Is one away enough?

[nm825]

Pretty average applicant with Step 1 of 234/Top 40 school by NIH funding. My advisor insists one away is enough, but I just want to confirm this.

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[doggydog]

Pretty average applicant with Step 1 of 234/Top 40 school by NIH funding. My advisor insists one away is enough, but I just want to confirm this.

Yes as long as you do well on your home and away.

If you do poorly on one then it's not enough.

 

[alpinism]

Don't take any chances.

Unless you have some compelling reason otherwise try to do at least 2 aways at programs where you would like to train.

 

[doggydog]

Yeah, then go on 25 interviews at places you would like to train to not take any chances.

 

[HLxDrummer]

I had a lower board score and did one away. Didn't match at the top of my list, but matched. Seems most people have been doing two aways. Just be real with yourself - are you going to be exhausted and not performing your best after working your ass off for your home then first away? Part of the reason I only did one was personal reasons, another was I didn't want to risk looking bad because I had just been trying to impress people for three months solid. Just some food for thought.

 

[Perfect Hair Day]

A friend of mine only did one away rotation, matched this season. Board scores were above average but I don't think they were "elite".
I'm only doing one away rotation - strengthen your application in every other measure that you can and you'll probably be okay with one away rotation.

 

[gamerEMdoc]

I think I away is fine, assuming your app has no major weaknesses, you actually have a home program (many do students do not), and you are pretty confident you’ll get half decent sloes on your two rotations. There are very few programs that expect more than two Sloes, but if you get a bad one, its nice to have a 3rd one if it’s good.

 

[bengaltiger211]

Heard from my program that this was a hot topic among the APDs/PDs. From their perspective, seems like the answer is very clear: do one away, unless you do not have a home EM program.

I did one away with a home EM residency program and it wasn't an issue whatsoever in getting interviews or during interviews. Especially if you got honors, extra aways only add risk.

I know people who have wanted to get a sense of practice environments or regions (urban, county, rural etc) - but definitely don't feel like it's a requirement. Seems to just be adding to the frenzy/stress/cost of applying to EM.

 

[gamerEMdoc]

I disagree with this advice wholeheartedly. DO NOT do more than 1 away if you are average or above average on paper already. Just focus on killing that one away if you already have a home elective. I'm on the residency recruitment committee on my program and so many people end up shooting themselves in the foot with a less than stellar second away SLOE when their app would have been fine without that extra rotation. I mean, it ended up helping us, since it allowed us to realize red flags that weren't otherwise present in their application. But from an applicant's point of view, it's stupid to do more rotations than necessary since you risk exposing your weaknesses more.

Not sure this is completely true. If you do great at your first away, obviously a second away can only hurt you, so that's true. But that's making the assumption that both your home and your first away were both good and you got good sloes. If you didn't, then the second away would be helpful in that scenario. So for every person that does a second away and gets a bad sloe that sinks them, there's someone with a bad sloe on their first away that does a second away that helps. I bet its a wash in terms of whether they help or hurt. Its all an individual situation. I'm of the belief that a second away is just unnecessary, and probably helps some people and probably hurts some people, but for the most part, its unnecessary assuming you have a home program.

 

[Trail Blazer]

I disagree with this advice wholeheartedly. DO NOT do more than 1 away if you are average or above average on paper already. Just focus on killing that one away if you already have a home elective. I'm on the residency recruitment committee on my program and so many people end up shooting themselves in the foot with a less than stellar second away SLOE when their app would have been fine without that extra rotation. I mean, it ended up helping us, since it allowed us to realize red flags that weren't otherwise present in their application. But from an applicant's point of view, it's stupid to do more rotations than necessary since you risk exposing your weaknesses more.

I think that the number of aways someone should do is entirely dependent on what that applicant wants to do. I think we all agree that at least one away is required. But even for those applicants that are above average on paper, multiple aways can be helpful. Most folks are going to get decent SLOEs as long as they show up on time, are receptive to feedback, and continue to learn throughout their rotation. Those that receive poor SLOEs typically did something on their rotation to deserve them like saying something inappropriate, showing up late, being disinterested, or demonstrating poor progression of learning.

One thing we don't talk about enough are the benefits of multiple aways. Many students are only exposed to one type of hospital during medical school, be it academic, community, or county. Each of these types of programs differ greatly in how lectures are given, the types of patients you see, and the resources at hand. It is also extremely hard to get the flavor of an ER on an interview day. You don't get to see how support staff interact with the residents, what type of scut work occurs, how consultants treat consults, and what type of patient population you can see. The interview day also doesn't let you know what type of on shift pace and learning environment you prefer, how much autonomy is afforded to the residents, and how much cleanup there is after a shift. Rotating multiple places can give you all of this and more. Speaking from experience, I did 3 aways plus my home institution (2 academic, 1 county, 1 community). Prior to going on my last away, I thought it was going to be my number 1 on my ROL given it was back home, a very well respected program, and a fit for my SO. Thank god I rotated there because I did not enjoy my time in the department, but loved the residents and the staff. I doubt I'd have known this if I hadn't rotated there.

For most applicants there is not a one right answer. Yes you can match with a home rotation and an away. You can also match with a home rotation and 3 aways. If your evals on your 3rd year rotations are generally good and don't say that you are a creeper, your SLOEs should also be fine. It is true a bad SLOE can torpedo your applications, but if you have an outlier SLOE with 2 decent ones, most residency committees will ask you about the SLOE and realize that it was more of a fit issue.

 

[Bea5T]

What do you guys recommend for a DO student applying acgme with a home em rotation at a DO residency?

 

[gamerEMdoc]

I would probably do two aways. Many DO candidates do more, and schedule 4-5 EM rotations, but I honestly think that's too many. As long as they are all at sites with an EM residency, I think 3 EM rotations is enough.

 

[Perfect Hair Day]

I would probably do two aways. Many DO candidates do more, and schedule 4-5 EM rotations, but I honestly think that's too many. As long as they are all at sites with an EM residency, I think 3 EM rotations is enough.

Would you be satisfied with say, a middle 1/3 and a top 1/3, or two middle 1/3, from someone who did two rotations? Someone has to be average in this process.

 

[gamerEMdoc]

Sure. I see that all the time. And it depends on where the SLOEs are from. A "middle 1/3" from USC is not the same as a middle 1/3 from a small community program. You have to take in to consideration the level of candidates the individual programs are getting to factor in the talent level of the student.

 

[Jlaw]

What do you guys recommend for a DO student applying acgme with a home em rotation at a DO residency?

absolutely do more. As an average DO applicant I did 4 aways, it was a bit much, I was crispy by the time I finished the last one. I think 3 is probably a good number. Keep in mind that most rotations = interview so if you do 4 aways thats 4 interviews right away. This is good and bad, my program vets our rotators thoroughly so if you are not on your A game for the month or piss someone off you aren't going to match with us. Conversely if you do well as a rotator you are going to be ranked to match.

 

[gamerEMdoc]

Most programs wait until after the match to start looking at scheduling students for the upcoming year.

 

[chillaxbro]

1 is technically enough but most people do 1 home and 2 aways

 

[BigGAC1]

I would probably do two aways. Many DO candidates do more, and schedule 4-5 EM rotations, but I honestly think that's too many. As long as they are all at sites with an EM residency, I think 3 EM rotations is enough.

I'm curious why you think its too many? I understand some people say that they get burned out, but I did 5 and have no ragerts. Sure I was tired, but I felt that my skills improved significantly with each successive rotation and (as far as I can guess) my 2 latter SLOEs were the most beneficial to my application. Sure you can only submit 4 SLOEs, but a courtesy interview is still an interview for a DO struggling to garner invites. Honestly, if there were more time between the start of 4th yr and interview season I would have done even more aways... Why is this line on thinking wrong from an APD perspective?

 

[gamerEMdoc]

Its because you are looking at it from an individual perspective of one student and Im looking at it from a more global perspective of all students who want to do EM. There arent enough EM rotations at residency sites to go around it seems. Many students struggle to get 2-3 EM rotations. If someone is doing 5-6 rotations, they are taking up more than they need and blocking out someone else.

Dont get me wrong, Im not saying dont do more than 3. If a student thinks they need more to secure more interviews thats their right. I just dont think its necessary.

 

[almirbhflfc]

Pretty average applicant with Step 1 of 234/Top 40 school by NIH funding. My advisor insists one away is enough, but I just want to confirm this.

Well, I only did one audition, 22x Step1/23x step 2, comlex1: 52x Comlex2: 59x. I am a Canadian DO student, only got 1 EM interview, matched into it since I crushed the interview/audition with those score you can get more interviews easily. Just shine on your one audition, and you will set yourself up well.

 

[Pam_Beesley]

Heard from my program that this was a hot topic among the APDs/PDs. From their perspective, seems like the answer is very clear: do one away, unless you do not have a home EM program.

I did one away with a home EM residency program and it wasn't an issue whatsoever in getting interviews or during interviews. Especially if you got honors, extra aways only add risk.

I know people who have wanted to get a sense of practice environments or regions (urban, county, rural etc) - but definitely don't feel like it's a requirement. Seems to just be adding to the frenzy/stress/cost of applying to EM.

So if my school doesn’t have a residency program, they obviously cannot write a real SLOE. They apparently do some Committee letter that counts for just a general rec letter. If my step 1 is greater than 240 and I’m doing well in third year, can I get by with one away plus my home program or do I really need the two SLOEs?

 

[doctoroxygen]

So if my school doesn’t have a residency program, they obviously cannot write a real SLOE. They apparently do some Committee letter that counts for just a general rec letter. If my step 1 is greater than 240 and I’m doing well in third year, can I get by with one away plus my home program or do I really need the two SLOEs?

You absolutely need two SLOEs.


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[gamerEMdoc]

So if my school doesn’t have a residency program, they obviously cannot write a real SLOE. They apparently do some Committee letter that counts for just a general rec letter. If my step 1 is greater than 240 and I’m doing well in third year, can I get by with one away plus my home program or do I really need the two SLOEs?

No you really need 2 SLOEs. Are you required to rotate at your school for EM in the forth year? If they dont have a program, makes more sense to just do a few aways than waste one of your months doing something that wont net a sloe.

 

[Pam_Beesley]

No you really need 2 SLOEs. Are you required to rotate at your school for EM in the forth year? If they dont have a program, makes more sense to just do a few aways than waste one of your months doing something that wont net a sloe.

Yeah I am required to rotate. It’s kind of dumb, but I guess they’ll help make sure I’m ready to do well on my aways. I was planning on two aways anyways. I already have one and have a ton of vsas out for a second one. They were telling us though that we didn’t have to do two aways at an EM advising meeting, and that just seemed plain weird to me.

 

[gamerEMdoc]

Yeah I am required to rotate. It’s kind of dumb, but I guess they’ll help make sure I’m ready to do well on my aways. I was planning on two aways anyways. I already have one and have a ton of vsas out for a second one. They were telling us though that we didn’t have to do two aways at an EM advising meeting, and that just seemed plain weird to me.

Depending on the school the quality of "EM advising" leaves much to be desired. If there is a residency program, the advising is typically ok. If there isn't, the advising usually isn't. Telling students what a residency is looking for when you don't work for a residency is like advising someone on relationships when you've been divorced 4 times. Choose your advisers carefully!