away rotations

[ACSurgeon]

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what is every one's thought on doing an away rotation for gen surg? I believe I'm a solid applicant numbers wise. While I have 1 program in mind that I would like to go to (just to be in a certain city) I would be okay going to any of a dozen other programs nearby (none of which are crazy competitive, I don't think).

Some of my residents/ attendings seem to think aways can only hurt you if you are a solid applicant. They agree that it can help you get into your number one, but it can also black-ball you from that program as well. What is the general consensus?

 

[beefballs]

depends on your level of competitiveness, if you have lower than avg board scores or the place is competetive go, but with the intent on busting butt all day. My classmates that were avg applicants at bigger name places and knew hat is where they wanted to go did aways, but it can backfire.

if you are competitive at the places you want to go and don't have aclear cut #1 i wouldn't. BUt there are many ways to skin a cat

 

[SouthernSurgeon]

what is every one's thought on doing an away rotation for gen surg? I believe I'm a solid applicant numbers wise. While I have 1 program in mind that I would like to go to (just to be in a certain city) I would be okay going to any of a dozen other programs nearby (none of which are crazy competitive, I don't think).

Some of my residents/ attendings seem to think aways can only hurt you if you are a solid applicant. They agree that it can help you get into your number one, but it can also black-ball you from that program as well. What is the general consensus?

I did one and thought it was helpful. I got a letter out of it, impressed them (at least that's what they said...), and got the added perspective of seeing how things were done at a different hospital system than my home program (which I think helped me determine better what I want from a residency).

I can't tell you definitively whether you should or shouldn't - that is an individual choice since gen surg is a field where aways really aren't "necessary."

But if you do go, remember that it is a month long interview. In order to impress, you need to basically be better than the interns. You also need to keep a positive attitude - no whining or complaining for a month, regardless of whether the rest of the team does. Don't talk about other programs you like or all the interviews you are getting - you are on a focused mission to show them how much you love their program.

One additional note - I went on an away to a program that looks very good on paper and that I thought would be at/near the top of my rank list. After spending a month there it moved to the middle (i.e. it is still a "solid" program but not exactly what I want). It is really helpful to get that insider perspective on a program.

 

[sockandmittens]

I did two aways, doing more than that will likely drive you a little insane and is quite expensive.

One schools was a great school from a region that traditionally didn't interview students from my school. So as I saw it, I had nothing to lose by going since they likely weren't going to interview me without me showing up. I ended up loving it and would be thrilled to end up there. The other was a place that I was interested in and was an easy location to get to/find housing etc. Also, a place I really enjoyed and would be thrilled to end up at.

So the good things about aways- you really get a good idea of the program, which you'll end up trusting more than a good interview day. If you do well, it can really help you. However, I have a friend who did two and they didn't interview him/her. You really have to be perfect all the time. I was incredibly sick of smiling by the end- because you just can't stop. It's way easier to lose ground than gain ground.

So, I'll pass on my chair's advice. Only do an away somewhere that you want to see, do not do it to get a job. They absolutely backfire all the time for good applicants who have perfectly good social skills. There is nothing more miserable and stressful than showing up to a hospital where you don't know how anything works, don't know anyone, and than supposedly trying to impress them against their home school med students. It's a risk and it's hard. Good luck!

 

[Musashi450]

I chose to do an away rotation at a place I knew I wanted to go to. I felt it was important for me to see more of the program and get more face time with the attendings. I also come from a lesser known school and realized that this would probably work against me. So did it work? I did get an interview but idk ask me in about a month (26 days...ugh)

Still though I think an away rotation is invaluable. You'll get to see what the program is ACTUALLY like and (more importantly) you get to see a different type of practice. I think you really have to know your personality though. If you are the type of person that gets along well with others easily you'll probably do fine. Problem is people that don't get along with others probably aren't aware of their personality. This is why I think its important to get an HONEST opinion from a mentor on this. Also I completely agree that it is 10x easier to shoot yourself in the foot then it is to look good but what I found was the MOST important was simply being pleasant (not brown nosing) 24/7. If you atleast are acting happy and willing to get the job done after being on for 14 hours, I think it gives a good impression to those around you for how you will be if you end up there. Study too but atleast in my case, no amount of studying would have prepared me for the types of questions I was being asked. You'll get questions wrong in a months time but you just need to be willing to learn. And when you get a question wrong, make sure you go look at it.

 

[thedrjojo]

I did one away as well. I didn't stress about it, was more going to see how things work elsewhere and to check out the program, not to do a month long interview. I think that helped me stay relaxed and not be overbearing. The result is I got a letter, impressed the PD enough that he was willing to make a call to another program if I so desired (I kid you not... at the time I finished up in the end of september I had 2 interviews already, one where he knew the chair and said if that was a place I saw myself going to that he would make a call for me), got an interview (which I didn't think was going to be a problem even pre-away), and have received calls from the assistant PD/Chairmen claiming I will be ranked "very highly" (my only such calls to date btw...)

I think overthinking and overstretching is the easiest way to shoot yourself in the foot. Go and be yourself and work to your fullest. They really won't remember if you could remember each type of thyroid cancer, or if you had one off day, but they will remember if you worked well with the team, appeared eager, willing to help, etc. Cause really, if you have to pretend to fit in to make them like you, is that where you really want to be for 5+ years?

My only concern is that I found it impossible to rank a place high that I hadn't spent significant time with (so my top two are between my home program and my away) because you get such a small show on the interview, how can you dedicate 5 years on just that. So second looks are very important IMHO, and aways can give you that peace of mind (but then again, you can only do so few aways, what if they become duds)

 

[Musashi450]

Completely agree with you thedrjojo on the interviews! At the end of the day I honest to god couldn't tell most of the programs apart and just have done my list based on location and gut. I haven't done any second looks only because I figured it would only make me worse had I done well on an interview. If I had done bad, it wouldn't have helped me at all.

I was also going to edit my original comment but will just say it here. Realize that SDN is a self selected group of neurotic gunners (jesus I hope I don't fit that mold...) Point is, I'm willing to bet most of us are going to say we did an away. For the reasons I said above and for what others will point out, their are just as many equally important reasons NOT to do an away so don't go thinking most people do them. They don't!

 

[ACSurgeon]

Thanks for the replies everybody. That's the same advice I got from folks at my school. Like I said, I think I am competitive at my number 1 program, and I know students going there, and so, have enough insiders information that I don't feel the need to do an away to get more info, but rather to increase my chances of matching there (since a lot of the process seems so random). Maybe I should talk to the PD there to become more than just another random applicant?

Also, given this double-edge nature of doing an away for gen surg, why is it so helpful for ortho/uro/plastics? Maybe I should ask why isn't it as risky? Is it because few-to-no applicants are considered competitive enough on paper to not need an away? Is it just another box to check on the app?

Thanks again!!

 

[Musashi450]

Also, given this double-edge nature of doing an away for gen surg, why is it so helpful for ortho/uro/plastics?

Thanks again!!

I'm told that for those specialties, the average step score is significantly higher which leaves little for PDs to go off of when trying to whittle the pile down when giving out interviews. Plastics for example, if I remember right, has something like a 2:1 ratio for applicants vs. spots available. This just means that because its so competitive, not doing an away (and getting to know the small group of people that those specialties are) probably hurts you. I'm willing to bet it is probably just as risky...maybe even more so since everyone is more likely to know everyone.

 

[SouthernSurgeon]

I'm told that for those specialties, the average step score is significantly higher which leaves little for PDs to go off of when trying to whittle the pile down when giving out interviews. Plastics for example, if I remember right, has something like a 2:1 ratio for applicants vs. spots available. This just means that because its so competitive, not doing an away (and getting to know the small group of people that those specialties are) probably hurts you. I'm willing to bet it is probably just as risky...maybe even more so since everyone is more likely to know everyone.

Agree with this. I would say it isn't "more helpful" to do aways in those fields, but rather "more hurtful" not to do aways.

It is a matter of expectations - in the surgical subspecialties they expect that everyone will do pretty much as many aways as they can.

 

[BlondeDocteur]

Yup. I started off the year expecting to apply in plastics, and did three aways (four months straight of sub-is). That was par for the course, more or less.

For general surgery I think there are several good reasons to do aways.

1) You are genuinely interested in a specific program or two and want insider info
2) you worry you aren't competitive enough for a specific program so you want to "shine" for them
3) You want famous names to write your LORs
4) If there is regional bias against your medical school-- i.e. for us we're told "nobody ever believes you'll leave New York"-- then doing an away in a different part of the country reinforces the perception you're willing to go anywhere for your training
5) your home surgery department doesn't really like you, or you know they won't take you
6) if you're worried your medical school isn't perceived well and you want to prove you're "nationally competitive."

 

[SLUser11]

Yup. I started off the year expecting to apply in plastics, and did three aways (four months straight of sub-is). That was par for the course, more or less.

For general surgery I think there are several good reasons to do aways.

1) You are genuinely interested in a specific program or two and want insider info
2) you worry you aren't competitive enough for a specific program so you want to "shine" for them
3) You want famous names to write your LORs
4) If there is regional bias against your medical school-- i.e. for us we're told "nobody ever believes you'll leave New York"-- then doing an away in a different part of the country reinforces the perception you're willing to go anywhere for your training
5) your home surgery department doesn't really like you, or you know they won't take you
6) if you're worried your medical school isn't perceived well and you want to prove you're "nationally competitive."

You missed the most important reason, which is to experience a different way of doing things. Most medical students experience a single program, and it's obvious that there are more than one way to train a general surgeon.

By doing an away rotation, you can get a better idea of what exactly you are looking for in a program.....university/community, fellows/no fellows, students/no students, big/small, etc etc etc.

I did 2 away rotations, and ranked one of the programs very low, and one right in the middle....more than anything, these experiences helped me realize what I didn't want in a program.

To the OP, I strongly recommend you do an away rotation, assuming that you don't suck.....if you do suck, then stay home and try to hide your inadequacies from your future suitors.....

Also, as a final tidbit, I am involved in the interview process at my own institution, and when I see medical students who haven't done away rotations, I always ask them "why not." To me, it can mean that they're scared that they'll betray themselves....

 

[Pir8DeacDoc]

I think that aways are smiled at in the surgical sub-specialties because we have smaller programs, in general. One bad apple can really throw off the balance. General surgery programs tend to have a herd of residents and so one bad apple can be forgotten about or minimized.

We like knowing that you are more than just a stat sheet. Can I work with you? That's really what I want to know.

 

[ACSurgeon]

You missed the most important reason, which is to experience a different way of doing things. Most medical students experience a single program, and it's obvious that there are more than one way to train a general surgeon.

By doing an away rotation, you can get a better idea of what exactly you are looking for in a program.....university/community, fellows/no fellows, students/no students, big/small, etc etc etc.

I did 2 away rotations, and ranked one of the programs very low, and one right in the middle....more than anything, these experiences helped me realize what I didn't want in a program.

That's one way to look at it. However, I've been advised [by residents/attendings] that when you are doing an away, you are at a disadvantage for being at an unfamiliar site with students at their home school, AND have higher (unrealistic?) expectations to meet. Therefore, they conclude, doing an away can only hurt if you are strong on paper (as if you are being set up to fail on aways and you have to fight an uphill battel to prove that you are good enough for them).

To the OP, I strongly recommend you do an away rotation, assuming that you don't suck.....if you do suck, then stay home and try to hide your inadequacies from your future suitors.....

Also, as a final tidbit, I am involved in the interview process at my own institution, and when I see medical students who haven't done away rotations, I always ask them "why not." To me, it can mean that they're scared that they'll betray themselves....

I believe I am a strong candidate, and have received excellent feedback from my residents and attendings (so, I probably don't suck ). I have one program that I would really like to go to (to be close to family), and from input from residents and attendings I am competitive based on the school I go to and my numbers/activities. So, what I am trying to decide is whether the benefits outway the risks. Also, I'd be open to doing an away at my #2 or #3 choice if that is perceived as a strength (I'd be okay "risking it" with these programs compared to my number 1).

 

[SouthernSurgeon]

That's one way to look at it. However, I've been advised [by residents/attendings] that when you are doing an away, you are at a disadvantage for being at an unfamiliar site with students at their home school, AND have higher (unrealistic?) expectations to meet. Therefore, they conclude, doing an away can only hurt if you are strong on paper (as if you are being set up to fail on aways and you have to fight an uphill battel to prove that you are good enough for them).
.

I think this gets kind of overblown. When I did my away, I'd say the only significant learning curve was that took me about 3 days to get comfortable with the computer system and with the charting system (i.e. how to gather all my pre-rounding info and write notes/orders); other than that the "unfamiliarity" was limited to some silly things like the chief wanting me to present the vitals in a different order than what I was used to or not knowing where the locker rooms were for 2 days. If you are motivated, hard-working, and have the requisite fund of knowledge you can get up to speed pretty quickly and do well.

 

[BlondeDocteur]

I agree. Like I said, I did three of 'em (and one of those "aways" meant working at 4 different hospitals, one per week) and the learning curve wasn't too bad. I think total I worked at 14 different hospitals in 4 months, and I never felt inept.

Of course everyone *knows* you're a visiting student. You're not supposed to know where the dressing supplies are on your first day. But luckily, people are evaluating you on your knowledge, personality, and work ethic more than on your insider info on the paging system.

That being said-- if by a week or so you haven't gotten the swing of things, that will reflect poorly on your ability to adapt, get things done, etc., which is IMHO crucial to being an effective surgery resident.

And SL is completely right-- not an exhaustive list. I did all my aways at busy university programs, but comparing New York versus not-NY, the burbs versus urban, and so forth was very important.

 

[ACSurgeon]

I agree. Like I said, I did three of 'em (and one of those "aways" meant working at 4 different hospitals, one per week) and the learning curve wasn't too bad. I think total I worked at 14 different hospitals in 4 months, and I never felt inept.

Of course everyone *knows* you're a visiting student. You're not supposed to know where the dressing supplies are on your first day. But luckily, people are evaluating you on your knowledge, personality, and work ethic more than on your insider info on the paging system.

That being said-- if by a week or so you haven't gotten the swing of things, that will reflect poorly on your ability to adapt, get things done, etc., which is IMHO crucial to being an effective surgery resident.

And SL is completely right-- not an exhaustive list. I did all my aways at busy university programs, but comparing New York versus not-NY, the burbs versus urban, and so forth was very important.

good to know. thanks!

 

[ACSurgeon]

I think this gets kind of overblown. When I did my away, I'd say the only significant learning curve was that took me about 3 days to get comfortable with the computer system and with the charting system (i.e. how to gather all my pre-rounding info and write notes/orders); other than that the "unfamiliarity" was limited to some silly things like the chief wanting me to present the vitals in a different order than what I was used to or not knowing where the locker rooms were for 2 days. If you are motivated, hard-working, and have the requisite fund of knowledge you can get up to speed pretty quickly and do well.

Thanks!

 

[SLUser11]

That's one way to look at it. However, I've been advised [by residents/attendings] that when you are doing an away, you are at a disadvantage for being at an unfamiliar site with students at their home school, AND have higher (unrealistic?) expectations to meet. Therefore, they conclude, doing an away can only hurt if you are strong on paper (as if you are being set up to fail on aways and you have to fight an uphill battel to prove that you are good enough for them).

I'm very familiar with that side of the argument, and we have relatively wise posters here who also think aways can only hurt a strong applicant, but I just feel that the benefits outweigh the risks.

If you are a strong applicant, then you'll do well, and you have nothing to worry about. Show some confidence in your skillz. I know the process is intimidating, but if you are a clinical bad@ss, then it's really a buyer's market.

Also, it's very possible that your "top 3" will change after you gain more knowledge about those programs and better understand your options in general. For that reason, you don't necessarily have to do aways at these places. If you are at a big university program, do an away at a community program, etc.....try out some different cities that you are not familiar with...maybe rotate near your family or friends.....just some options.

 

[Dr.LeoSpaceman]

I think part of the issue has to do with the level of program at which you are doing an away. If you are talking about a "top 10" type program, being an "above average" applicant isn't going to make a difference once the whole process starts. It might be enough to get you in for an interview, but the other 80-100 (in a few cases considerably less than that) are going to be just like you. At that point, differentiating yourself from everyone else is your main goal. Spending a month somewhere, and doing well, is one way to do that. Sure, it's high risk/high reward, but if we're talking about the big name programs, you have quite a bit less to lose. And if you can get an LOR out of it, all the better.

If you're looking to make a significant geographic change, it's also probably a good idea. I interviewed on the East Coast and the Midwest, and am from an East Coast med school. People in the Midwest were always very interested when I showed up for interviews as to why I wanted to move. Fortunately, I had an easy answer in that I'm originally from the Midwest and still have family there.