Interesting point -
I'm not really sure of the impact of AIs - at my school a rotation in Ortho does not count as an AI, as they have few PGY-1 rotations - instead you must do a sugery AI (as most orthos must undertake this as part of their PGY-1 rotations).
In the end, I have elected to do do my AI in medicine - yeah, I know, that as a person really interested in surgery, this may seem as a hinderence, but I recon that I will have MANY opportunities to shine as a PGY-1 in general surgery while as a prelim....
In the end, we could all use a bit more of medicine (although the surgical specialties may grip about their insight).
Has this hindered my application? Perhaps. I did not do a Sub-I (as it is referred to here) and will not do so until Jan 2004, as an MS IV. My reasons for this is that I would rather have it asside from my actual internship, and will take a SICU elective thereafter.
Yes, I understand that taking the Sub-I earlier may be beneficial. But I do think that what one learns in such a rotation deteriorates dramatically.... How much do you remember from your earlier roations? Think about what you learned in you early MS III rotations - it will not be too dissimilar in your early MS IV vs. early PGY-1 rotation.
In the end, I really do think it matters to the applicant. Do you need that extra "Honors" on your transcript - it is well known that most MS IV's are automatically given this. If so - then do your Sub-I early - It can only hurt you if you screw it up. Otherwise, it can provide an excellent letter of recommendation - it is expected that you will do so, ortherwise you will be marked - can the more advanced residents argue otherwise?
In the end, I do think that it is really up to the individual - you know what you can bring to the interview "trail" as it is. Although I have yet to match - i do find that one must know their strengths and weaknesses -
For me - my weakness is in medicine - and although I would love to spend an additional month in surgery (which I love) - I would rather spend that time in a field that I could most definitely improve upon -
After all - once my MS IV year is over - I am obligated to the curriculum of my residency program director.
In short - do what you need to do.
If that be a Sub-I (AI) in your field of choice to get your letter of recommendation to bolster your application - then so be it.
But, should you choose to a Sub-I based of your own deficits - I believe you should look a bit deeper.
With kind regards,
Airborne