Picking a clinical rotation site

[DrOptimusPrime]

I’m in a dilemma between picking a clinical rotation site for 3rd/4th year.

I have the option to go to a site that has a bunch of residents (almost all core) including EM residents but it’s really far from any family/friends. I’m 90% sure I want to pursue EM.

second location is about 15 minutes away from family. Has only one residency program (IM). It’s close to other EM residency programs in the area that are DO friendly but I would obviously have to apply for auditions there.

My school allows us to pick our 4th year rotation sites at the same 3rd year site or any of the other core sites including the one with an EM residency.

If I go to the site with the EM residency I’ll be able to work with residents and hopefully make a good impression for residency and be prepared for audition rotations. If I choose the one closer to family I’ll definitely be less miserable but I don’t know if I’ll end up hurting myself professionally.

any advice on what I should do? I know the thread about residents vs non residents is all over SDN but this ones a little different. Any help is appreciated!
TIA.

---

Members don't see this ad.

 

[Cranjis McBasketball]

Always pick the site with more residents.

 

[calivianya]

Do you actually get to choose for real, or do you rank them in a lottery? Be prepared not to get what you want, no matter how you formulate your list, if it’s the latter. I fell down to my #10 choice if I remember my list correctly. Either way, I didn’t get any site I wanted.

Regardless, you should definitely go to the place with the residency program if you have control over it. If you impress them over the next year, it could literally get you a job later. It’s only one year of your life. Depending on how busy your site is, you may not miss seeing your friends and family much. I have barely been able to breathe during some of my rotations - wouldn’t have seen any family or friends even if they lived in the house next door, so you may have less time to socialize than you think.

 

[DrOptimusPrime]

Thank you both for your response. It is a lottery system but our school has been known to match almost students into their top 3 the last 5 years (they send out interest forms early on, before the official lottery). I tried to think through it, but also our school doesn't make us stay at the same site for year 3 and 4. I can go to the site with residencies during my 4th year and complete all my core EM, Surgery, ICU etc at another site if I wish.

Do you think 3rd year is just as important as 4th year?

 

[Angus Avagadro]

Do what is best for your career. Obviously support is nice, but should not be a deciding factor. Training with residents as a 3rd year gets you familiar how a teaching service runs, you make presentations, and get familiar with the emr. As a 4th yr, you will be looking for residencies and want to make a good impression, not learning the ropes.

 

[calivianya]

Thank you both for your response. It is a lottery system but our school has been known to match almost students into their top 3 the last 5 years (they send out interest forms early on, before the official lottery). I tried to think through it, but also our school doesn't make us stay at the same site for year 3 and 4. I can go to the site with residencies during my 4th year and complete all my core EM, Surgery, ICU etc at another site if I wish.

Do you think 3rd year is just as important as 4th year?

My school told me the same thing about matching students into their top three choices. I’d take it with a grain of salt. The other person with me at my rotation site went lower on her list than I did.

Tbh, I’d argue that 3rd year is more important to get right as far as sites go. I already have three letter writers from my 3rd year site - one has already submitted and I’m waiting on the rest. You can get letters from your fourth year rotations in theory, but if you’re waiting until fourth year, you don’t have a whole lot of time from when fourth year starts to when apps open to get those letters in. There’s always the possibility that someone backs out, you don’t get your letters on time and your application is incomplete, we get a new COVID strain and you end up unable to complete your auditions, etc. and you’re having to scramble for letters at the last minute. Getting letters from places with residencies is valuable as your writers can talk about how you work in a team with residents, so if you can get those knocked out in third year, you’re going to save some headaches.

You’ve also got to remember that only part of your fourth year matters for getting a job - your auditions, which can be anywhere. The rest of it is just busy work and finishing up requirements. I’d pick the site close to your family for the end of fourth year because real talk is you’re just going to be phoning it in by that point anyway.

And of course what @Angus Avagadro said above - you’re going to look better for fourth year if you already are familiar with working in a team. I’ve had preceptor based rotations where they made me do a full presentation and ones where they just wanted me to tell them what was important, so how prepared you are to work in a team is going to be really a dice roll if you haven’t been working with residents before. You don’t want to look bad on an audition.

 

[Ho0v-man]

A lot of schools will let you move back home to set up your fourth year however you want. So you could pick the resident site, get good letters/training, then head back to this area for 4th year and auditions at those nearby programs.

 

[genessis42]

How would you make it work if there are very few sites in teaching hospitals or with residents?

My school has a preceptor-type system and the rotations end up being a mixed bag.

 

[fldoctorgirl]

How would you make it work if there are very few sites in teaching hospitals or with residents?

My school has a preceptor-type system and the rotations end up being a mixed bag.

Make the best of it and use 4th year to make up for deficiencies. That's my plan at least. I'm at a site where I've had a few rotations with residents but a lot have been preceptor-based. I haven't felt like I've been hugely deficient thus far, but I am planning on making sure I do aways in M4.

 

[genessis42]

I think rotation quality varies a lot by school. The older ones like PCOM definitely have it better than the newer schools.

 

[Dr.Bruh]

I can tell you that if you're applying EM it doesn't matter. Go where you want to be the most. The other site having IM residents is better than nothing. I applied EM this year and only had 1 core rotation with residents (gen surg) and got 28 invites (including a few top 20 programs). Both of my step scores were below average too. It's all about the SLOE (I had an honored SLOE from my one audition). In fact, I had two community ED rotation (no residency just me and an ED doc) 3rd year and those prepped me the most for my actual EM audition. If you're going academic IM or surgical subspecialty then its probably better to go with the resident based clerkship site bc they typically require or weight other letters. But with EM the only letter that matters is the SLOE which you will get through a VSAS.

Also, someone above mentioned working with residents gets you familiar with EMR but that was 100% opposite for me. I did full notes on all my community rotations. My resident rotations (including my EM audition) were the only rotations i've ever had where I did absolutely zero charting.

 

[hallowmann]

When you say close to family, do you mean like parents or do you mean spouse and kids? If its parents, I'd choose the place with the most residencies. What if you change your mind and want to do something else? Having a residency program and people in a residency that can vouch for you in LORs will make a difference. Even if you stay doing EM, you could easily get a SLOE from the one site, then all you need to do is another 1-2 auditions and get more, which will help.

You will be spending a lot of time in the hospital in 3rd year. You won't have a ton of time to spend with family anyway. Save that for 4th year where outside of a couple of auditions, you can pretty much stay home the whole year.

If your family is your spouse and kids, stay in the one close to home for obvious reasons.

 

[DrOptimusPrime]

Thank you all for your advice. I ended up choosing the one close to family for obvious reasons and after speaking to the dean at my medical school I was told that I could go to the site with residencies for 4th year since no one can do EM until 4th year anyway. I would also be on the same page as the rest of my classmates since we will all do EM together. She also assured me that I could do multiple rotations at that site if I want to and do other EM rotations at other contracted hospitals without them being auditions or I could count them as auditions. I chose the site close to family not only because of family but also being able to do both where I have 4 rotations with residents and another 4 one on one with preceptors. Thank you all for your advice. I find out in a week where I end up.

 

[DrOptimusPrime]

Just to provide an update going to a site with less residents prepared me well for auditions and residency. I was treated as a resident by my preceptors and was able to learn more. I think this is very site dependent. The site with residents was an HCA site which most students didn’t really like so I was saved. I matched my first choice in residency and felt super great about the process. I felt super prepared for auditions.

 

[ToKingdomCome]

Honestly it doesn’t really matter as much as you think

 

[getfat]

Honestly, it doesn’t really matter as much as you think

I have to agree. I picked the site with residents on every core rotation but psych. I didn't feel like i learned a lot because the residents were so burnt out that they didn't have the energy to teach me. When I made presentations, nobody was listening. That became obvious later when I had better teachers that actually listened to my presentation.
On top of that, I worked resident hours and had much less time to study compared to my classmates. But hey at least i now know what working 24s feels like. Really helped me now that most programs are transitioning to night float.
You would be surprised how beneficial having a support system is, especially with how high-stakes exams like Step 2 are now.

 

[BlueBleck]

I have to agree. I picked the site with residents on every core rotation but psych. I didn't feel like i learned a lot because the residents were so burnt out that they didn't have the energy to teach me. When I made presentations, nobody was listening. That became obvious later when I had better teachers that actually listened to my presentation.
On top of that, I worked resident hours and had much less time to study compared to my classmates. But hey at least i now know what working 24s feels like. Really helped me now that most programs are transitioning to night float.
You would be surprised how beneficial having a support system is, especially with how high-stakes exams like Step 2 are now.

Honestly it doesn’t really matter as much as you think

+1.

You will be a better med student with residents, but imo it's a wash after PGY1. For me, the first 2 months of residency was more instructive than all med school. Including multiple spots with residents.

Also these days, if you have a pulse you can get into EM. There were hundreds of SOAP spots.

I feel like life only gets busier and busier. I'd personally choose to live with family. You never know how much time you have left with the people you love.