Psych Externship vs. Best Friend’s Overseas Wedding...How to Handle This?

[L8rg8r]

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I’m a rising M4 at a Southern MD school applying to psychiatry. I applied to 40+ externships to try to unlock my home region (NYC), mostly targeting big academic programs as advised by my mentors. I didn’t apply to community sites or smaller teaching hospitals. Out of all that, I only received one offer via VSLO, and I haven’t had any direct communication from the program yet.

Here’s the dilemma:
My best friend (one of only three people in my life I’d consider family) is getting married overseas on a Tuesday right in the middle of this rotation. I wouldn’t normally consider skipping a rotation day, but this is a once-in-a-lifetime event for someone who’s always shown up for me (and also told me to pursue my dreams of medicine despite odds stacked against me).

The rotation will cost me ~$3,000 total to attend, and again, it’s the only one I got. I know these rotations are important, especially when you're coming from a less well-known school.

So I’m torn: Should I email the program coordinator now to see if I can either delay my start or take a few days off? Or should I wait until I arrive and try to coordinate directly with the resident/attending once I’ve built some rapport? The wedding is exactly at the halfway point of the externship, and I'd have to miss at 3-4 days total since the wedding is on Tuesday.

I want to handle this professionally without burning bridges but also don’t want to make a bad first impression. I'm doing a rotation with the psychiatry department at my school for my LOR before the externship, but we don't have a home psych residency. Any advice from people who’ve navigated similar conflicts or know how flexible psych sub-is tend to be?

 

[splik]

As a previous sub-i course director, I dealt with visiting students need to be away not infrequently. You should contact the course director (i.e. the attending of record) to ask if it is okay to take a few days off to attend a family wedding. Explain you are very much wanting to keep the sub-i if possible as they are a top choice for residency and no other dates were offered. Offer to make up the time (e.g. by doing some weekends or overnights). I would never ask a student to make up the hours (though its not a bad idea to follow a resident on call either) but I would expect them to at least offer to make up the hours (i.e. it is not professional to expect to just take off without making up the hours). Bonus if you actually do.

There may also be a maximum number of days you can be away to pass the rotation. 4 days might be pushing it. Most psychiatrists are going to be much more understanding of balancing professional and personal needs but it will be dependent on the specific attending and institutional policy.

 

[L8rg8r]

[QUOTE="splik, post: 0, member:
As a previous sub-i course director, I dealt with visiting students need to be away not infrequently. You should contact the course director (i.e. the attending of record) to ask if it is okay to take a few days off to attend a family wedding. Explain you are very much wanting to keep the sub-i if possible as they are a top choice for residency and no other dates were offered. Offer to make up the time (e.g. by doing some weekends or overnights). I would never ask a student to make up the hours (though its not a bad idea to follow a resident on call either) but I would expect them to at least offer to make up the hours (i.e. it is not professional to expect to just take off without making up the hours). Bonus if you actually do.

There may also be a maximum number of days you can be away to pass the rotation. 4 days might be pushing it. Most psychiatrists are going to be much more understanding of balancing professional and personal needs but it will be dependent on the specific attending and institutional policy.
[/QUOTE]

Thank you!

I haven’t received the attending’s contact info; only the program coordinator. Should I fill them in as well, and have them relay my message? Not sure how involved everyone is in the process.

I will definitely be asking if I can make up the missing days. Honestly I wouldn’t be opposed to making up a full week in return, that’s how important this wedding is to me.

 

[clozareal]

As someone who missed an important wedding because of an away rotation sub-i, I was more anxious than the program cared about. It would have been totally fine to miss a few days, although I only say that now after I matched into that program I did a sub-i at.

 

[comp1]

I can tell you that med students almost uniformly overestimate their importance to a rotation, do with that what you will.

 

[TexasPhysician]

I’d explain the situation in advance and offer to work every weekend in exchange for 4-5 days off in a row. Overseas to me means 2 days round-trip of just traveling. I wouldn’t want to risk missing the wedding over flight issues despite all this effort. That means 4, maybe 5 days off.

I’d word it in a way that I truly hoped to add consults, inpatient, or whatever else on the weekends to make an impact on more faculty/resudents. I would express how much I want to attend this program for residency. Mandatory or not as a make-up, where am I allowed to participate on weekends? If I can’t be there on weekends, can I help someone else gather research for a paper or what can I do?

The answer may very well be “no” to the trip or you fail the rotation due to school policies. Then it’s the trip or the rotation.

Not having a home psych residency is certainly not ideal.

 

[Merovinge]

As someone who had a destination wedding that most of my closest friends attended, but a few missed, that's the deal with a destination wedding. It would be absurd to hold that over someone. Also getting married on a Tuesday of all days overseas is a huge demand on your guests.

I cannot imagine someone who is family level close to you not understanding that you have a critical rotation to be putting your best foot forward with. Maybe I'm getting ancient here but medicine is a demanding field and you need a very large hurdle to clear for an appreciable reason not to show up (like immediate family gravely ill).

 

[Sushirolls]

If you aren't in the bride/groom party, than it isn't truly that important you are there. Emphasize the rotation.

If you are in the wedding party, and they are that important to you, then you place it priority.

 

[Stagg737]

Will say that if this occurred where I'm at it probably would not be a big deal as a negative or a red flag or anything like that, but would almost certainly affect how well we could gauge a candidate. The biggest problem is that it cuts down on our already limited time to evaluate you. Rotations are typically going to be 4 weeks long, so if you're missing even just 3-4 days of that it only leaves around 15 days to show what you're capable of, probably even less considering the first couple days are often spent just getting oriented to the rotation and expectations. That's not a lot of time, especially if you're hoping for the attending or residents to put in a good word for you with the PD/committee.

As an attending, I would question why someone had to miss essentially a quarter of the rotation, but wouldn't hold it against them. However, if you're working with residents they may not love the idea that a sub-I missed a bunch of an audition rotation to attend a friends international wedding. They may be understanding, but some may look at it and think, "If they're missing their audition rotation, how much of a team player are they going to be as a co-resident?" It may be nbd, but it could also upset people especially if it's a work-horse type program already.

I can tell you that med students almost uniformly overestimate their importance to a rotation, do with that what you will.

While this is certainly true, we have had several sub-I's come through our service who moved significantly up the rank list after our input and 1 or 2 who got black balled and didn't even get an interview after rotating here (one was outstanding on paper). I can say with a lot of confidence that the biggest reason I matched where I did was because of a very strong audition rotation where the attending and multiple residents spoke highly of me to the PD.

Again, may be nbd and turn out fine, but if this is a top program for OP and their ONLY audition in the reason then I completely understand their concerns.

 

[calvnandhobbs68]

As an attending, I would question why someone had to miss essentially a quarter of the rotation, but wouldn't hold it against them. However, if you're working with residents they may not love the idea that a sub-I missed a bunch of an audition rotation to attend a friends international wedding. They may be understanding, but some may look at it and think, "If they're missing their audition rotation, how much of a team player are they going to be as a co-resident?" It may be nbd, but it could also upset people especially if it's a work-horse type program already.

Yeah I'd agree with this. And also yes, really the only reasonable thing would be to offer to work at LEAST the number of weekend days you're requesting off for the wedding. You're certainly not essential to the team/rotation but remember this is supposed to be your sub-internship rotation that you want a good LOR from, even more so if you don't have a home residency program. Just to be completely blunt, interns generally don't get to take 3-4 days off randomly in the middle of required rotations for friends weddings.