Clerkships/Rotations Away from Home Medical School?

[pianola]

Say I go to school X and want to do a clerkship/rotation/whatever at school Y...

(1) Is it usually easy to get permission to do one? (From both institutions).

(2) Is it expensive to do away rotations? Which school will I end up paying?

(3) How common are away rotations and how are visiting students graded?

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[Law2Doc]

Say I go to school X and want to do a clerkship/rotation/whatever at school Y...

(1) Is it usually easy to get permission to do one? (From both institutions).

(2) Is it expensive to do away rotations? Which school will I end up paying?

(3) How common are away rotations and how are visiting students graded?

There are a couple of schools with variations on this, but the general rule is that you are allowed to do a couple of away rotations in your fourth year of med school. You will not generally be able to do your third year core rotations (clerkships) away, and most schools won't let you do anything away prior to 4th year. Yes, it is sometimes expensive -- the rotation will let you know what costs are involved, but of course you continue to have to pay your home school's tuition regardless. Away rotations are fairly common in 4th year of med school. About half of the students will do at least one, although that is a guess. It is meant to be an "audition" for residencies, so you will have another school who knows you well before you have to apply, and thus they tend to only be done in the first half of the fourth year, and only in the specialty you are hoping to go into. Visiting students receive the same kind of grades that the home students get, based on performance. It is very subjective because by fourth year there really aren't tests in rotations, just performance evals.

 

[Mobius1985]

Permission is not a problem, generally, if there is space for you. So arranging things early increases your chance that it will work out.

You don't pay tuition to the host school, but there's a good chance you may need to pay malpractice policy cost (your home institution may only cover you while you are in their territory), lodging, transportation there, and for additional immunizations or titers that your home school may not have required.

You will have a contact person who will fill out an evaluation provided by your home school (at least they do it this way where I go).

 

[pianola]

Thanks. That's very interesting. I wonder if I'll have the energy/time to do the paperwork for an away rotation by my fourth year of medical school.

I do appreciate you med students who post in pre-allo. 👍

 

[LizzyM]

I wonder if I'll have the energy/time to do the paperwork for an away rotation by my fourth year of medical school.

If you want to match in a specific field at a specific hospital, you may be very motivated to do what you think that you need to do to make that happen.

 

[Law2Doc]

If you want to match in a specific field at a specific hospital, you may be very motivated to do what you think that you need to do to make that happen.

Yeah, as I said above, it's basically an "audition". If you do well there and make the right friends, you probably earn yourself a better match ranking by that place. However if you don't do well there, it can have the reverse effect. And sometimes it will help you decide you don't like the place.

 

[flip26]

Yeah, as I said above, it's basically an "audition". If you do well there and make the right friends, you probably earn yourself a better match ranking by that place. However if you don't do well there, it can have the reverse effect. And sometimes it will help you decide you don't like the place.

I know that people always want nothing but "merry sunshine" in their lives, but sometimes the best thing that can happen to you is this one...I feel that way about the application process in general - I don't need umpteen reasons to want to go to 30 or 40 schools, but I am always in search of factors that would allow me to remove some of them from consideration to make this a more manageable process...

 

[CCLCMer]

Say I go to school X and want to do a clerkship/rotation/whatever at school Y...

(1) Is it usually easy to get permission to do one? (From both institutions).

(2) Is it expensive to do away rotations? Which school will I end up paying?

(3) How common are away rotations and how are visiting students graded?

At my school, like Law2Doc said, we cannot do our required third year clerkships at other institutions outside of Cleveland. (There are four hospitals in Cleveland that we can go to for rotations.) But we can do our research year or any fourth year electives at other schools if the other school will agree to take us. There is no limit for us that I know of about how many electives we can take at other institutions as long as we get all the required clerkships done in Cleveland.

I haven't applied for any aways myself (I'm still a third year), but my understanding is that many at least have an app fee that you pay to apply to rotate there. Beyond that, it will depend. People from other schools who do aways at the Cleveland Clinic get accomodations and meals for call thrown in. (They have special call rooms set aside for the visiting students to stay in while they're here.) So you wouldn't need to worry about housing or transportation to and from the hospital, just food for times when you're not on call. Some other places would require you to find your own housing and transportation, so that would be something you'd have to set up before you went for the away.

I think a lot of people do aways, but I don't know how many. I'm planning to do one or maybe two during my fifth year (which is like the fourth year at most med schools because CCLCM is a five year program). I'm not sure how the grading works for most schools. We don't get clinical grades at CCLCM (it's P/F all five years). So even if I did get graded on an away, it wouldn't count as more than a Pass or Fail at my home school. I think probably for students from schools with clinical grades, whatever grade they get from the hosting institution would be what they would get at their own school. Someone from a school with grades can feel free to correct me if I'm wrong.

 

[pianola]

Thanks for the perspective, all of you. I think it could potentially be very interesting/beneficial to study at several different institutions/hospitals which is why I wanted to ask ahead of time. Probably I will be motivated to look around by my fourth year.

I've just been thinking: Looking at med school websites (which clearly don't tell the whole story), I think there might be certain clerkships that really appeal to me at schools where I might not be admitted. Perhaps it's easier to do a visiting clerkship at (competitive school X) than it is to get admitted 🙂confused🙂? Or at least, if I'm able to be successful at a couple of institutions, competitive or otherwise, maybe it will help me match. Some of the schools that I'm looking at seem to have a depressingly narrow range of matches...🙁

I certainly didn't realize that away clerkships were so common; good to know. Thankfully, I have a while before I have to dedicate myself to any particular plan...

 

[Law2Doc]

Some of the schools that I'm looking at seem to have a depressingly narrow range of matches...🙁

Ignore that. It's not the school that matches, it's the student. Meaning it's a very individual process. If you do well in med school and on the boards and maybe squeeze in some cool research along the way (even if you have to take a research year off along the way to go work at the NIH or something), there is really no reason you cannot match pretty much anywhere. An away rotation can certainly help your cause if you do well at it.

But since you did raise the issue: You really don't get the info you think from match lists -- I looked at them when I was a premed, but now that I know more I tell med students to stay away from them. They don't paint an accurate picture and most of the assumptions that premeds use when analyzing them simply are wrong. You usually have no idea whether the fact that 70% of the school does primary care means that nobody gets anything else, or whether the school simply does a better job of "selling" the virtues of primary care. People gravitate toward fields they enjoy and so if a school does something well and has lots of influential mentors, you will often see a lot of people flock to that field. Also, you don't really know what are the better schools in the various specialties -- a big name school may be great in one field and truly malignant in another, so going by school name in determining whether a match list is good is crazy. A school that is tops in medicine may be the place people want to leave in droves in ortho, and so on. How can you possibly know as a premed? This kind of thing is what you learn by sitting down with a mentor in your desired field and hearing the word of mouth as to which programs you are likely to be interested in and which ones are hell on earth. A lot of it is dictated by the personalities of the people running the department, not the school, so you can't know anything without tapping into the network of folks who know who works where.
Similarly, counting the number of folks matching into competitive specialties is sort of pointless because it doesn't really tell you how many wanted those. I mean, if only one person at a school matches into derm but he's the only one who wants it, is that better or worse than the school were two people matched into derm but a dozen desperately wanted it? And at most schools some of the top students will go into IM every year, even though they could easilly get the top competitive slots. Happens every year. Once you get to this stage, unlike applying to med school, getting the most prestigious isn't going to be the real focus, it simply isn't that important. The goal is to match into that which you see yourself doing for the rest of your life, what you find enjoyable, and will not dread getting up for every morning at dawn. So somebody who likes taking care of patients might steer clear of things like rads where you have less patient contact, even though they can get it or though the lifestyle is appealing. Or if you find one of the medical specialties fascinating, you might opt for that over the lifestyle of derm or optho. You simply don't know the interests and motivations of folks seeking residency, but should realize that their choices are based more on what they want to do with their lives and less on what the most prestigious thing they can get will be. So I say sitting down with a match list as a premed is a waste of time, and so I sure wouldn't get depressed over one. You cannot possibly know what you are going to be interested in (most med students change their minds at least once), don't know what programs are good in each specialty, and don't know whether the lack of folks going into particular specialties reflects the interests of the students, the good job the school has done in inspiring folks into certain noncompetitive fields, or a lack of ability to match into those fields by that particular group of students. All I can tell you is that from any US allo school, if you do well in school and on the boards, have some interesting research, and interview decently, I see no reason preventing you from matching into any specialty. It's all about you, not the school that determines the trajectory.

 

[pianola]

Thank you for your thoughtful reply. Honestly, the residency (to me) is as important or more important than whether or not I get into school X, Y, or Z. It definitely helps to have some perspective.

A little off-topic but: I'm more worried about residency than I am about medical school itself; there are a lot of "what ifs". What if I choose a specialty I hate? What if I choose a specialty I like and have difficulty paying off loans? What if I 'lose it' after 4 weeks of 80-hour work weeks? Any of these could potentially end up being major tragedies...If I happen to lose a few nights of sleep as a 3rd and 4th year in med school, well, ok, that stinks, and I can complain about it like everyone else and then proceed to get on with my life. However, If I choose a specialty I hate AFTER 3rd and 4th year...that's a little bit more permanent and I may have to do some major retracking.

And I'm a woman so I have no idea how I'll be able to accommodate children should I choose to have them.

OK thanks again.

 

[Law2Doc]

Thank you for your thoughtful reply. Honestly, the residency (to me) is as important or more important than whether or not I get into school X, Y, or Z. It definitely helps to have some perspective.

A little off-topic but: I'm more worried about residency than I am about medical school itself; there are a lot of "what ifs". What if I choose a specialty I hate? What if I choose a specialty I like and have difficulty paying off loans? What if I 'lose it' after 4 weeks of 80-hour work weeks? Any of these could potentially end up being major tragedies...If I happen to lose a few nights of sleep as a 3rd and 4th year in med school, well, ok, that stinks, and I can complain about it like everyone else and then proceed to get on with my life. However, If I choose a specialty I hate AFTER 3rd and 4th year...that's a little bit more permanent and I may have to do some major retracking.

And I'm a woman so I have no idea how I'll be able to accommodate children should I choose to have them.

OK thanks again.

As for having kids, the consensus seems to be that there is never a "good" time to have kids, so you may as well crank them out whenever the stars align. On this career path you are always going to be interrupting something.
As for residency, use your third year rotations to help decide what you are interested in. You get a wide variety of rotations: Medicine, Surgery, OBGYN, Psych, Peds, and at most schools FM and Neuro. Within these, you probably get some token exposure to the medicine subspecialties, to derm, optho, gas, rads, ortho. If there is a specialty you might be interested in that you don't think you'll get exposed to, then use your first and second year wisely and do some shadowing. Once you are in med school, you'll find that docs are much more eager to teach and show you stuff. And at some point you'll find what you like (and maybe what you don't like) and it will help you to make a better decision. If you are wrong, you can always do another residency, but that's a lot of years. Or sometimes can outright switch without too much backtrackng (I believe Panda who posts on this board jumped from FM to EM).

 

[ButImLETired]

As for having kids, the consensus seems to be that there is never a "good" time to have kids, so you may as well crank them out whenever the stars align. On this career path you are always going to be interrupting something.
As for residency, use your third year rotations to help decide what you are interested in. You get a wide variety of rotations: Medicine, Surgery, OBGYN, Psych, Peds, and at most schools FM and Neuro. Within these, you probably get some token exposure to the medicine subspecialties, to derm, optho, gas, rads, ortho. If there is a specialty you might be interested in that you don't think you'll get exposed to, then use your first and second year wisely and do some shadowing. Once you are in med school, you'll find that docs are much more eager to teach and show you stuff. And at some point you'll find what you like (and maybe what you don't like) and it will help you to make a better decision. If you are wrong, you can always do another residency, but that's a lot of years. Or sometimes can outright switch without too much backtrackng (I believe Panda who posts on this board jumped from FM to EM).

Hey, sorry to hijack Pianola's thread, but now that we have Law2Doc's attention, I have come up with a couple of questions...

1) I am personally "interested" (as much as one can know at this point, anyway) in cardiology. I realize that it's a fellowship, not a residency (correct me if I'm wrong) and that I would have to first go through an internal med residency. I also think I gathered that IM in theory isn't all that competitive to get into- however, the cardio fellowship is. How does that process work exactly (the process of getting a fellowship, instead of a residency)? Do people usually become fellows at the same hospital at which they've been training? What is the timing of the application process? What criteria are used (are Step I scores and med school grades still as relevant at that point)? Is it total fallacy to assume that since IM isn't super competitive as a residency, your med school performance isn't as important for a competitive fellowship like cardiology as it would be for, say, a derm residency?

2) As for doing some clinical stuff at a school away from one's home institution, can you go to other states to do it? It's also sounding like it's more of a "first come, first serve" type thing which seems a bit odd to me if it really does give you a significant advantage in the match. Example: the Cleveland Clinic is obviously THE place for cardiology, so if I wanted to get an IM residency there would I really be able to do a fourth year rotation there- even though I won't be at a med school in Ohio? Would that really help me with getting a residency there?

THANKS!

 

[CCLCMer]

Hey, sorry to hijack Pianola's thread, but now that we have Law2Doc's attention, I have come up with a couple of questions...

I'm going to throw in my two cents here, since you did ask about CCF and all. 😉

1) I am personally "interested" (as much as one can know at this point, anyway) in cardiology. I realize that it's a fellowship, not a residency (correct me if I'm wrong) and that I would have to first go through an internal med residency. I also think I gathered that IM in theory isn't all that competitive to get into- however, the cardio fellowship is. How does that process work exactly (the process of getting a fellowship, instead of a residency)? Do people usually become fellows at the same hospital at which they've been training? What is the timing of the application process? What criteria are used (are Step I scores and med school grades still as relevant at that point)? Is it total fallacy to assume that since IM isn't super competitive as a residency, your med school performance isn't as important for a competitive fellowship like cardiology as it would be for, say, a derm residency?

You don't get a fellowship instead of a residency. You do a fellowship AFTER a residency. So if you want to be a cardiologist, you would have to do three years of IM residency. While you were a resident, you would apply for fellowships in cardiology. I think where people go depends on the people as well as on the hospital. I have gotten the impression that CCF likes to keep its own people. Even as medical students, we were highly encouraged to do our rotations at CCF instead of one of the other Cleveland hospitals, and we've also been encouraged to consider staying here for residency. I guess it makes sense, because they know how we've been trained.

I think for fellowships your Step 1 score and med school grades won't matter at all. But who you know from residency will be very important, because you'll need good LORs. If you want to come to CCF, research experience will be helpful because this is an academic center. Don't think that you can blow off your Step 1 just because you're going into IM though. The top IM programs are very competitive to get into.

2) As for doing some clinical stuff at a school away from one's home institution, can you go to other states to do it? It's also sounding like it's more of a "first come, first serve" type thing which seems a bit odd to me if it really does give you a significant advantage in the match. Example: the Cleveland Clinic is obviously THE place for cardiology, so if I wanted to get an IM residency there would I really be able to do a fourth year rotation there- even though I won't be at a med school in Ohio? Would that really help me with getting a residency there?

You can definitely go to another state. There are tons of OOS students who come here to do aways or clinical research. I don't know how much advantage doing an away would give you, but if you work hard during your away and people like you, it can only help you. But doing an away won't always help you, and it won't guarantee anything. It's more like a trial run. You get to see what it's like to work at that hospital, and they get to see what you're like as a potential future employee. But maybe you'd decide you don't like it there, or they'd decide that you're not a good fit. If you bomb your away, it won't help you and it might hurt you. So you shouldn't do one unless you're really prepared to give them your best game.

 

[Law2Doc]

Hey, sorry to hijack Pianola's thread, but now that we have Law2Doc's attention, I have come up with a couple of questions...
...
THANKS!

I agree with CCLCMer above. You apply for IM residency. At some point during that residency, you apply for fellowship. How you are doing in your residency, various exams, as well as the older pre-residency stuff all factors in. But it is a different application process and you can do a fellowship at a different place than where you do residency. As CCLCMer suggests a lot of places take their own at this stage, so doing well at an IM residency should help in staying on as a fellow there. But plenty of folks have wanderlust and apply elsewhere.

For the same reasons it makes no sense to decide as a premed what you want to do residency in, it makes even less sense to "know" what you want to do a fellowship in at this stage. You are going to find you like and dislike things differently than you currently believe. Most med students change their minds at least once. You may hate IM and not want to put up with it for 3 years to get to cards. You may fall in love with psych, neuro, ortho. You cannot know from this vantage point. So it really doesn't pay to worry about fellowships as a premed.

As for the derm vs cards question, it's hard to say which ultimately is hardest. There are always some of the smartest people in med school who go into IM rather than things like derm -- folks who go into what they like over what gives a good lifestyle. And most of these folks will go into one of the subspecialties. So whether you'll be competing with some of the folks who could have done derm when you apply for cards is actually not improbable -- the less competitive IM folks tend to become internists. But with all the years of training and other subspecialties to choose from there is a decent weedout factor -- and a lot of smart folks will also get drawn away to do Heme-Onc or GI or XYZ, so there is dilution of smart folks as well. So hard to guess. The cards fellows I know are very sharp, but whether they were in med school is something only they know.

 

[pianola]

Thanks for hijacking the thread, actually. The more I find out about residencies the better. I know it's not possible/likely to 'know what you want to do' before entering medical school, but knowledge is power.