Away rotation questions!

[gstrub]

For those of you in the know, here are some questions I thought of...

1. I will have time for 3 4wk away rotations. I will probably apply to 30-40 programs. What criteria should I use in determining which places to rotate (besides the obvious "where I want to go"). What is the likelihood of an away rotation hurting me, assuming I am not a total idiot or kill someone, etc.

2. Relating to the above...how did you guys pay for/find places to live away. Seems like it would be impossible to pay for an apartment in a place like SF AND pay my current rent simultaneously (even on my meager MD/PhD stipend).

3. Step II score...I can have this done before interviews. I had 230 step I and am confident I could beat 240 on II. Should I go for it?

4. Are there any resources besides the NIH fund list that can help me determine which programs have more active research going on? I know the major ones are all active in research...what I am looking for is a way to determine which programs are clearly clinical (I am trying to lean away from these).

Any tips are greatly appreciated!
Thanks,
G

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[exmike]

For those of you in the know, here are some questions I thought of...

1. I will have time for 3 4wk away rotations. I will probably apply to 30-40 programs. What criteria should I use in determining which places to rotate (besides the obvious "where I want to go"). What is the likelihood of an away rotation hurting me, assuming I am not a total idiot or kill someone, etc.

2. Relating to the above...how did you guys pay for/find places to live away. Seems like it would be impossible to pay for an apartment in a place like SF AND pay my current rent simultaneously (even on my meager MD/PhD stipend).

3. Step II score...I can have this done before interviews. I had 230 step I and am confident I could beat 240 on II. Should I go for it?

4. Are there any resources besides the NIH fund list that can help me determine which programs have more active research going on? I know the major ones are all active in research...what I am looking for is a way to determine which programs are clearly clinical (I am trying to lean away from these).

Any tips are greatly appreciated!
Thanks,
G

in terms of step 2, i'd aim for a 250+. 230 is below average and 240 is average, so what does getting a 240 say, it means you're still average.

in terms of getting your face out there, you dont necessarily need to do four week rotations. sometimes, two weeks is enough and you can spread yourself out further. or even three weeks. then you can cram more of them in.

 

[resxn]

I've said it before and I'll say it again, doing an away rotation will more often hurt you than help. I would not do a subI at the program(s) to which you most want to match, I would do your 2nd tier schools instead. The reason is that unless you are perfect in personality, intelligence, and work ethic, you will not stand out that much more than everyone else in ENT. You have to be stellar. If you're not stellar, you're average.

Match statistics show that most people do NOT match at the schools where they do a subI.

Your advantage of doing multiple subI's is to see what kind of programs you like and why. It helps you understand where you want to go and why. But a subI will more likely do nothing for you or hurt you than it willl help. I've heard that from 2 chairman as well.

 

[gstrub]

Wow, thanks resxn. I'm hoping to hear that from other people than you on this one...seems like this is a very important decision then. It also begs the question, how do I determine which schools to do rotations, not having the experience of someone who has interviewed? I guess I could break down my pics into "tiers" based solely on word of mouth.
Thanks,
G

PS exmike that answers my question...definitely take step II and score well. Thanks.

 

[Pir8DeacDoc]

speak to your faculty. They may know folks or have connections at a few programs that might be in your range. If you decide to do an away (and do well) then doing one at a place where your faculty's letter really means something could put you over the top and get you a spot. I don't see the advantage of going to a program that is a reach. It would be tough to stand out as a sub-I at a super top notch program. Going to a reasonable place that might not get many sub-I's would seem a good idea.

 

[giganerd1982]

you believe in yourself. What does that mean? Well, if you are confident that 1) you can get along well with residents and attendings - in other words a truly likeable person - and 2) are willing to work our a** off, DEFINITELY do a Sub-I. In my case, I rotated at a top program and it went incredibly well. It has substantially increased my chances of matching there.

 

[TheMightyAngus]

Match statistics show that most people do NOT match at the schools where they do a subI.

Whoa. Is there evidence of this? If so, how do you explain the phenomena of loads of students matching at their home programs? Lots of inbreeding at my school at least.

Also, other than ranking your #1 program, is there any way to improve your odds of matching where you want to end up? Or are applicants, for the most part, at the whim of the dice?

 

[resxn]

you believe in yourself. What does that mean? Well, if you are confident that 1) you can get along well with residents and attendings - in other words a truly likeable person - and 2) are willing to work our a** off, DEFINITELY do a Sub-I. In my case, I rotated at a top program and it went incredibly well. It has substantially increased my chances of matching there.

Yeah and if the chairman says, "You were awesome on your subI, truly great. You'd be a wonderful addition to the program. In fact, we got to know you so well, I'm not sure it's necessary for you to spend the cash to come back out and interview. I'd hate for you to spend so much money when we won't learn anything more about you next month in that artificial setting, so we'll put you on our rank list regardless."

That's a euphemism for "thanks for coming, don't let the door hit you on the way out."

 

[Pir8DeacDoc]

In my case, I rotated at a top program and it went incredibly well. It has substantially increased my chances of matching there.

What evidence do you have for this? If you were post match then your post would be more useful (IMHO).

 

[giganerd1982]

I agree Pir8, in that I would have something to stand on if I was post-match. However, I can tell you that doing research with one of the ENTs there has both given me an *outstanding letter* (according to my interviewers thus far) and an outspoken advocate at that place. In other words, part of working your tail off on the away rotation means getting involved in a clinical project with one of the docs. I should have made that clear in my last post.

 

[Pir8DeacDoc]

Thanks for clarifying. Good luck with the match

 

[neutropeniaboy]

This is my take on away rotations after having done them, been a resident supervising sub-Is, and now being a fellow watching sub-Is over again.

If you have above average board scores, excellent grades, and have done some research, don't bother doing away rotations. You already stand a good chance of matching, so doing a sub-I will either do nothing for you, or it could possibly hurt you.

If you are average, don't do a sub-I. It is more likely to hurt you than help you.

If you are below average, do sub-Is. You really have a means to better your chances by proving that you are intelligent and a hard worker.

In the last 6 years, I've seen multiple med students rotate through my residency and my fellowship. I had exposure to all of them. I can think of only 2 or 3 that really impressed me. The rest I eventually fell out of favor with because I thought they were either a) lazy, b) unprepared, c) malignant, or d) arrogant. Unfortunately, most of the sub-is that were a, c, or d were the ones with great grades and board scores.

So, do a rotation if you must. But, be warned: as resxn said, it will more than likely hurt your chances of getting in that place.

 

[resxn]

This is my take on away rotations after having done them, been a resident supervising sub-Is, and now being a fellow watching sub-Is over again.

If you have above average board scores, excellent grades, and have done some research, don't bother doing away rotations. You already stand a good chance of matching, so doing a sub-I will either do nothing for you, or it could possibly hurt you.

If you are average, don't do a sub-I. It is more likely to hurt you than help you.

If you are below average, do sub-Is. You really have a means to better your chances by proving that you are intelligent and a hard worker.

In the last 6 years, I've seen multiple med students rotate through my residency and my fellowship. I had exposure to all of them. I can think of only 2 or 3 that really impressed me. The rest I eventually fell out of favor with because I thought they were either a) lazy, b) unprepared, c) malignant, or d) arrogant. Unfortunately, most of the sub-is that were a, c, or d were the ones with great grades and board scores.

So, do a rotation if you must. But, be warned: as resxn said, it will more than likely hurt your chances of getting in that place.

well said, great points about the below-average applicant.

 

[TheThroat]

Would echo what resxn and NPboy have said: subI's usually don't help. I would say that the only caveat to that is that if you really love a place and really want to be there and are really ready to work like a dog and think that you can be golden for a month, doing a subI at your favored program might help. I didn't say that it definitely would help, or that it even would probably help, only that it might help. One of my classmates rotated through our program and said that he literally got up at 4 am and rounded on the entire head and neck service before the R2's did their rounds. He scutted like crazy, read up on the patients every night, and tried as hard as he could to look golden without stepping on other students or residents toes. Its much harder than it sounds. I didn't do a subI and am glad I didn't, but I also didn't match at my #1 program and would sometimes wonder if doing a subI wouldn't have helped me. That said, I loved my program and am extremely pleased with the education I got there.

 

[neutropeniaboy]

You know, Throat's post reminded me of something as well. When I did my sub-Is, I really wasn't sure about one of the places. I heard good things about it from other medical students and attendings, but I also heard negative things about it. It was in a geographic area I was considering. The program had no special people that could write blow-away recommendation letters, but I wanted to see if it would be a good match. So, I did an away there. I ended up really liking the program and the residents -- that is until I was interviewed; then some of the attendings started asking very uncomfortable questions. So, it was an education nevertheless. Maybe I would have never matched there (I didn't; but I didn't rank it too highly either).

 

[drfunktacular]

You know, Throat's post reminded me of something as well. When I did my sub-Is, I really wasn't sure about one of the places. I heard good things about it from other medical students and attendings, but I also heard negative things about it. It was in a geographic area I was considering. The program had no special people that could write blow-away recommendation letters, but I wanted to see if it would be a good match. So, I did an away there. I ended up really liking the program and the residents -- that is until I was interviewed; then some of the attendings started asking very uncomfortable questions. So, it was an education nevertheless. Maybe I would have never matched there (I didn't; but I didn't rank it too highly either).

My imagination is running wild...

 

[resxn]

My imagination is running wild...

My favorite urban legend interview question and response:

Applicant walks into interview. The interviewer's very first question, without so much as an introduction, is, "So, how many times a day do you masturbate?"

Without batting an eye, the interviewee responds, "Not as often as I deserve."

 

[drfunktacular]

My favorite urban legend interview question and response:

Applicant walks into interview. The interviewer's very first question, without so much as an introduction, is, "So, how many times a day do you masturbate?"

Without batting an eye, the interviewee responds, "Not as often as I deserve."

Heroic.

 

[maxnm]

I would have to agree that doing an externship can be a two edged sword. As a medical student I did an away rotation where I had family living. That is how I afforded to do the away rotation. While there I saw that it was a decent program, but was not my fit. I don't know if i could have found that out by just interviewing there. When I interviewed at the program they told me that they liked me and wanted me to come there. Who knows if that was true because I ranked that program low and did not match there. As a resident I saw the other side of the story. We have had medical students that have come through who we knew would not be a good match for our program. When they came for interviews the attendings said that they never would have picked up on those negative traits they saw during the month and probably would have ranked them highly otherwise. Also, I would not recomend doing more than 1 or two. You have to work your ass off to impress everyone and you can get worn out.

 

[Marianne11]

I'm confused. I also heard sub-internships can hurt you. But what about away rotations? Setting up an externship or rotation away isn't that just like what you'd do locally at a hospital affiliated with your school or are all away rotations considered sub-I??

 

[Dunce]

Away rotations are at programs not affiliated with your home school.
Remember that there are many schools with one or two main hospitals only. Not every institution has a ton of affiliated hospitals close by where their students get farmed out to.

In ENT specifically, every away rotation should be considered to be at the level of a Sub-Internship even if not clearly stated.

 

[Marianne11]

Away rotations are at programs not affiliated with your home school.
Remember that there are many schools with one or two main hospitals only. Not every institution has a ton of affiliated hospitals close by where their students get farmed out to.

In ENT specifically, every away rotation should be considered to be at the level of a Sub-Internship even if not clearly stated.

Many of the programs that I am interested in say you "must rotate through" or you will not be considrered for an interview. So I guess all my away rotations will be sub-I

 

[resxn]

Many of the programs that I am interested in say you "must rotate through" or you will not be considrered for an interview. So I guess all my away rotations will be sub-I

"many" of the programs? You've got to be kidding me. Also, I thought that was illegal (by Match rules) or unethical or extraordinarily inappropriate. If not, it should be.

So what that means is that for these programs who take maybe 1-3 subI's/month they will only consider b/w 5-15 students over the 5 months that students typically do subI's? That's ridiculous, and in my opinion the program is severely limiting/hurting themselves by doing that.

 

[ent]

I was also told the same thing by two of the top 5 ENT programs in the country: "rotate through our program if you would like to receive an interview." I am sure that they choose a couple of other applicants other than their own students and the visiting students as well, but they highly recommended an away. I did my aways in the cities close to where my parents live. Personally, arranging 4 week housing in another city I had no close friends or family was not something I wanted to do.

 

[blz]

I spoke to our ENT chairman and he told me if you look good on paper then its usually better to not do an away rotation. He recommended only doing an away if you are sure you will impress them (which is very difficult as a medical student at a foreign institution). I'm still not sure I want to do away rotations. His reasoning makes sense. I mean, its easy to impress someone with a super high board score but i would imagine its a lot harder to impress someone about your fund of knowledge in ENT when they practice it every day and know it at expert competency.

 

[montypython]

I spoke to our ENT chairman and he told me if you look good on paper then its usually better to not do an away rotation. He recommended only doing an away if you are sure you will impress them (which is very difficult as a medical student at a foreign institution). I'm still not sure I want to do away rotations. His reasoning makes sense. I mean, its easy to impress someone with a super high board score but i would imagine its a lot harder to impress someone about your fund of knowledge in ENT when they practice it every day and know it at expert competency.

I received the same info from attendings and current applicants who did aways who both said that it is very hard to standout during an away rotation when every student is working their tail off, which makes most sub I's look like the "average" hard working student. And because a student appears "average" in person, her or she can actually place a blemish on an application that originally looked outstanding on paper.

 

[ent]

I think that the two previous posts have a point. Every program is different. If you are really interested in one program or city, I would suggest doing some research to see if the majority of people matching (or a good number at least) at that program have done aways there in the past or not. If you look outstanding on paper with excellent recommendation letters, I would suggest thinking twice before doing an away at your desired program as well.

 

[exmike]

I consider myself a fairly strong applicant on paper. I dont think doing aways hurt me at all. I received interviews from both of my away programs. I certainly wasn't a lazy bum during my Sub-I's, but I didn't cure head & neck cancer while I was there either. I think in many cases it raises your chances of interview - particularly at a competitive program you that otherwise might not give your app a second look.

Secondly, Ive gotten interviews from great programs that I didn't rotate through, and I've gotten rejected from mid-tier programs I didn't rotate through. Its certainly not the case that top programs require a sub-I to get an interview, although it may help if you do do so.

 

[BOOURNS]

I would suggest doing some research to see if the majority of people matching (or a good number at least) at that program have done aways there in the past or not.

How would one go about procuring such information?

 

[resxn]

How would one go about procuring such information?

easiest way is to call up the program coordinator (secretary) and ask. Some of them are nice and will tell you, others are not and they won't. You could try to e-mail a resident or an attending and ask. You may also be able to get the name of a student from that school applying to ENT and ask them.

 

[rmm262002]

What about doing an away elective for the overall experience of it? The ENT program at my school is only 1 spot per year, so I plan on doing a rotation in NYC (NYU or Eye & Ear, most likely), where there is a much larger program (4 students per year), with strengths different from those at my institution, so I can get exposed to more areas of otolaryngology. Both of those places will likely be difficult for me to match into, so I don't think I am making things any worse for myself. I think I can show that I am a better prospect than the Pass I received in surgery (my first rotation) a year prior would indicate.

 

[Mariah246]

I spoke to our ENT chairman and he told me if you look good on paper then its usually better to not do an away rotation. He recommended only doing an away if you are sure you will impress them (which is very difficult as a medical student at a foreign institution). I'm still not sure I want to do away rotations. His reasoning makes sense. I mean, its easy to impress someone with a super high board score but i would imagine its a lot harder to impress someone about your fund of knowledge in ENT when they practice it every day and know it at expert competency.

Huh. I'm kind of conflicted here.

Is this just an ENT thing or does this advice apply for many fields?

Our academic advisers have indicated that the majority of people DON'T receive an interview where they do an away rotation or away Sub-I. Even fewer actually match at the same place where they did an away or Sub-I.

But when we go to specialty-specific advisers to get advice on whether we're competitive for X specialty or how to structure a schedule with the goal of matching into X specialty, the advice (for the most part) is always a universal "get as much exposure as possible. Do aways. Take vacation time if possible in order to rotate at different locations. Shine."

 

[ENT12]

If you consider yourself a "normal" person, and you don't mind hard work....then doing an away rotation is a great thing to do.

My advice is to do one at a top tier program...and do one at a safe program.

It is true that you don't have to do an away (Sub I) to get an interview....but it greatly increases your chances.....A place like Hopkins only interviews about 30 people out of 300 applications. Everyone applying has great scores and credentials. An away rotation is basically a 1 month interview.

Of course most people don't match at their away rotations. If a place had 10 people rotate through...and only 3 spots...they can't take everyone. But, many residents that I met on the trail had done a Sub I at the place that they matched....MANY.

Some here have a bias.....

If you make a 260 on Step 1 with 3 publications in Science and are junior AOA...then you might not want to do an away.....for the other 99% of us...it is a GREAT idea.

And, contrary to what some believe, everyone on the interview trail is NOT like the person I described above.....

 

[ent]

I hope that next year's 4th years take some of the advice on this site seriously when doing or even scheduling aways. Talk to your attendings, residents, and people who have matched this year and try to avoid mistakes made by them and listen to what they are willing to share with you.

 

[exmike]

now that I've matched, I'm ambivalent about the whole away thing. It really does improve your chances at getting interviews - I met many people who were ok applicants but got an interview at a top tier program because they rotated there. however, not many of those actually matched there so was it a practice in futility? I'd rather be spared the expense of a courtesy interview. So maybe getting your foot in the door, ie getting an interview is easy, but blowing them away and getting to the top of their rank list is very hard. For example, my friend who has lower step 1 but better grades than me did an away at a top program in a specialty even more competitive than ENT, and he ended up matching there b/c they loved him (AND he was a pretty good candidate).

 

[ENT12]

You know...there are really 2 types of interviews for people that do away rotations....

1. They interview you your last week. This is basically a courtesy. They will probably not take you.

2. They ask you to come back at the regular interview time. This is a good sign. It seems silly, but it means that they want to take the time to look you over and give you a shot to come there.

This doesn't hold true everywhere....but I have had more than 1 residency director tell me this.

 

[ENT12]

I had 4 buddies in Ortho all match where they did away rotations ( I matched in ENT where I did an away).

The key is YOU HAVE TO WORK YOUR BUTT OFF. It is not a time to see the city. It is not a time to take vacation. WORK hard.....

 

[drfunktacular]

Bearing in mind all foregoing advice re: aways/sub-I's, etc.:

When is the latest time I could do an away with the intention of getting a LOR from an OSH and still have it benefit me as far as getting interviews? Is late Sept/early Oct too late?

 

[rmm262002]

A slightly different question regarding away electives: I currently have a 4 week away elective scheduled, and 2 weeks at my home school (where there are only 2 attendings and no residents). I have two more months to schedule. One has to be a surgery sub-I, so I can honor it (I only got a pass in the clerkship, which was my first), and the other can be research or clinical. Here lies my question: am I better off doing a month of research or clinical work? Since there is no research going on at my school, this would be my only opportunity to get some research done, but I don't want to take away from clinical time. Does anyone have an opinion of which would be more beneficial?
Thank you.

 

[DrDre311]

A slightly different question regarding away electives: I currently have a 4 week away elective scheduled, and 2 weeks at my home school (where there are only 2 attendings and no residents). I have two more months to schedule. One has to be a surgery sub-I, so I can honor it (I only got a pass in the clerkship, which was my first), and the other can be research or clinical. Here lies my question: am I better off doing a month of research or clinical work? Since there is no research going on at my school, this would be my only opportunity to get some research done, but I don't want to take away from clinical time. Does anyone have an opinion of which would be more beneficial?
Thank you.

Depends on whether or not you already have pubs/research projects. Pubs are much more valuable than "research projects" but they take a long time to come to fruition (i.e. if you start one as an MS4 I'm not sure it would have time to make it into a publication). I'm not an expert, especially not on the oto match, but if it were me I'd do another away elective in oto. You need LOR's from well-known surgeons if you can get them.

 

[TheThroat]

If you don't have any research, by all means get into a project. I worked on a project for 10 weeks between my third and fourth year of med school and never have gotten a publication out of it. BUT, whenever I was asked about my research project in interviews, I talked about the project that I did. Even had some slides from the project printed out to show the interviewers.

Not having any research sets you apart from the other oto applicants, but not in a good way.

 

[rmm262002]

If you don't have any research, by all means get into a project. I worked on a project for 10 weeks between my third and fourth year of med school and never have gotten a publication out of it. BUT, whenever I was asked about my research project in interviews, I talked about the project that I did. Even had some slides from the project printed out to show the interviewers.

Not having any research sets you apart from the other oto applicants, but not in a good way.

Fortunately, I have some minor publications in emergency and pulmonary medicine from prior to med school, but apart from a case report on tracheal rupture, none of them are remotely close to otolaryngology (even that's a stretch).
Unfortunately, a number of faculty began leaving my institution just as I was starting to get something started research-wise. I have made some contacts with a number of other nearby institutions, but nothing has come through yet.
I am becoming more interested in the idea of taking a year off to do research, because it is something I enjoy, and because one can only do so much in a few weeks.

Thanks for your advice.

 

[5150]

I plan on doing an away rotation during the time block in which Academy meeting is taking place. Is this away rotation suicide? Is it better off to simply not do an away, rather than do an away where there is a chance you may miss quite a bit of face time with attendings?

Any advice greatly appreciated! Seems like all the students I've been talking to have had pretty negative opinions about this. Wondering what the perspective is from the residents. Thanks!

 

[scala]

I feel like the people that will be able to truly know you during an away are the residents. In some programs this carries a lot of weight since PDs look to residents in order to rank their applicants. Therefore I think its still worth going regardless of the meeting.

In addition, subi's are usually a month long. You will get plenty of face time with attendings regardless.

 

[5150]

Thanks for the input! I'm more or less set on doing the rotation regardless... (don't have a choice at this point), but I just wanted to hear some honest opinions. I don't plan on trying to get a letter from this rotation given how late it is, and also because attendings will be missing for 4-5 days at the academy meeting. Is it viewed in a poor light if you do an away rotation at an institution and don't get a letter of rec, or is this a common occurence?

 

[Catalyst]

I wouldn't stress about doing an away and not getting a letter... this is actually a pretty common occurrence for people who have letters from their home ENT dept and is not frowned upon in my experience. I personally think that doing the rotation at a time when you can meet the PD/Chair is good b/c you can ask them questions and see whether the program is for you or not. But residents do provide input in my experience.. so if they like you and you want to be there that'll certainly help.