could an away elective hurt me?

[thefifteenth]

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I am a current 3rd year medical student applying to pathology for residency next year. I come from an unranked medical school in the midwest and I look great on paper (step 1 250+, rank ~20/175ish, honored most of my 3rd year clerkships). I'm looking to do aways during aug-dec to explore potential residency programs, be with family, and live in cool, new places. My med school right now is in a very undesirable area and I've been frustrated with my clinical experiences all year since I've dealt with mostly incompetent residents who have no interest in teaching or simply don't know how to. My residents here are 90% FMGs (not kidding) or American grads who could not match anywhere else (mostly true but of course there are exceptions).

All of these things make me want to do aways but I'm a little worried about how these aways might impact my future since I don't think my clinical skills match up to my test taking abilities. I've had evaluations that are great, average, and a couple really nasty ones. I personally feel a little uneasy around patients, however most docs I work with tell me they can't believe i'm going into path since I'm so "personable" or something. On the other hand, the few crappy evals I've gotten and my own feelings of inadequacy and awkwardness on the wards makes me worried that I'll screw myself over with these month-long aways at places I'm seriously considering for residency. What should I do?

 

[DaSein77]

you are making a mountain out of a mole hill...go do a few electives, its not a big deal. pathology departments are generally very friendly and low key. they all assume you know very little. the hardest part is the presentation, which is not hard. i did a few away electives and it was very informative for choosing a residency programs and helped me to get good letters. go and do a few at places you think you want to go for residency. you will meet cool people and learn a lot about what you do and do not want in a program.

 

[KCShaw]

Not sure I even understand the question.

In general, I think everyone should do an away rotation or two in something, somewhere. As far as pathology specifically, I think it's useful to rotate with a couple of different programs if you can. I have no idea how an away elective could hurt, unless you want to stay at a local program but diss them entirely by never doing a rotation with them and instead doing an away rotation. But you would probably do a rotation locally if you really wanted to stay there for whatever reason.

As far as local clinical rotations being an issue, that doesn't necessarily relate to the pathology program. In most institutions the path department has its own microculture and may not be as affected by issues in clinical training. Feeling awkward on clinical rotations is to some extent part of training -- and at any rate need have no bearing on the question. Those things are worth keeping in mind, sure, but I don't see how they have any bearing on whether doing an away rotation could be harmful. Merely that doing a local rotation and clinical medicine don't trip your trigger right now, even though you haven't mentioned any exposure to the local path department/program.

 

[KluverB]

The blunt and short of it: if you suck, they may well hurt you.

 

[Unty]

You cannot suck unless you are a complete ahole, completely disinterested or do not show up on time. You cannot screw up a pathology rotation because little is expected of you (knowledgewise)except for being as interested as possible.

Good luck.

 

[Path_to_Endo]

What makes you want to go into pathology? What experiences have you had? You definitely will run into many. FMGs in pathology. Honestly, if you went to a small allopathic school and rocked the boards, don't count yourself out of clinical specialties.

 

[Deucedano]

Away rotations can hurt you, but as others have pointed out, only if you are an a-hole, uninterested, cocky or overzealous. There were quite a few med students who rotated at my program ("a top program" on the west coast) that were voted down by the residents because of the reasons I stated above. I still think away rotations are extremely helpful in helping you gain perspective on how other programs operate. I did an away at Penn, despite not wanting to go there at all, and really like it (to the point where I almost ranked it #1).

My stats were very similar to yours and I firmly belived my away elective allowed me to speak intelligently about what I was looking for in a program. If you are really concerned about making a bad impression at a program you want to go to, just do a rotation at a place you have no intention on going. As long as you are not an a-hole and they like you, you can get good letters that will help you even more.


Given your stats you will likely not need to do an away to get into a good program, but it will help you get an idea of what you want in a program. If you really dont want to do an away, you can always spend a few days a a program after you interview as a "second look" to get a better idea of the program. People often overlook this option which can be very useful if the program is close to your medical school. Hope that helps!

 

[thefifteenth]

Thanks guys! I was just worried they would expect brilliance and be unimpressed by anything less. I will indeed pursue these aways as I can't wait to experience path at other institutions!

 

[2121115]

With your stats it can only hurt you, your chances are already good for matching at a good program. An away rotation will only give you a chance to mess it up or keep your chances the same.

 

[DaSein77]

With your stats it can only hurt you, your chances are already good for matching at a good program. An away rotation will only give you a chance to mess it up or keep your chances the same.

Same can be said about showing up to interviews with no clue about the basics of a path residency because you have zero exposure from having done zero electives

Do aways and I would suggest doing at least one at a large academic center. 2 months around residents and other path med students will make you so much more informed about what you do and dont want with your training. Its the next 4-6 years of you life, be as informed as possible, get immersed in what you plan on doing. If you mess up, who cares. At least you were prepared for your interviews and will likely be more confident about your rank list next year.

 

[pathstudent]

Only if you show up and constantlytalk about how the job market sucks because university programs over train residents to get free gross monkeys.

 

[2121115]

Same can be said about showing up to interviews with no clue about the basics of a path residency because you have zero exposure from having done zero electives

Do aways and I would suggest doing at least one at a large academic center. 2 months around residents and other path med students will make you so much more informed about what you do and dont want with your training. Its the next 4-6 years of you life, be as informed as possible, get immersed in what you plan on doing. If you mess up, who cares. At least you were prepared for your interviews and will likely be more confident about your rank list next year.

The difference is that you *have* to do interviews, and you do NOT have to do an away rotation. Away rotations are for candidates who have flaws they need to overcome by impressing in person, or for candidates who come from a terrible medical school with no pathology department. If you are sporting a 250+ Step 1 and you can avoid putting your foot in your mouth in an interview, you do not NEED an away rotation. It can only hurt you. On a program's rank list, an unknown with high board scores will always beat a known dud. And an unknown with mediocre board scores will almost always beat a known dud.

 

[pianoguy05]

The difference is that you *have* to do interviews, and you do NOT have to do an away rotation. Away rotations are for candidates who have flaws they need to overcome by impressing in person, or for candidates who come from a terrible medical school with no pathology department. If you are sporting a 250+ Step 1 and you can avoid putting your foot in your mouth in an interview, you do not NEED an away rotation. It can only hurt you. On a program's rank list, an unknown with high board scores will always beat a known dud. And an unknown with mediocre board scores will almost always beat a known dud.

I fundamentally disagree with this. There is a significant difference between the workings of a small pathology program and a large academic medical center. I came from a small program this past year, with a very good Step 1/application and the most frequent question I had at the large, big-name institutions at which I interviewed was, "you're from [small school X]...do you think you can handle life/volume here at [Big School U/Ivy U]?" I had completed an away elective at a big-name tertiary care center and accordingly was able to use that to my advantage ("yes...I've had experience at an institution which grossed >50K/year and ran on a 1 day cycle vs. my small school's 3-day cycle and <20K/yr). I agree with you in saying that you don't need to do an away, but I absolutely disagree in stating that it can only hurt you. I think there are many positive aspects to an away rotation, and if the OP wishes to do such, I would absolutely encourage doing it, if they're seriously considering pathology. That said, I'm not sure I would advise an away in pathology if you are considering another field. I'm not so sure that would help your application.

 

[DaSein77]

The difference is that you *have* to do interviews, and you do NOT have to do an away rotation. Away rotations are for candidates who have flaws they need to overcome by impressing in person, or for candidates who come from a terrible medical school with no pathology department. If you are sporting a 250+ Step 1 and you can avoid putting your foot in your mouth in an interview, you do not NEED an away rotation. It can only hurt you. On a program's rank list, an unknown with high board scores will always beat a known dud. And an unknown with mediocre board scores will almost always beat a known dud.

Not doing electives can only hurt you during interviews. And since you have to do interviews, its bad advice to tell someone they are good one paper, so don't do an elective because it could only hurt (which isn't totally true either). If it does hurt you, its only at one or two programs. The OP will match and will get good interviews based on the stats, but little experience or talking points during interviews could be the difference in matching at his/hers top rank. In any case, most 3rd year med students have no idea what path residency entails...its the rest of your life, go make sure you can handle grossing, hours of scope time, etc.

Do an elective or two...if you are worried, don't do one at a place that you are likely to rank high. Not doing one can only hurt you during interviews.

 

[KLPM]

I wonder what a complete A-hole will look like on a pathology rotation?

"OMFG IS THAT A SPLEEN? LET'S THROW IT LIKE A FOOTBALL! CATCH!"

 

[Euchromatin]

I wonder what a complete A-hole will look like on a pathology rotation?

"OMFG IS THAT A SPLEEN? LET'S THROW IT LIKE A FOOTBALL! CATCH!"

Hehehe

I think rotating through our department helped most of the path-interested medical students who did it. I don't know how you could effectively demonstrate that you were truly interested in pathology, or even really know what training and a career in the field entailed without doing some sort of pathology rotation (whether at your home institution or away). The only cases I can think of in which a rotation hurt a medical student are those that have already been mentioned, i.e. the rotator was egregiously:

lazy - There was one rotator who regularly showed up really late, never came to any of our lectures, etc. This person actually left for the day right after lunch (on more than one occasion) even though a resident or staff had told them that they wanted to meet at such-and-such time later that afternoon to look at slides or gross an interesting specimen or whatnot. In spite of this person's top-notch step scores, they were NOT ranked to match.

stinky - please, shower/bathe regularly. Having a breath mint after your morning coffee or spicy onion lunch before you sit at the scope with someone is a nice gesture as well.

stupid - Rotator goes up to the frozen room with me and watches/helps with the frozen section evaluation (we cut our own frozens, so the entire process was seen and explained). Then we carry the specimen downstairs to the gross room and I start explaining how we're going to gross the rest of it - rotator (on their second path rotation, btw) stops me to ask "so when are we going to do the frozen section?" 😕

Seriously though, as long as you are not a total crazypants, a pathology rotation should be a piece of cake that will give you a good opportunity to get some LORs and the perspective to speak much more knowledgeably on your interviews.

 

[KluverB]

With your stats it can only hurt you, your chances are already good for matching at a good program. An away rotation will only give you a chance to mess it up or keep your chances the same.
...
The difference is that you *have* to do interviews, and you do NOT have to do an away rotation. Away rotations are for candidates who have flaws they need to overcome by impressing in person, or for candidates who come from a terrible medical school with no pathology department. If you are sporting a 250+ Step 1 and you can avoid putting your foot in your mouth in an interview, you do not NEED an away rotation. It can only hurt you. On a program's rank list, an unknown with high board scores will always beat a known dud. And an unknown with mediocre board scores will almost always beat a known dud.

^^^
QFT.

It's a double-edged sword.

This may, of course, be program dependent, but we certainly had candidates come through, who, although were hard working, did their best, and were very much liked by residents and fellows, were nevertheless only average in their abilities, and were ultimately not even ranked by the selection committee as their "in person" presence could not overcome their "low" board scores and average performance.

On the other hand, we had candidates who looked clearly great on paper, managed to not be a-holes for one day, and not only did they get ranked, but matched, only to turn out July 1st to not only to be a-holes, but incompetent a-holes to boot.

It's much easier to shine for a single day then it is everyday for several weeks!

 

[KCShaw]

Eh, if you want to play the fear game, you're welcome to do so. You can banter around all the worst case scenarios, cower about some suboptimal evaluations, and spend your time as that kid looking for ways to avoid or please while everyone else learns and grows and improves and takes your residency spot and in a few years takes your attending job. I've seen more residency applicants get dissed for a perceived lack of interest in pathology &/or lack of understanding of what they're getting into because they chose not to do a pathology rotation, than get dissed for being a little awkward. Yeah, sure, if you suck and show it to whoever you're rotating with, then your chances at that specific program are dinged. In exchange you've still gained rotational experience which will put you in better stead at the other pile of programs out there.

The question of away elective vs local elective I still think has little to no relevance as far as one sucking goes. If you suck at your local program then it's got a better chance to make it into the dean's letter or whatever your school produces. If you just suck on an elective then maybe you get a slightly less flowery recommendation letter, if any. It's just not the thing to base a decision on. Go, see, do. And hey, you might not even suck!

Drink the coffee, so to speak -- there's a chance it might be poisoned or carry some horrible disease, but there's a better chance it doesn't.

 

[2121115]

Eh, if you want to play the fear game, you're welcome to do so. You can banter around all the worst case scenarios, cower about some suboptimal evaluations, and spend your time as that kid looking for ways to avoid or please while everyone else learns and grows and improves and takes your residency spot and in a few years takes your attending job. I've seen more residency applicants get dissed for a perceived lack of interest in pathology &/or lack of understanding of what they're getting into because they chose not to do a pathology rotation, than get dissed for being a little awkward. Yeah, sure, if you suck and show it to whoever you're rotating with, then your chances at that specific program are dinged. In exchange you've still gained rotational experience which will put you in better stead at the other pile of programs out there.

The question of away elective vs local elective I still think has little to no relevance as far as one sucking goes. If you suck at your local program then it's got a better chance to make it into the dean's letter or whatever your school produces. If you just suck on an elective then maybe you get a slightly less flowery recommendation letter, if any. It's just not the thing to base a decision on. Go, see, do. And hey, you might not even suck!

Drink the coffee, so to speak -- there's a chance it might be poisoned or carry some horrible disease, but there's a better chance it doesn't.

Well, the OP stated he has some bad evals and he is worried about his clinical skills not being up to his test taking ability. I would take that as a STRONG indication to NOT do any away electives. Just go into the match with a 250 Step 1 and impress on interview day. If there is a chance you are not very impressive in person, then there is no reason to risk it. With a 250 Step 1 and a good interview day, he will stand a great chance of matching at any number of top programs. For someone at a high risk of not coming across great on a rotation (which he readily admits to) I would most definitely not risk it.

 

[DaSein77]

I just went through 13 interviews at a variety of places across the country. Aside from screening for douchiness, the overwhelming number one factor was finding out if you know what you are getting yourself into and actually want to do it. Like I said before, a 250 will land you good interviews and likely will get you one of your top ranks...but if you don't have a solid background, interview days will be a lot more stressful and likely to hurt your chances of matching at your top program/s. A lot changes on the interview trail and what you thought was your number 1 may drop quite a bit, and vice versa for some of your initial lower ranks. Come match day, there may be a big drop off between your desire to go to your number 1 and number 2. There are a lot of factors, but your interview is a big one and may make the difference. Get some experience and dont leave things to chance.

 

[thefifteenth]

To clarify....I have indeed done a pathology rotation at my own institution and loved it, however I am not interested in staying in the area.

Anyways I've decided to do 2 away electives in pathology--one surg Path and the other in autopsy pathology. I have no doubt that the surg path rotation will be a good glimpse into my future career but I am wondering if an autopsy pathology rotation is worth doing (a pathologist I spoke to cautioned against this) Thoughts?

 

[KCShaw]

I wouldn't consider 2 more "necessary" by any stretch. I think it's a matter of preference, but don't completely ignore doing other things you won't get a chance to do again..ever.

One of them being purely an autopsy rotation isn't likely to help much, unless you already have some interest in forensic pathology. There also aren't that many academic pathology departments that really do enough autopsies for a purely autopsy rotation to be busy and beneficial (averaging 1 or 2 pretty much every day, if not more). Keep in mind that most pathologists do few to zero autopsies, and are generally considered low reward for the amount of time spent. Thus, few attendings are likely to encourage you to bother with them, and are less likely to attribute much benefit to the experience. Having the 2 other pathology rotations under your belt, at least one being general surg path, is what will most tangibly "help" you. That said, a good autopsy rotation with people who are interested and knowledgeable can be great, in and of itself. And if you're talking about a forensic autopsy rotation then I would be all the more encouraging -- it still won't help much for a general residency application, but you're almost assured of seeing more cases and working with people who are interested in it and tend to focus their approach, rather than the all day hospital/academic autopsies which can become a bit tedious.