Just a few things that have been in other ortho posts over the years and on orthgunner about excelling on aways. And just mention something, Orthojoe has some great advice but make sure you feel out the program a little before going all in. Meaning I wouldn't intubate patients while on ortho service, also for example one program before rounds we were supposed to only look up Hb/Hct for the postoperative patients and put them on a post it on the chart...if you saw a patient without the resident it looked bad. Other program you were expected to have seen all the postoperative patients, write notes, and take down bandages so seniors could see wound during rounds. So it varies on what is expected and viewed as appropriate, makes the process fun!! Here ya go:
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Excelling on Aways
From SDN
"Memorize Koval's Handbook of Fractures, Netter's Orthopedic Anatomy, and Hoppenfeld's Physical Exam of the Spine and Ext.
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That's what I did, and it worked."-PGY2
"- Always be early for rounds, meetings, conferences with a good attitude.
- Always offer to round, get numbers, write notes
- Take the initiative. If you round with the team, grab the chart and write a note, start filling in post-op orders or procedure notes, filling out scripts.
- Don't just sit there watching your residents or asking..."how can i help". Always find a way to be busy, reading a book, doing scut, etc.
- On rounds, have all of the supplies ready for dressing changes...and if you pre-round, have the dressings off so that your resident can look at the incision and they you can put the dressing back on.
- Meet as many people as you can, even if you're an introvert, talk with as many residents and attendings that you can.
- Know your place, ask the team if there is room for you to scrub in, grab the retractor, try to fill in the space of an intern.
- Don't be a show off or put down other rotators, answer only when asked a question, and don't ask questions just to showcase that you read something.
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"- Knowing Koval, Browner, Campbell's, Miller are fine and dandy but that has no bearing on who we usually rank. We want people who we can get a long with, someone we can trust when they are our juniors on service, and who will make great ortho interns. As far as knowledge goes, you are responsible for anatomy...period. Anything else is gravy."
- don't suck up, be friendly, upbeat but not annoyingly so.
- be ready to scrub on any case where they could use the hands
- round with any team that could use the help when you have time
- don't wait to be asked to help - assume the role and get to work - paperwork, scripts, dressings changes, dictate clinic visits, etc.
- be everywhere but be invisible: don't make a point of trying to be noticed, you will be if you're there early and stay late
- no matter how much the residents cut up/rag on each other - don't get involved. you don't know these people well enough to join in (usually)
- be prepared to work 15+ hr days and 100+ hour weeks. this is your interview for 4 weeks so bust your ass
- be nice to everybody! scrub techs, nurses, cafeteria workers, etc. talking behind anybody's back and/or being unprofessional can ruin the reputation you spent weeks trying to build
- know your place. you are a student and owe paying your dues, even as a rotator. scrub and stand, be the retractor-boy, insert the foley and help the tech prep the leg/arm/pelvis, etc.
- be ready to help out in the OR in any way - learn where the supplies are in case you're not scrubbed, help move the pt from bed to table, help walk them to the recovery room, etc
-listen and learn from everybody including the intern that's only done ortho for 1-3 months more than you have. they still know more than you do and may be your chief later on if you match there
- always, always introduce yourself to the scrub tech and get your own gown and gloves after being told there is room to scrub (i always ask the residents before assuming i'm going to scrub)
- be the last one scrubbing
- help out other rotators behind the scenes if you can/need to. trying to show them up will make you look bad, but helping them out will add to your comraderie as a rotating group of students and make you all look better.
- don't ask for favors or time off
- don't show up on days off (if you get them) or stay after they tell you to go home (unless everybody else is staying to do something you could help with)
- show some interest in the city/location outside the residency. take the time to see if that's a place you want to live for 5 years (see above for when to do this)" –Ortho Resident
"Almost wholly agree, but I think a couple caveats about these two are in order:
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1) Rounding with other teams can be a negative thing in some programs. If you round with someone else, and your resident suddenly comes up with something he wants you to do, you won't be there and that potentially can be a negative thing. Alternatively, if your team is having lunch or relaxing, and you're rounding with another team, you'll look like you're sucking up. I would definitely get a feel for the program you're at before you do this, as it may not be acceptable everywhere.
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2) Don't show up on your day off, but if you know they have a busy day or are short on residents, make the offer.
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One other thing to add:
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If the residents invite you to go out for a drink or dinner with them, make absolutely sure that you go."
"I agree, very good advice above. We definitely need to get a sticky on this.
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"Only things I would reiterate/emphasize. As mentioned above, we could care less about you getting a random pimp question correct if you come off as a weirdo. We want cool people that work hard, don't complain, are enjoyable to be around with, and are trustful.
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Also, stick to the rules above the whole month. One stray action or comment even on your last day can land you on the DNR (do not rank) list."
From Orthogunner
"Since we are knee deep into away rotation season, we wanted to provide you with some pointers on Away Rotation Etiquette. There is an etiquette you need to follow when rotating at an Ortho program. You need to understand that an away rotation can make or break you. You need to fit into the program you are at. You need to kiss ass without giving people the impression that you are kissing ass. You need to understand that you are a guest at a program. You are on a month long job interview. Here are some tips:
1. When you see any Orthopaedic Attending, greet him appropriately. If you are bold,* you can introduce yourself. The point is that if you greet attendings, they will wonder who you are and will ask the residents about you. It is flattering for them to know that you want to come to their program. Know everybody's name.
2. Do not annoy anyone. This one is easier said than done. There are some residents who will dislike you after ten minutes. The point is to not give anybody a reason to think you are annoying. Do not keep saying that you want to go to this program. Do not keep asking stupid questions. Do not show off or answer questions that make your resident look bad.
3. Be everywhere at all times, but be invisible. You want to be there always, but you don't want to be around so much you get on people's nerves. You don't want people asking where you are. Just be around, be accessible. Blend in without crowding space.
4. Do not try too hard to fit in. Be yourself. The thing about away rotations in Ortho is that everybody is trying to impress and fit in. Residents don't really care what your numbers or resume looks like. Residents want to know that you are a hard worker and won't weaken the team. Residents want to know that you will be a friend of theirs if you come to the program. They want to know that they can grab a beer with you or go hang out. They want people that are going to make life as a resident easier and more fun. So if you are rotating at a program, realize this and try and figure out if the residents are the kind of people you would hang out with. If you don't like them, then they probably won't end up liking you and you will probably be unhappy at that program.
5. Do not ask for favors. Doing an away rotation sucks. You are poor. You do not know anybody. You will likely need favors such as rides to here and there, etc, etc. Do not ask to crash at their place for a few days. In general, do not ask for favors from residents. They are not your friends. Hopefully by the end of the rotation they will be, but asking for favors with get you know where. Similarly, do not ask if they want to hang out or go out. If you are liked, they will ask you.
6. Do not treat your rotation like a vacation. If you are rotating at a place near fun activities, you don't want to let everybody know that you are taking the weekend off to go skiiing. Nobody wants to hear that while they were on call their medical student was off enjoying life that they can't. Save your vacation for after you match. You don't want to be regretting that weekend skiing when you don't match."
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What Program Directors Look at
From SDN
As someone who reviews applications and participates in the ranking of applicants, I can give you my perspective. My colleagues seem to be similar as well, but everyone looks at candidates slightly differently.
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When I am reading applications to decide who to interview, this is the order of things I look at.
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1) Name, medical school, undergrad, and where you are from: Obviously things you can't change or influence, but they give an idea as to where you are from.
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2) USMLE: Anything above 230 makes this component of your application a basically a non-issue. Scores in the 220s means you should have something else that makes you stand out. 210s and below probably rules you out unless I know you or you rotated and did an awesome job. 240-260s is a bonus. Regarding when to take Step 2. If you got above 240 I don't really care if you have a Step 2 score listed or not.
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3) Letters of Recommendation: I'm looking for strong letters of recommendation from ORTHOPAEDIC SURGEONS, especially ones I may know. You want a good mix, so try to maybe get a letter from a well known surgeon or chairman, and also some really personal letters from people you worked with. A really strong letter from someone I know that states you are one of the best medical students they worked with, or that they are trying to recruit you is probably the best thing you can have in your application. Letters from general surgeons are neutral, and I would actively discourage you from getting letters from family medicine, internal medicine, psychiatry, etc.
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4) Research: You don't need a Nobel Prize. However, it is good to see that you have taken part in at least one or two research projects and that you understand the research process. Publications are not necessary. The research also does not need to be ortho specific.
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5) AOA
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6) Personal Statement: If you have something truly unique about yourself, here is your place to share it. Many times what you put in your personal statement will be who you become to the committee. You'll be the cattle rancher guy, or water skier girl, or the wrestler, or whatever. However, the personal statement is also a place to totally hose yourself. Do not put anything in there that could be construed as even remotely weird or unusual. Many otherwise good applicants have been passed over because the set off the weirdo or DB meter. If there isn't anything really unique about you, that's ok too, just go bland. Better to be neutral than negative.
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7) Activities: This gets a quick glance over. Once again anything that is unique or special is helpful. Being part of 20 B.S. med school organizations, while potentially a huge time commitment, does not really add to your application.
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8) Grades: All honor helps, but unfortunately figuring out most transcripts is more difficult than calculus. Since every school uses a different grading scheme, its very difficult to determine is pass the best, or honors, what's a 5, or A's, etc. Just don't fail stuff.
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I hope this helps. In terms of how to excel and get a spot. Study really hard your first 2 years, by getting great grades you will be inadvertently studying for the USMLE. Then do what it takes to get a good score on Step I. If you want to set yourself apart, spend a little bit of time on a research project. During years 3 and 4 get to know your orthopaedic department and really work your butt off on your rotations. I have noticed that the effort put in by the medical students seems to be going down each year. Get there early, stay late, be helpful without being annoying. Try to facilitate and make the residents lives easier rather than being another thing they have to worry about.
