by November at the latest but you have little control over that.
5. Take Step 2 during an elective or research month if you can. Don't do it during your away(s) if you can avoid it. If you already have a good (220+) or great (240+) Step 1 score, you would probably do well to put off Step 2 as long as you can. If you need to bump your Step 1 then take it early.

 

[mrjohndaniels]

I disagree quite a bit with the last poster. My thoughts in general are as follows.

1. Four is a lot of "audition" rotations. You will get tired, but I think they can be very valuable. You should do an audition rotation for yourself, to figure out if you really would want to be a resident at a certain place. A lot of people here think they can hurt you, but I think the ones that I did only helped and maybe even helped me a lot. You have to do a good job, yes, but fear of doing a bad job should not deter you. If you don't think you can be a good medical student somewhere, what makes you think you would be a good intern/resident? It's also really important to meet people in the program leadership. I would do as many audition rotations as you feel you are able at the places you think you would most like to go. That said, an audition rotation is not a guaranteed interview, but it might help differentiate you when a program makes its rank list.

2. June is not too early to take step 2. The earlier the better in my opinion. Get it out of the way. Most people don't have a dramatic change in score, so I wouldn't worry about going down unless you don't study.

3. Try to have free time to study for the exam, or at least a very cush rotation. You do want to study for Step 2, but it doesn't have to be like you did for Step 1. I studied about 12 hours/day for Step 1, and maybe 6 - 8 for Step 2.

4. The earlier letters are in the better. I would say they should absolutely be in by the time MSPEs are released. You may not be able to ask for letters until August or so (since you will need to do a Sub-I), but think about the reliability of the people you are asking letters from. Don't badger your letter writers, but send a thank-you if they're not in by Sept. 1 as a way to remind them.

5. For your audition rotations, I would say do a Sub-I if you want to really know what it's like to be at a place. You also will get a chance to develop a relationship with an attending (who you might ask for a letter, at least for that institution). They get tiring, and yes, you can look bad. Most people are reasonable and recognize that students from other schools will have more trouble with things like computers and will focus on your medical knowledge, skills, and presentations, all things you should have regardless of where you are. Consults are easier but can be variable in your exposure to the workings of the system. That said, if you're doing four, five months of Sub-Is will wear you out (your school + 4 others), so you might want to consider some consults as a way to change it up.

I'm sure my advice might draw criticism, but I feel like it's more in line with what I've actually observed in my own fourth year. A lot of the things I've read here about audition rotations being a nightmare didn't really pan out to be true for me or my classmates who did them.

Some other advice:

Do your home Sub-I earlier (preferably before aways) to get letters from it.

Try to finish all aways by early/mid November. Definitely before Thanksgiving. You will need time to interview.

I know I haven't matched yet, but again, all of these things are based on my own experience and post-away follow-up from PDs that I experienced, and I feel it differs significantly enough from what is usually said on sdn that I wanted to at least offer it as an opinion. Take it as one opinion of many.

 

[gutonc]

I disagree quite a bit with the last poster.

FTR, you seem to disagree with a single point I made. We agree on the rest.

 

[mrjohndaniels]

FTR, you seem to disagree with a single point I made. We agree on the rest.

Fair enough. I kind of pieced that post together, and after all the writing, I guess it felt like more than it actually was.

 

[jdh71]

As noted, I haven't read the whole thread. Though I tend to agree with gutonc about most things, including Detroit and Houston . . .

So don't do a ton of aways. Why? As an American grad, you won't really need to. Pick one or two places.

Don't do an away sub-i. You might enough up looking like a tool because you won't know their system. It's much better to pick a sub-specialty. I might suggest pulmonary, renal, or ID.

Pick your spot(s) carefully. Elite places are notorious for having you do a rotation and then not bothering to ask you back for an interview - UCSF being notable for this. If you aint got the CV for the program before the rotation, it's unlikely doing the rotation will help you that much. Now, the nice thing, is that, for the most part those programs outside of the top 10ish, will likely invite you back because it is the classy thing to do.

Good luck.

 

[oklahoman]

are aways even necessary? do pd's or interviewers ask you about it if you dont do any aways and stick with home sub-i, micu, im elective at home? i'm under the impression that they can help but usually count for little, if anything, and are very expensive. i got high 220's on step 1, i'm taking step 2 ck early (that's what my school recommends for everyone), from low-/mid-tier school in the midwest (figure it out), a bunch of solid extracurriculars, looking to go to the coasts at a solid university program with good fellowship placement.

 

[jdh71]

are aways even necessary? do pd's or interviewers ask you about it if you dont do any aways and stick with home sub-i, micu, im elective at home? i'm under the impression that they can help but usually count for little, if anything, and are very expensive. i got high 220's on step 1, i'm taking step 2 ck early (that's what my school recommends for everyone), from low-/mid-tier school in the midwest (figure it out), a bunch of solid extracurriculars, looking to go to the coasts at a solid university program with good fellowship placement.

No. Not necessary. Not at all.

 

[Deferoxamine]

I am an MS3 currently planning my fourth year with hopes of going into Internal Med. Facing a little trouble with how to schedule the first 5 months of fourth year and when to take Step 2, now that all my cores are practically done.

So far my fourth year plans include:
-Cardiology (last rotation of my third year, my elective) mid May- mid June
-Infectious Disease mid June - mid July ( Hopefully easy going b/c I want to take Step 2 by late June)
Followed by 4 internal medicine rotations each at a different university residency program I am interested in from mid July to mid Nov.

Concerns:
- Is four months of straight auditions likely to result in burn out and effect my audition performance OR is it normal to do it this way?
- Is it too early to take my Step 2 in June? If so, when is better? I'm a bit reluctant to take it later during my auditions.....
- Any suggestions on what rotation I should do while I try to study for and take Step 2?
- By what month do letters need to be into ERAS, (esp to be considered in the interview selection)?
- For IM auditions is it better to do a general IM vs a sub-speciality? If feel like by working on a primary care team, the residents and attending will get to see your skills so much more than being on a consult service.

Any other tips or helpful advice on how to plan IM auditions effectively would be much appreciated!!

I applied in the current 2010-2011 cycle. I did no away rotations. I got advice from the 2009-2010 IM group in my school -- and the consensus was that doing aways vs. no aways made NO difference in where people got interviews or matched.

So I vote no aways. You say you want to do 4. Let's compromise at 1. Go schedule a month at a solid place, do a subspecialty elective there, kick ass, and get a great LOR.

 

[heathen]

My advice is to have as easy a 4th year as possible and enjoy life.

 

[RamblinRose]

I disagree quite a bit with the last poster. My thoughts in general are as follows.

1. Four is a lot of "audition" rotations. You will get tired, but I think they can be very valuable. You should do an audition rotation for yourself, to figure out if you really would want to be a resident at a certain place. A lot of people here think they can hurt you, but I think the ones that I did only helped and maybe even helped me a lot. You have to do a good job, yes, but fear of doing a bad job should not deter you. If you don't think you can be a good medical student somewhere, what makes you think you would be a good intern/resident? It's also really important to meet people in the program leadership. I would do as many audition rotations as you feel you are able at the places you think you would most like to go. That said, an audition rotation is not a guaranteed interview, but it might help differentiate you when a program makes its rank list.

2. June is not too early to take step 2. The earlier the better in my opinion. Get it out of the way. Most people don't have a dramatic change in score, so I wouldn't worry about going down unless you don't study.

3. Try to have free time to study for the exam, or at least a very cush rotation. You do want to study for Step 2, but it doesn't have to be like you did for Step 1. I studied about 12 hours/day for Step 1, and maybe 6 - 8 for Step 2.

4. The earlier letters are in the better. I would say they should absolutely be in by the time MSPEs are released. You may not be able to ask for letters until August or so (since you will need to do a Sub-I), but think about the reliability of the people you are asking letters from. Don't badger your letter writers, but send a thank-you if they're not in by Sept. 1 as a way to remind them.

5. For your audition rotations, I would say do a Sub-I if you want to really know what it's like to be at a place. You also will get a chance to develop a relationship with an attending (who you might ask for a letter, at least for that institution). They get tiring, and yes, you can look bad. Most people are reasonable and recognize that students from other schools will have more trouble with things like computers and will focus on your medical knowledge, skills, and presentations, all things you should have regardless of where you are. Consults are easier but can be variable in your exposure to the workings of the system. That said, if you're doing four, five months of Sub-Is will wear you out (your school + 4 others), so you might want to consider some consults as a way to change it up.

I'm sure my advice might draw criticism, but I feel like it's more in line with what I've actually observed in my own fourth year. A lot of the things I've read here about audition rotations being a nightmare didn't really pan out to be true for me or my classmates who did them.

Some other advice:

Do your home Sub-I earlier (preferably before aways) to get letters from it.

Try to finish all aways by early/mid November. Definitely before Thanksgiving. You will need time to interview.

I know I haven't matched yet, but again, all of these things are based on my own experience and post-away follow-up from PDs that I experienced, and I feel it differs significantly enough from what is usually said on sdn that I wanted to at least offer it as an opinion. Take it as one opinion of many.

I am an MS3 currently planning my fourth year with hopes of going into Internal Med. Facing a little trouble with how to schedule the first 5 months of fourth year and when to take Step 2, now that all my cores are practically done.

So far my fourth year plans include:
-Cardiology (last rotation of my third year, my elective) mid May- mid June
-Infectious Disease mid June - mid July ( Hopefully easy going b/c I want to take Step 2 by late June)
Followed by 4 internal medicine rotations each at a different university residency program I am interested in from mid July to mid Nov.

Concerns:
- Is four months of straight auditions likely to result in burn out and effect my audition performance OR is it normal to do it this way?
- Is it too early to take my Step 2 in June? If so, when is better? I'm a bit reluctant to take it later during my auditions.....
- Any suggestions on what rotation I should do while I try to study for and take Step 2?
- By what month do letters need to be into ERAS, (esp to be considered in the interview selection)?
- For IM auditions is it better to do a general IM vs a sub-speciality? If feel like by working on a primary care team, the residents and attending will get to see your skills so much more than being on a consult service.

Any other tips or helpful advice on how to plan IM auditions effectively would be much appreciated!!






Thank you all very much for your replies. They have been extremely helpful. To give you a little more background, I am a DO student. I have done my IM rotations at the county facility we are affiliated with, which has it's own DO IM residency. But because of my desire to sub-specialize, I realize that I will have to apply to MD IM programs. This is why doing "home" rotations and a sub-i would be a bit less beneficial for me. (Let me know if you think this is untrue). My Step 1 is a 226. I plan on taking my Step 2 by late June so that I can improve upon my score.

My question(s) to you now would be:

- All of the residencies I have at the top of my list, take students for Internal Med rotations. There is no need for travel because all of them are in southern california. Because my "home" facility has an IM residency I am not applying to, I am (sort of) forced to look elsewhere to make an impression. That being said is 4 away rotations OK? If I wanted to compromise then 3 of them would be straight Internal Med and one would be a sub-speciality. Is this still excessive?

 

[gutonc]

My question(s) to you now would be:

- All of the residencies I have at the top of my list, take students for Internal Med rotations. There is no need for travel because all of them are in southern california. Because my "home" facility has an IM residency I am not applying to, I am (sort of) forced to look elsewhere to make an impression. That being said is 4 away rotations OK? If I wanted to compromise then 3 of them would be straight Internal Med and one would be a sub-speciality. Is this still excessive?

Yes, 4 is still too many. And doing 3 or 4 IM SubI's is going to be exhausting and will likely cause you to perform poorly on the last 2 or 3 of them.

Also, not having a LOR from your home program SubI (DO or otherwise) is a big red flag. It looks like you're trying to hide something.

 

[jdh71]

My question(s) to you now would be:

- All of the residencies I have at the top of my list, take students for Internal Med rotations. There is no need for travel because all of them are in southern california. Because my "home" facility has an IM residency I am not applying to, I am (sort of) forced to look elsewhere to make an impression. That being said is 4 away rotations OK? If I wanted to compromise then 3 of them would be straight Internal Med and one would be a sub-speciality. Is this still excessive?

I agree a bunch of extra sub-i's is pretty stupid. Go with a consult service. Sub-i @ home, early, step 2 early, and if you want to do one or two more away's go where they've taken people from your DO program before (I'm assuming I know where that is based on what you've said), and I'd suggest do Pulm at USC and GI at LLU.

 

[medicine4me]

Sorry this is long. I need to work on being succinct for Lent before I start intern year, obviously.

1) I was trying to get Step 2 CK done early as well. I think 4 aways is a lot to sacrifice. I'm not sure how your school's elective system works but we are only offered 4 elective months and to do them all on aways in the beginning leaves very little time at the end of the year to chill a bit before intern year (unless you have some exotic away rotation like ID in a foreign country which mixes vacation and learning towards the end of the year).

2) Anyways, that's all besides the point. Since my school is huge, we were suggested to give LOR's by the first half of October (this is not really set in . This gives you about 2-3 rotations in fourth year to get some LOR's. You need 2-4 LOR's for IM programs. You already definitely need the following: 1) chairman's letter 2) letter from MS4 sub-I (preferably inpatient I suppose). So, in summary, you need 1-2 more LOR's. Maybe getting an LOR from an away may be helpful, but I have mixed feelings about it. Meh. I guess for those "you gotta know the area to get interviews there" BS I kept hearing (e.g. California, NYC) it may help (please note, I have no idea if this is the case since I am a current applicant and these areas were not extremely huge/desirable on my list, even though I did apply to a lot of NYC programs).

3) Back to the rotations and CK. Yes, earlier done the better. People who had family medicine last were pretty lucky to "tie everything together", I suppose, but don't let that deter you at all. Study hard however you do it, USMLEWorld style or what have you. Do it when you feel comfortable because you want consistency or improvement in your application. We only had 2 weeks between 3rd and 4th year and I ended MS3 with peds. Did my CS in June and was fine and did CK in the second rotation of MS4. Results of CK need to be in by October and latest November 1st.

Good rotations for the beginning of MS4 for study time: the theme is outpatient type hours (which is something you're following, it seems), whether it's an outpatient sub-I (if required), radiology, some cush specialty (medicine or not), or shift schedules (e.g. ER and ICU depending on how scheduling shifts works out amongst peers at your institution)

Good rotations for LOR:
- I really enjoyed my outpatient sub-I, believe it or not. I worked with a handful of different attendings, luck had it that I worked with the division chief and the clinical director of the rotation the most and I asked both for LOR's in case one fell through.
- Another inpatient type thing, perhaps, like ICU if an attending is on service for 2 weeks or medicine or subspecialty consults. This can also be one of your away's if you choose.

I hope that made sense? Feel free to reply or PM if needed. I realize that was a bit all over the place because that's how I feel today. My apologies.

 

[DrVanNostran]

What would you guys recommend, MICU sub-I or general internal medicine sub i? Those are the only 2 offered at my school, the others ones offered are at places affiliated with our school. Would a MICU sub i letter > general sub i? Or does it all really not make a difference, just try to honor whatever I do...

 

[gutonc]

What would you guys recommend, MICU sub-I or general internal medicine sub i? Those are the only 2 offered at my school, the others ones offered are at places affiliated with our school. Would a MICU sub i letter > general sub i? Or does it all really not make a difference, just try to honor whatever I do...

It doesn't really matter all that much. Some places may wonder why you didn't do a gen med Sub-I but as long as it "counts" it's not that big of a deal. If you're particularly interested in Cards or PCCM, you could spin the MICU month as a plus. But overall it won't matter much.

The only thing I will say is that it will likely be easier to do well on a general IM sub-I than a MICU sub-I unless you've already done some ICU as well. It's different medicine in the ICU and will be more like a 3rd year rotation for you unless you have experience going in. The gen med Sub-I will be like your clerkship but with more patients and no shelf exam.

 

[DrVanNostran]

Thanks gutonc. I ended up signing up for the General IM AI in July. I think I may do a PICU or SICU rotation later in the year to get a flavor of working in the ICU. Thanks again!!

 

[desijigga]

IM programs have to fill between 20-40 positions every year, no way all those people rotate through the program. I am DO student also, I plan on doing 1 away sub I and a sub-specialty sub I, rocking it, taking step 2 in august, turning my application in on sept 1st. I think rotating through and sucking up is part of the osteopathic residency process, I believe in the allopathic process audition rotations are not needed at all and like others said can do more harm then good.

So far I have done Cards and ID as late 3rd year Electives at an academic center (would love to go here, but MI has lame internship rules and I aint wasting a year), I am scheduled for MICU and Gastro at the same place later in 4th year. I need to figure out what other sub specialty I should do in sept and NOV? neprho, heme/onc, pulm, rheum or something non IM? (its my 4th year can I do something fun, or will I be grilled at interviews, hey buddy what did you do urology in september for??) Any input gutonc or JDH??

btw ID is not an EASY rotation, it is very busy. Albiet you learn a ton

 

[gutonc]

So far I have done Cards and ID as late 3rd year Electives at an academic center (would love to go here, but MI has lame internship rules and I aint wasting a year), I am scheduled for MICU and Gastro at the same place later in 4th year. I need to figure out what other sub specialty I should do in sept and NOV? neprho, heme/onc, pulm, rheum or something non IM? (its my 4th year can I do something fun, or will I be grilled at interviews, hey buddy what did you do urology in september for??) Any input gutonc or JDH??

No, nobody will care if you don't do all IM rotations your 4th year. This isn't ortho or urology where you're expected to forget the rest of medicine as soon as your last 3rd year shelf exam is complete. In fact, IM programs will consider you more well rounded if you don't just do IM stuff. So take that urology elective, or rads, or gas or whatever. I did a 2 week pain elective which was commented on positively in interviews. Nobody asked about my pulm rotation.

 

[jdh71]

IM programs have to fill between 20-40 positions every year, no way all those people rotate through the program. I am DO student also, I plan on doing 1 away sub I and a sub-specialty sub I, rocking it, taking step 2 in august, turning my application in on sept 1st. I think rotating through and sucking up is part of the osteopathic residency process, I believe in the allopathic process audition rotations are not needed at all and like others said can do more harm then good.

So far I have done Cards and ID as late 3rd year Electives at an academic center (would love to go here, but MI has lame internship rules and I aint wasting a year), I am scheduled for MICU and Gastro at the same place later in 4th year. I need to figure out what other sub specialty I should do in sept and NOV? neprho, heme/onc, pulm, rheum or something non IM? (its my 4th year can I do something fun, or will I be grilled at interviews, hey buddy what did you do urology in september for??) Any input gutonc or JDH??

btw ID is not an EASY rotation, it is very busy. Albiet you learn a ton

Agreed. You're doing plenty. You scream, "I want to do IM!!" Which is a good thing because too many of our bretheren would prefer to do something more glamorous, better paying, or working less hours (hopefully all three!! )

 

[desijigga]

Thanks guys, You guys are correct. Heck I am gonna throw in another EM elective, optho, urology, rads, and if I have time some sports medicine...

 

[DrVanNostran]

In terms of a sub-I letter...is before Nov. 1 (MSPE) considered early? I think mine will be in around Oct 15. I know that a lot of IM programs send out interviews early around the first week of Sept. I'm not sure if the AI/LOR plays a role that early in the game.

 

[ToxyBee]

Given a choice between a general IM sub-I or an in-patient cardiology elective, which one would you recommend? I'm kind of concerned about going into a foreign hospital / system and looking like an idiot for the first week with the sub-I, so I'm leaning more towards cardiology. But would it look bad if I declined the sub-I and went for the easier choice? My away elective is scheduled for late in the year and is mainly intended to get to know the hospital and see if I would enjoy it there.

 

[DrVanNostran]

A sub-I in general medicine may be easier than an inpatient cardiology elective. I have a feeling you will essentially work as an AI in the cards service taking consults, running down to radiology, etc.

I am in the midst of getting my aways set up. Personally, I would do the cardiology elective for the reasons you mentioned; plus, I feel like it is easier to shine in a speciality rather than the general medical floors.

 

[Analfissure]

Current third year trying to figure out what and what not to do in regards to auditions. I see this post is from 2011, and was wondering if auditions / suB-I's at multiple away sites is really necessary? I really only wanted to do a at home sub-I + maybe one more away one for a LOR. Did not want to spend 2-3 months at out of state places, unless its going to really increase my odds of getting that interview. Any advice would be greatly appreciated

Thanks.