Applying without ACGME Sub-I...

[trustmeimlying]

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Soooo...I decided fairly late to do psychiatry (~early April or so), and I sent in a bunch of applications through VSAS but I've had no luck thus far, and it's getting late in the game. As I was waiting for news from ACGME programs, I set up a few pysch rotations (1 child & adolescent inpatient, 1 adult inpatient) in July/August at DO programs just to get additional exposure...I'm planning on going the MD route for residency, unless I absolutely love one of the DO programs I'm rotating through, but I'm concerned that the lack of an allo sub-I will hurt me...

(I know, I know, a ton of people have said its not necessary to do sub-Is for psych, but I just feel that a PD would look more fondly upon someone who did complete one)

Basically, my question is, will the two DO rotations next year suffice? I know it's not as ideal as an allo sub-I, but if I don't get to rotate through any ACGME psych places, I at least want to prove my commitment to the specialty...

Thanks for any advice!

 

[Atom bum]

How do they even know you have done a sub I? I dont think pds will have any idea how many you have done....at least I am hoping this is the case myself because I can't do any subis for various reasons.

 

[trustmeimlying]

I was under the impression that they would know which rotations you'd done in the first half of the year, but I could be completely wrong, it would not be the first time. I also only have one psychiatry LOR and 2 IM letters right now, so I wanted to get a 2nd psych LOR from one of my 4th yr rotations...meh, hopefully I'm just overthinking this

 

[st2205]

If you're looking to match somewhere I don't think this will hurt your chances. If you've got your heart set on one place (which it doesn't sound like you do), then getting a little more well-known could help a bit.

I did not do any audition rotations and matched to my #3. I listened to most the advice on here which basically tells you to not sweat it and you'll be fine. In general, this is quite true. However, if I were to go back, I think I'd apply it to my situation a little differently. I wasn't looking at huge power-house places or even the next tier, but I had more specific reasons why I may have preferred my #1 over my #3. I listened to the advice here and didn't stress. However, I think an audition would have shown I was more serious about the program (being at a more obscure program now and seeing how people are ranked, I was surprised how much it differed from the conventional wisdom offered here).

In any case, it sounds like you don't really have your heart set on any one specific place, in which case I'd say that the conventional wisdom is correct and that you'll be fine.

 

[trustmeimlying]

Awesome, thanks so much! I really don't have a specific program in mind, I'd just like to end up at a university program in a decent sized city (ideally with an addiction or forensic fellowship in-house)...

 

[Elisabeth Kate]

I was under the impression that they would know which rotations you'd done in the first half of the year, but I could be completely wrong, it would not be the first time. I also only have one psychiatry LOR and 2 IM letters right now, so I wanted to get a 2nd psych LOR from one of my 4th yr rotations...meh, hopefully I'm just overthinking this

You're overthinking it. Your ERAS will be submitted on September 15th (hopefully), so your last rotation listed will be August and that's IF your school has a grade for your August rotation yet (mine didn't). Most people start 4th year in July, so the fact that you don't have a psych rotation listed for July or August or the fact that you have a DO one listed means absolutely nothing because PDs have no idea what rotations you'll be doing in September, October, November, December, etc., etc., etc. Nothing past August will be on your transcript. Hardly half the year.

Now yes, if you're wanting to go some place that's beyond your scores, it's good to do a rotation there, but in general, you don't need to. In my case, I submitted VSAS 4 times for a single rotation I really wanted. They kept rejecting me and I kept applying over and over again (I can be relentless when I want something). Eventually, the med student coordinator personally emailed me and asked about my interest. I told her why I wanted to do an elective there and she wrote back to me the next day and set up my rotation for me. I'm not suggesting you do the same necessarily as it totally could have gone the other way and she could written me to tell me to knock it off and move on, but it worked out for me, so it might be something to consider if it's your dream program.

 

[wolfvgang22]

Elisabeth is absolutely correct and I admire her tenacity.
I did a child psychiatry sub-I rotation in November prior to the match at a very prestigious program as an MS4 in 2008, and even got a supplemental letter of recommendation from a well-known psychiatrist. But nobody knew about it during pre-Match interviews unless I told them, and then they didn't seem to care all that much whenever it did come up.
I don't regret doing the sub-I though, it was very educational.
I think sub-I's are only useful for the Match in two situations: 1.) You actually want to match at the program you are doing the sub-internship at, or 2.) you do the sub-I before you submit your info to ERAS.

 

[CrileDO]

How do you get a Psych LOR if you're at a DO program and won't have a sub-i at an academic center by the time you apply? Will getting one from a community attending suffice?

 

[MLT2MT2DO]

How do you get a Psych LOR if you're at a DO program and won't have a sub-i at an academic center by the time you apply? Will getting one from a community attending suffice?

I'm curious as to why you would think that it wouldn't suffice. I'm sure the former would be best but I can't imagine the latter wouldn't suffice.

 

[st2205]

My letter was from a community guy. It was strong, though, and I wasn't applying to top 10 programs. But a few pretty strong programs.

 

[CrileDO]

Thanks, guys. I apologize if I implied it wouldn't be enough. I just wasn't sure. I planned on asking my preceptor for one at the end of this month, but wasn't sure if that would be good enough. I don't plan on applying to any big name programs. Probably only state universities in my region of the country.

 

[OldPsychDoc]

I'd much rather see a letter from an attending who'd worked closely with a student for a few weeks and had observed them conversing with patients, interacting with staff and teams, etc., than an academic department chair who had, in essence, a "pre-interview" with a student about their interest in psychiatry.

 

[vistaril]

Soooo...I decided fairly late to do psychiatry (~early April or so), and I sent in a bunch of applications through VSAS but I've had no luck thus far, and it's getting late in the game. As I was waiting for news from ACGME programs, I set up a few pysch rotations (1 child & adolescent inpatient, 1 adult inpatient) in July/August at DO programs just to get additional exposure...I'm planning on going the MD route for residency, unless I absolutely love one of the DO programs I'm rotating through, but I'm concerned that the lack of an allo sub-I will hurt me...

(I know, I know, a ton of people have said its not necessary to do sub-Is for psych, but I just feel that a PD would look more fondly upon someone who did complete one)

Basically, my question is, will the two DO rotations next year suffice? I know it's not as ideal as an allo sub-I, but if I don't get to rotate through any ACGME psych places, I at least want to prove my commitment to the specialty...

Thanks for any advice!

I don't even understand what you are asking....are you actually asking whether it is ok to not have any 'sub-i's'(whatever that means...I kinda reserve that term to 4th year core medicine and surgery rotations but to each their own) in psychiatry when you apply? Of course it's ok....large numbers of applicants won't have scheduled anything yet...and some won't schedule anything extra at all. Nobody is going to care.

 

[MacDonaldTriad]

Terms like sub-I, away rotations, and particularly “audition rotations”, are relatively new concepts in medical school education. No so long ago, almost no one did rotations outside of their school’s affiliated hospitals and everyone completed the list of required rotations including psychiatry so we didn’t pay much attention. If you did well in psych and didn’t need more psych experience to decide on it no one cared. If you wanted the opportunity to do a little derm or something else you will never get to see again, that was great.
I think away sub-Is are cumbersome, expensive, poorly standardized to the grading culture of your school, but probably the best way to get a read on a program, and the best way to get noticed if you do well. This last one is a big if.

 

[trustmeimlying]

Awesome, great to hear...thank you all for your help and advice, I'll attempt to stop panicking now...now to narrow down my list from 80 programs...

 

[CrileDO]

Terms like sub-I, away rotations, and particularly “audition rotations”, are relatively new concepts in medical school education. No so long ago, almost no one did rotations outside of their school’s affiliated hospitals and everyone completed the list of required rotations including psychiatry so we didn’t pay much attention. If you did well in psych and didn’t need more psych experience to decide on it no one cared. If you wanted the opportunity to do a little derm or something else you will never get to see again, that was great.
I think away sub-Is are cumbersome, expensive, poorly standardized to the grading culture of your school, but probably the best way to get a read on a program, and the best way to get noticed if you do well. This last one is a big if.

Would you say that you think most students would be better served to skip the sub-i than do it? I say this because I have a chance to do a sub-i in Psychiatry at a program I'd really like to match, but don't want to hurt my chances there by performing poorly or not getting along with someone important at the program for whatever reason.

 

[st2205]

Would you say that you think most students would be better served to skip the sub-i than do it? I say this because I have a chance to do a sub-i in Psychiatry at a program I'd really like to match, but don't want to hurt my chances there by performing poorly or not getting along with someone important at the program for whatever reason.

I think that will depend on how competitive the program is and how competitive you do or do not look on paper.

 

[CrileDO]

I think that will depend on how competitive the program is and how competitive you do or do not look on paper.

It's a state U program with mostly FMGs (not that this is an indicator of quality). So, from what I understand, it probably wouldn't fall into the incredibly competitive category for Psychiatry programs. It would be a favorite of mine because of its geographical location.

 

[Nasrudin]

It's a state U program with mostly FMGs (not that this is an indicator of quality). So, from what I understand, it probably wouldn't fall into the incredibly competitive category for Psychiatry programs. It would be a favorite of mine because of its geographical location.

I'd say do it if you want to make sure that's where you want to go unless you've had regular or even sporadic interpersonal problems on rotations.

It seems like a place that would be glad to have a person who has strong interest and is a decent worker who's known to them.

 

[st2205]

It's a state U program with mostly FMGs (not that this is an indicator of quality). So, from what I understand, it probably wouldn't fall into the incredibly competitive category for Psychiatry programs. It would be a favorite of mine because of its geographical location.

If you don't have any connection to the area and it's an obscure place, then it could show you're serious. However, if you're from the area or if it's a place where people aren't self-conscious and have a rejection complex about their Podunk town, then it wouldn't be as big of an issue.

 

[CrileDO]

I'd say do it if you want to make sure that's where you want to go unless you've had regular or even sporadic interpersonal problems on rotations.

It seems like a place that would be glad to have a person who has strong interest and is a decent worker who's known to them.

I don't really recall any interpersonal problems I've had on my rotations, so I may give it a shot. I just know that it's easy to rub people the wrong way and it's a really subjective thing. Maybe I'm overthinking it.

If you don't have any connection to the area and it's an obscure place, then it could show you're serious. However, if you're from the area or if it's a place where people aren't self-conscious and have a rejection complex about their Podunk town, then it wouldn't be as big of an issue.

Thanks for the input. I am from the state where the program is, and would love to stay here if it's a decent program.

 

[Elisabeth Kate]

Would you say that you think most students would be better served to skip the sub-i than do it? I say this because I have a chance to do a sub-i in Psychiatry at a program I'd really like to match, but don't want to hurt my chances there by performing poorly or not getting along with someone important at the program for whatever reason.

I would definitely do an away rotation there, if not a sub-I. Aways are as important for you to audition the program as it is for the program to audition you. You could come away from the rotation and decide you really don't want to match there after all.

 

[MacDonaldTriad]

Would you say that you think most students would be better served to skip the sub-i than do it? I say this because I have a chance to do a sub-i in Psychiatry at a program I'd really like to match, but don't want to hurt my chances there by performing poorly or not getting along with someone important at the program for whatever reason.

Away Sub-Is are a good way to get interviews in places you otherwise might not get interviews at. I think they are for reach places, and if you don’t impress these places or you are not felt to fit in very well, you wouldn’t want to train there anyway. Similarly, they may not be what you thought they were and you can move them down your list whereas just an interview may not have given you this insight.
Of the 100 or so people programs interview, very few applicants have done rotations with them. This is by no means an expectation. If you fit well into the kind of applicant a program interviews, you will probably be invited. You just cannot rotate at a significant portion of places you are interested in. If there is clearly one program you know you want the most, or that one program you would really like, but it is a bit of a long shot, then pick one of these to rotate to. In the former case, either side (or both) might decide no. This is better for both sides to find out before the match. In the latter case, both sides may decide yes, a very happy outcome on both sides. Trust me you really don’t want to be at a program that doesn’t want you, and programs really really don’t want residents who don’t want to be in their program.