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Much like every other piece of advice you are given in medical school, advice about how to set up your fourth year elective rotations often get brushed off until, well, right before fourth year. Some medical schools have a very seamless process of setting up electives, but if you are an international medical student, you are pretty much on your own. Furthermore, if you are trying to do an elective rotation outside of your network, you have your work cut out for you.

What remains true for every student, however, is that fourth year electives (especially those during the summer before ERAS is submitted) are very important. Despite what you may think, program directors actually do care about what electives you are doing, and will often ask you about them in your interview. While it may be completely overwhelming to even think about scheduling AWAY rotations while you are struggling just to plan out your regular electives, trust me: it will be worth it in the long run.

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First of all, it’s important to make a distinction between an “away rotation” and an “out of network” rotation. Basically, your medical school has a set of contracts with various hospitals around the area (or even the country with many Caribbean medical schools). A regular away rotation within your hospital network is much more straightforward to secure, while trying to go out of network can be extremely painstaking, and you have to plan ahead for these (more on this later).   

So if this can be such a complex process…why is it worth it? 

Varied Clinical Experience

If you are an IMG, you know that sometimes we get placed in less than favorable hospital situations. Often times, program directors are worried about how your clinical experience in an unknown community hospital compares to academic medical centers associated with U.S. medical schools. One way to squash their concerns is to demonstrate that you have a variety of clinical experiences that have contributed to a more rich learning experience. Securing away rotations at other hospitals, especially more ‘well known’ institutions can really help make your case to program directors during residency interviews.

Letters of Recommendation

We all know how uncomfortable it is to ask for letters of recommendation when you feel like you never got solid 1:1 time with an attending. Furthermore, you may not have had the opportunity to work with multiple attendings in your chosen specialty. By planning away rotations for the summer before ERAS in your chosen field, you will have an opportunity to demonstrate your work ethic and passion to another attending in your field, and be able to secure an additional fantastic letter of recommendation just in time to submit to ERAS. By this point in the year, you will have honed your skills as a medical student and will likely garner a lot of respect from this new group of medical professionals!

Demonstrate Your Commitment to Your Specialty

In this highly competitive residency application process, program directors are paying close attention to what they perceive to be your level of commitment to their specialty. Especially if you are applying to certain specialties that are considered “backup” specialties to some, program directors are especially meticulous in weeding out the “backup” candidates. It’s for this reason that it especially important that you demonstrate your commitment to your specialty. This is difficult to do, however, just by repeating multiple rotations within your own institution. Show your commitment by going out of your way to schedule (and nail) away rotations in your specialty.

A Chance to Audition

What better way to show a program what an outstanding candidate you are than to work your ass off for them for a month? This is exactly what an audition elective is, and it is essential that you schedule these to improve your chances of landing an interview, and eventually a match into your preferred program! Often times programs will automatically interview individuals that auditioned with them. Unless you are applying to only a few programs, it's in your best interest to schedule as many away “audition” rotations as possible! 

What’s left to consider?

Ok, so now that I've convinced you that you should schedule some high quality away rotations, there are some major things to consider. First of all, scheduling away rotations even in network can be quite obnoxious. We all know that med-ed coordinators can be extremely hard to get ahold of and sometimes very difficult to work with. For this reason, you must plan ahead. Think about when and where you would want to do these away rotations and do your research.  What information do they need? What are the time frames in which you are allowed to apply? Is this particular rotation very competitive? You must think about all of this in advance. And, if you are planning to do an away AND out of network rotation, be prepared to jump through a lot of hoops. In these cases, ‘single elective affiliation agreements’ between your school and their hospital must be signed and reviewed by lawyers. Some institutions even require you to provide your own insurance, or even will charge for the application or rotation, itself. 

For all of these reasons, and the consideration of how important away rotations are in your pursuit of a residency, it is essential that you start the process of securing your coveted spot as soon as possible!  Do your research, make your calls, and most importantly, BE POLITE, courteous, kind and grateful. You never know who is watching!


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Leila Javidi

Leila Javidi

Leila Javidi, MD, MPH is a graduate of Saint George's University, a Family Medicine resident at Mount Carmel Health System, and a certified consultant with MST Consulting. Although she had never before considered herself a “standardized test guru,” over the course of her first few years of medical school she developed a fool-proof study style — and crushed her exams. She loves to teach and she prides herself on her ability to motivate students to achieve their maximum potential. She is most known by her students for her sense of humor, her ‘pep talks’ and her ‘no-excuses’ study mentality.
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