Should You Do ‘Away Rotations’ As a Fourth-Year Med Student?

When Katy Wyszynski, DO, was a medical student, she pursued three away rotations in emergency medicine.

She purposefully chose month-long rotations that were distinct from one another — one at a level 1 trauma center, another at a level 2 trauma center, and one in Philadelphia at “a very high acuity trauma center,” she said.

“Through these rotations, it really showed me that I did want to work with patients and populations that were more underserved and like a true safety net hospital, rather than a different type of shop,” Wyszynski said.

An away rotation generally refers to a month-long clinical rotation medical students apply to and complete outside of their home medical school.

There are many different terms for an away rotation, Wyszynski said, including rotating internship or sub-internship. These terms all basically mean the same thing.

“It’s a chance to work with faculty and residents at that institution, as a way to learn and to help sort of support your own application to residency,” said Sharad Jain, MD, associate dean of students at UC Davis School of Medicine, Sacramento, California.

Everyone will experience something a little bit different from doing an away rotation, said Wyszynski, who is now beginning her second year of emergency medicine residency at JPS Health Network in Fort Worth, Texas.

“I got so much hands-on experience from doing procedures to even seeing really sick patients alongside the residents and the attendings, and the teaching that’s associated with that really is invaluable,” she said.

It varies whether residency programs expect medical students to complete away rotations, Jain said.

Some of the more competitive residency programs — including those in orthopedic surgery and dermatology — often expect medical students to take on away rotations, he said. “I think some of the more competitive fields want to see how you’re going to perform in those areas.”

However, for other specialties — such as the primary care fields of family medicine and internal medicine — it’s not at all expected or even recommended for medical students to do them, Jain said.

Still some students hoping to pursue those fields may choose to do them anyway.

“You do these away rotations in the specialty that you are applying…to kind of get your foot in the door as a medical student,” Wyszynski said.

“So it really does go both ways in my perspective,” she added. “The medical student is truly auditioning, doing an audition rotation or an away rotation to be evaluated. But then the student is also evaluating the program to see if they would be a good…match.”

Do away rotations really help medical students find and land their desired residency spots? Once a medical student decides to pursue an away rotation, how do they find the right one?

We lay out what you need to know about sub internships from applying early to making professional connections while there.

Letters of Recommendation, Exposure, and More

Those interested in pursuing emergency medicine need two formal away rotations to be a competitive applicant, Wyszynski said.

In this case, it is important to obtain a Standard Letter of Evaluation or SLOE, she said. A sub-internship provides a student the chance to get such a recommendation letter.

The letter requirement allows residency programs in emergency medicine to compare applicants “in a very similar manner,” Wyszynski said. Emergency medicine is a rigorous residency program with a “very difficult schedule,” she said. “So it really helps, both the program and the applicant identify and confirm, ‘I really want to do emergency medicine.’”

An away rotation also allows a medical student to get exposure to the field of emergency medicine because not all medical schools require it as a core rotation in the third year of training, Wyszynski said.

Other fields — including most surgical specialties — also recommend away rotations,she said.

“It’s almost like a 1-month interview,” Jain said, “because you are, you’re there every day and they’re asking you questions. They’re seeing how you work with the team. They’re checking out your medical knowledge. They’re really getting a good sense of the applicant.”

Wyszynski ultimately landed a residency spot at one of the institutions where she did an away rotation during medical school. The third-year residents impressed her with how smart, competent and capable they were. “And I thought to myself, ‘I want to be that type of doctor.’”

Other students who are pursuing fields that don’t necessarily recommend an away rotation such as family medicine may choose to do one anyway.

Heather Barnes, who is just starting her fourth year of medical school at Arizona College of Osteopathic Medicine in Glendale, Arizona, hopes to ultimately pursue a residency in family medicine. She chose to sign on to five away rotations because for her it was really about returning to Northeast Ohio where she is from and where her husband is currently a medical resident. Barnes then plans to complete her remaining core rotations in Ohio as well. She sees her away rotations as an audition of sorts for residency programs.

“I think you can showcase more during a whole month being there than just an hour-long interview,” she said.

Even if she wasn’t trying to move back to Ohio, Barnes said, she would have pursued away rotations anyway.

Arizona College of Osteopathic Medicine isn’t affiliated with a home hospital like many other medical schools are, she said. It does have a few affiliated hospitals with dedicated residency programs, Barnes said, but they are rural and not anywhere near the campus.

“For family medicine, for internal medicine, it can be helpful to see a program and to get your foot in the door…,” Wyszynski said.

It comes down to how important it is to have a sense of security during the Match process, Barnes said. “I think for me, it was just nice to have multiple auditions. Like that way when I get to a rank list, I’ve had interface at multiple different spots in Ohio so my chances of staying in Ohio are greater.”

Going on an away rotation, for her, also is a signal of personal expansion. She obtained a master’s degree in Illinois prior to medical school, “and I really do think that these pivotal life moments of living in a completely different state, completely starting from scratch, not knowing anyone, they really served as a nidus for the most growth I’ve had in my life ever,” she said.

Start Early

Barnes advises students interested in pursuing one or more away rotations to start planning them early. She began applying and scheduling her five sub-rotations back in December.

“Basically from January until May, I was submitting applications on VSLO [AAMC’s Visiting Student Learning Opportunities system], reaching out to programs directly, really like emphasizing ‘I want to come here. I’m really interested in getting back to Ohio,’” she said.

Students interested in away rotations should reach out to education and/or clinical coordinators, Barnes said. “Look for hospital officials with titles like residency coordinator or rotation coordinators or education coordinators,” she said.

“Don’t fall into the group of people that’s like: ‘You know I’m stressed right now. I feel super busy right now’” and procrastinate starting the process, Barnes said. Try to take an hour out of your day and begin the application process.

“Sitting down to organize something that will help you exponentially in the next few months is like, it’s really such like a mental shift to think that way,” she said.

‘Shoot Your Shot’

Regardless of the specialty, if you are really interested in a specific program, even if it’s a reach program, and you don’t think that you necessarily would get an interview or they would even accept you for an away rotation, “I would say shoot your shot,” Wyszynski said.

“It doesn’t hurt to apply to these rotations. You can apply to any rotation anywhere in the country regardless of where you go to medical school.”

That said, there are certain downsides to away rotations. “The financial strain is a very real downside of these away rotations,” Wyszynski said. Many institutions offer financial stipends for housing, she said, but it’s not always enough.

For that reason, many people do at least one away rotation relatively close to where they already are located geographically, she said. That’s not always possible, especially if a medical student is interested in pursuing a competitive specialty such as orthopedic surgery where you might have to take an away rotation far away because it’s the only one you can get, she said.

Despite some potential difficulties, they’re worth pursuing, said Wyszynski, who is also president of the American Academy of Emergency Medicine Resident Student Association.

“I would say that I made invaluable connections when I was a medical student that I still use as mentors during residency,” Wyszynski said.