Away Rotations Part 2

Continuation of Part 1… now you’ve finally arrived at your designated away institution! Hopefully by now you have heard from your institution about what to expect for the first day, but if not, I would email the chief resident of service or the secretary about one week prior to your start day to at least figure out where and when to meet the team on day 1. You can get all of the other logistics after that. For my first away, I also spent my first day there (I arrived a day early) to get the lay of the land around where I was staying and where the hospital was. Make sure to set your alarm and get everything ready for your first day.

General Tips

  1. First one in, last one out — this one is probably the most commonly given advice for away students. This is highly variable on what you are doing but you should aim to be the first one on your team who shows up and the last one to leave. Sometimes, that might not happen (some residents will really insist that you leave), but try your best. The point of this is that you should never be late, you should never leave early, and you should never miss anything (AKA try to be present, always). At the start of the day, I would always get there first to print the list for the team and start collecting overnight events/vitals/labs for everyone. If you are fast at prerounding, you won’t really even be showing up THAT much earlier… for me, usually 15min before the intern showed up was what I set myself to. At the end of the day, make sure that everything has been tied up and ready to go — all notes are done, all consults have been seen, nothing pending. This brings me to the next point…
  2. Know everyone on your list, even if you’re not assigned to — I’ve found that starting off, most teams won’t let you do too much because they need to gauge where you are, which is why if you show that you can handle the entire service, you’re already off at a great start. I spent any free moment I had during the day reading about my patients, learning their latest labs/imaging/etc., so that I was the most up-to-date on everyone. You’ll never know when you can throw out a nugget that no one was expecting, and then you’ll just look extra prepared. And before I left everyday, I would do another run through the list just to make sure I knew the latest on everyone and generally what I could expect overnight.
  3. Take call — I’m not sure if every service will assign call, but if you have the chance to, you should offer to take call. With my specialty, call tended to be home call, which meant I usually gave the residents my phone number and they would call me if anything was worth coming in for. Even if you are never actually called, at least you showed effort by volunteering. This includes showing up on the weekend.
  4. Ask “how can I help”, not “is there anything to do?” — Residents always want to say “no” to the last one, so don’t let them! Also, the more you find out how you can help, the better you will get at figuring out yourself what needs to be done, which brings me to the next point…
  5. Anticipate needs and be prepared — This, I think, was what really makes you stand out. You should always be thinking several steps ahead of what’s happening. If you don’t know how to do that, ask first to learn. Have everything you need on hand for rounds. Since I was on a surgical rotation, my pockets were literally full of staple removers, suture removers, gauze, tape of all kinds, baci, steristrips, etc. In the OR, you should at least know the procedure well enough that you can figure out what comes next. Do you need skin hooks or a certain kind of retractor? Do you need scissors? If you can figure out these things before it’s asked of you, it just makes you look extra good.
  6. Make your residents look good AKA be a good team player — It’s not always about making yourself look good, it’s about being in a team. When your resident is operating in front of the attending, do whatever you can to make it stupidly easy for them. Grab things for your resident so they don’t need to waste time getting it. If you know an answer and the resident doesn’t, absolutely DO NOT show off in front of an attending unless asked. Say good things about your residents (if they are honest) if an attending asks.
  7. There is no “free time” — If you find that you have free time on your rotation, you’re doing it wrong. I’m not saying you need to be a machine, except that’s what I’m saying. Even if there’s no work to be done, you should be reading about something – your patients, conditions, surgeries, recent literature, etc. You never know when you’ll be asked about something.
  8. Be professional/polite but also be yourself and try to feel the program — Because away rotations are sometimes considered month-long interviews, you need to be polite to everyone you meet (you never know when something might get back to someone). But at the same time, you should also be yourself and see where you belong in that program. For example, on my second away I was really cautious at first, but I found that by letting myself go a bit, I could still be polite and at the same time made friends with a bunch of the scrub nurses and anesthesiologists so that by the end, they were telling my attendings how much they loved working with me, and honestly, I missed them! It made me feel like I really belonged in that program, and that’s the kind of feeling you want to leave with.

Mid-rotation — At about halfway through your rotation, you should try to get at least an informal evaluation by a resident and an attending (multiples if possible). Ask them to be honest, and most importantly, ask them how you can improve. It never feels good to be told that one is “bad” in any way, but you want to be the best you can be so let them give you pointers NOW while you still have time to show them you can change. For example, on my first rotation I was told that I seemed a little unprepared for surgeries. While that upset me a little bit because I thought I wasn’t, clearly I wasn’t studying enough, so I took the next few weeks to really read up as much as I could for surgeries. By the end of the rotation, that same resident told me I ended with the same knowledge as at least a PGY2 level.

End of rotation

  1. If you have to give a presentation — make sure you pick a topic that at least some of the senior residents, who likely have seen other medical students rotate through, approve of. Usually, I try to pick a topic related to a patient that I’ve seen at some point so that you can have some clinical context. I did not repeat a single talk I gave, which meant I had to research for three; in the end, I’m not too upset about that because it meant that I learned A TON about three areas in my field, score! Pick sources that are in the literature, ideally from big-name journals if you can. Make sure you thoroughly read the articles and understand the experiments. Don’t make your powerpoint all words. Have summary slides. Run your presentation by a resident if possible before presenting to attendings.
  2. Ask for more feedback — When you’re done, you want to gauge how you did. Try to schedule meetings with attendings a week before your last week so you’re not just chasing them down to ask for feedback. This is the time to…
  3. Consider asking for a LOR — If you think you made a good impression, and it should not be hard to figure that out because hopefully you’ve been getting feedback along the way, you can consider asking for a letter. There’s a bunch of stuff out there about who to ask; in the end, I think you should ask whoever knew you the best and would write you the best letter, be that a chairman or not. Make sure that if you do ask for a letter, you have everything ready (personal statement draft at the very least and a CV).
  4. If you have an interview while you are there — Treat this like any other interview. Dress nice and look good. Make sure you’ve prepped before about the basic questions (“tell me about yourself”, “why this specialty”, “why this program”). Practice your answers. Be confident but be yourself. Be polite and professional to everyone you meet.

Whew, that was long and hopefully comprehensive. If you have any questions, leave them down below!

Away Rotations Part 1

These days, it seems like a bunch of medical students are doing away rotations. They offer a bunch of benefits (and harms) — exploring a new city, a new hospital, moving closer to a loved one for at least a little while, and sometimes, they can help you match at a residency program. Now I say sometimes, because if you’re planning on going there, you need to be on your A+ game. Having just finished two away rotations fairly successfully (I think), I’m writing this post to offer some advice to those who are interested in doing away rotations.

I’ll be breaking this post up into two parts — first, what to do before you get to your away institution, and then part two will be what to do once you are there.

Should I do an away rotation? This is something for you (and your adviser) to discuss. For most of the uber competitive specialties, it’s almost “required” for you to do an away rotation. For the less competitive fields, many argue that away rotations end up hurting more than helping. If you are dead set on going to a certain program for whatever reasons (e.g. your fiancee has a job in that city), you probably should do an away rotation. Otherwise, I think most people do not need to do an away rotation.

How do I apply? VSAS, affiliated with AAMC, is the site that most institutions use for away rotations. I say most because there are some institutions that have their own application for away rotators (off the top of my head, I know that University of Alabama and Thomas Jefferson University do). You log in with your same ID and password for you AMCAS if you happen to remember that. You can find a variety of different rotations from your typical 4 week sub-internship to more “fun” rotations like medical disaster management. Most institutions open up their applications in May; however, you can look at what they require earlier than that. Almost every school requires its own immunization form (some require titers, others just documentation that you have had a vaccine), and some require combinations of background checks, urine drug screens, LORs, etc. Make sure you have everything prepared as soon as possible since away rotation applications are reviewed on a rolling basis.

I’m not sure what the “right” answer is for how many to apply to. I was planning on doing two, and maybe three, so I applied to five institutions. I got accepted at all of them (to my knowledge, it’s not usually “hard” to get accepted at away rotations) and then picked the ones that worked best with my schedule (some institutions overlap their rotations with others, so you need to plan accordingly). Make sure that if you accept an offer or reject an offer that you do so in a timely fashion to be professional (at least 2-3 weeks in advance of start date). It appears that most places get back to you within one month of applying.

I’ve been accepted; now what? My biggest stress prior to going away was finding housing. Oy, what a nightmare. Here are some of my tips:

  1. Rotating room — this website was designed for away rotators. You can trust that most of these places are fairly reliable since you cannot list unless you have a university-affiliated email address. You can search by institution and then by hospital. I used this service to both find a place for me to sublet and to list my own apartment. I had no issues with either of them. I did not think many people would want to stay in my apartment, but I actually got four inquiries, so I can only guess that lots of students use this site!
  2. Craigslist — everyone knows craigslist, right? Unfortunately, one of the places I went to rotate at did not offer much on rotating room, so I was forced to resort to craigslist. You have to be smart on this website is all I have to say. To weed out sketchy people, I look for good grammar/spelling in the post, lots of pictures of the actual room you will be renting, and at least some information about the people who live there (roommates or whoever you’re subletting from).
  3. Use your connections — I ended up not being successful with this but one of my classmates was able to find both of his places through his church network. If you know friends (or friends of friends), ask around and see if anything is available. Residents are also good resources since they come from all over. If your school has an alumni network that you can get in touch with, that is another place you can look for someone to stay with.

Once I found my housing, I tried to figure out logistics. The way I ended up doing payment was I paid half of my rent (through paypal) upfront to “save” my room, and then I paid the remainder once I arrived at the location. I also asked for additional information like laundry, parking, where to buy groceries, etc. We also discussed rules of subletting, how to pick up keys, etc. The last thing you want to worry about on an away rotation is housing, believe me, so try to get this all sorted out before you go up there.

Transportation — at one of my rotations, I was going to be located within walking distance to the hospital, so I opted to fly there. At the other rotation, I would spend time at several institutions, all separated by at least 10 minutes, so I knew I would have to bring a car down. I don’t have much advice on this except plan, plan, plan.

Packing — I have such a love-hate relationship with packing. On the one hand, the planner geek in me goes crazy. On the other… well, the planner geek in me goes crazy. I always start out with looking up the weather for where I’m going to go, and then I try to think of what I expect my rotation to be like. Since I am applying for a surgical specialty, I had a feeling I would spend a majority of my time in scrubs, so I packed less “nice” clothes and packed my trusty Dansko shoes and two clean scrubs (I wasn’t sure if I would be able to wear their hospital scrubs or what so I wanted to be prepared). I packed a couple of what I call “normal people clothes” to wear if I ever had time off, and more on that later but I do not recommend wasting luggage space with this if you can. Do not forget your white coat, obviously, and try to get it as clean as possible. My white coat picked up some nasty stains over third year, so I actually went and bought a new one online to bring to my away rotations. Bring medical supplies as needed — I left my reflex hammer at home since I doubted I would require it (and I did not). And then otherwise, make sure to pack you usual toiletries, medicines, etc. Some places will interview you while you are there — if you can, ask your rotation coordinator about this sneakily, although most tell you upfront. If you are going to interview, make sure you pack interview attire!

Since I rotated over the summer, I knew I wanted to pick warmer weather clothing. I tried to pick colors that would complement, so the palette I ended up going for was roughly black, camel, pink, cobalt blue, yellow, and kelly green. For shoes, I brought flip flops for casual wear, clogs for the OR, and then two pairs of comfortable shoes that I could wear both for the clinic and outside the hospital (I went with brown loafer flats and black flats).

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Feel free to ask any other questions below about aways! Part 2 will go into the meat of rotating away, so stay tuned.