Away rotations / Sub-I's

[ComstockOSU]

Hey,

I have heard varying answers from different faculty, so curious as to others opinions and experiences.

Assume I want to match IM,
Is it advised to spend my 3-4 audition rotations (ie rotations at institutions to which I wish to apply/be accepted) doing general IM Sub-internships?

Or would taking rotations that strengthen weakness be preferred (like neurology, nephrology, etc)? I understand that they would help me be more knowledgeable in general, but in terms of matching, is a IM Sub-I a superior rotation?

I do not want to miss the opportunity to pursue areas that I am weak, or that are interesting, and at the same time, I want to maximize my potential to match at a program. Picking up a non general IM elective may be detrimental to making a stellar impression on an away, because I would have no experience in that field specifically, and would be adding to my learning curve...

Advice, experience etc appreciated.

---

Members don't see this ad.

 

[muscles]

If I understand correctly, you're essentially asking if you should do away rotations in general medicine versus a specialty field?

If that is your question, I would do most, if not all of them in a specialty field. I think you would really be missing out on a lot if you did 4 months of general medicine senior year of med school, even if they are all done at away institutions, when you could be learning a lot from great teachers at other schools in a specialty field. I did an away rotation in critical care and it went really well; they knew coming in that critical care would obviously be a weakness of mine, but I worked very hard and in the end got a great letter of recommendation from a nationally known intensivist.

In my experience, when you do away rotations they are interested more in finding out what kind of intern you'll be rather than how much knowledge you've acquired. They'll have 3 years during your residency to teach you what you need to know - so don't be afraid to do an away rotation in a field that is a weakness. Show them you are passionate and interested in that field and you'll be fine...

My $0.02.

 

[ComstockOSU]

If I understand correctly, you're essentially asking if you should do away rotations in general medicine versus a specialty field?

That is exactly what I am asking. Thank you.

 

[Linus2007]

I would recommend a subspecialty as opposed to sub-I. Both are doable and you can probably get LORs but it a lot easier to dissapoint with a sub-I than subspecialty.

As I just finish up my last ever elective (woohoo!) I think the mentality and goal of sub-Is and subspecialties change.

Sub-Is: My main goal with sub-I was survive and then after that was try to impress the attendings for LOR. Working 80 hours a week and capping every night on call meant I had little time to read up or go above and beyond. As I usually averaged about 15mins - 1 hour of sleep on call I also ended up just sleeping and doing activities to boost my morale. I did well because I knew the system and knew how to get past roadblocks (something that required all of third year). Plus if you are planning to an away at a 'prestigous' residency you will have the potential of having third and fourth year med students cockblocking you.

Subspecialties: Awesome hours with only a select level of knowledge, albeit in depth, required. You are not required to know anything at all at the beginning, but you have to show that you have learned something. when you see a patient with a disease process you have seen before. I was able to read up on the latest research articles to chat about over the weekend, and at night I was able to read up on issues specific to my patient. The most you will have is maybe one 4th year medical student to cockblock you. ICU rotations are also good rotations to do for the same reasons mentioned.

If you do plan to do an away sub-I or indeed any sub-I do it in July/August with the new interns. Most institutes require you to perform at the level of an intern and will compare you to the interns. If they can tell the difference between you and another intern (in the negative sense) then the away rotation hurt you a little. Better to play on an even field by going up with interns who are also not familiar with the hospital system.

 

[Rogue_Leader]

Some other things to keep in mind.

1) You could do a general medicine sub-I, but remember what being a sub-I entails. Doing H&P's, interacting with the ER, knowing how to interact with social workers, writing daily notes, entering orders, setting up outpatient follow up, calling consults, setting up family meetings, all of which will have different procedures than your home institution. You'll pick it up, sure, but doing an away rotation is about impressing the faculty as soon as possible, and taking 2 weeks to get comfortable with how things work at the away site won't help you to impress the attending, which ultimately is the goal of doing an away rotation. Doing a sub-specialty elective means your duties are limited to reading the patient chart, the outpatient notes, interviewing the patient, presenting him, and maybe writing a note. You don't have to get too involved in the logistics of general medicine, so you can focus more on being a super star.

2) When doing consult electives, you'll have more face time with the attending than with general medicine. On medicine, it's often the resident who runs rounds, and attending rounds may be few and far between. This will vary from site to site, and attending to attending. Some places or attendings will chose to let the resident run rounds and then he/she will do her own rounds with the resident while you're left to take care of the scut on your own. If that's how the attending on service decides to do things, you won't get any benefit of doing an away rotation. On consult rotations, I think it's more common for the med students to always round with the attending, so when it comes to hopefully getting a solid recommendation from the rotation, this is your best bet.

3) You're a med student, you don't know everything. This may seem obvious, but when doing a gen med Sub-I, deficits in knowledge can be more apparent if you have difficulty in generating a plan for a complex patient. When on a specialty rotation, at least you have some slack in that you're being compared to a fellow's level of competency, rather than an intern level of competency. If you want to do a Sub-I rotation, I would suggest ICU, since the attending would presume that you don't have any ICU experience and his expectations would be somewhat lower (It sounds bad, but impression is everything, maybe even more important than how good you actually are).

 

[viostorm]

I am in a similar situation scheduling my away rotations.

Against advice of others, I have decided I'm only going to do 1 medicine sub-I, and that will be at an away school.

I'm doing MICU at my home school.

Other then that I'm doing nothing in the Internal Medicine department. I'm doing a month of surgery, month of radiology, month of path, month of derm, even some peds in case my kid that gets sick I'll have some idea what to do.

I figure I'll get plenty of medicine exposure my residency, I just want to have fun fourth year and develop a broad knowledge of things I won't have an opportunity to do when I'm a resident.

 

[ComstockOSU]

All good input. I like the discussion. Please keep it coming.