Anesthesia Away Rotations (CCM) --General Questions

[CCM Guy]

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I am a rising MS4 student that is interested in anesthesia. I have read a lot of threads regarding anesthesia but have not found one that answers my specific questions, but I apologize in advance if this is stated somewhere already.

1. My medical school has no anesthesia contact third year so all of my experience has to happen through 4th year electives. We have no residency program so our anesthesia department is made up of all attendings (most of whom are older and fairly removed from the residency process).

2. I want to end up in critical care and really like the idea of achieving that goal through anesthesia (rather than IM/pulm or Surgery). As I look to VSAS to schedule away rotations I see that there are those available in the SICU and general anesthesia clerkships. Based on my lack of experience in the OR setting (in regards to anesthesia) I am inclined to apply for the SICU away rotations but am usure if this will be beneficial in increasing my odds of matching there/interacting with anesthesiology residents and staff. Would it simply be better to do a general anesthesia away rotation and simply put in good work hours and be interested in learning despite my lack of knowledge?

3. Since we do not have a residency program I am not sure if I want a LOR from the anesthesia department at my medical school or will I need to try and acquire one from an away with a PD? I have a good rapport with the IM department but am unsure if a letter from the IM chair would be beneficial (perhaps since the PGY-1 year is IM based it would be helpful?).

4. Other question(s) which I will think of later...

Just writing my thoughts down as I think about them.

Thank you

 

[PMPMD]

I am a rising MS4 student that is interested in anesthesia. I have read a lot of threads regarding anesthesia but have not found one that answers my specific questions, but I apologize in advance if this is stated somewhere already.

1. My medical school has no anesthesia contact third year so all of my experience has to happen through 4th year electives. We have no residency program so our anesthesia department is made up of all attendings (most of whom are older and fairly removed from the residency process).

2. I want to end up in critical care and really like the idea of achieving that goal through anesthesia (rather than IM/pulm or Surgery). As I look to VSAS to schedule away rotations I see that there are those available in the SICU and general anesthesia clerkships. Based on my lack of experience in the OR setting (in regards to anesthesia) I am inclined to apply for the SICU away rotations but am usure if this will be beneficial in increasing my odds of matching there/interacting with anesthesiology residents and staff. Would it simply be better to do a general anesthesia away rotation and simply put in good work hours and be interested in learning despite my lack of knowledge?

3. Since we do not have a residency program I am not sure if I want a LOR from the anesthesia department at my medical school or will I need to try and acquire one from an away with a PD? I have a good rapport with the IM department but am unsure if a letter from the IM chair would be beneficial (perhaps since the PGY-1 year is IM based it would be helpful?).

4. Other question(s) which I will think of later...

Just writing my thoughts down as I think about them.

Thank you

2. Do the SICU rotation if the unit is staffed by anesthesiologists. Many are staffed by surgeons - would still be good experience, just not as good for getting into anesthesia. Usually general anesthesia rotations are not great for LORs because you will have a different staff every day. But if you want to do an anesthesia residency, you still need to do a general anesthesia rotation. I would not rank a candidate who never rotated in anesthesia.

3. If you rotate with anesthesiologists, you can ask for a letter. Usually you get one non-anesthesia letter. IM is a good choice if they know/like you.

 

[pie944]

I am a rising MS4 student that is interested in anesthesia. I have read a lot of threads regarding anesthesia but have not found one that answers my specific questions, but I apologize in advance if this is stated somewhere already.

1. My medical school has no anesthesia contact third year so all of my experience has to happen through 4th year electives. We have no residency program so our anesthesia department is made up of all attendings (most of whom are older and fairly removed from the residency process).

2. I want to end up in critical care and really like the idea of achieving that goal through anesthesia (rather than IM/pulm or Surgery). As I look to VSAS to schedule away rotations I see that there are those available in the SICU and general anesthesia clerkships. Based on my lack of experience in the OR setting (in regards to anesthesia) I am inclined to apply for the SICU away rotations but am usure if this will be beneficial in increasing my odds of matching there/interacting with anesthesiology residents and staff. Would it simply be better to do a general anesthesia away rotation and simply put in good work hours and be interested in learning despite my lack of knowledge?

3. Since we do not have a residency program I am not sure if I want a LOR from the anesthesia department at my medical school or will I need to try and acquire one from an away with a PD? I have a good rapport with the IM department but am unsure if a letter from the IM chair would be beneficial (perhaps since the PGY-1 year is IM based it would be helpful?).

4. Other question(s) which I will think of later...

Just writing my thoughts down as I think about them.

Thank you

1. I was the same way in terms of needing to do stuff during 4th year, nothing during third year except a one hour simulator session during our surgery rotation.

2. I would do a General Anesthesia over the ICU rotation, especially if you don't have much exposure to it. If you can get some experience in anesthesia before making a life decision based around it, probably a decent thing. In general, I think people get more out of the OR experience and its more enjoyable as well. Finally, it's probably good to have at least one general anesthesia rotation under your belt from a application point of view.

3. I used an IM letter, mixed it up, just a physician who I worked with a lot. If you spend the month consistently working with a few people they might be able to write you nice letters. People disagree over what is a better letter, a generic one from a 'big name' vs a personal letter from someone you know well. I liked having the latter, but people I'm sure disagree.

On a side note, I think I was a sinking MS4 as opposed to rising.

 

[cchoukal]

Both posters are correct; doing only an OR anesthesia elective makes it hard to get a letter in that you may not work with the same attending twice AND it would be really tough to match into anesthesia having never done an actual rotation in it.

As someone who came from a medical school with a very mediocre anesthesia program, I can tell you that you do not need a letter from your home department to interview at prestigious programs.

So what to do? Well... You just really need to do an anesthesia rotation. Can you do two electives away? It's not unheard of. Can you do an extended elective at the program you mentioned, spending some time in the OR and some in the ICU (I did an away elective that covered both Peds OR and Peds pain). Even a solid week in the ICU with the same attending each day should be enough for that attending to write a letter (assuming you mention ahead of time that you are a visiting student there specifically because you have no home program and want to get the most exposure/make the best impression possible).

Many programs offer away electives. Select carefully, as some programs (such as the one where I am currently on faculty) do not automatically grant letters or interviews just because you rotate with us.

3. A letter from an IM chair, assuming it is a strong letter in your favor, would be taken very seriously by an anesthesia PD, but needs to be in addition to a letter from someone in our field.

Good luck.

 

[CCM Guy]

Okay, thank you for the feedback. Here are a few more questions if you do not mind.

1. The "gossip" here on whether you want to do an away at your top ranked schools is contradictory. There is the argument that since you do not have a lot of experience in anesthesia (at least at my school), you will just end up looking like an idiot and ruin chances. The other side of the coin is that attendings and PDs do not expect students to know much on anesthesia aways and all you need to do is be eager, ask questions, read, etc... as you go. I have a mediocre Step I so I was hoping that aways would allow me to "apply up" to more competitive residency that maybe would have weeded me out below a Step I cut off.

2. In regards to LORs I was thinking 1 from IM, 1 from an anesthesia attending here (we have no residency program so does that diminish the impact of his letter?), and 1 from ???. I have a good rapport with family medicine as well but I figure that plus an IM letter is too much primary care. Surgery is tricky at my school in that they want you to do a 4th year elective with our surgery chair to get a letter from him and I will not have time for that if I want to do two aways plus anesthesia elective at my home institution. I had planned on that 4th letter being from an away rotation. Thoughts?


Thank you in advance

 

[pie944]

Okay, thank you for the feedback. Here are a few more questions if you do not mind.

1. The "gossip" here on whether you want to do an away at your top ranked schools is contradictory. There is the argument that since you do not have a lot of experience in anesthesia (at least at my school), you will just end up looking like an idiot and ruin chances. The other side of the coin is that attendings and PDs do not expect students to know much on anesthesia aways and all you need to do is be eager, ask questions, read, etc... as you go. I have a mediocre Step I so I was hoping that aways would allow me to "apply up" to more competitive residency that maybe would have weeded me out below a Step I cut off.

2. In regards to LORs I was thinking 1 from IM, 1 from an anesthesia attending here (we have no residency program so does that diminish the impact of his letter?), and 1 from ???. I have a good rapport with family medicine as well but I figure that plus an IM letter is too much primary care. Surgery is tricky at my school in that they want you to do a 4th year elective with our surgery chair to get a letter from him and I will not have time for that if I want to do two aways plus anesthesia elective at my home institution. I had planned on that 4th letter being from an away rotation. Thoughts?


Thank you in advance

People seem to suggest that doing an away rotation can be positive/negative/neutral in terms of application strength. Some people are super strong on paper and a rotation will be unlikely to boost their status, but has more of a chance at hurting it. At the same time some people may not be the strongest on paper, but really shine clinically and it is more likely to help than hurt their application. I think for the majority of people it probably doesn't move your application significantly in one direction or the other. However, if you feel that your Step I score is not on the stronger end of the spectrum, doing an away rotation with a lot of effort/enthusiasm/reading will more likely help the overall strength of your application than hurt it. In terms of where, why not do it where you think you might want to end up? You could shine and help your chances, you also might find out the #1 dream ain't such a great dream.

In terms of LOR, I got one from Internal Medicine and the rest from Anesthesiologists. I would lean towards more anesthesia based letters, during the away rotations try to get the same attendings and hopefully get a couple letters out of the process.

 

[PMPMD]

Okay, thank you for the feedback. Here are a few more questions if you do not mind.

1. The "gossip" here on whether you want to do an away at your top ranked schools is contradictory. There is the argument that since you do not have a lot of experience in anesthesia (at least at my school), you will just end up looking like an idiot and ruin chances. The other side of the coin is that attendings and PDs do not expect students to know much on anesthesia aways and all you need to do is be eager, ask questions, read, etc... as you go. I have a mediocre Step I so I was hoping that aways would allow me to "apply up" to more competitive residency that maybe would have weeded me out below a Step I cut off.

2. In regards to LORs I was thinking 1 from IM, 1 from an anesthesia attending here (we have no residency program so does that diminish the impact of his letter?), and 1 from ???. I have a good rapport with family medicine as well but I figure that plus an IM letter is too much primary care. Surgery is tricky at my school in that they want you to do a 4th year elective with our surgery chair to get a letter from him and I will not have time for that if I want to do two aways plus anesthesia elective at my home institution. I had planned on that 4th letter being from an away rotation. Thoughts?


Thank you in advance

I don't expect an MS on their first anesthesia rotation to know much anesthesia-specific knowledge. I DO expect some general medicine, physiology, etc and a drive to learn. But a lot of anesthesia is glossed over in med school if covered at all - inhalational/IV anesthetics, airway management.

I think your plan for LORs is fine. I did my away late and didn't get/need a letter. When/if you do your away, find out who the influental people in the dept are - chairman, PD, chief(s), other people on adcom. Try to work with them as much as possible. Taking call can get you more face time than the regular daytime - depending on how busy tye call night is.