Is it worth it to audition for Internal Medicine?

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gluon999

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I am a rising 4th year from an avg. school with solid board scores (99) and one research pub. with some good and some great clinical evals. Should I spend a month doing an audition for IM at an away school that is lets say in the top 10? Not to sound cocky, but I figure with my stats I have a decent chance of getting into an above avg. school in cities such as NYC, Boston, Chicago, etc. I don't have any particular schools in mind, but one of the top schools in those cities would be something I pick if I decided to go ahead with the audition.

Will it really help me all that much in the big scheme of things or would I be competitive anyway? I would rather spend that one month NOT trying to impress some one if possible.

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You're going to be competitive anyway. If you have your heart set on a single location (i.e. you just HAVE to be at MGH), then you might want to consider a rotation there -- both to make an impression and more importantly, see if the program lives up to your expectations.

If you'd be happy in any of the top programs in NYC or boston or any other city, then don't bother.
 
Obviously, it really comes down to what you want and who you are. I've done a few...

  • An away rotation at a school can be a boon to your application by allowing you to say, "I know this program and have demonstrated clear interest." This works well when you know where you want to be and can perform favorably.
  • An away rotation can help by letting you get a letter of rec from a world leader, program director, or other known/impressive person.
  • An away rotation can teach you that the things you think are standard and normal are not actually so. I was amazed at seeing how great institutional variance can be.
  • An away rotation can allow you to do rotations in specific areas not offered at your home institution.
  • An away rotation can also be expensive (city housing, parking, travel and registration fees).
  • Applications can be daunting. You might require a respiratory mask fit test, or 2 PPD tests a week apart. (I've seen some interesting requirements.) All places require proof of malpractice insurance and forms from your Dean and registrar. Some even require letters of recommendation and essays.
  • They can also be more time consuming and more work than you'd have at your home institution. Getting access to new buildings and medical records are not fun, and all the work that goes into setting them up may not dispose you to looking good. ("Sorry I'm late for rounds, I was getting my photo ID.") Learning a new system is challenging. Living somewhere else will never be as comfortable.

It sounds like you're pretty apathetic about the whole thing. Arranging away rotations can be enough of a hoop-jump to dissuade folks, and if you don't see a benefit from it, there really isn't a point.

Don't do it if you don't see a benefit.
 
...and more importantly, see if the program lives up to your expectations....

I think this is key. A lot of people come back from away rotations and sub-I's with a very different perspective about the place. All the stuff they seem to miss on the tour. You find out that the lousy medical records system nearly doubles the time it might take at your home school. You find that when you order imaging you don't ever get a read without several phone calls. You find out that the program is playing fast and loose with the 80 hour work week requirement. You find that some of the residents aren't as happy as the one or two they get to talk to interviewees.
That is almost as important as making a good impression on an audition. Because if you go there for a month and find it dreadful, you save yourself a big headache later.
 
Will it really help me all that much in the big scheme of things or would I be competitive anyway? I would rather spend that one month NOT trying to impress some one if possible.

I think you have given us your answer. With a great board score (IMHO I would call a 99 more than just "solid") and presumably decent grades to go along with it, you will be in the mix for some of the top IM programs as is. If you don't want to go spend a month trying to wow some program, you don't have to.
 
Thanks all for the good advice. If I do end up pursuing IM, I don't have any specific schools in mind that I am interested in, so I can tease out the pros and cons on the interview trail. Therefore, I will hold off on the thought of away electives for now.
 
Thanks all for the good advice. If I do end up pursuing IM, I don't have any specific schools in mind that I am interested in, so I can tease out the pros and cons on the interview trail. Therefore, I will hold off on the thought of away electives for now.

Just bear in mind that programs put on their best faces for the interview -- send you on tours with the more upbeat residents, show you the nicest parts of their facility, and don't dwell on things like bad medical record systems, an inability for residents to get out of the hospital any time close to sign out, etc. So I would, at a minimum, contact alumni from your med school at the program to get the real skinny rather than rely on what you can tease out on interview day. It's easy to dress a program up nicely for a half day. You won't always see the kind of stuff that's important in that brief exposure.
 
I think you have to consider your personality as well. Be honest-- are you the sort of person who would be helped by an away? Do you work very well on teams, have a great work ethic, and get evals back raving about how fantastic it was to have you around? If so, then absolutely go for an 'audition' rotation. If not-- let your paper self do the talking.
 
Law2Doc: I agree with you, but I would only be able to look at one place for a month and that would still leave me with rest of schools where I would have to go by what I hear and see on interview day. So it would be kind of a low-yield if I am not set on a school. I will get in touch with alums from my school who are currently at residency programs in which I am vaguely interested.

BlondeDoctuer: Judging by my evals, I am pretty well liked, hardworking, and a pleasure to be around. I agree with those evaluators. :laugh: But I guess it just comes down to whether I want to spend an extra month trying to impress someone when I could just let my stats and letters do the talking. I think in the end, I will go with the latter.
 
If you know what questions to ask, and aren't too shy to ask some pointed ones, you can get a good assessment from just the interview. Things I always ask, if someone else hasn't:
-what time does the intern (or R2) arrive in the morning?
-what parts of the medical record are handwritten? (i.e. are progress notes and orders electronic?) If mostly written records, what sorts of things are you allowed to dictate instead of writing?
-who does the discharge summaries?
-do you have access to any records from home?
-where are your call rooms in relation to where you work in the hospital?
-what kind of meal allowance do you get, and what are the cafeteria hours?

You also have to pay close attention to how people interact with each other. Morning report and education days are golden for this kind of thing. Even when people are on their best behavior, some things are still obvious. And if they're not on their best behavior, even better.

So you can find out what you need to know if you pay attention.

However, from a resident's perspective, I've seen things go horribly wrong on interview day, and paint a really unflattering and inaccurate picture of the program. And on an audition rotation, you'd recognize it as an anomaly. Whereas if you only go there on interview day, your judgment will be inappropriately skewed.
 
...
-do you have access to any records from home?...

This can cut two ways. It either means you can go home earlier and finish up things from the comfort of your living room, or it means that after the 80 hour work week, the hospital really still thinks you ought to be doing things from home.
 
Well, few programs can stay under 80 hours in my field without access from home. And, while you do raise a good point about being expected to do things from home, the suckiness of the kind of work you're doing from home during junior residency is balanced out in senior residency and your chief year by the convenience of monitoring and fixing from home whatever mess your junior is making.

Plus, it's actually kind of nice to be able to sign out and go home, when you have 70 patients and it's well past signout time, and you still need to dictate stuff and finish progress notes.
 
Well, few programs can stay under 80 hours in my field without access from home. And, while you do raise a good point about being expected to do things from home, the suckiness of the kind of work you're doing from home during junior residency is balanced out in senior residency and your chief year by the convenience of monitoring and fixing from home whatever mess your junior is making.

Plus, it's actually kind of nice to be able to sign out and go home, when you have 70 patients and it's well past signout time, and you still need to dictate stuff and finish progress notes.

Yeah, well I'm noticing many residents (even less junior ones) doing a full day's work on their couple of days a month "off" thanks to home access, which is likely in violation of the 80 hour work week rules. If you work close to 80 hours average, go home, and are still expected to do another 20 online or doing dictations, that's kind of a violation you might want to watch out for. Sure it's convenient, but it's still a violation and defeats the spirit of the rule which is supposed to generate better rested and attentive residents. IMHO, the only things you ought to be expected to do after the 80 hour average limitation should be studying for boards/specialty exams and reading up on your patients. So IMHO this home access cuts both ways.

However I would agree that if you aren't expected to do anything after you sign out, but if you wake up in the middle of the night saying "F*&$, I forgot to order XYZ!", it's nice to be able to fix that mistake and go back to sleep, rather than try to get somebody on the phone to fix that for you. For those situations remote access is a plus.
 
Technically, as long as you're not physically IN the hospital, or getting pages from the hospital that you're required to return, you're not on duty.

In fact, I'm a bit surprised that no one's thought to turn education conferences into Webinars, and add them to our list of things to do from home.

We can argue all day about how it violates the "spirit" of the rules, but when it doesn't violate the letter of them, and the examples of violations in spirit provided by the ACGME don't specify it as one, you aren't going to get very far. Especially when there are plenty of programs still violating the actual letter of the rule.
 
Technically, as long as you're not physically IN the hospital, or getting pages from the hospital that you're required to return, you're not on duty.

In fact, I'm a bit surprised that no one's thought to turn education conferences into Webinars, and add them to our list of things to do from home.

We can argue all day about how it violates the "spirit" of the rules, but when it doesn't violate the letter of them, and the examples of violations in spirit provided by the ACGME don't specify it as one, you aren't going to get very far. Especially when there are plenty of programs still violating the actual letter of the rule.

Right, but I'm saying that having home access might be a hint that a program expects you to be putting in significant time on top of the 80 hour week it's allowed to keep you. Thus it might be something to be wary of and not blindly look at as a positive.
 
Well, that's actually my expectation as well. IMHO, a program where you can get all your work done within 80 hours-- even in July of your intern year--is a program where there isn't enough going on for me to learn what I need to know.

I'm OK with an overwhelming workload, because I know that at some point it will start to seem manageable. And in learning how to make it manageable, I will also become an excellent physician.

And that's my real goal. Not a cushy life as a resident.
 
Well, that's actually my expectation as well. IMHO, a program where you can get all your work done within 80 hours-- even in July of your intern year--is a program where there isn't enough going on for me to learn what I need to know.

I'm OK with an overwhelming workload, because I know that at some point it will start to seem manageable. And in learning how to make it manageable, I will also become an excellent physician.

And that's my real goal. Not a cushy life as a resident.

I guess, but that depends a lot on the specialty. If you are doing surgery and you need the hours in the OR to get better I agree with you. If you are doing medicine at a community hospital and it's a difference between spending 10 hours/day working up 55 year old men with chest pain and 15 hours a day doing the same, I'm not sure you learn any more if you are doing 70 or 80 hour weeks, plus home work. You probably could learn more at 70 if it meant you slept now and then.
 
You missed my main point, which is that you get better and faster with time. What takes 70 hours at the end of intern year can take upwards of 100 at the beginning. I want to be able to spend those 30 hours at home being inefficient, rather than at the hospital.
 
You missed my main point, which is that you get better and faster with time. What takes 70 hours at the end of intern year can take upwards of 100 at the beginning. I want to be able to spend those 30 hours at home being inefficient, rather than at the hospital.

I didn't miss your point. I just think that is but one possible outcome. The other is that the hospital has found a way to get 100 hours a week of work out of you during your training regardless of how good you get. There is always more they can ask you to do when they aren't hindered by hour limitations when they get you to do stuff at home. I see the potential for abuse here. At least something worth watching out for.
 
I'd say to still do an audition at your top choice. It lets you evaluate the program just as much as they evaluate you. I did one at a program I thought would be my top choice for sure. Turns out all the residents were miserable and the program was very malignant, i'm glad I only spent a month there instead of taking a chance of ending up there for years.
 
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