Questions about Sub-Is

[Lys726]

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I am currently a third year DO student who will be going into Pediatrics and have a couple of questions regarding a sub-I - Some background info: I am hoping to get accepted into the allopathic residency in my area (state school, not super competitive, accepts comlex and has taken several DOs from my school in the past 4 years) due to geographic constraints. Due to the scheduling tactics of my school, the prime months I have available to complete electives are August, November and December. My stats are decent - 618 Comlex, top 10% 1st 2 year grades, so far all Pass with Honors on clinical rotations and completing MPH concurrently. I have been told that a sub-I can help as well as hurt your chances at a program - Should I do a practice sub-I at a different away institution in August and try to get a good letter from that rotation - then complete a subI at my 1st choice program in say November, during interview season? Or should I take my chances and do a subI right away in August to try and get a letter from an attending at my 1st choice? Or should I do just an audition rotation, not necessarily a sub-I instead? Sorry for the long post, Im just really conflicted as to how to schedule my fourth year and could use any helpful advice!! Thanks so much!!

 

[Bitsy3221]

I am in allopathic school, so take my advice for what it is worth, since I am not sure if the DO status throws a wrench into the machine, although I don't see why it would.

I did a couple of sub-I's (one at my home program and one away) in my fourth year, and I honestly did not see a whole lot of difference in them as compared to my third year rotation. You go in, work hard, see your patients, know everything about them and read a lot. If you honored all (or most) of your third year rotations, you should be fine doing a sub-I, so I don't think you NEED a "practice" sub-I before you go to your first choice. If you WANT to do one, well that is a different story.

Externships can be expensive--application fees, double rent/utilities, hidden costs such as gas, parking, etc. so if this is a concern for you, skip the practice sub-i.

I don't think it would matter tremendously about your timing (Aug vs. Nov), as arguements could be made either way, and you made them. A LOR would help, but is not necessarily required.

And as far as I know, an "audition elective" is just an unofficial term for any away rotation, as you are essentially auditioning for a job based on your performance over a month. You don't formally sign up for an audition elective.

As far as helping or hurting you: If someone is a great "on-paper" applicant with awesome grades, high board scores and a few publications but they come across as a jacka$$/doofus in person, they may not want to do an away rotation at a program they are interested in as it could hurt them. On the other hand, if you are a so-so or average applicant on paper but go to a program, work your tail off, be interesting and engaging, get to know some people in important places, then this may help you get an interview, if not move you up on the rank list. Be honest with yourself--you may be in a different city, know no one, not know your way around the hospital and will not know "the system" so if this is going to ruffle your feathers too much, you may want to rethink doing a sub-i at your first choice program--think instead about going to a strong, well connected "name" program that may not necessarily be your first choice. You will be able to get good letters, but if you bobble the rotation, you won't have shot your chances at your top program. IMHO, if you got all honors in your clinical rotations, you will probably continue to do well in your fourth year and a sub-i will only help you.


I don't know if this helps any, but good luck with whatever you decide.

 

[group_theory]

I don't think it would matter tremendously about your timing (Aug vs. Nov), as arguements could be made either way, and you made them. A LOR would help, but is not necessarily required.

I think November is a little on the late side. Interviews invites go out in October/November and interview season is usually November - Jan (with a few in Feb).

Now if you are doing a sub-I at a place in November, you might impress the selection committee enough to go "gosh, we overlooked this guy ... maybe we should invite him for an interview" but otherwise if you do it in August, you can impress the various attendings, get strong LORs ... and with good numbers ... will get many pediatric interviews than if you wait till November.

 

[Bitsy3221]

I did my sub-I in late Oct/early Nov, and personally I thought that was an optimal time. Although it depends on the specialty and the program, in surgery a lot of programs don't seriously start reviewing candidates until after the Dean's letter comes in on Nov 1, so it was still well within the timeframe. I was able to schedule my interview the week after my sub-I ended, thus not only saving me a plane trip but also allowed me to interview while I was still "fresh" in their mind. The caveat to this, of course, is that I never intended to get a LOR during that rotation--I agree that if that is a priority you really should do it early. In addition, if you do not think you would be very likely to get an interview based only on you application, you should do it early as group-theory said.

That is my n=1 experience with externships, and I will let you know next Thursday how successful my strategy was! 😉

 

[lovelyaries]

I am also a third year DO student who is going into pediatrics. I actually just completed a pediatrics subinternship at an allopathic instituition that I am applying to this fall. I decided to do a subinternship because I felt it would prepare me for internship year, I would have more responsibility and be able to perform at an institution that I was interested in. My school makes us do redundant rotations since it is primary focused so it just happened that this hospital takes third year medical students for sub-Is. Of course, I have thoroughly researched doing a subI vs. a consult service, but I decided that the positives outweighed the possible negatives. I am glad that I did the sub-I because I have a better understanding of what it takes to be an intern, I got to see how the program works, and I got to really interact with the attendings and residents at the level of an intern. I think that if you work hard, have worked hard, are the type of person that is easy to get along with, and show lots of enthusiasm that they will love you.

I don't know how many programs you are applying to, but I am applying to a lot of programs up and done the east coast. I foresee it being super busy during the interview process, so I would recommend doing the sub-I at program of interest if possible in August with possibility of getting a letter since applications can be submitted Sept.1st and you would be fresh in the program's mind. I have a couple people in the class ahead of me that I talk to and one is going thru the allopathic match for pediatrics and decided that she would do a consult service rather than do a sub-I. She got a LOR from a top peds program and that seems to have helped her get interviews at big programs.

I think that your COMLEX scores, top ten ranking first two years, honors and completing an MPH makes you a very good candidate for peds programs and really if you do a rotation whether it is a sub-I or one on a consult service and they see that you are hardworking and enthuasiastic I don't see why they wouldn't want to interview you. If you want to chat some more about it, email me at [email protected]

 

[NNguyenMD]

I am currently a third year DO student who will be going into Pediatrics and have a couple of questions regarding a sub-I - Some background info: I am hoping to get accepted into the allopathic residency in my area (state school, not super competitive, accepts comlex and has taken several DOs from my school in the past 4 years) due to geographic constraints. Due to the scheduling tactics of my school, the prime months I have available to complete electives are August, November and December. My stats are decent - 618 Comlex, top 10% 1st 2 year grades, so far all Pass with Honors on clinical rotations and completing MPH concurrently. I have been told that a sub-I can help as well as hurt your chances at a program - Should I do a practice sub-I at a different away institution in August and try to get a good letter from that rotation - then complete a subI at my 1st choice program in say November, during interview season? Or should I take my chances and do a subI right away in August to try and get a letter from an attending at my 1st choice? Or should I do just an audition rotation, not necessarily a sub-I instead? Sorry for the long post, Im just really conflicted as to how to schedule my fourth year and could use any helpful advice!! Thanks so much!!

A Sub-I at a pediatric program you are particularly interested in is definitely something you should do, though I also rec that you also do one at the primary clinical site of your home institution before your application goes out as well.

I think doing one in August is a good idea. I think that doing one in November is a very bad idea. Decreases the number of days you can schedule interviews, unless you don't plan on applying to more than 10 or 15 I suppose December and January will suffice. Remember most places only interview the first 2.5 weeks of December, the rest of the month is closed for interviews because of the winter break.

IMHO, I think its pretty tough to screw up a Sub-I unless you've got a really nasty attending or team of house officers who are out to get you. 95% of the time this won't be the case. I'm a below average student at my institution, I got fantastic evals from all my away Sub-I's. All I did was work really hard, and show that i wanted to be treated and worked like an intern, not a medical student. Show them that you can be independent and handle the responsibilities of an intern, push your senior residents to let you present a good case at report, read lots to show your attending how smart you are, and keep a hawk's eye on your patients. There are no exams for Sub-I's, so there is no excuse to skip out early in the day to study for shelves or whatevers.

 

[Lys726]

Thanks for all the advice and suggestions, I really appreciate all the help 😀 ...I'm still somewhat conflicted as to what to do. It is frustrating that I only really have August and November as months to do really any important audition rotations per se due to my scheduling. My 3rd year clerkship months in peds (1 outpatient, 1 inpatient) were somewhat disappointing in that I ended up working with so many attendings that none of them got to work with me long enough to write a great letter - I can get some good letters from other attendings, but I know I will need at least one from a Peds attending. So, my main goal for August is going to have to be getting a LOR - now I just have to decide whether to accomplish that by going to a big name hospital as a visiting student and doing a consult service in august, or do a Sub-I at my first choice program which is not a big name program at all...decisions, decisions, decisions 🙂

Thanks again for the tips, and good luck to everyone else who is planning their 4th year electives !