It's basically what Isserson says. "It's a two-edged sword." You can hurt yourself if you don't perform up to par and yet you can help yourself if you do perform up to par.
Think of it. You're going into a new environment. Everything is foreign. You spend the first couple days trying not to get lost, figuring out how to log on to the computer systems, etc. Lots could go wrong. On the other hand, a lot could go right.
With that said, there is no beter way to get a feel for a program than by rotating through it. While they are evaluating you, you too are evaluating them. With this said, it may reasonable to do rotations at places you know very little about but are willing to consider. Vice versa, it may not be necessary to do a rotation at a place you know a lot about.
Perhaps the right question is to ask whether or not your current rotations at home are solid enough to suffice come application time. If they are not solid enough, is it enough to warrant an away rotation?
Another thing is how do your numbers look? If they are subpar, and your gut feeling tells you that come application time, programs you really want to get into will overlook your application, then by all means rotate there. You have very little to lose. If your numbers are great and your gut feeling is that programs will look at you come application time, then rotating through may not do very much. If you don't know how your numbers will look, then I hope you have a lot of programs you like and will apply to.
Most US students who are applying for IM don't bother with audition rotations, partly because as the previous user stated, they can be a double edged sword. You can help your chances, but you can also hurt your chances if the attending you happen to work with isn't all that thrilled to be working with you. If you feel that you "must" train at a particular program, then I think that doing an audition rotation is a good way to show the program that you really want to be there. From your standpoint, it also helps you to get to know the program far better then if you were just to interview there. Some people do audition rotations and discover that they don't actually like the program that they thought that they were going to like. The biggest drawback of doing an away rotation for me was just the cost associated with moving to an area for 1 month.
I'm really glad that fuzzylogic started this thread because I had the exact same question. Does anyone have any suggestions as to whether to do a sub-I at the institution or whether to just do an elective like Renal, Cards, etc. My other question is if I do an externship at a place I'm interested in, in October, is that too late to ask for a letter of Rec? Any advice would be very much appreciated. Thanks
It is my understanding that the first day you can submit ERAS is September 1st. I'm not sure what you need to have completed in order to do this. You may be able to submit without any LORs? I think the last day you can change/add things to your application is November 1st. Therefore, you would need to have your LORs written and submitted by then. If this is correct, the latest you could probably do a rotation and get a LOR would be September.
Feel free to correct me if I'm wrong on any of these points.
I think that it's better to do an elective in a subspecialty then to do a sub-I at another institution. Sub-I evaluations do carry more weight and attendings do usually get to know you better in them, but electives have several advantages over sub-i's. Your performance in a sub-I may be hindered by your unfamiliarity with the way things are run at the hospital, this will be less of an issue during an elective where you will have fewer responsibilities. I've noticed that some attendings have lower expectations on student performances during electives, so if you take your work seriously (ie offering to stay late or come in early), it will be easier to impress an attending during an elective then a sub-I. Finally, the fellows in certain specialties who do not get that many students doing their elective with them are oftentimes very appreciative of having a student on the service with them who will see patients for them while they are doing other work. This can be very valuable in ensuring a strong letter of reccomendation or evaluation too, since attendings frequently rely on fellow and resident feedback for what to write in their evaluations.
October is technically not too late to ask for a LOR since you can add additional letters of support to your application to some programs after submitting your application in ERAS (earliest submission date is ~Sept 1st), but it would be preferable if you could do your elective earlier in the year so that the letter can count as one of the required letters to complete your application. Remember that some attendings require some amount of time to write their letters of reccomendation too. Some programs that you will be applying to will also not allow you to send additional letters beyond the required 3-4 letters (most programs require 3 letters including your chairperson's letter, some will allow you to send 4-5). Some students do not just use their away electives to get letters to send to different program though, doing an away rotation during October, November, or December can still be advantageous in showing a strong interest in the program and you can sometimes meet with the program director or chairperson to discuss your interest in the program during your rotation. If the attending really likes you, he or she may be willing to make a phone call for you too or put in a good work with the PD. Just be cautious about taking off too much time during your away elective if you do one in December or January, as even though most attendings expect that you will need to be away for interview purposes, it probably doesn't help you look like a dedicated student. On the other hand, another consideration is that if your away rotation is in a city where a number of programs that you are interested in are located at, you could save money on traveling cost by doing your rotation during an interview month. I don't think that there's anything wrong with taking 3-4 days off for interviews during an away elective for interviews, I just wouldn't try to schedule too many interviews during an away elective. I would tell you what Iserson's reccomends, but I can't find my book right now.
Along these lines, how easy is it to actually do away rotations? Will most institutions allow outside students to rotate? And, if they agree to let you do a clerkship, how much flexibility is there as to when you can do it? Thanks.
Most hospitals run on a monthy (4-week) rotating schedule; so it's usually not too difficult to fit away rotations into your regular rotation schedule. Some electives at different schools are definitely more difficult to get into then others due to their popularity among students from other schools and because they have to accomadate their own students first. I'd reccomend looking into setting up an away rotation during early spring of your third year because there is sometimes a lot of paperwork that needs to be filled out too (malpractice, immunizations, transcripts, etc). Some also require approval from attendings too. Most do not charge tuition (I've heard that Hopkins is one of the few that may charge tuition), but I was only able find a few that offered housing options to visiting students. Your office of student affairs should have a lot of information about away rotations past students have done from your school, the other main source that you will have to use are school/hospital websites.