ENT with EM backup

[bambam02]

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Is it doable or would I be shooting myself in the foot for the EM community? Like everyone applying to ENT, I'm Apprehensive about not matching, and the inky realistic backup that I would be happy with is EM. I'm thinking one AI in EM, and 1 home and 2 always in ENT would be the way to go. Any thoughts?

 

[OtoHNS]

My advice would be to ask this question in the EM forum. No one here is going to know how an EM program would react to finding out that they are your backup specialty. However, if you're even a borderline competitive candidate for ENT, you should be a solidly competitive or even shoo-in candidate for EM.

As far as ENT, why do you want to do so many rotations? The general consensus here is that away rotations are more likely to torpedo your chances at that program than ensure you a spot there.

 

[Wordead]

My advice would be to ask this question in the EM forum. No one here is going to know how an EM program would react to finding out that they are your backup specialty. However, if you're even a borderline competitive candidate for ENT, you should be a solidly competitive or even shoo-in candidate for EM.

As far as ENT, why do you want to do so many rotations? The general consensus here is that away rotations are more likely to torpedo your chances at that program than ensure you a spot there.

I know this was always NeutropeniaBoy's advice before, but I think even he has been moving away from that opinion. I think the only people I met on the interview trail that didn't do an away were from powerhouse programs - Hopkins, OSU, etc. If you look at the compiled data from this year's match (granted, only about 35% of all matched responded, but thats still pretty significant):

# ENT sub-i's completed (including home) % completing # of sub-i's
0 2%
1 11%
2 35%
3 45%
4 5%
5 2%
n = 110

So 87% did at least one away and the majority of matched applicants did 2 or more. And I think 50% of those who responded matched at a place they rotated. I definitely agree that more often than not, people shoot themselves in the foot on aways...... but I dont think it's possible to get away with not doing any aways anymore.

 

[OtoHNS]

So 87% did at least one away and the majority of matched applicants did 2 or more. And I think 50% of those who responded matched at a place they rotated. I definitely agree that more often than not, people shoot themselves in the foot on aways...... but I dont think it's possible to get away with not doing any aways anymore.

Does that include rotations at their home programs? Because that would almost certainly account for the majority of those applicants. I'd be shocked if 50% of all matched applicants matched at a program where they did an away rotation.

I think the big question here is whether doing an away rotation (or multiple away rotations) increases your chance of matching vs. not matching. I'm not convinced it does. If someone is a strong enough applicant to match, he should match somewhere whether or not he does any away rotations. Does an away rotation add something to your application compared to an otherwise equal applicant who did not do an away?

However, every applicant is different and should decide based on their own individual circumstances. Just because "everyone else is doing it" is not a good reason to do anything in life.

There are useful reasons to do away rotations:
1. If you really want to match at a certain program or geographic location, it is probably worth rolling the dice to try and nail a spot there.
2. If you're a borderline applicant and want to impress in person.
3. Just to see how things are done somewhere else. Back in the day, I did 1 away rotation and knew within 48 hours that I did not want to match there. This experience was useful in evaluating programs later on the interview trail.
...etc.

All I'm trying to say is that you should have a good reason for doing an away rotation and not just do several because that's what you think you're supposed to be doing.

 

[Wordead]

Does that include rotations at their home programs? Because that would almost certainly account for the majority of those applicants. I'd be shocked if 50% of all matched applicants matched at a program where they did an away rotation.

I think the big question here is whether doing an away rotation (or multiple away rotations) increases your chance of matching vs. not matching. I'm not convinced it does. If someone is a strong enough applicant to match, he should match somewhere whether or not he does any away rotations. Does an away rotation add something to your application compared to an otherwise equal applicant who did not do an away?

However, every applicant is different and should decide based on their own individual circumstances. Just because "everyone else is doing it" is not a good reason to do anything in life.

There are useful reasons to do away rotations:
1. If you really want to match at a certain program or geographic location, it is probably worth rolling the dice to try and nail a spot there.
2. If you're a borderline applicant and want to impress in person.
3. Just to see how things are done somewhere else. Back in the day, I did 1 away rotation and knew within 48 hours that I did not want to match there. This experience was useful in evaluating programs later on the interview trail.
...etc.

All I'm trying to say is that you should have a good reason for doing an away rotation and not just do several because that's what you think you're supposed to be doing.

Yes. 19% said they matched at home, 31% at an away.

I agree with the rest of your post. I just wanted to let applicants know that perhaps the tides were changing. I think it's difficult to suss out whether you're "borderline" or not these days as well - I had an average # of interviews and matched at a good program, but I also feel like if I hadn't matched at this program I could easily have been SOAPing, or at least going to a program where I'd be less happy. Some of the unmatched people posted on the spreadsheet too with their stats - many did better than me on step, had more pubs, etc. Assuming honesty on the spreadsheet, a lot of non-borderline people didn't match.

 

[OtoHNS]

Yes. 19% said they matched at home, 31% at an away.

I agree with the rest of your post. I just wanted to let applicants know that perhaps the tides were changing. I think it's difficult to suss out whether you're "borderline" or not these days as well - I had an average # of interviews and matched at a good program, but I also feel like if I hadn't matched at this program I could easily have been SOAPing, or at least going to a program where I'd be less happy. Some of the unmatched people posted on the spreadsheet too with their stats - many did better than me on step, had more pubs, etc. Assuming honesty on the spreadsheet, a lot of non-borderline people didn't match.

Very interesting. There's still certainly the possibility that the numbers you cite are a sampling error and overrepresent the real percentage, but they could very well be true. Maybe because of good advice on sites like this one, students are better prepared for their away rotations and better understand how to make a good impression than applicants from a few years ago.

 

[neutropeniaboy]

I know this was always NeutropeniaBoy's advice before, but I think even he has been moving away from that opinion.

No.

No.

No.

The vast majority of people who rotate at an institution end up making themselves look worse.

However, I will say that if you ever felt that you could exceed the status quo, a rotation is an excellent way to do it.

Sadly, most fail at impressing.

 

[Wordead]

No.

No.

No.

The vast majority of people who rotate at an institution end up making themselves look worse.

However, I will say that if you ever felt that you could exceed the status quo, a rotation is an excellent way to do it.

Sadly, most fail at impressing.

I must have misunderstood you then.

Is your program matching people who haven't done any aways? It seems to me that even if you don't match at the place you rotate, to NOT do any aways would make you an outlier. I dont think there was a single interview where I wasn't asked "where have you rotated and what did you think"? To just say, "nowhere" seems dangerous to me and I'd like to hear you expand on your thoughts.

 

[neutropeniaboy]

About half of our residents did not rotate at our institution. Often we rank them higher than people that did rotate that we actually liked.

The caution I have always stressed is that medical students think doing a rotation somehow automatically gives them a leg up in the application. What most seem to not recognize is that they are constantly being judged while on the rotation. Most fail to recognize that it is an extensive and extended interview, and because of that - mixed in with general Millennial mentality - students just don't seem to get the fact that they're expected to work and demonstrate interest and knowledge.

Why show up and irritate the program coordinator with demands? Why show up to the OR and say "what are we doing today?" How is it that after an entire year of clerkships you don't know how to take a history and present? Why on earth would you think it would be acceptable to argue with an attending? Wait, you're on the otology service this week but you wanted to see that cool laryngectomy?

My warning has been to avoid doing rotations because most simply shoot themselves in the feet. Why do that to yourself? The biggest issue is that students think they are up to the task and will do great on a rotation, but they've never received (or taken to heart) any real criticism of performance.

Just peruse the clinical rotation threads and listen to the complaints students have about performance evaluations - it's as if students expect residents and attendings to hold their hands and deliver whatever they want on silver plates. You forget yourselves and your positions: you are here to work, learn and demonstrate understanding. That's an away rotation.

 

[Wordead]

About half of our residents did not rotate at our institution. Often we rank them higher than people that did rotate that we actually liked.

The caution I have always stressed is that medical students think doing a rotation somehow automatically gives them a leg up in the application. What most seem to not recognize is that they are constantly being judged while on the rotation. Most fail to recognize that it is an extensive and extended interview, and because of that - mixed in with general Millennial mentality - students just don't seem to get the fact that they're expected to work and demonstrate interest and knowledge.

Why show up and irritate the program coordinator with demands? Why show up to the OR and say "what are we doing today?" How is it that after an entire year of clerkships you don't know how to take a history and present? Why on earth would you think it would be acceptable to argue with an attending? Wait, you're on the otology service this week but you wanted to see that cool laryngectomy?

My warning has been to avoid doing rotations because most simply shoot themselves in the feet. Why do that to yourself? The biggest issue is that students think they are up to the task and will do great on a rotation, but they've never received (or taken to heart) any real criticism of performance.

Just peruse the clinical rotation threads and listen to the complaints students have about performance evaluations - it's as if students expect residents and attendings to hold their hands and deliver whatever they want on silver plates. You forget yourselves and your positions: you are here to work, learn and demonstrate understanding. That's an away rotation.

I, and I'm sure a lot of applicants read your primer, which was very valuable and (hopefully) avoided the mistakes of past rotators. I think everyone I rotated with treated it as you said - an extended interview. I think out of the 30+ rotators I was with, there was maybe 1 person who wasn't on top of things and it's hard to imagine people doing those things you mention (not that I don't believe it, I just cant conceptualize spending a month and a lot of money to not do your best and try and secure a spot). I matched at a place I rotated, and a lot of applicants I met did too. To be honest, I do not think I would have even gotten an interview at my program without rotating there. I'm not saying I was the greatest subI ever - i can think of a dozen embarrassing mistakes I made during my rotation. And I would say I'm fairly average in terms of being an impressive rotator and applicant. But I think the away really helped.

And if half your residents DID rotate - well, I'd call that a pretty huge proportion and strong evidence that doing an away does help, if one is able to avoid doing the bonehead things that you mentioned. Being able to do that is the limiting factor of course, like you said. But to avoid aways altogether - does that lower or increase your chances of matching overall? That's the real question in the end.

 

[neutropeniaboy]

You guys don't see things from our perspective when you rotate. Since you all think you're at the top of your games, you miss the obvious things that we see. I've stressed what these are before.

 

[Wordead]

That's not strong evidence unless you also have access to the rank list.

The students who did aways there are also presumably much more likely to rank the program highly, given that they must have had significant interest in the program in the first place to do the away.

Knowing where the rotators fall relative to the non-rotators on the rank list is the better measure of how much the away helps/hurts.

Well, that's true to an extent, but how many of those rotators would have even been offered an interview without rotating? I suppose you could say that if they weren't ranked highly then it doesn't matter, but in the end they matched at NPB's program - and to a med student, that's the only thing that matters.

 

[Arcan57]

Is it doable or would I be shooting myself in the foot for the EM community? Like everyone applying to ENT, I'm Apprehensive about not matching, and the inky realistic backup that I would be happy with is EM. I'm thinking one AI in EM, and 1 home and 2 always in ENT would be the way to go. Any thoughts?

Wandered in here based on the title. The sentiment expressed on this thread regarding aways is very different than in EM were aways are (mostly) expected. Demonstrating commitment to EM is an important factor for most programs and high Step scores may not balance a lack of documented interest. Given the tone of this thread and the difficulty of scrambling into an EM spot, it sounds like you should convert one of those aways into EM.

 

[neuronal]

I honestly have to agree with everything neutropeniaboy is saying. I did one away as a medical student, and it was tough to shine (at least in the beginning) when you aren't used to an entirely new system at your away institution.

 

[DermatoFIGHT]

Can you find out if certain programs prefer you to rotate to be ranked highly? All it takes is someone to really like you and that is it. I did my entire fourth year as aways and it was exhausting. To shine in a new place, staying in some craigslist sublet, not having the best diet or routine, being prepared for all your cases, readings, new systems, and to earn Honors at the end of it was so incredibly hard. It really takes a lot of out of you and there is no guarantee. You will be burned out.

A friend of mine in ENT did apply EM/IM combo as a backup. You have to have backups especially with each year getting more competitive. Do you have an advisor or someone in the ENT world you are tight with?

 

[Throwaway25]

Similar situation here -- Rising M3, and I've always thought I'd do EM. I've been active in student EM organizations, in contact with EM faculty, etc. Still really interested in EM. But I also really liked what I've seen of ENT, but knowing how competitive it was, I figured I wouldn't stand a chance as I generally don't test well. But since I got my Step 1 score back (~250) I find myself wondering if it's a viable option after all, but like the OP, am concerned that my chances at a great EM match would be harmed by a change in focus and split effort.

The good: Strong pre-clinical grades and a good Step 1. Positive comments from attendings on my suturing, and generally very good fine motor skills. Have home ENT program.

The bad: No research heading into M3. Mid-tier state US MD school.

What to do now? Only 2-3 weeks of open time before M3 starts.