When should your IM sub-internship be done?

[Pewl]

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I had heard from some people that it is a good idea to do your requisite sub-internship at your home institution prior to doing away rotations. Do you believe this to be true for rad onc as well? I heard some rad onc program directors like to see a letter of rec from an IM doc. On the other hand, doing an IM sub-internship so early on would cut into valuable away rotation time!

What do you guys think?

 

[arthurdent]

I had heard from some people that it is a good idea to do your requisite sub-internship at your home institution prior to doing away rotations. Do you believe this to be true for rad onc as well? I heard some rad onc program directors like to see a letter of rec from an IM doc. On the other hand, doing an IM sub-internship so early on would cut into valuable away rotation time!

What do you guys think?

RO letters >> IM letters. And away rotations are great for letters and auditioning. I definitely would not prioritize a subI over an away, IMHO

 

[39094]

I had heard from some people that it is a good idea to do your requisite sub-internship at your home institution prior to doing away rotations. Do you believe this to be true for rad onc as well? I heard some rad onc program directors like to see a letter of rec from an IM doc. On the other hand, doing an IM sub-internship so early on would cut into valuable away rotation time!

What do you guys think?

I would say that many PDs want to see some sort of Medicine letter in your application and do look at sub-I grades so it's probably a good idea to make sure that gets done before you submit ERAS. Obviously it's a huge time issue depending on how many aways you are planning to do. I ended up doing my aways first and then did my sub-I in August so the grade came out just before transcripts went in and I was able to get a letter in time. My med school gives us a lot of flexibility in scheduling so I was able to pull that off but that may be more difficult if you're at a school with a more traditional schedule.

 

[Pewl]

I would say that many PDs want to see some sort of Medicine letter in your application and do look at sub-I grades so it's probably a good idea to make sure that gets done before you submit ERAS. Obviously it's a huge time issue depending on how many aways you are planning to do. I ended up doing my aways first and then did my sub-I in August so the grade came out just before transcripts went in and I was able to get a letter in time. My med school gives us a lot of flexibility in scheduling so I was able to pull that off but that may be more difficult if you're at a school with a more traditional schedule.

Does the medicine letter that PD's want to see have to be from your sub-I? Could it be a letter from your internal medicine rotation?

I plan to do quite a number of rad onc away rotations. A 3 week Sub-I (as my school requires) would definitely cut quite a bit into that time. I'm definitely considering putting off that sub-I, but i just wasn't sure how rad onc PD's view that.

 

[yeasterbunny]

All my letters were rad onc and I did my sub-I in February. I had no problems.

On the contrary, I actually had more rad onc people I wanted to get letters from than I could actually use, between the chair, PD, research mentor, people who knew me well from home rotation, and away rotation people. It would have helped if I had done my research with someone with a bigger name.

 

[RadOncRudy]

All my letters were rad onc and I did my sub-I in February. I had no problems.

On the contrary, I actually had more rad onc people I wanted to get letters from than I could actually use, between the chair, PD, research mentor, people who knew me well from home rotation, and away rotation people. It would have helped if I had done my research with someone with a bigger name.

I agree...I had all rad onc or research letters submitted to rad onc programs. My impression was that the only reason I needed an IM letter was for my TY/prelim med applications. I also don't think that it matters which rotation you use to obtain an IM letter, I asked an attending I had for IP med 3rd year. I did do a sub-I in August because I had to, but given the option I would have done another rad onc away instead (I was only able to do 1 away). I would do your sub-I whenever it is most convenient in terms of not interfering with aways, research, or interview season.

 

[Pewl]

Thanks for the feedback.

Has anyone else here had an experience where a rad onc PD strongly suggested that you have an IM letter? I recall one person saying that the rad onc PD he spoke said that any application without an IM letter is "severely lacking."

 

[39094]

Thanks for the feedback.

Has anyone else here had an experience where a rad onc PD strongly suggested that you have an IM letter? I recall one person saying that the rad onc PD he spoke said that any application without an IM letter is "severely lacking."

I think I might be that person....

This was told to me by both a PD and an associate PD of one of the "Deathstar" programs. I think it's quite variable depending on what the program values.

 

[IndyXRT]

I had this same impression back when I was applying (that you need a letter from an IM sub-I). However, looking at it from the other side of residency, it seems that an interviewer would be more interested in what another radiation oncologist had to say about you than what an IM doc had to say. I would think that getting away rotations in time to obtain LORs would take precedence. But that's just my two cents (for the record, I listened to the advice and did my sub-I first, preventing me from getting a LOR from my away rotation).

 

[MHotep]

If you intend to apply to a top-ten (MGH, The Brigham, Columbia, Hopkins, Penn...) internal medicine program for internship, then you have to do your medicine sub-I relatively early.

I was choosing between radiation oncology and medical oncology, so I did a medicine sub-I and a medical oncology sub-I relatively early. I did my home rad onc rotation very early. I still had time from July through September for potential away rotations. There are threads about away rotations already, but I’ll get on my soap box and scream loudly again -- if you have a strong home institution, then you should really think long and hard about away rotations. I promise to be a bit more explicit on the topic of “away rotations” after match day.

For people going into specialties (medicine, surgery, ER, Ob/Gyn) where away rotations are essentially sub-I's then I would agree that you need to do your home sub-I first to get your feet underneath of you. When you go to a new institution you can't even find the bathroom, let alone the core lab, micro lab, pathology, ER, radiology--and that is half of what being a sub-I is about. At least after doing your home sub-I you would be competent at patient management--the other half of being a sub-I.

 

[Pewl]

If you intend to apply to a top-ten (MGH, The Brigham, Columbia, Hopkins, Penn...) internal medicine program for internship, then you have to do your medicine sub-I relatively early.

I was choosing between radiation oncology and medical oncology, so I did a medicine sub-I and a medical oncology sub-I relatively early. I did my home rad onc rotation very early. I still had time from July through September for potential away rotations. There are threads about away rotations already, but I’ll get on my soap box and scream loudly again -- if you have a strong home institution, then you should really think long and hard about away rotations. I promise to be a bit more explicit on the topic of “away rotations” after match day.

For people going into specialties (medicine, surgery, ER, Ob/Gyn) where away rotations are essentially sub-I's then I would agree that you need to do your home sub-I first to get your feet underneath of you. When you go to a new institution you can't even find the bathroom, let alone the core lab, micro lab, pathology, ER, radiology--and that is half of what being a sub-I is about. At least after doing your home sub-I you would be competent at patient management--the other half of being a sub-I.

What if your home instituation does not have a home program?

 

[MHotep]

What if your home instituation does not have a home program?

You'll likely have to sacrifice matching at a hardcore internship by forgoing medicine sub-I's in favor of away rotations.

 

[IndyXRT]

You'll likely have to sacrifice matching at a hardcore internship by forgoing medicine sub-I's in favor of away rotations.

Hmmm. . . I'm not sure the majority of those going into radiation oncology would consider this much of a sacrifice.

 

[MHotep]

Hmmm. . . I'm not sure the majority of those going into radiation oncology would consider this much of a sacrifice.

I agree.

But there does exist a minority of rad onc aspirants who desire a more rigorous internship. For this minority, postponing the medicine sub-I would be a sacrifice because it would likely result in not receiving interviews from the top medicine programs.

 

[mikedc813]

I doubt that IM letters count for much of anything. If I were a PD, I surely wouldn't care if an internist thought you were great. However, I would care if a radiation oncologist thought you were great.

 

[39094]

I doubt that IM letters count for much of anything. If I were a PD, I surely wouldn't care if an internist thought you were great. However, I would care if a radiation oncologist thought you were great.

I've mentioned this before in other threads but will say it again, it depends on what program you're talking about. I was told by 2 different program directors that any application without a strong Medicine letter would be "severely lacking." Now I agree with the above as my other 3 letters were from Rad Onc docs but the contents of my Medicine letter came up during interviews more than once.

 

[MHotep]

I doubt that IM letters count for much of anything. If I were a PD, I surely wouldn't care if an internist thought you were great. However, I would care if a radiation oncologist thought you were great.

IMHO, the basic tools for being a good physician do not differ from specialty to specialty.

My medicine (medical oncology) letters came up on many of my rad onc interviews. I only had 2 rad onc letters; 1 PhD thesis advisor letter (a medical oncologist by training); and 1 medical oncology attending from my med onc sub-I. The med onc sub-I attending had the opportunity to see me work after being awake all night admitting and managing REALLY sick patients. That letter can say a lot about the true individual...not just the front that we as med students can put on from 9 am to 5 pm. I could be jaded by my medical school, but I just cannot fathom that a strong letter from a world-renown medical oncologist would fall on deaf ears within a radiation oncology department.

In terms of level of clinical responsibility, rad onc rotations just don't compare to the medicine sub-I's. (At least from my personal experience.)

 

[IndyXRT]

IMHO, the basic tools for being a good physician do not differ from specialty to specialty.

My medicine (medical oncology) letters came up on many of my rad onc interviews. I only had 2 rad onc letters; 1 PhD thesis advisor letter (a medical oncologist by training); and 1 medical oncology attending from my med onc sub-I. The med onc sub-I attending had the opportunity to see me work after being awake all night admitting and managing REALLY sick patients. That letter can say a lot about the true individual...not just the front that we as med students can put on from 9 am to 5 pm. I could be jaded by my medical school, but I just cannot fathom that a strong letter from a world-renown medical oncologist would fall on deaf ears within a radiation oncology department.

In terms of level of clinical responsibility, rad onc rotations just don't compare to the medicine sub-I's. (At least from my personal experience.)

Well, if the physician is world-renowned, then of course their letter would be given weight. I think, though, that a letter from an unknown IM physician would seem to carry less weight (in my mind) than a letter from an unknown radiation oncologist.

 

[MHotep]

Well, if the physician is world-renowned, then of course their letter would be given weight. I think, though, that a letter from an unknown IM physician would seem to carry less weight (in my mind) than a letter from an unknown radiation oncologist.

We need rad onc letters. But do we need 4 rad onc letters just for the purpose of having 4 rad onc letters?

I think that after 2-3 strong rad onc letters, that getting a strong letter from outside of rad onc is cool, especially if your other option would be getting a luke warm rad onc letter from someone who does not know you well.

 

[IndyXRT]

We need rad onc letters. But do we need 4 rad onc letters just for the purpose of having 4 rad onc letters?

I think that after 2-3 strong rad onc letters, that getting a strong letter from outside of rad onc is cool, especially if your other option would be getting a luke warm rad onc letter from someone who does not know you well.

No, I don't think you need to have 4 rad onc letters. I think that you should aim for 2-3. It is fine to have letters from other specialties that you have worked with. I was just throwing my two cents in by saying that, at least for me, a letter from an IM supervising a sub-I is not essential (I realize that opinions differ on this, though). Radiation oncology is such a small field that the liklihood of someone on the interview trail knowing your letter writer is fairly good. When you know the letter writer, it is hard not to lend a bit more credence to what they are saying than if you did not know them.