3rd year student - Should I do an away rotation in ENT?

[kastle6797]

Hey guys here's the deal. I am an MSIII in the Northeast that's pretty set on ENT. My wife is pregnant and (if all goes well) will have a baby in late August/early September. Her family lives in Texas and we really want to go there to have their support during residency. At this point I don't know the specifics of each program but would strongly consider any of them based on their location in Texas. Step 1 is 251 and 3rd year grades are not back yet (probably 2HP and 1H). Research-wise I'm getting started on a prospective study now but trying to get involved in something more short term (i.e. retrospective) that I can at least have on paper. My question is, should I do an away rotation in August or September at a Texas program or is it not worth it (based on the gamble of away rotations in general)? I ask because I don't want to miss out on my wife's delivery but really feel like I need to find a way of getting my foot in the door in Texas.

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[Leforte]

Don't miss the birth of your child.

Away rotations can be good or bad - we have discussed this here in the past. There is also a cultural difference between the NE and Texas (or really any place and Texas !) - which may or may not "help" you if you did an away rotation.

My personal opinion is that 90% of applicants look better on paper than they are in person. And unless you are a rockstar and keen on a particular place, I would not do an away rotation. In fact, when ranking applicants, I have observed that candidates often are ranked lower than they otherwise would since it only takes one faculty to say something negative and out of respect, most of the other faculty will agree to rank the candidate lower.

If you are keen on an away - You could look at July or October. if you must go in Aug/Sep, go in August since the Academy meeting is in September and the faculty will be gone for a week.

 

[neutropeniaboy]

My question is, should I do an away rotation in August or September at a Texas program or is it not worth it (based on the gamble of away rotations in general)? I ask because I don't want to miss out on my wife's delivery but really feel like I need to find a way of getting my foot in the door in Texas.

Doing an away rotation is a tricky thing to do successfully.

In order to really be fully understood by the faculty and residents, you must rotate at an institution. In order to overcome any potential shortcomings on your application, you must do an away rotation at a place (or places) where you could potentially match. However, in doing so, you must ensure that you don't doom yourself to rejection by showing the faculty and residents that you are unfit for that particular residency. Otherwise, you should just apply to the program without doing an away rotation. In doing so, the faculty and residents may not have a full grasp of who you are and could potentially overlook real-world shortcomings you have.

Modified catch-22?

I personally have been subjugated to all four possibilities:
1. As a student, nail a rotation and be wanted
2. As a student, screw myself on a rotation
3. As an attending, shoot down a medical student because of observed shortcomings
4. As an attending, like someone who didn't rotate who subsequently turned out to be a dud.

I generally tell students not to do rotations simply because (as LeForte said) 90% of students ruin their chances by doing a rotation away. Why? They're annoying. They are either too eager or not eager enough. They try to outshine other students or (worse) residents. They aren't prepared for cases. They don't take overnight call. Quite simply, they show themselves not to be hard workers or knowledgeable. Less often, there are a few students out there who just "get it" and work their assess off during the rotation, are normal people, and are prepared and knowledgeable for their level.

On the other hand, I've interviewed some students whom we as faculty have universally loved, but after making phone calls have come to realize that they ain't what they said they were. Reverse is true too.

Yes, we make phone calls. Otolaryngology is a small field, and faculty members know a lot of people in different places. During this interview season, I have either emailed or made phone calls to colleagues at 15 different institutions -- all concerning our top 15 candidates.

So, you'll have to roll the dice.

If you think you can exceed where 90% of students fail, do the away rotation.

 

[Germanada]

Thanks first of all to neurtropeniaboy and leforte for their perspectives. I have a similar question regarding aways, but with a bit of a twist.

ENT is one of the two specialties I am strongly considering. I am going to medical school in Canada (one of the two big name academic schools there), and would like to do residency in the States (particularly since Canadian ENT programs are not eligible for the US boards - I like keeping my options open).

Even though Canadian graduates don't count as IMGs in the match, I was wondering whether programs would want me to have done at least one rotation in the U.S. system, seeing as how the two medical systems are indeed different; particularly considering the added pressure of needing to secure an H1 visa, which not all programs sponsor.

On the one hand I wouldn't want to mess with my chances of matching by doing an away (seeing as how 90% of students don't appear to convince you guys on aways, claiming "I will of course be one of those top 10% who do" is probably a tad arrogant ), on the other hand I don't want to mess up my chances of matching by not getting U.S. experience?

What's your take on this? Thanks in advance for the advice, I really appreciate it.

Oh, and congrats to the OP - you must be so excited!

 

[kastle6797]

Thanks to the above posters. Your input is much appreciated.

 

[Butler]

For students that don't have a program at their home institution, aways are pretty much a necessity no? What would be your advice for someone like myself interested in ENT without a home program.

 

[VisionaryTics]

Just wanted to bring up an article in this month's Archives of Otolaryngology -- Head & Neck Surgery.

Qualities of Residency Applicants
Comparison of Otolaryngology Program Criteria With Applicant Expectations

Liana Puscas, MD; Scott R. Sharp, MD; Brian Schwab, BS; Walter T. Lee, MD
Arch Otolaryngol Head Neck Surg. 2012;138(1):10-14. doi:10.1001/archoto.2011.214

ABSTRACT


Objectives To evaluate the criteria used by otolaryngology programs in ranking residency candidates and to compare residency candidate ranking criteria among otolaryngology programs and applicant expectations.
Design Cross-sectional, anonymous survey administered during the 2009 and 2010 match cycles.

Setting Otolaryngology residency programs.

Participants Otolaryngology residency program applicants (PAs) and otolaryngology program directors (PDs).

Main Outcome Measures The PDs were asked to rank the importance of 10 criteria in choosing a residency candidate on a 20-point scale (with 1 indicating utmost importance; 20, not important at all). The PAs were asked to express their expectations of how candidates should be ranked using those same criteria.

Results The interview and personal knowledge of the applicant (mean rank, 3.63) were the most important criteria to PDs, whereas the interview and letters of recommendation (mean rank, 3.65) were the most important criteria among PAs. Likelihood to rank program highly and ethnicity/sex were the least valued by PDs and PAs.

Conclusions Although PDs and PAs agree on the least important criteria for ranking otolaryngology residency candidates, they disagree on the most important criteria. This information provides insight into how programs select residency candidates and how this compares with applicant expectations. Furthermore, this information will assist applicants in understanding how they might be evaluated by programs. Improved understanding of the match process may increase the likelihood of having a good fit between otolaryngology programs and matched applicants.

From the comment section:

Given the utmost importance placed on personal interaction (either through the interview or personal knowledge of the applicant) by PDs, PAs interested in a particular residency program may want to consider doing a rotation at that site. For every applicant doing his/her OHNS rotation either at home or away, our survey confirms that this rotation is an audition, and an applicant's performance will weigh heavily in the ranking process. This has been found to be true in another competitive specialty, namely, orthopedic surgery, in which away rotations increased the chances of matching.23

 

[Leforte]

I believe that our comments in the previous posts support the article. We all agree that an away rotation is an audition. Unfortunately, people can perform poorly in their away rotation and the personal knowledge of the applicant IS used to rank the applicant - near the bottom of the list.

I do not see in the article any comments that doing an away rotation increases your chances of matching at the programs where away rotations were completed.

Also, as we have said before the interview is VITAL to getting a high position on the rank list.

 

[Fah-Q]

The wildcard here is that the OP is from the northeast and he wants to match in Texas. We all know that there are regional biases in the match. An away rotation would demonstrate a sincere interest in wanting to change locations.

Might I suggest that you look into doing a rotation at MD Anderson. You would get exposure to residents from 2 residencies (UT-Houston and Baylor), get to work with some big names, and see some great cases. Can you do it in July or October?

 

[OtoHNS]

The wildcard here is that the OP is from the northeast and he wants to match in Texas. We all know that there are regional biases in the match. An away rotation would demonstrate a sincere interest in wanting to change locations.

Might I suggest that you look into doing a rotation at MD Anderson. You would get exposure to residents from 2 residencies (UT-Houston and Baylor), get to work with some big names, and see some great cases. Can you do it in July or October?

Yeah, the geography issue is actually important. If those TX programs know you want to move to TX, it will probably boost your chances for an interview.

Another option would be to let the TX programs know that you are particularly interested by either emailing/calling them or having faculty from your school contact people they know.

 

[ayushman80]

Would it be safe to say that the same qualities that a person needs to honor core rotations are the same qualities they need to succeed in away rotations? If someone has done well on cores, they should look fairly good on aways, right? Basically, from what the attendings here have said in order to do well on away rotations: Read up on cases, be nice to everyone, do overnight call, and don't let 4th year senioritis settle in too early.

 

[OtoHNS]

Would it be safe to say that the same qualities that a person needs to honor core rotations are the same qualities they need to succeed in away rotations? If someone has done well on cores, they should look fairly good on aways, right? Basically, from what the attendings here have said in order to do well on away rotations: Read up on cases, be nice to everyone, do overnight call, and don't let 4th year senioritis settle in too early.

Yes, this is all true. There's a couple other things to keep in mind, though.

1. You are much more likely to be late/be slow/get lost/look like an idiot on an away rotation because you are new and don't know your way around/don't know the EMR system/etc. People are going to unconsciously judge you relative to medical students from that school who will presumably not have these problems. Unfair? Of course. But true nonetheless.

2. Attendings and residents are less likely to give you the benefit of the doubt compared to medical students from there. Home medical students are at least somewhat "part of the team," and it's in a program's best interest that all of them match. You are not part of the team as an away rotator, and thus the margin for error is less.

Not to say that it can't be done, but just assuming that your performance will be the same as at your home institution is a recipe for making a bad first impression.

 

[medstylee]

my advice is to go for the away rotation. i did one and matched at a program that i'm not so certain i would have matched at otherwise (mainly b/c of geography). i have now seen several rotators come through my program, both good and bad. it's just my opinion, but i don't think it's too hard to impress a program if you are likeable, smart and not lazy. trust me, you'd be surprised to see how lazy some (or many) rotators can be. figure out early on how to be most helpful (gathering vitals, pre-rounding, writing notes... it's different at each place) and do that. don't be annoying in doing so (a pitfall for some). we don't expect much from you surgically - but when we allow you to suture, tie, etc, we expect to see you learning from the things we teach you. read a lot, even if you're tired. don't spout off your knowledge in a way that makes people think you're showing off (something a lot of us hate!). you're most likely going to have to do a presentation of some sorts (some places a small talk for residents, some places make rotators do grand rounds!). In any case, kill that presentation. May sound silly, but that will probably play a big role in your evaluation. Follow the rules. If they tell you less than 10 minutes, keep it to less than 10 minutes. It's really annoying to sit through a 20 min talk that was supposed to be 10 minutes, especially when the other students follow the rules. Pick an interesting topic - try to pick something that will be interesting and perhaps novel to everyone, even the senior residents and attendings who seemingly know everything...

anyway, those are my rules, based on my observations. i can tell you that the applicants who rotate with us get a lot more airtime when we have our rank meeting because we know so much more about them. oh, and about being at a disadvantage compared to the home institution students - that probably won't be an issue if you rotate in, say, September when the home students have already mostly passed through. best of luck.

 

[JennLinnC]

I have sort of a different question regarding otolaryngology rotations. Are they hard to get? I know that the field itself is very competitive, so I would imagine that the away rotations are competitive as well. I have no upper classmen to ask so any input would be appreciated.

 

[ZagDoc]

I have sort of a different question regarding otolaryngology rotations. Are they hard to get? I know that the field itself is very competitive, so I would imagine that the away rotations are competitive as well. I have no upper classmen to ask so any input would be appreciated.

Not necessarily but I'd apply early and apply to a several (you can always decline if you receive more than one invitations). I remember when I went through the process I applied to a couple, and had to write a couple "why I want to rotate here" letters. A couple places also required letters of rec, board scores, CV, etc. Organizing aways can be tricky. Different medical schools are on different rotation schedules (i.e. dates don't match). Certain programs are "popular rotation sites" with a lot of applications. Certain schools have a lot of sub-i's certain years and less room for rotators as a result. If you're dead set on a certain program, phone calls (esp from a faculty from your program who is affiliated with the place) can help.

 

[JennLinnC]

Thanks for the reply. I'll be doing rotations and Geisinger Danville and Ohio State and a Sub-I at Georgetown. Any tips on how to win them over and get some good recommendation letters?

 

[Chakrabs]

Thanks for the reply. I'll be doing rotations and Geisinger Danville and Ohio State and a Sub-I at Georgetown. Any tips on how to win them over and get some good recommendation letters?

You win em over the same way you win over any rotation - first one in, last one out; know your anatomy cold; ask the seniors if they have any case reports or projects they need to finish and then go finish them; be cheerful. Its really not that difficult.