Away rotations and rationale?

[yalla22]

Do most people decide to do away rotations and if so, why exactly? Is it just to experience a new hospital setting or anything else? I think i heard that if you want to match in a particular program it is good to try to do a rotation at the school and impress faculty over there in the process - if so, how effective is this usually? Also, does anyone know if you can do your core clerkships away and if there is a limit to the number you can do?

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[njbmd]

Do most people decide to do away rotations and if so, why exactly? Is it just to experience a new hospital setting or anything else? I think i heard that if you want to match in a particular program it is good to try to do a rotation at the school and impress faculty over there in the process - if so, how effective is this usually? Also, does anyone know if you can do your core clerkships away and if there is a limit to the number you can do?

Away rotations can been good for gaining an experience that you otherwise would not be able to achieve at your home institution.

I always caution against doing an away rotation just to "impress" the residency program director because you want to be there. If you are a strong candidate for a program (good grades and good board scores), you don't want to take a chance on ruining your chances of a match. Impress them during your interview and leave it at that.

On the other hand, some of the more competitive places in some of the more competitive residencies like neurosurgery, will not interview applicants that have not done an audition rotation. If this is the case, schedule your "audition" early. These program generally have some kind of approval process so get that information and get your application done early in your fourth year. Do beware that these types of programs will not approve your application for rotation unless you have the grades/board scores to be a competitive candidate for their program.

Doing an audition rotation can also backfire if you are a strong candidate but "screw-up" during that rotation. There are many definitions of "screwing up" but some residency applicants have been able to "tick off" an attending or two and ruin their chances of matching. You may get the interview but you won't be ranked no matter what how good you looked on paper because they don't think that you will fit in or they just don't like you.

Doing an away rotation can solidify or change your mind about a particular program too. Again, many applicants will do an audition rotation, do an excellent job and enhance their chances of matching if they were competitive to begin with. Doing an audition rotation is not going to overcome major deficiences but can put you in a more positive light because you are a "known entity".

The bottom line with an away rotation is that you weigh your pros and cons. Doing an away rotation at a very strong program can solidify your educational experience and bring a dimension that you previously had not experienced. In that manner, you can only benefit. If you are a weak candidate (grades and boards), you can only help your cause if you do an audition rotation and impress everyone. If they like you and you do a good job, they will rank you.

On the other hand, if you are a strong applicant, you are going to get the interview so do your impressing there. Go back for a "second-look" if you think you need more exposure and do your audition at another "reach-program" where you need to impress.

 

[SomeDoc]

I think i heard that if you want to match in a particular program it is good to try to do a rotation at the school and impress faculty over there in the process - if so, how effective is this usually?

It can go both ways- based on their evaluation of you, either you impress them, or you don't. I'm assuming most who do away rotations have a vested interest in doing a residency there, so I'm guessing they'll try to shine as much as possible.

 

[postbacker]

Doing an audition rotation can also backfire if you are a strong candidate but "screw-up" during that rotation.

This begs a question: any anecdotes of people being asked to leave residencies after they "get to know you?" How often does this happen? What kind of recourse does the student have?

 

[njbmd]

This begs a question: any anecdotes of people being asked to leave residencies after they "get to know you?" How often does this happen? What kind of recourse does the student have?

Residents are "fired" from residency programs because they don't get the job done or make major mistakes. If you are asked to leave a residency, you can file a grievance but do you actually want to stay in a job where you are not wanted? Certainly it's better to move on to another residency program (or even another specialty) if things are not working for you. There are other residency programs that would be a better fit and most program directors (not all) are willing to allow a resident to move on to a place that is a better fit. Firing a resident doesn't happen often but it will happen occasionally. The bottom line is that the resident makes some changes and moves into another program and never has the same problem again.

On the other hand students are not "fired" from audition rotations because they are not employed in the first place. They just will not be ranked (or they will receive a poor grade) when it comes to the match. If your audition rotation doesn't work out, that place wasn't a good fit your you in the first place. If a prospective "away rotation" does not give you approval to rotate there, I certainly would not apply for residency there either. Choose another "away rotation" and get your experience elsewhere.

 

[chandelantern]

I've heard mixed opinions about the away rotations or sub-I's. some people say absolutely - it will help you stick out when you are applying there for residency, others say it can hurt more than help. I think it would be a great way to really experience what the program is like and help you decide if it would be a good match for you. on the other hand, a residency director told me that they would have ranked an applicant to match had she NOT done a sub-I here and they saw how she operated. The residency director said it may have just been a personality conflict with the current residents but that meant a lot and thus dropped her off the list despite a great application and interview.

Also, if you have the opportunity to do a sub-I in a specialty that your home institution isn't as strong in I do think that can help when applying for programs all over. For example, if I apply to peds residency I will try to do a sub-I at an institution that has a dedicated free standing children's hospital and a good program in x sub specialty b/c Mayo isn't exactly known for peds.

 

[Pittiful]

Like an aggressive investment, it offers above average returns but is risky. It would be interesting to see if men take this risk more than women...

On the other hand, you're not really risking that much if there are many residency programs you'd be happy at.

 

[AmoryBlaine]

I've heard mixed opinions about the away rotations or sub-I's. some people say absolutely - it will help you stick out when you are applying there for residency, others say it can hurt more than help. I think it would be a great way to really experience what the program is like and help you decide if it would be a good match for you. on the other hand, a residency director told me that they would have ranked an applicant to match had she NOT done a sub-I here and they saw how she operated. The residency director said it may have just been a personality conflict with the current residents but that meant a lot and thus dropped her off the list despite a great application and interview.

Also, if you have the opportunity to do a sub-I in a specialty that your home institution isn't as strong in I do think that can help when applying for programs all over. For example, if I apply to peds residency I will try to do a sub-I at an institution that has a dedicated free standing children's hospital and a good program in x sub specialty b/c Mayo isn't exactly known for peds.

That's a huge reason. Interestingly, a few of my all-star friends who are applying to supercompetitive stuff have been told by advisors not to do aways. The rationale behind this is that they can only hurt themselves as their grades/scores/LORs will almost certainly get them an interview.

 

[Acherona]

I also have some questions about aways --
Is there some sort of selection process for aways? I would guess that most people are going to apply to the better programs. So should I assume I will get what I want or do I need to apply to several programs?

Also, can I apply for an away before I have finished my family med and peds rotations? They officially publish that you must have finished all your core clerkships but i'm wondering if they will consider me anyway as long as the rotation I want is not related to peds? I'm talking about somethign not that competitive like neuro or path.

 

[Critical Mass]

Quick question about schools you guys go to...

Can you do guys do sub-I's at other places in the same specialty? Let's say, for instance, that you want to do multiple medicine sub-I's because you love medicine that much. Can you do a medicine sub-I at your school, another at a program down the highway, and yet a third in a neighboring state?

If possible, would this be a viable strategy to ensure a solid step 2 CS?

Also, I've been given different answers on this Q, so I thought that I'd try here. Exactly what is the difference between a sub-I and a 4th year selective? I think that somebody once told me that you get paid for a sub-I and/or that step II is required, but I find that hard to believe.

 

[naegleria brain]

i was lookin into this for nsg as well. yes, you can. in the neurosurgical example, the majority do multiple sub-I's in neurosurgery at away institutions. very few have taken Step II's. none were paid.

it's probably more to get sweet-ass LOR's and expose yourself to places you might wanna go to for residency.

 

[Tired]

Quick question about schools you guys go to...

Can you do guys do sub-I's at other places in the same specialty? Let's say, for instance, that you want to do multiple medicine sub-I's because you love medicine that much. Can you do a medicine sub-I at your school, another at a program down the highway, and yet a third in a neighboring state?

The short answer is yes, but be sure you check with your school about what you are permitted to do, because I actually got burned on this during this year. For example, we are permitted to do up to 3 away rotations, and there are no restrictions on the number of times you can do the same rotation. However, within our Department of Surgery, there is a rule that you can only do 3 months of the same specialty and still get credit.

In my case, I was unaware of the Dept of Surgery rule, so I did 3 Ortho rotations at military hospitals. Then I went to do a 4th rotation at my home institution, and was told no. Meanwhile the Medicine people were doing 4+ sub-i's.

Also, I've been given different answers on this Q, so I thought that I'd try here. Exactly what is the difference between a sub-I and a 4th year selective? I think that somebody once told me that you get paid for a sub-I and/or that step II is required, but I find that hard to believe.

You PM'd me about this a while ago, and I'm sorry I forgot to write you back.

Sub-i's are intended to give students the experience of "being the intern" on the wards while still having student-level supervision. It varies by school, but at mine you follow your own patients and report directly to the resident or attending, rather than having to go through the intern. Some places let students write orders, others still require a cosigner. I am unaware of any sub-i where you get paid. I have also never heard of step II being required, though I suppose the higher-prestige away rotations might want them, since some of these are actually competitive to get.

Generally, I just referred to all my ward time in 4th year as a "sub-i". I don't think there's really a huge difference with other electives, I think it's more of a semantic issue.

 

[Samoa]

I also have some questions about aways --
Is there some sort of selection process for aways? I would guess that most people are going to apply to the better programs. So should I assume I will get what I want or do I need to apply to several programs?

Also, can I apply for an away before I have finished my family med and peds rotations? They officially publish that you must have finished all your core clerkships but i'm wondering if they will consider me anyway as long as the rotation I want is not related to peds? I'm talking about somethign not that competitive like neuro or path.

I had not finished my core rotations when I did my aways, and I just chose places that didn't require the rotations I hadn't had. Most places didn't have that requirement, so I assumed those that did, meant it.

However, I now think I may have been wrong about that. If you're curious, you can always call and ask the department's rotation coordinator. The department usually cares more about getting a firsthand look at their future applicants than about whether you've completed your cores at that point, and they will tell you up front whether their Dean's office will let it slide.

 

[soeagerun2or]

Do most people decide to do away rotations and if so, why exactly? Is it just to experience a new hospital setting or anything else? I think i heard that if you want to match in a particular program it is good to try to do a rotation at the school and impress faculty over there in the process - if so, how effective is this usually? Also, does anyone know if you can do your core clerkships away and if there is a limit to the number you can do?

Aren't you the same one asking which school he/she should go to for prestige in matching? Why would you even consider asking about rotations if you haven't yet matriculated?