Tips for Away Electives: Making an Impression

[helpfulstranger]

Hello all,

I just want to get some feedback from residents and ophthalmologists on what makes medical students stand out in a positive way during their ophthalmology electives. What gives the student that extra edge? I know this topic has been discussed extensively, but I always find it piecemeal, scattered tangentially in other threads. I was hoping to consolidate advice in one place.

The following is a great example of what I mean:

www.medaholic.com/how-to-excel-and-be-a-superstar-during-your-clerkship-electives/

I am hoping here to get some ophthalmology specific advice.

Thanks and all the best,

HS

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[billambeer]

The first question you need to ask is if you believe one is even necessary:

I would say lean toward the do not do it position. However, there are many people, who are right that you may get an interview at a place that would otherwise pass over your app. Sometimes the timing is wrong and you can't show off your skills to the right people or they don't like your variety of skills, or maybe you showed your skills once and by the time you get familiar with the place, you're tired of performing or you feel too safe… this is high risk, high reward. I am from a high power institution and we had a ton of away students; they generally did not show their best side and I feel the expenses they made to come to my school was wasted.

Furthermore, I personally did not do an away, nor did anyone in my or the previous class; and we all got our top 3 choices. The same is true for a majority of people I interviewed with.

Then again if you really want to get a top position at a specific school, I'd say you might be happy you did it. Some people do this so that they can get letters, research projects, etc from noted professors because their home institution isn't a good optho school.

 

[taco bell]

Honestly, I prefer doing away rotations at programs that screen externship applicants before you apply at the program especialy when a faculty member/clerkship director reviews your CV, Step scores, etc -- at least that way you know that you have passed their requirements for rotating and will most likely get an interview (assuming you dont make a fool out of your self during the rotation)..

 

[kwel]

The first question you need to ask is if you believe one is even necessary:

I would say lean toward the do not do it position. However, there are many people, who are right that you may get an interview at a place that would otherwise pass over your app. Sometimes the timing is wrong and you can't show off your skills to the right people or they don't like your variety of skills, or maybe you showed your skills once and by the time you get familiar with the place, you're tired of performing or you feel too safe… this is high risk, high reward. I am from a high power institution and we had a ton of away students; they generally did not show their best side and I feel the expenses they made to come to my school was wasted.

Furthermore, I personally did not do an away, nor did anyone in my or the previous class; and we all got our top 3 choices. The same is true for a majority of people I interviewed with.

Then again if you really want to get a top position at a specific school, I'd say you might be happy you did it. Some people do this so that they can get letters, research projects, etc from noted professors because their home institution isn't a good optho school.

So if you come from a school with a strong ophtho program it might be better/safer to just do your electives at home rather than away (even if aiming for another "top" institution for residency)?

 

[DrZeke]

I did aways in different regions to show my interest. I found them to be helpful for a few reasons:

1) I got to see how different programs work compared to my home program. This helped me have a sense of what I want out of a program and how things can be done.
2) I got to be involved in patient care a bit more - at my home program things are really really busy and students observe a lot more then actually work up patients.
3) I made some good connections.

I think if you're a tool then don't do an away. If you're terrified you're going to annoy people, then don't do an away. But, in general, most people I know that did aways from my school had a great time and got interviews at their aways. Just aim for places where you are competitive...and where you have genuine interest.

 

[Hemichordate]

What if you just want to do multiple rotations to get more ophtho experience? In that case, would doing an away by necessity be a bad idea?

 

[billambeer]

So if you come from a school with a strong ophtho program it might be better/safer to just do your electives at home rather than away (even if aiming for another "top" institution for residency)?

That's what I was suggesting. Most of the away students I worked with were from places like Arizona where some of their faculty are private attendings who have no real interest in academics/name dropping. They would come to my school (a top 20 ophtho school) to meet bigger names and set up projects with them.

The only issue was that some of them were kind of boring and really didn't understand that they were being interviewed every second of their stay. Then when one of them gave a talk (that was actually quite impressive), one of my attendings tore into one of his images and it made him look unprepared.

For some people these circumstances are disadvantageous (is that a word?) because they will look better on an application and in a short interview than over an extended period where these little things can eat away at a person's image.

But, as I suggested above, if you have a lot of personal confidence and you really want to get into a specific school (like a top 10), I would say go for it because the probability of matching there is slim anyway. Might as well risk it, right?

 

[wakeringer]

I think I may actually provide a bit of a different perspective here. I am a MS4 who matched into Ophtho this year. While doing an away at a top tier institution (many people's motive for asking for advice here on SDN) may help you get an interview, big wig letter, research project, eventually accepted, etc.; some of the disadvantages have also been outlined above.

I did an away rotation at a mid to lower tier institution where they do not have many requests for away rotations. I ended up being the only student on the rotation and had a very intensive month where I worked closely with the Chair, PD and residents. I was very enthusiastic and generally impressed people on the rotation (at least that what the PD/residents/etc told me). If you are charismatic, an away rotation can be very valuable. The rotation also provided me with an additional LOR from a region I was interested in and a case report publication with one of the senior residents. This undoubtedly scored me more interviews in the region. I was even able to call/email other local programs and express to them my interest in the city/region and cite my experience and LOR from the away rotation. This got me at least 2-3 additional interviews. Overall, I had a fantastic experience and would have been extremely happy matching into that program.

I have a hard time wording this without sounding too conceded but basically the away rotation for me provided a "back-up" on my rank list. From my experience there I was pretty sure they ranked me highly and I was able to put a few of my dream schools higher on the rank list.

In summary, as an average to slightly above-average applicant it may be better to do ("risk") an away rotation at a lower tier institution and attempt to be ranked highly by them (or in an area with other programs that may recognize your geographical wants) rather than a top 10 institution that you may have little chance at in the first place. In hindsight, the away rotation was the best thing I did to strengthen my app and affirm my choice of ophtho even though I didn't match there.

Hope this helps! Good luck.

 

[ophthope]

In summary, as an average to slightly above-average applicant it may be better to do ("risk") an away rotation at a lower tier institution and attempt to be ranked highly by them (or in an area with other programs that may recognize your geographical wants) rather than a top 10 institution that you may have little chance at in the first place. In hindsight, the away rotation was the best thing I did to strengthen my app and affirm my choice of ophtho even though I didn't match there.

Wakeringer's experience was exactly what I saw this year - away rotations at mid/lower tier institutions can put you head and shoulders above other applicants on that institution's rank list if you are a little bit charismatic and really work hard. I knew of folks who did an away like this, ended up loving the program more than some "top tier" programs, ranked it really highly and matched there happily.

Conversely, an away rotation at a top-tier program probably isn't going to be very beneficial to you. I doubt anybody at Bascom even realizes you are there. But that mid tier midwest program? They're really glad to have you, you're really glad to be there, and often it turns out to be a great experience.

 

[DrZeke]

On the other hand, I know people who did away rotations at Bascom and who got invited to interview. It's not everyone that manages this, but it is typically people who are competitive for the position to begin with...numbers-wise, research-wise, personality-wise... I think it can be helpful, because there are so many applications to go through and sometimes you just get overlooked. We've all been on here looking at some of the stats on people and thought "gee, why didn't XYZ school interview them, they seem to be the type they are looking for..."

I had a similar experience with my aways as described by Wakeringer...I opted not to go on aways at top 10 institutions knowing that I was not initially competitive for them. I think what helps is having a strategy and working with someone/multiple people who are part of the admissions process. I had a friend who did 2/3 aways with low (sub 220) board scores and barely any research at top 10 programs and she did not get invited to interview. So...I think if you're super competitive go to those programs it can help, if not then don't go. There is a good chance you will get those interviews anyways if you look amazing on paper. If there is a program, you are dying to get an invite at and can't stand not to get or something like that (regional necessity, family...) then why not go?

I think there are a few people who still make bad impressions on aways and don't get invited for an interview, but what I noticed on the trail is that these cases seemed few and far between. Most people I know got invited and were well-received.

Basically, aways are not everything. If you're in a competitive range for matching to the specialty - read the article that they published about who matched in 2012 - you have a good chance of matching. If you have to sit here all stressed out and deep down don't really want to do any aways, then don't do one.

 

[hurdlepup]

I think I may actually provide a bit of a different perspective here. I am a MS4 who matched into Ophtho this year. While doing an away at a top tier institution (many people's motive for asking for advice here on SDN) may help you get an interview, big wig letter, research project, eventually accepted, etc.; some of the disadvantages have also been outlined above.

I did an away rotation at a mid to lower tier institution where they do not have many requests for away rotations. I ended up being the only student on the rotation and had a very intensive month where I worked closely with the Chair, PD and residents. I was very enthusiastic and generally impressed people on the rotation (at least that what the PD/residents/etc told me). If you are charismatic, an away rotation can be very valuable. The rotation also provided me with an additional LOR from a region I was interested in and a case report publication with one of the senior residents. This undoubtedly scored me more interviews in the region. I was even able to call/email other local programs and express to them my interest in the city/region and cite my experience and LOR from the away rotation. This got me at least 2-3 additional interviews. Overall, I had a fantastic experience and would have been extremely happy matching into that program.

I have a hard time wording this without sounding too conceded but basically the away rotation for me provided a "back-up" on my rank list. From my experience there I was pretty sure they ranked me highly and I was able to put a few of my dream schools higher on the rank list.

In summary, as an average to slightly above-average applicant it may be better to do ("risk") an away rotation at a lower tier institution and attempt to be ranked highly by them (or in an area with other programs that may recognize your geographical wants) rather than a top 10 institution that you may have little chance at in the first place. In hindsight, the away rotation was the best thing I did to strengthen my app and affirm my choice of ophtho even though I didn't match there.

Hope this helps! Good luck.

wakeringer, If you hadn't written this I would have thought I got on here in my sleep and wrote this. I agree for the most part.

 

[billambeer]

I think I may actually provide a bit of a different perspective here. I am a MS4 who matched into Ophtho this year. While doing an away at a top tier institution (many people's motive for asking for advice here on SDN) may help you get an interview, big wig letter, research project, eventually accepted, etc.; some of the disadvantages have also been outlined above.

I did an away rotation at a mid to lower tier institution where they do not have many requests for away rotations. I ended up being the only student on the rotation and had a very intensive month where I worked closely with the Chair, PD and residents. I was very enthusiastic and generally impressed people on the rotation (at least that what the PD/residents/etc told me). If you are charismatic, an away rotation can be very valuable. The rotation also provided me with an additional LOR from a region I was interested in and a case report publication with one of the senior residents. This undoubtedly scored me more interviews in the region. I was even able to call/email other local programs and express to them my interest in the city/region and cite my experience and LOR from the away rotation. This got me at least 2-3 additional interviews. Overall, I had a fantastic experience and would have been extremely happy matching into that program.

I have a hard time wording this without sounding too conceded but basically the away rotation for me provided a "back-up" on my rank list. From my experience there I was pretty sure they ranked me highly and I was able to put a few of my dream schools higher on the rank list.

In summary, as an average to slightly above-average applicant it may be better to do ("risk") an away rotation at a lower tier institution and attempt to be ranked highly by them (or in an area with other programs that may recognize your geographical wants) rather than a top 10 institution that you may have little chance at in the first place. In hindsight, the away rotation was the best thing I did to strengthen my app and affirm my choice of ophtho even though I didn't match there.

Hope this helps! Good luck.

That's an interesting perspective I had never thought of. I'll pass that idea along to my underclassmen.

 

[kwel]

One resident told me aways really aren't worth it in ophtho because it's extremely hard to contribute a lot due to the nature of the field. You rarely ever help in surgery, and in clinic it's hard to be useful unless you've mastered the slit lamp exam--and we know MS4 skills pale in comparison to resident skills. It becomes more of a shadowing experience that can be useful for seeing the mechanics of the program, but otherwise it's nearly impossible to impress anyone because you're such a beginner at everything. Thoughts?

As I think about this it actually makes sense. My school has a reasonably good ophtho program (would probably be in the top 20) so I get a good experience here and don't think I'd benefit like those at institutions with lower-tiered ophtho programs might.

 

[airplanes]

One resident told me aways really aren't worth it in ophtho because it's extremely hard to contribute a lot due to the nature of the field. You rarely ever help in surgery, and in clinic it's hard to be useful unless you've mastered the slit lamp exam--and we know MS4 skills pale in comparison to resident skills. It becomes more of a shadowing experience that can be useful for seeing the mechanics of the program, but otherwise it's nearly impossible to impress anyone because you're such a beginner at everything. Thoughts?

As I think about this it actually makes sense. My school has a reasonably good ophtho program (would probably be in the top 20) so I get a good experience here and don't think I'd benefit like those at institutions with lower-tiered ophtho programs might.

I did my home rotation (a top 15ish) and learned a ton. I was able to take that experience to my away at a top 10 (a busy program with a ton of volume). They gave me my own lane and lenses and I teched and worked up my own patients. I went through as many as I could, basically functioning at the same level as the new R2s, who were in their second month of residency.

Having a great month at my home program really set me up to excel in that kind of environment. The opportunity for autonomy was there and I took it. I was one of only a few away students to be invited back for an interview, and believe me, it wasn't my average-ish stats.

Aways are high-risk, high-reward. For me, it was my dream program and there was no chance in **** I would have gotten an interview there based on my application alone.

Another thing is, look at your feedback. Do you generally get along with residents/attendings and is that reflected in your evals? That's important. I definitely know some characters in my class who look great on paper but were denied interviews at all their aways. Something to think about.

 

[hurdlepup]

One resident told me aways really aren't worth it in ophtho because it's extremely hard to contribute a lot due to the nature of the field. You rarely ever help in surgery, and in clinic it's hard to be useful unless you've mastered the slit lamp exam--and we know MS4 skills pale in comparison to resident skills. It becomes more of a shadowing experience that can be useful for seeing the mechanics of the program, but otherwise it's nearly impossible to impress anyone because you're such a beginner at everything. Thoughts?

As I think about this it actually makes sense. My school has a reasonably good ophtho program (would probably be in the top 20) so I get a good experience here and don't think I'd benefit like those at institutions with lower-tiered ophtho programs might.

I have a different perspective on this than you. Those "lower-tier" programs may actually give you a good chance to get resident-level training as a med student, because you aren't last in line behind a million fellows and all the residents. My home institution doesn't have a residency, so I had 6 weeks of one on one with the attendings before I did two aways. Consequently, I'm pretty good with most parts of the ophthalmic exam and got to do some lid stuff and split an enucleation with my colleague. Never really did any gonioscopy though. On my second away I got my own lane and split the patients with the first year, and I checked each patient out with the attending. Definitely not shadowing.

 

[kwel]

I did my home rotation (a top 15ish) and learned a ton. I was able to take that experience to my away at a top 10 (a busy program with a ton of volume). They gave me my own lane and lenses and I teched and worked up my own patients. I went through as many as I could, basically functioning at the same level as the new R2s, who were in their second month of residency.

Having a great month at my home program really set me up to excel in that kind of environment. The opportunity for autonomy was there and I took it. I was one of only a few away students to be invited back for an interview, and believe me, it wasn't my average-ish stats.

Aways are high-risk, high-reward. For me, it was my dream program and there was no chance in **** I would have gotten an interview there based on my application alone.

Another thing is, look at your feedback. Do you generally get along with residents/attendings and is that reflected in your evals? That's important. I definitely know some characters in my class who look great on paper but were denied interviews at all their aways. Something to think about.

I look a lot better on paper than I would on a rotation, so it seems like it could only work against me. Does having done an away give you any additional benefit after you've gotten an interview (I know it def can help in GETTING the interview)? FAculty at my school told me I could probably get interviews at most of the places I'm interested in, which is enough for me not to risk doing an away and ruining my chances. But if doing an away could provide additional benefit beyond the interview, like improve my chances of actually matching, I might consider it...

I have a different perspective on this than you. Those "lower-tier" programs may actually give you a good chance to get resident-level training as a med student, because you aren't last in line behind a million fellows and all the residents. My home institution doesn't have a residency, so I had 6 weeks of one on one with the attendings before I did two aways. Consequently, I'm pretty good with most parts of the ophthalmic exam and got to do some lid stuff and split an enucleation with my colleague. Never really did any gonioscopy though. On my second away I got my own lane and split the patients with the first year, and I checked each patient out with the attending. Definitely not shadowing.

Sorry I didn't mean to imply that lower-tiered institutions w/o ophtho residencies don't give you good experience, especially since it sounds like you had a great one. I just meant that some of the benefit of doing an away at a top program is that you get to network/do research with/get LORs from well-known faculty that can aid you through your interview process. People with strong home ophtho programs have less of a need to seek those kinds of opportunities outside their home institution, so the benefit of doing an away becomes much less.