too many sub-i's?

[avgjoe]

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Was just planning out my fourth year, and I'm tempted to do 3 sub-i's, one at my home institution, and two at places i really want to match at. is there any such thing as too many sub-i's? I've heard that most people do at the most 2, is there any negative that comes of doing more?

 

[Blade28]

I don't think so. You don't want to burn out, but for purposes of LORs, a couple early sub-Is can really help.

Personally, I scheduled two away sub-Is - one in August and one in October.

 

[dell2004]

Was just planning out my fourth year, and I'm tempted to do 3 sub-i's, one at my home institution, and two at places i really want to match at. is there any such thing as too many sub-i's? I've heard that most people do at the most 2, is there any negative that comes of doing more?

Can be a bad idea. Surgery directors (from what I've heard) will question, "why did this guy do so many sub-I's?" "Did he do pretty bad his third (or whole med school) year? Trying to make up for prior bad perfomances?" This may or may not be true...but the safest bet is 1 sub-I (a hard, respected one) at your home institution and an away at the the institution you really want to go to. I've never personally seen it work to one's advantage to do a whole load of sub-Is.

 

[manwhoisthursdy]

Can be a bad idea. Surgery directors (from what I've heard) will question, "why did this guy do so many sub-I's?" "Did he do pretty bad his third (or whole med school) year? Trying to make up for prior bad perfomances?" This may or may not be true...but the safest bet is 1 sub-I (a hard, respected one) at your home institution and an away at the the institution you really want to go to. I've never personally seen it work to one's advantage to do a whole load of sub-Is.

I'm not sure I'd agree . . . if you have great third year grades, then why would they assume you are trying to "make up for it"? Anyway in some specialties doing a sub-I at school x really ups your chances of matching in school x. So I'd say do three if you have the energy for it.

 

[Malftap]

I'm a 4th year and I'm on my last of three sub-I's in neurosurgery. Like the original poster was thinking about...I did my first sub-I at my med school and then back-to-back away sub-I's. Personally, I can tell you that I'm burned out but I got an interview at the first place I did a sub-I and I feel that if I didn't go there I probably wouldn't have received an interview. So I think you can do three but be prepared to work. Good luck with your scheduling.

 

[avgjoe]

thanks all. I think I'll have pretty good grades and have a good step1, so hopeuflly they won't mistake my intentions and just realize that i want an interview 🙂. I'm also only applying to West Coast schools (few in number) so since you guys do seem to think that sub-i's help you get interviews then that'll help me out a lot.
malftap, in terms of burning out, did you do all 3 right in a row? Is there a reason you chose to do it that way rather than taking a break in-between?

 

[Malftap]

I did all three in a row. Neurosurgery is an early match so I scheduled the rotations like that so I was able to visit the places before interviews were sent out. I realized by doing all three in a row that I made my fourth year schedule way too hard by scheduling other hard rotations in surgery. That's about to change when I get back. My advice...don't make your 4th year into an mini-intern year.

 

[avgjoe]

okay last question for g-surg folks.. what sub-i's are good to do? Trauma, and then what? thanks all!

 

[hcj13]

okay last question for g-surg folks.. what sub-i's are good to do? Trauma, and then what? thanks all!

i would pick what ever is the busiest service in your medical school, otherwise good general rotations trauma, GI, sug onc are all good to do. then consider what your interests are in fellowship training.

 

[Vincristine]

I did three months of g-surg sub-i's with two weeks off after the first one (at home) allowing time to get myself half way across the country for the two strait away sub-i's. I didn't mind the work (if you can't hack 3 g-surg sub-i's, then maybe a g-surg residency is not for you!). What got frustrating was not being able to sign my own orders -- more specifically answering my intern's questions about patient management, but then needing the same person cosign my stuff.

You might also want to consider a different surgery away rotation -- maybe vascular, or trauma -- if you find something that interests you.

If you're a 3rd year, I applaud you for thinking about this now. Hell, a year ago I wasn't even going to be a surgeon 🙂

 

[Blade28]

I agree, pick the busiest, most intense rotations possible - you'll learn the most that way. I'm finishing a general surgery/GI/trauma rotation now, and back in August, did a cardiothoracic surgery rotation (since I'm interested in that).

I agree with Vincristine - not being able to write your own orders is VERY frustrating.

 

[imtiaz]

i have a question. sub-i's can be 2-4 weeks as far as i know. is it better to do fewer 4 week sub-i's or more 2 week sub-i's? i was thinking of doing 3 or 4 sub-i's but doing them for 2 weeks each so i can hit all the places i want to hit and show my face. what do you guys think about this?

 

[Blade28]

Two weeks seems kinda short to me, if you're looking to really check out a program, get your face known, meet attendings, obtain a letter of recommendation, etc.

 

[avgjoe]

Two weeks seems kinda short to me, if you're looking to really check out a program, get your face known, meet attendings, obtain a letter of recommendation, etc.

to get a LOR, by when should we finish our sub-i? August? September? Also, do they look at our medicine sub-i when applying? (basically, should I do the med sub-i before applications or does it not matter?)

 

[Celiac Plexus]

Do as many as you want. PDs don't care if you did one sub-I or 4. As far as picking "the hardest" rotation at your school to do a sub-I... I think that's poor advice. Some may find this statement distasteful, but one of the big reasons to do a sub-I is to get a letter of recommendation to support your excellent abilities/ work ethic. That said, pick a rotation on which you will get some good face time with as important a surgeon as you can. THe ideal LOR is from someone who knows your abilities well, and is from someone that program directors have heard of/respect. So don't worry about how "hard" the rotation is.

As far as taking a sub-I for purely learning purposes... again don't necessarily take the hardest rotation. Pick carefully... pick the rotation with the best teachers. A good teacher does not have to have 30 patients on the census to teach you some great things. In fact, he/she will probably have more time to teach if the census is a reasonable 10-15.

I'd like to echo malftab's comment about not making your 4th year into an intern wanna-be year.

I encourage you guys to take some relaxing rotations, and enjoy yourself. There is nothing that you will learn as a student that you won't learn in the first couple of months of internship.

Good luck.

 

[Glass Half MD?]

I did three consecutive visiting rotations- 1 trauma, 1 SICU, and 1 General Sub-I all away from my home school. Not all of us are surgical god badasses like Vincristine that merely got bored because they knew more than the residents. You definately get burned out. Three months of visiting aways is not equal to three months of surgery residency, so the whole "if you can't hack it, rethink surgery" isn't true in my opinion. When you are doing a visiting rotation, the objectives are to impress the residents and hopefully the attendings with your work ethic and preparation for cases. It is kind of like a political campaign for yourself. You should try meeting, even if only briefly, as many attendings as you can. Express interest in the program and drop a CV Hollywood style. Residents, on the other hand, have the objective of trying to not look too stupid, getting all the work they need to get done, and learning a thing or too. Being in three different cities back to back to back gets tiresome. You don't really know anybody. Unless you actively trying making time to tour where you are at, you are in the hospital all day and either sleeping or preparing at night. By the third rotation, I found myself getting briefly confused as to which city I was in when I wasn't in the hospital. I am definately a hard worker, after the first week and a half of my third rotation I was running on empty. I toughed it out, but I was eager for it to be over. So, yes, three rotations are possible but us mere mortals do get burned out. However, all three rotations were sucesses that I felt helped me probably secure a spot at the programs.
As to 2 vs 4 week rotations, most programs offer only 4 week blocks with there schedule. With two week rotations, the tradeoff is that you can, in theory rotate at more programs, but after two weeks you start getting very comfortable with the surgical team and contribute more when you figure out how things work and what your role is on the particular team. You're going to look your best the last two weeks and help residents the most. Residents are vital to rotation success. In two of my three rotations, residents volunteered to personally write letters to the surgery department saying I was a hard worker and someone they would want to work with, etc. This helps immensely.

I did three months of g-surg sub-i's with two weeks off after the first one (at home) allowing time to get myself half way across the country for the two strait away sub-i's. I didn't mind the work (if you can't hack 3 g-surg sub-i's, then maybe a g-surg residency is not for you!). What got frustrating was not being able to sign my own orders -- more specifically answering my intern's questions about patient management, but then needing the same person cosign my stuff.

You might also want to consider a different surgery away rotation -- maybe vascular, or trauma -- if you find something that interests you.

If you're a 3rd year, I applaud you for thinking about this now. Hell, a year ago I wasn't even going to be a surgeon 🙂