Why Should I Do an Away Rotation?

Graham Walker, MD

Disclosures

June 14, 2011

Question

Are there benefits to doing away rotations? Will they give me an edge on my residency applications?

Response from Graham Walker, MD
Chief Resident, St. Luke's-Roosevelt Hospital Center, New York, New York

There are 3 main reasons to do an away rotation, and at least one of them will apply to you.

First, an away rotation can be an "audition" for the residency program in which you're interested. You should try to rotate at your top choice based on location and reputation (although it's hard to get a sense of your top choice before you do residency interviews). The experience will give you the chance to get to know the personality of the program and impress your future attending physicians and senior residents. You can get a sense of how well you might fit in. Programs will often (but not always) give better rankings to students who have rotated with them because they have had a relationship with the students and feel more confident about their abilities and skill set.

Of course, you have to do well in your rotation. If you are having a bad couple of weeks or something goes wrong or even if things don't click, that will not help your application. Of course, if you've done a great job but don't gel with the program, you probably won't want to match there, anyway. Consider yourself lucky to have found out early.

The second reason to do an away rotation is to get a recommendation letter from a program in a particular region. Medicine (or whatever your chosen specialty is) is a small world, especially in academia. Because program directors in New York, for instance, know each other and trust each others' opinions, an excellent letter of recommendation from Program Downtown may help you get into Program Uptown -- maybe more so than your own school's evaluation. Of course, logistics will also play a role in your choice of away rotations. If you're in Texas but have your heart set on doing residency in New York, you may choose to do a closer away rotation in Texas, even if it's not your number-one residency choice.

The third reason, which applies to everyone, is that medicine is practiced differently at different institutions. There is more than one way to manage diabetic ketoacidosis, for instance, and being exposed to something other than your medical school's way of doing things will help you get a sense of the environment in which you want to train. If most of your clinical rotations have been at a tertiary care, super-subspecialized academic medical center, consider an away rotation at a county facility or a community hospital. You are likely to learn different management strategies, see different diseases, and work with different populations. You may realize that there are, in fact, certain benefits to training in a residency environment that differs from your own.

Have I convinced you to do an away rotation? If so, read on for some advice.

  1. There is no bad time to do an away rotation (except after the residency rank list is submitted). Most people prefer to schedule away rotations around September -- just in time for residency applications -- but don't let that stop you from doing one in the summer or winter. You should, however, do a rotation or subinternship in your chosen specialty at your home institution first. That way, you already know what to expect and can spend your time shining on your away rotation, where people won't know you, you won't know the system, and your first impression is even more important.

  2. Don't be discouraged if you are not able to do the away rotation you want. It is not the death knell of matching at the program if you don't rotate there. More than half of my fellow residents never rotated here, for example.

  3. The same rules apply to all rotations: work hard, take initiative, be professional and punctual, and develop your own plan. Try to go the extra mile on your away rotation, though. Smile. Ask intelligent questions. Introduce yourself to attending physicians and residents, and make sure they know you plan to apply in their field (it makes us residents much more excited if we know you are one of us). Occasionally I have seen medical students acting overly aggressive or showing off their knowledge, so remember that the residents are there to learn as well, and they have much more experience than you (and can tell the program director if they get a bad vibe from someone).

Away rotations are a great experience: you get to see a new city or location, meet new faculty and residents, and gain a much deeper exposure to a program that you might only get a glimpse of during an interview. I highly recommend them, if only for the experience you receive working as an outsider and adapting to a different way of practicing medicine than you might at your home institution.

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