The ULTIMATE GUIDE for Matching into Competitive Specialties – PART TWO

How to SHINE on clinical rotations and away rotations

Overview

• Mindset
• Rockstar habits
• Studying for shelf exams
• Things to avoid doing
• Away rotations

WARNING: This is a long, detailed guide. If you don’t have a bunch of time and just want the key points, skip down to the different bolded key-words in the section subtitles that may interest you. I plan on uploading a High Yield Summary of this information in the next few days, so look out for that.

Intro: First of all, if you have made it to your third year clinical rotations, CONGRATULATIONS! For most of you, this means you are past the step one hurdle (although I know many programs are switching schedules so that you take step one AFTER you have some rotations under your belt). Most people like third year much better than years one and two because they are finally in the hospital or clinic, doing exactly what they came to medical school to do — take care of patients. For others, third year is particularly stressful because of the subjective nature of grading via evaluations. I was in the latter group. I DID NOT ENJOY my third year. Luckily, though, I was given some good advice (and combined it with common sense) on how to make it through with flying colors. I was blessed to come out of third year with outstanding grades in all of my core clerkships. Over the next few paragraphs I’m going to tell you how to do the same.

MINDSET

Ok, so if you read part one of my guide, you already know how important it is to believe you can do well, so I won’t rehash that (go back and read part one if you need a refresher). For your clinical clerkships, the main things I will focus on regarding mindset are being open-minded, flexible, engaged, a team player, and bulletproof (not taking things personally). I’ll talk about WHY here, and HOW in the next section.

Be open-minded.

• I know you think you know what you want to do… but you really might not. Fun fact: At different times in my journey I wanted to do Sports Medicine (majored in it in undergrad, so thought maybe I wanted to do physical medicine and rehabilitation, or maybe even orthopedic surgery!), OBGYN (but then I HATED my 3rd year rotation), and finally dermatology. I also really enjoyed psychiatry and adolescent medicine (subspecialty of pediatrics).

• Seek out experiences! I never got a chance to shadow or rotate in ophthalmology, interventional radiology, ENT, plastics, etc. Who knows if I would have fallen in love or not? I only experienced dermatology (and fell in love) because I specifically sought it out.

• Main point here: during your third year, try to approach each rotation as though there were a possibility you might actually enjoy it. You really never know how your career path may change, or what will click.

Be flexible.

• This is the name of the game for 3rd and 4th year. You will learn: medicine is as much ART as it is science. This can be frustrating because preceptors and attendings will want different things from you, sometimes opposing things. Be ready to adjust quickly from person to person, and don’t complain.

• Let me repeat part of that last bullet point for emphasis: PRECEPTORS WILL WANT VERY DIFFERENT THINGS FROM YOU. One will say she wants you to be very detailed in your presentations each morning, the next will say he wants you to report only pertinent changes since yesterday. One will say be prepared to present a brief topic every day on rounds, another will say there is no time for that. One will say medical students should always stay for afternoon rounds, another will say go home and study. You can’t control how wide the swings will be between the desires of attendings/residents. All you can do is EXPECT them and PREPARE for them.

• It is much easier to be flexible when you are prepared. You get prepared by asking students who took the rotation before you how it went and how different attendings were and asking each preceptor their specific expectations for you on the first day that you work with them (more on that later).

Be engaged.

• Success in the preclinical years was based mostly on your test scores and grades. In the clinical years and beyond, your success will be a function of how many people know you and like you. SO, always act interested, even if you are not. Lack of interest on your part will lead to lack of investment from your preceptors, which will ultimately affect your grade.

• Learn the art of LOOKING engaged even if you are groaning on the inside, itching to go home and watch basketball wives. Body language is important. Ask questions. Offer to help. Speak up on rounds. Don’t ask to leave early.

• Avoid being on your phone. I get it… you were actually looking up pancreatic pseudocysts on your Up To Date app. It honestly doesn’t matter what you were actually doing, if your preceptor sees you on your phone, the first assumption will be that you are texting or on social media. If you really must google something, SAY OUT LOUD that you are about to look something up before you just pull out your phone. Try to bring a tablet or small pocket book to look up information instead (unless your preceptor EXPLICITLY says he/she is a fan of cell-phone usage on rounds).

• On each rotation, the preceptors and residents are going to ask you what you want to go into. Don’t feel the need to tell them what you want to do (particularly if you want to do something very competitive). Unfortunately, once people know you want to go into another specialty, any small, wrong action can look like you’re uninterested because you are going into something else. If people think you are uninterested and unengaged, this will affect how much they like you, and ultimately affect your grade.

Be a team player.

• Your success will NEVER depend on you making another student look bad. If you feel you have to do this, first of all you’re a terrible human, and secondly, everyone can tell you’re a gunner and therefore… you can’t sit with us.

• Look at the other students as members of the team. They are not your competition! You are competing with YOU from yesterday. Do you know information you didn’t know yesterday? Great, you’re winning. Are you better at suturing than you were yesterday? Excellent, what a win. Do more attendings/residents know you and like you than before? YOU ARE LIT.

• For those of you that don’t know how to be team players, I’ll just give this explicit advice: do NOT answer questions attendings directed at another student. Do NOT offer information regarding another student’s patient on rounds (give it to them directly, just like you would have wanted them to do to you!). Follow the golden rule here. Honestly, if residents or the attendings catch a whiff that you are doing these kinds of things, wave your good grade good-bye. No one likes a gunner.

Be bulletproof.

• Patients will change their story in front of the team. Earlier in the morning, they told you they never had any surgeries in the past… then on rounds they tell the attending they had two open heart surgeries, a knee replacement, and a boob job. It’s the most ANNOYING thing imaginable. You will be embarrassed because it will make you look like you didn’t ask those questions, or WORSE, like you lied while rounding. Please know, this happens to the BEST of us. It cannot be avoided. Just keep smiling, take it in stride. Yell about it to bae later.

• Try not to complain in front of members of the team. It brings morale down, and it makes you look bad. Talk to your friends LATER about how annoyed you are that the attending takes 4 hours to round on 5 patients, or how much you hate writing notes. While at work, you need to act like you are loving every minute of this.

• Be tough. You are going to get less sleep than you would like. Some days, you won’t have time to eat lunch. Some of your residents or attendings will be mean to you for no reason. You may sit in the wrong chair in the auditorium and get snapped on about it. You might talk to slowly on rounds and get snapped on about it. You will get asked questions you don’t know the answer to in front of the whole team. Another medical student may be a gunner and hide information about your patient from you. These things will happen. Take a deep breath, and let them roll off. You have made it this far because you are READY for this. Don’t let any of these jerks ruin your future for you. You can do this.

• Try to remember: these are the days you prayed for. You asked to be here. You FOUGHT to be here. You are PAYING to be here. Don’t mess it up with a bad attitude.

• A quick word on learner mistreatment. There IS behavior that is over the line. It is never OK to be sexually harassed, cursed at, physically assaulted, or demeaned. If any of these things happen, please find out the appropriate authority to report this behavior to.

• Lastly, to be bulletproof, sometimes you have to admit that you don’t have it together. Maybe you are dealing with anxiety or depression. Maybe you are burned out. Maybe you are ill. Please get the help you need to make it through. Remember that therapy/counseling works wonders. See your doctor if you need to get checked out. You can’t run on empty, make sure to take care of yourself.

ROCKSTAR HABITS

First things first: Get to work EARLY EVERY DAY (early, not on time) and never ask to leave early (except in cases of emergency, and then make that clear)

Things to find out at the VERY BEGINNING of each rotation:

• Who is evaluating you? Will it just be attendings? Will is be residents and attendings? Do you have to give paper evaluations to multiple people over the course of the rotation? Will you have someone new evaluating you once a week?

• THIS IS CRUCIAL: Find out the expectations your attending and residents have for you at the beginning of each rotation (or every time they switch). Note: different attendings and different residents have different expectations. If you don’t know them, you can’t fulfill them. Unfortunately, if you don’t ask for them, they may NEVER tell you, but they will still grade you against standards you never knew they had.

• How many patients are you expected to follow on the team? Are you supposed to be writing notes in the computer and signing them over to a resident? Are you supposed to be writing notes and signing them over to the attending? How would they prefer you present patients on rounds (Quick presentations with only new and pertinent information such as abnormal lab values etc, or longer, more detailed presentations, including reporting normal findings and lab values)?

• Who are you going to be working with? Residents, or directly with the attending? How can you contact them? Do they want you to text them, page them, call them, or just go looking for them? Believe it or not, the answer to this question can vary widely.

• Are there lectures and conferences you are supposed to be going to as a medical student? Where are they, when are they, and who do you need to tell before you go so no one thinks you’re just roaming the halls?

Develop a system for pre-rounding.

• For each patient I would look at nursing notes for overnight events, then vitals and ins/outs overnight (and record the ranges), then AM labs (or following up any labs that may have been ordered in the evening), then imaging or other studies from the day before, then I would look at the medication reconciliation (to make sure they were actually getting all the medications that were ordered, confirm that all medications were still indicated, confirm none had fallen off, and to check how often they were needing their PRN, or “as needed” medications such as pain medications and anxiety medications). After looking at all this, I would go see the patient.

• Make sure to know any major events that happened over the past 24 hours. Did the patient get a procedure? Were there any changes in their mental status? As the medical student, you will not be the first person made aware of these things. In fact, very often, your intern or resident will know first because nurses call/page them directly. The only way you can know this information is by making it your priority to stay informed, keep in touch with the nurses, and tell your intern/resident that you want to stay involved so they give you information as it comes up.

• Always remember to think GLOBALLY about the patient as well. This includes things like:
  • Is the patient on IV fluids (and if so, should they be)? Are their electrolytes low? What diet are they on? Do they need some type of medication for GI prophylaxis? What medication are they on for DVT prophylaxis and why? What lines and tubes do they have in (including arterial lines, peripheral IV’s, central lines, foley catheters, g-tubes etc), what date were they put in, and do they still need them? What is their code status? What is the contact information for the patient’s next of kin?
  • As a medical student, you have the most time of anyone else on the team because you will be carrying less patients than the interns/residents. This means you should be the EXPERT on the details about each of your patients.
  • Quick note: if you know something about your patient that your intern or resident doesn’t know, NEVER try to show them up in front of the attending on rounds. REMEMBER: the game is how many people know you and LIKE you. That’s rude and embarrassing, just don’t do it. If you have information you think is important, make sure to pull your intern aside and let them know. It’s also important for patient safety: as a medical student, you may not know if immediate action needs to be taken based on the information you have.

• If you are on an outpatient rotation, all of this changes. Instead of the above tips, look at the previous notes in this clinic for return patients and have an idea of what the interval plan was supposed to be so you can follow up on how well the patients complied, and how well treatment plans worked. If it is a new patient coming in, know which questions to ask them based on the rotation you are doing.

Develop a system for presenting on rounds.

• As previously stated, find out from each attending how they want the medical student to present on rounds. Don’t watch the interns/residents present and assume the attending wants you to present the same way. Attendings often want the students to give more detailed presentations than the residents, including normal lab values and normal physical exam findings.

• Try to run your plan by the intern before presenting. There won’t always be time for this, but it is helpful if you can.

• Usually, the attending will want you to present in some version of a SOAP format:
  • Subjective: What happened overnight, how the patient feels this morning etc
  • Objective: Vitals, Labs, Imaging studies etc
  • Assessment: One-line statement summarizing who the patient is and what you think is wrong with the patient.
  • Plan: What the team should do for the patient, usually organized by problem

• The SOAP format can be modified in many ways. For example, some attendings will want you to start with a summary statement similar to the assessment before you start talking about the subjective.

• I found it helpful to have my information written out on a sheet of paper in the order I would present it so my presentations were organized and I didn’t forget things.

• Here’s a potential kicker: some attendings DO NOT WANT you to read off a paper for your presentations. Some are ok with you having a paper for reference as long as you aren’t reading verbatim, others don’t want you to look at a paper AT ALL. For the record, I think those attendings are RIDICULOUS, but they exist. I had multiple attendings force me to present without any references. If you are on a rotation with this type of attending, you MUST come in earlier so you have time to get all the information you need, and then truly digest the information so you can present without cues on your paper. Sorry, I don’t write the rules, I’m just trying to give you the tricks of the trade. You can’t say I didn’t warn you!

• Learn how to go through a chest x-ray and an EKG before starting your medicine rotation. Just know or memorize some systematic way of going through them.

Interacting on rounds:

• I’m sure someone has told you in the past that there is no such thing as a stupid question. I’m sorry, my friend. They lied. Questions that you could easily find the answer to on your own make you look like there are key gaps in your medical knowledge. Here is the golden rule for appropriate questions on rounds/in the OR/in general:

IF YOU CAN EASILY GOOGLE THE ANSWER OR LOOK IT UP ON A REFERENCE WEBSITE OR BOOK, DO NOT ASK IT.

• Look up original articles on topics related to your interesting patients on a regular basis. Be prepared to talk about the things you read on rounds. Be careful not to be annoying about this though; find ways to casually integrate one or two lines about something you read in a recent article while you are talking about the plan as opposed to stopping rounds for a dramatic presentation.

• If you don’t know the answer to a question on rounds, say “I’m not sure, but I’ll look that up and get back to you.”

• If an attending tells you to look something up and report to him/her later, actually look it up! Some students will just hope the attending forgets, but YOU will be better than this. Look up the information, and if they forget, remind them casually the next day. “Oh, Dr. B, remember when you told me to look up the proper treatment for such-and-such?” The attending will be pleased that you followed up on the learning opportunity. Three brownie points for you! Just don’t do this when things are busy or people are rushing around. It’s all about timing and flow.

• Find ways to be helpful without being in the way. Learn where the team would prefer the medical students to stand or sit. Follow up on labs and tests. Pay attention to how the team positions themselves around the patient’s bed on rounds so that the attending has easy access to the patient for physical examinations. Note where the light switches are in the rooms so you can turn them on or off as needed. Take note of what size gloves people wear so you can pass them along. If a particular resident is always asking for saline or gauze or tape, carry some around in your pocket and provide it when they ask.

• Try not to be annoying. This is really hard, because “annoying” is subjective. Avoid  constantly following residents/interns around, and asking questions when people are clearly busy or stressed.

• For surgery, it is particularly important to be helpful without being in the way. When you know you’re going to scrub in on a case, find out which OR it will be, try to go in early and help set up IF the techs/nurses want you to/find that helpful. On some surgery rotations, it is even appreciated if you help prep the patient before the attending comes in. learn what size gloves people use and have them out and ready. Always identify yourself as the medical student when you walk in. Review pertinent anatomy before cases. Don’t distract the attending when he/she seems very focused. Try to find more relaxed moments to ask questions/make observations.

• Take note of “TO-DO’s” for your patients and offer to help with the ones that can be done by a medical student. You likely cannot place orders or do procedures, but you can offer to call family members to update them on the patient’s progress, or follow up with the social worker regarding the status of a patient’s rehab placement, or running a stat blood sample down to the lab. By doing these little tasks you are being truly helpful to the team, making your intern/resident’s life much easier, and taking charge of your patient’s care.

• If you are told to leave early, feel free to leave early. You can give some pushback if you really think of a way you can be helpful, but to be honest most of the time you staying there just means more work for the resident/intern. Go home early, read, study, eat, see the sun.

Ask for feedback.

• ALWAYS start the rotation by asking what is expected of you! After that, at certain intervals (ie weekly) ask for feedback about whether or not you are reaching their expectations. Make changes right away based on their feedback.

• If I was going to be working with an attending for two weeks, my feedback schedule would be something like this:
  • Day one – ask for expectations
  • Day 7 – ask for brief feedback
  • Day 12 or 13 – ask to schedule a brief meeting for feedback at the end of rotation

• When you ask for feedback, make sure you are specific. The average person isn’t great at giving constructive criticism because it is awkward. So when you ask, “How have I been doing on the rotation?”, a typical answer will be “Oh, you’ve been doing just fine!”. Four weeks later, when you get your evaluations back, you’ll be shocked when they rate you straight 5/10 on all categories. To avoid this, don’t let attendings get away with weak feedback like “You’ve been doing just fine!”, which means absolutely nothing. Follow up with, “Thank you so much! What can I do to be even better during this next week?” When you ask this question, preceptors are forced to actually THINK and give you something to work on.

• Make sure you actually make the changes they suggest! You should NEVER have to be corrected on the same thing twice. If you get pimped about a topic, make sure you go learn it COLD. Some attendings like to ask you the same question later in the rotation to make sure you learned the answer. The WORST thing you can do is get the same thing wrong twice. That makes it look like you simply don’t care. If someone makes a comment about you being the last medical student to show up every day, be the FIRST to show up from that point on. If they tell you to read more, READ MORE. If they tell you to speak more loudly on rounds, SPEAK MORE LOUDLY on rounds.

• Going back to my point earlier about not taking things personally, if you follow all this advice and still get an average or bad evaluation at the end, DON’T TAKE THIS PERSONALLY! It really does happen to the best of us. There are some attendings that give bad evaluations to everyone. There are others that pick ONLY ONE student per cycle to give an outstanding evaluation to. There are yet others that grade you against “resident-level competency” and therefore give all medical students average grades because they are not on a resident’s level yet (very unfair). DO YOUR BEST and then shrug off the rest.

Letters of recommendation:

• If you are on a rotation with attendings that you will want letters of recommendation from, make sure you let them know you may be interested in this early. I would often wait until I had worked with them for one to two weeks or so, and then after a feedback session, I’d say: “Thank you so much for the feedback! If I were to improve in the ways you suggested, by the end of the rotation would you feel comfortable writing me a strong letter of recommendation?” Other people feel that it is awkward to ask early, and would suggest you waiting until the end of the rotation. Either is fine, but I liked to get an idea of their vibe earlier than later. If their answer to that question was wishy-washy, or lacked enthusiasm, I knew that it would be unlikely for their letter to be strong and that I needed to start thinking about additional letter writers.

• If you want until the end to ask, still make sure to ask if they can write you a STRONG letter. Use your intuition to gauge their response. If they seem hesitant, it will NOT be a strong letter.

• Feel free to ask as many faculty members for letters as you would like. You can pick and choose which letters you apply to certain programs on ERAS later. Also, you don’t have to use all of your letters. It’s good to have them, though, just incase.

Case reports:

• If you are on a rotation and you are involved in the care of an interesting or unique patient, offer to write a case report if you have the time. Not only will this make you look like a rock-star, it will also allow you to develop closer working relationships with the residents/attendings who are co-authors, and it will also result in an extra research publication for your CV and ERAS application. Do as many of these as possible.

STUDYING FOR SHELF EXAMS

I don’t have TOO much to say about this because people study differently. Hopefully after taking step one, you know how you learn the best. I’ll just tell you what worked for me:

• I got review books for each rotation (honestly don’t even remember which books I used except “Step Up to Medicine” for my internal medicine rotation and “Dr. Pestana’s surgery notes” for Surgery). I would try to read through as much of these review books as possible over the course of the rotation.

• My main studying tactic: practice questions and more practice questions. I bought u-world for the whole year and did the u-world questions relevant to each rotation during the rotation. There were also NBME subject-exams (rotation specific practice exams written by the same people who write the shelf exams) for purchase from the official NBME website. I purchased and completed at least one of these per rotation before taking the shelf.

• Read 15 min a day/ do 15 min of questions a day AT LEAST. Try to do this during down time IN THE HOSPITAL. The truth is, when you go home you want to watch real housewives of Atlanta and sleep. You won’t have time to study after getting home everyday. So truly take advantage of downtime in the hospital. As a student, there will be lots of it. (Just make sure if you are going to be studying, try not to be completely out of your intern/residents’ sight for hours on end. Let them know that you will be reading a bit since there isn’t much to do patient-care-wise at the moment, but tell them to contact you if they need anything or if something is happening.)

THINGS TO AVOID DOING

• Lying. NEVER, EVER LIE. I’m not sure why it works out this way, but the day you say you looked at someone’s leg and there was no lower extremity edema, you’ll have a patient who had bilateral below-the-knee amputations a few months ago. One of the most PAINFUL things I had to watch during third year, was an attending berate a medical student for lying that he saw a head CT for a patient. The student said the head CT had been normal. When we looked at it on rounds, there was a large brain bleed causing a midline shift.
• Never report physical exam findings you didn’t see because your intern/resident said it was there or because it was in a note
• NEVER disrespect nurses or other staff. I don’t think I need to give a reason for this. Just be a good person. Also, you are not ABOVE the nurses. The nurses have a completely separate career and job than the one you are training for. They are experts in their field, and you are simply a trainee in yours.
• NEVER pimp your intern/resident in front of the attending.
• Never document or report an important finding without telling your intern/resident
• Never do a procedure on a patient by yourself.

I’m sure there are a TON more, but this is what comes to mind.

AWAY ROTATIONS

An away rotation is basically a month-long opportunity for you to show a program how amazing you are. It is a chance for you to truly get to know the program and it’s residents and faculty members.

For context, I did 3 away rotations in dermatology in the beginning of my fourth year (after one month of dermatology at my home program) for a total of 4 months of back-to-back dermatology rotations. My last away rotation (at Harvard) was actually from late September to early October, after ERAS had already been submitted. I worked VERY hard on all my away rotations, to the point of exhaustion at times. I think it was well worth it because I was able to immerse myself in the different programs’ cultures, have an idea if they were a good fit for me, as well as develop lasting and rewarding relationships with residents and faculty. I picked my aways based on the programs that I ACTUALLY thought I might want to attend, and didn’t spend so much time thinking about the chances that I would get an interview there (I’m NOT saying I recommend this approach, just telling you my story). At each away, I made sure to schedule an in-person meeting with the chair of the program, the program director, and as many other faculty members as possible.

My general philosophy on away rotations: for MOST specialties, MOST students will benefit from doing as many aways as their schedules allow. I say  “most” because there are specific situations in which away rotations can harm you instead of help you, which I will discuss below along with other common questions people ask me about away rotations.

How should I pick which away rotations to apply to?
Ideally, by the time you are applying for aways, you should have an idea of the top ten programs you would like to go to, or a specific area of the country you want to move to. List these programs out and then do your research. On spreadsheets like the ones you find on student doctor network (please proceed with caution, its crazy on there) people will usually comment on the likelihood that people get interviews after getting an away at that program. It is also important to take into account how many spots the program has etc. The most important thing that will affect whether you get an interview there, however, is actually how many connections you have at the program prior to doing your away. The game is always about how many people know you and like you. Go back and look at The Ultimate Guide, part 1, to read about developing connections. If you have NO connections at a program, they only have two spots, and they don’t tend to give interviews to rotators, you probably shouldn’t apply there. After you think about all of this information, just apply where you actually want to go. There is no point doing an away at a place you don’t want to go to just because you want an interview; a month is a long time to waste.

How many away rotations should I apply to?
I knew I wanted to do 3 aways, so I applied to 6. You don’t want to apply to TOO many because you don’t want to get them all, and have to cancel multiple. I would advise applying to 1-3 more than you want to go on.

Should I actually even do any aways?
You should only do away rotations if you know you will be able to shine both clinically AND socially. You don’t have to be an extrovert, but you DO have to mentally prepare yourself to smile and talk to people daily, get there early every day, network, and sometimes even suck up to an attending or two. If you are the type of person that typically turns people off with your first impression, it is not worth it. Keep a little mystery: Just stay at your home program and avoid making a BAD impression elsewhere, which is worse than NO impression.

Many top-ranked medical schools actually advise their students not to go on any away rotations at all. The idea behind this is that if a student is coming from a highly acclaimed medical school, residency programs already have preconceived notions about their academic abilities, clinical prowess, and confidence. If a student from one of these institutions rotates and fails to meet expectations, they may do more harm to themselves than good. For some people, their resume looks better than they look in person.

MOST people will benefit from doing away rotations. You can do almost ANYTHING for a month or two! So, if you know you have a particular location you want to go to, or a particular program you want to go to at all costs, or just want to increase the numbers of interviews you are offered, aways are typically the way to go. You WILL need to make sure you are a complete rock-star rotator, using the tips and tricks in the above guide.

Is there anything I can do to increase my chances of getting the aways I applied for? Apply EARLY, namely the moment the application opens up on VSAS (or on the specific program’s website since not all programs use VSAS). Follow up with the program coordinator within 1-2 weeks after applying to inquire about the status of your application. Knowing a faculty member at the institution may help as well (I initially got denied for one of my aways because there was “no more space”. I emailed a faculty member that I knew there and was scheduled for an away by the end of the afternoon.)

If I cancel an away, is there a chance I may still get an interview at that program?When you apply, the program will eventually get back to you about whether or not the date is available. You are then given time to accept the offer and schedule. Once you are on the schedule, if you get another rotation during the same dates that you would rather go to, you have to cancel, which opens up a spot for another applicant. People have told me anecdotally that they didn’t get interviews at programs they canceled on. This makes sense: when you cancel an away after already having it scheduled, the program assumes that you are cancelling on them for another program you would rather go to. This tells them that they are not high on your list. I’ve been told that if you decide not to accept an away offer before you are scheduled, then that doesn’t look as bad. In my case, I cancelled two aways and still ended up getting interviews at both. Ofcourse, it is better to be safe than sorry. That is why it’s best to apply to a smaller number instead of applying to 20.

How can I shine on aways?
Remember… an away rotation is simply a month-long interview. Do all the things aforementioned in this guide. Try to find a case-report to work on for every away rotation (this will allow you to build a closer relationship with faculty/residents). Make sure that as soon as you get scheduled for the away, you email the program director and chairperson and schedule in-person meetings with them. Make sure to form good relationships with the residents. Be kind to everyone you meet (things you should do at a baseline as well). Try your best not to treat other medical students as competition (even though in many cases, they are). This goes back to the MINDSET we talked about. You have to BELIEVE that what is for you, is for you, and no one can take your spot.

*Pro Tip* Try to activate the version of yourself that emerges when you are with close friends that you are comfortable with. We all have a more comfortable side, which tends to be more fun, nice, and laid back. Try your best to show the program this side of you early, and sustained throughout the rotation.

How early can I ask for letters of recommendation on away rotations?
The earlier the better! It honestly depends on the structure of your rotation. If you will be working with an attending for only a week, it may be worth it to ask after the week is over in a formal feedback session. If you will have the same attending for two or more weeks, you can work for a week and then ask for feedback and ask (as I said above) “If I were to make all of the improvements you suggested, would you be willing to write a strong letter of recommendation for me?” If you are doing away rotations after the ERAS deadline, you cannot get any additional letters at that point. Instead, you should have faculty members that truly love you to make a phone call for you.

OK THAT WAS A LOT OF INFORMATION OMG OMG! If you have any specific questions you think I should have addressed, please contact me!