How Can I Plan an Away Rotation?

Geoffrey A. Talmon, MD

Disclosures

June 08, 2012

Question:

I'd like to do an off-campus rotation, but the process of narrowing my choices seems daunting. How can I get started?

Response from Geoffrey A. Talmon, MD
Assistant Professor, Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska

The fourth-year curriculum at our medical school was made up of electives. After 2 years of sitting in a lecture hall and 12 months of experiencing the rank and file intrinsic to required rotations at an academic medical center, I was champing at the bit to experience something new.

The opportunity to take part in medical care off campus was exactly what I needed at that point -- something to remind me of what the lives of "real world" doctors were like and help me choose a potential residency.

However, my excitement was tempered with a bit of confusion when I met with my adviser to set up a schedule. The breadth and depth of my choices for off-campus experiences were staggering, as nearly every specialty offered a chance for such rotations. I could pick from a thick catalog, set up my own, travel abroad, or go rural. This was going to be harder than I thought.

Outside rotations were among my most, and least, valuable experiences in medical school and residency. Away rotations allow you to learn from a different set of minds, see another healthcare system, find people to write letters of recommendation, let future training programs get acquainted with you, and possibly give you more responsibility. However, as a lowly trainee, you might get lost in the shuffle with little to show for your time.

Many medical students are faced with the same hard choices that I faced. Going outside of your home institution often engenders logistical and financial challenges, especially if you are spending time far from home. How do you select off-campus rotations that are worth the potential investment of time and money, and how do you get the most out of your choice?

The most important factor is what you ultimately hope to get out of the rotation, which reduces your options quickly. Medical students go off campus for several reasons: to confirm a choice of specialty, get exposed to new procedures, see care in a different geographic location, or spend time with a potential training program.

The former two are usually the most problematic. If you are hoping to confirm a specialty choice, do a rotation that will closely emulate your future practice, whether that is family medicine in a rural area, obstetrics with little subspecialty support, or emergency medicine in an urban area, for example. This will give you the best snapshot of what your life will be like. To get procedural experience, choose a smaller practice environment because you'll have fewer trainees to compete with.

No matter the reason, your medical school likely has agreements with centers or clinics in a given area and can provide assistance with planning and let you know how students have evaluated locations.

Once you have narrowed your choices, contact students who have been on the rotation before. Although talking to your predecessors is common in the days or weeks before you start a rotation, it is often not considered during schedule planning.

Students can give you not only helpful tidbits about logistics while on the rotation, but also an insider's perspective on the experience. Did they believe the time was worthwhile? Did they get to do what you hope to do? Was training eclipsed by service responsibility? Was the student just a "fly on the wall" who didn't get to participate?

I had an off-campus rotation that was less than ideal. I had hoped to get operating room time that didn't involve a retractor and have some added autonomy on the inpatient side. Unfortunately, my attending didn't know what to do with a medical student, so I spent most of my time standing in the back of examination rooms. A few months later, an upperclassman told me that she had had a similar experience a couple of years earlier. If I had talked to her before setting my schedule, I might have chosen something else.

The next question is when to do your rotation. If you are embarking on an "audition rotation" with a program you hope to join or are working with a physician from whom you desire a recommendation, earlier in the year is better.

Visiting in August or September is optimal because it gives enough time for people to complete letters of recommendation, and you can also avoid residency interview season, when a residency program's attention is elsewhere. July is usually less desirable -- especially if you are hoping to gain procedural exposure -- because the focus then is on training new interns. November and December are when faculty members take holiday vacations, so your time may not be as fruitful.

The last and most commonly overlooked step is to make contact with the site you hope to visit early in the planning process. Ask to speak directly with attending physicians with whom you will be working. Let them know what your career plans are, why you are considering spending time with them, and what specifically you are hoping to learn. You can also ask about their expectations for students and what you can expect when working with them.

This not only gives your future preceptor a chance to know what your goals are, but it also can tell you whether the practice will give you the experience you want. Your preceptor can also tell you if the timing of the rotation will work for them. The information you gain from your potential supervising physicians can help affirm your choice or signal that your time may be better spent elsewhere.

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