Away Rotations


Omar Hariri, Class of 2017

Reasons to do an away:

Necessary – some fields (surgical subspecialties, EM) essentially require that you do away rotations

High interest in a specific program – i.e. if you really want to go somewhere specifically, and are confident that you can rock the rotation and make a strong case for that program to rank you highly. Keep in mind that you will give them plenty of opportunities to find things they don’t like about you – so make sure you are on top of your game. Sometimes their imagination of who you will be is better than what their opinion is after a month working with you, so it is a bit of a risk. Some specialties advise against doing aways as they feel the risk outweighs the benefits. Talk to faculty and residents in the field and keep in mind that sometimes faculty don’t fully understand this process as it is today.

VSAS:

Biggest hurdle here is immunizations: look at the AAMC standardized form and get it filled out as soon as possible (go to peoplesoft to find your immunization history). Drop it at student health and figure out if you’re missing anything. You likely have all required vaccines already. You will need to get a Hep B titer and some schools require MMR/varicella titers as well. The cheapest place to get these drawn is student health. If your Hep B titer is negative you will have to restart the series and your best bet is to call programs and let them know that you are being revaccinated (as the vaccines take several months and you will not have a titer to send them until it is too late).

Other requirements: Every program has their own requirements so you have to look at their individual pages. Some require background checks and drug tests. Most will require these done within a year and a few will accept the ones done before you started medical school, so figure that out and you may be able to save yourself some time and money. If you need to do them again, UTSW should offer you some reasonable options.  You will also need a photo, and usually that photo and your name will be the only thing on the sheet that residents or faculty will eventually take notes about you on. So find/take a nice picture and don’t give them a reason to judge you based on that (I used my first year white coat portrait – free and easy).

Applying to programs:
Apply as soon as possible. Especially in fields where everyone rotates and if you’re looking at a popular program – you should do your best to apply the day that applications open. I’m not saying you won’t get it unless you do that, but if you’re one of the first to apply you’ll also be one of the first to choose (month/service). After you apply, the registrar has to approve it before your application will actually be sent to the away program. You need to get the away form signed by the specialty coordinator at UTSW and turned into the registrar in advance of that. Don’t worry too much about some of the logistics and details like dates, you can figure that out with the registrar later – but they need to put at least an initial stamp on the course before your application is complete so that’s priority.

When you need things done in this process, you should be calling the coordinator in charge (as long as they don’t specifically say to not do this). Often, they are (un)surprisingly terrible at communicating via email in a reasonable time frame. Getting someone on the phone makes you a real person to them and just gets things done more effectively. Don’t give up if you get an email saying the rotation is full or are denied for some other reason – calling the coordinator can be a quick fix.

You may want to apply to several programs, especially if you are unsure where you want to go when their applications open. There is an unresolved debate about whether applying to an away and then not going leads to you being blacklisted for an interview. I think this is less of an issue if you only apply but may be significant if you schedule a rotation and then cancel after that. I think it’s worth applying to 1-2 extra programs if you aren’t fully confident about where you want to go when the application opens (and definitely if you are applying late).

You should apply to several different months at the same institution (no extra charge). because you won’t always get your first choice. Effectively communicating with these programs about your preferences will get you what you want a lot more successfully than being passive and just working through VSAS.

Selecting programs:
the programs you pick may be very important in where you match/interview depending on your specialty. If you plan on getting a letter, try to find a place where you will rotate on the same service and get the chance to work with the same attending frequently. Sometimes it is impossible to know what you’re getting yourself into unfortunately, but try to get as much information from faculty/residents/4th years who are familiar with specific programs. You’re going to make some decisions based on hearsay, which honestly is an unavoidable reality in this process. You may pick a program thinking that it will “open” up a region to you for interviews, which may or may not happen (in my case and several people I have talked to, it didn’t really seem to do that – your method may vary). Other things that are important to consider: how many of the residents were former rotators, how many rotators get interviews (some programs are notorious for not inviting back a significant amount of rotators). Remember, the ultimate goal for most of you in doing these rotations is to have a high chance of matching at these programs – do your best to not waste these valuable months.

Doing well on rotations:

1.  Work hard and don’t complain. Do not ask to go home. Be helpful. You are here to impress and showcase the best you can be and convince these people that they want you to be a part of their residency over the many other impressive applicants they will eventually choose from.

2. Do not be weird. Do not be overbearing. You will hear this over and over and think it’s the most useless piece of advice. Then you will see it and you will understand.

3. Understand you are being evaluated at all times. Every interaction. Do not be rude, arrogant, or inappropriate. To anybody. I have heard stories of rotators being taken off the rank list for rubbing a person the wrong way with a single out of line comment. Don’t talk back to a scrub tech that is taking out their frustration on you. Do not waste your entire month because you said something stupid without thinking.

4. Prepare. If surgical, know your anatomy cold. Read up on approaches and cases beforehand, know conservative management, indications for surgery, etc. You will spend a lot of time rounding, doing floor work, seeing consults with residents (ie where you demonstrate your ability to work hard and be helpful) but won’t see the attending until in the OR/clinic and that is the time you may be prompted to show your knowledge and preparation. But again, do not be overbearing. Nobody likes the person who is obnoxiously trying to prove themselves.

Other tips: You will spend the most time with residents. Residents do not care about who you are on paper. Things residents do care about: working with someone who they can rely on, someone who works hard and contributes to the team, someone who doesn’t make their day worse than it already is, someone who they enjoy being around and get along with, someone who is not annoying and doesn’t complain, and someone who makes their job easier and not harder. In essence, someone who will be a good co-resident (and hopefully, someone they feel could be a friend). Be that person. Pay attention to social cues. If the resident or attending is being short with you because they’re preoccupied, keep your mouth shut. If people are joking around, join in. Show that you can be a part of their group. Try to balance having a personality that people like while also being very cautious of going too far as I said earlier – it is better to be quiet than give them a reason to not like you, but you don’t want to be too reserved either. Social awareness is key – don’t be that oblivious person who just doesn’t get it, because that is what you will be known for and what they will remember about you when it comes time to making a rank list.

Also….anytime you enter an OR, introduce yourself to the scrub tech and circulator. It got brought up several times that I was the first to do that that week (which honestly just reflected poorly on the other students to the residents rather than making me look good). And always be polite to these people, even when you run into the unnecessarily annoying ones who always find something to complain about. It can be pretty irritating sometimes but it reflects well on you to not take it personally and brush it off (and these people will be glad to talk trash behind your back to residents/attendings should you get into a verbal altercation with them).

Sometimes being helpful is easier said than done. A lot of it comes down to being able to anticipate the next move. Often if you’re not doing something without being told explicitly, the resident may just do it themselves instead of telling you what they need (in the interest of time). So pay close attention to what goes on and try to get the job done quicker by doing these tasks that other people have to do. This takes time to get a feel for but do your best to get good at it quickly.

A little more ortho specific – in the OR get the patient on the table, take the bed out of the room, shave the limb, help prep the limb, tourniquet, etc. Don’t scrub before attendings or residents unless there’s a time window to do so – otherwise you are slowing down the team who will be draping (unless they teach you how to drape). Whenever you see anyone doing something that you can do, try to do it for them the next time (while they do the things that you can’t do as a student). On call – if resident has multiple consults, ask if they’d like you to go get a quick H&P on a straightforward patient. If going to see a patient that is going to need a splint, bring the supplies and get them ready while the resident is doing their H&P. On rounds, take down dressings (possibly before rounds if there are too many patients), have supplies on you to re-dress, always have your scissors on the ready. Most the people you will be working directly with are PGY2s fresh off intern year thrown into the mad house – if you can help them be efficient you will make things a lot better for them. And like I said, the more you can anticipate and do things without being told, the better.

Good luck. It’s a crazy whirlwind of a time but try to enjoy it – you’ll have a lot of fun being at the beginning of  your future career while working in new hospitals/cities and meeting future colleagues from all over the country.

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