Didn’t end up getting a Sub I. Am I screwed? And is there any benefit to applying to a later in the year one?

[LondonVibes]

I didn’t get any Sub Is for IM yet. Am I screwed?

I know that doing a home sub I is universally recommended and doing an away is unnecessary unless you like a specific program most of the time, but our school has no home rotations M3 or M4, so 100% of the students who do sub is here do aways.

Also, would it be beneficial to go for a later in the year sub I? My understanding is that it might be better as it’d be less competitive compared to earlier ones I failed to get, but it would strictly be for the sake of practicing clinical skills and being able to claim I did a sub I on interviews, but not getting a letter as it’d be way too late.

A September sub I is not an option as I have school mandated Emergency Medicine, so October would be the absolute earliest I could do one.

Alternatively, our school has us do rotations through April, so I could maybe schedule one post interview season so I could say that I plan a Sub I later which is better than nothing.

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[DoReMiFaSo]

If your app is otherwise good, then no, not at all screwed.

If your app is subpar, then doing a later away subI will still be helpful. But would recommend doing it at a place where you really want to match at. SubI = an extended interview. In the world of IM, it is rare to offer a student subI and not later offer the student at least a curtesy interview.

Not all subIs are meant for getting LORs. How exactly would a late subI rotation help? Say if you were to apply to my residency and not get picked initially for interviews. Then you do a subI here in say October and perform well clinically, and one of our faculty can vouch for you (doesn't need to be a LOR. I value calls/texts from faculty). Then our residency will not only squeeze you in for a formal interview, but also there's a good chance we will end up ranking you as well.

I do not recommend subI rotations in the Spring. Second half of MS4 is purely meant for residency match, checking boxes in order to graduate, vacation, onboarding paperwork, and logistical planning for residency.

- IM APD

 

[LondonVibes]

If your app is otherwise good, then no, not at all screwed.

If your app is subpar, then doing a later away subI will still be helpful. But would recommend doing it at a place where you really want to match at. SubI = an extended interview. In the world of IM, it is rare to offer a student subI and not later offer the student at least a curtesy interview.

Not all subIs are meant for getting LORs. How exactly would a late subI rotation help? Say if you were to apply to my residency and not get picked initially for interviews. Then you do a subI here in say October and perform well clinically, and one of our faculty can vouch for you (doesn't need to be a LOR. I value calls/texts from faculty). Then our residency will not only squeeze you in for a formal interview, but also there's a good chance we will end up ranking you as well.

I do not recommend subI rotations in the Spring. Second half of MS4 is purely meant for residency match, checking boxes in order to graduate, vacation, onboarding paperwork, and logistical planning for residency.

- IM APD

So are you saying that sub-Is later in the year are more helpful for specifically programs you want to go to, as opposed to the general "all around" application boost that comes from a June July or August sub-I?

What should my answer be if I'm asked "what were your responsibilities on your last sub-I?," given that it is now a super common interview question. I've been told that, outside of increasing your rank at a specific program, that this is usually the question a sub-I helps out with.

I've been told by peers that it's slightly more excusable to be without a sub-I at a program where we don't have a home sub-I versus a student actively rejecting the opportunity to do a home sub-I.

 

[LondonVibes]

Fwiw for context, I do have a weaker app (no Steps due to a failed Step and 3 research items with 2 of those being last author), but no red flags outside of a bad eval on the 2nd rotation, pending a COMLEX Level 2 result I took this Monday.

The eternal optimist in me says that not getting the sub-Is I applied for may be a blessing in disguise since what Level 2 studying taught me is that there is/was a lot of inpatient basic care that I did not know yet.

 

[Redpancreas]

I think your application would’ve benefit from a good Sub-I evaluation/LoR. Why did you NOT get one? If you signed up late, that sucks and try to be more on top of things. If it’s luck of the draw, I would appeal this to faculty. It’s not fair to give others something that may affect your application.

I would not delay your Sub-I. Do it ASAP with everyone else. Try not to be an outlier. Your experience won’t be as good if you do in March/April.

 

[GoSpursGo]

I think your application would’ve benefit from a good Sub-I evaluation/LoR. Why did you NOT get one? If you signed up late, that sucks and try to be more on top of things. If it’s luck of the draw, I would appeal this to faculty. It’s not fair to give others something that may affect your application.

I would not delay your Sub-I. Do it ASAP with everyone else. Try not to be an outlier. Your experience won’t be as good if you do in March/April.

It doesn't sound like there was much of a choice. It sucks, but for a school that doesn't have home rotations, some students get lucky and others don't. Even at better schools, there often aren't enough spots for EVERYONE to get a sub-I in their desired specialty before 9/15.

That said, OP I would still absolutely try and get an October sub-I. Even if you don't get an LOR, it will still allow you to talk about how your sub-I went when you go on interviews in November-January.

 

[LondonVibes]

I think your application would’ve benefit from a good Sub-I evaluation/LoR. Why did you NOT get one? If you signed up late, that sucks and try to be more on top of things. If it’s luck of the draw, I would appeal this to faculty. It’s not fair to give others something that may affect your application.

I would not delay your Sub-I. Do it ASAP with everyone else. Try not to be an outlier. Your experience won’t be as good if you do in March/April.

Faculty has nothing to do with it. Nobody at my school gets a home sub-I in any specialty. The school picks our mandatory EM but from what other students say, it doesn’t check the box for a sub-I there either. We have to do 10 or 11 rotations after that and have to find them on our own.

 

[LondonVibes]

It doesn't sound like there was much of a choice. It sucks, but for a school that doesn't have home rotations, some students get lucky and others don't. Even at better schools, there often aren't enough spots for EVERYONE to get a sub-I in their desired specialty before 9/15.

That said, OP I would still absolutely try and get an October sub-I. Even if you don't get an LOR, it will still allow you to talk about how your sub-I went when you go on interviews in November-January.

Yeah I think you got it. Without home rotations it’s 10x more difficult. Even at MD schools people fail to get aways sometimes, though a home subI is sufficient in IM.

October seems full and my school has a rule that would require finding the rotation in 2 weeks. Would November be fine or is that too late?

 

[GoSpursGo]

Yeah I think you got it. Without home rotations it’s 10x more difficult. Even at MD schools people fail to get aways sometimes, though a home subI is sufficient in IM.

October seems full and my school has a rule that would require finding the rotation in 2 weeks. Would November be fine or is that too late?

November is better than nothing. You're probably going to need to do a few interviews in October pre-sub-I, but you need to focus on doing the best you can and not worrying about what you wish you could have done.

 

[voxveritatisetlucis]

Ya it’s better than nothing. I feel like if a school can’t offer an IM sub-I it should probably be shut down tbh

 

[LondonVibes]

Ya it’s better than nothing. I feel like if a school can’t offer an IM sub-I it should probably be shut down tbh

Makes sense. I feel like we rightly get credit because we have excellent 3rd year sites. But maybe our admin does not understand the importance of sub-Is. Probably because a decade ago plenty of people were getting admitted without them but it's not easy now.

 

[LondonVibes]

November is better than nothing. You're probably going to need to do a few interviews in October pre-sub-I, but you need to focus on doing the best you can and not worrying about what you wish you could have done.

Thanks for the reply. I think I have a half decent shot at November. Did not get any November electives I applied for on VSLO but I'm hoping sub-Is will be less in demand. What should be my response if they ask "how did your sub-I go?"

 

[NotAProgDirector]

A potential problem with a Nov or Dec SubI will be scheduling interviews. You will likely have interviews in Nov. Will your SubI be OK with you taking multiple days off for them? Or will that impact your evals/letters from them?

If you are going to do an Oct or Nov SubI, you might want to consider submitting only 3 LOR's to programs and then state in your PS that you're doing a SubI in Oct/Nov and will add a letter from it once complete.

 

[LondonVibes]

Ooof. That's a solid point. Now that you mention it, a lot of places I am looking at have explicit rules against interviews during the sub-I. In your experience @NotAProgDirector, do you see any benefit to applicants doing their sub-I in January as a kind of "well, they'll have a sub-I before joining us."

From what I've heard, it's better than no intent but not anywhere near having done a sub-I pre November.

I know years ago many students were admitted into residency without a sub-I, but that is trending away from being true these days.

It's tough either way but right now I'm thinking attending interviews > doing a sub-I but also doing a sub-I helps with interviews so idk.

 

[NotAProgDirector]

It's possible you could schedule all of your interviews in Dec and Jan (if you had a SubI in Nov). A SubI in Dec is likely to be cut short by the holidays. Either will certainly make scheduling interviews perhaps more complicated. Of note you'll likely be gettinv interview invites in Nov, and they can come at any time of day. If you don't book an interview quickly, you may find that there are no slots left (theoretically shouldn't happen) or that all of the slots left don't work for you. So even if you avoid interviewing during a Nov SubI, you still will need to deal with invites.

I don't think that a late SubI is going to change many program's feelings about you. But it might help you start on better footing as an intern.

 

[LondonVibes]

I am submitting an application without a sub-I next week for Internal Medicine. Lower COMLEX scores and no STEP due to a failure the first time for context.

How often does the question of what did you do on sub-Is come up?

Also, if the question is asked more generally (eg what are your experiences in IM?), would talking about experiences in IM fellowships and IM outpatient rotations be appropriate? I did 2 outpatient rotations in IM fellowships and one in IM itself once I learned my sub I apps went nowhere, and got strong evals and 2 strong LoRs as well, so I am wondering if those could mitigate the lack of a sub I, and if so, how should I maximize the mitigation?