Personal view or opinion piece
Open Access

Unexplored Questions About Away Rotations – A Student’s Perspective

Jeremy Light[1], Santiago Gonzalez[1], Michael Franzetti[1]

Institution: 1. University of Arkansas for Medical Sciences
Corresponding Author: Mr Jeremy Light ([email protected])
Categories: Curriculum Planning, Postgraduate (including Speciality Training), Research in Health Professions Education
Published Date: 23/01/2019

Abstract

Many fourth-year medical students complete away rotations as elective courses within their specialty of choice. The popularity of away rotations is increasing and has become nearly ubiquitous in certain competitive specialties (Higgins et al., 2016). Benefits include obtaining letters of recommendation, diversifying clinical exposure, expanding research opportunities, and establishing a connection with a residency program. Some disadvantages include cost, stress, competitive nature among applicants, and separation from personal support networks. We are writing this to bring attention to the pros and cons of away rotations, and to the absence of substantial data available in the literature to help us understand the actual impact that away rotations may have on our residency matching outcomes.

 

Keywords: Away rotation; medical school; residency; NRMP Match; competitive specialties

Introduction

Graduating medical students complete an average of 1.8 away rotations in their fourth year of medical school (Higgins et al., 2016). Some specialties such as emergency medicine make it a mandatory task (King & Kass, 2017). In other specialties, and specifically in highly competitive ones, there is an unspoken rule that makes away rotations an additional requirement to successfully match. Regardless of whether away rotations are mandatory, as medical students, we feel pressured to attend a minimum of 2 rotations to demonstrate our commitment to the field we are pursuing.

Advantages

There are significant advantages to participating in away rotations - the most important being the ability to establish a connection with a program. Factors such as “prior personal knowledge of the applicant” and “away rotation within the department” has been ranked highly by program directors as essential factors in selecting applicants to interview and rank (National Resident Matching Program, 2018). Obtaining a letter of recommendation from a faculty member outside of their home institution may incentivize students who choose to do away rotations. Students interested in a specialty not available at their institution may also benefit from an away rotation, as it is the only means for obtaining letters of recommendation within their specialty of choice. Further opportunities to become involved in research activities may also be an additional benefit. Students with exceptional clinical and interpersonal skills may increase their chances of interviewing by going on away rotations, which may be of particular significance for applicants with lower grades and USMLE scores. Applications can also be screened based on the applicant’s geographical location (Nagarkar & Janis, 2018). Historically, applicants tend to be interested in programs that are not geographically distant; therefore, an away rotation at a program in a distant geographical area can increase the chances of getting an interview (Nagarkar & Janis, 2018). Attending a clerkship at another institution allows students to diversify their exposure to clinical practices and teaching styles. It also aids in determining if the applicant’s personality and career goals are a good fit for the program, which is a crucial component when creating a rank list.

Disadvantages

Although there are many advantages of away rotations, they do come at a price. The cost of transportation, housing, applications, and institutional fees add up to large sums of money. A medical student spends an average of $2,000 on each away rotation; however, it is not unusual for a student to spend as much as $5,000–$10,000 on a rotation (Winterton, Ahn, & Bernstein, 2016). These costs may create disadvantages for those students who cannot afford the financial burden of away rotations. In addition to financial hardships, students with introverted personalities who may not be accustomed to being “on” the entire time, may be negatively affected by away rotations. Being away from one's support network, and the competitive nature of fellow applicants may also contribute to the mental and emotional toll experienced by applicants.

Perspective

It is clear that away rotations are an asset to applicants, even when taking into account the costs and potential disadvantages. Although some data is available to explain the impact that away rotations have on residency matching outcomes, many questions remain unanswered. For example, a study investigating the effects of away rotations on matching outcomes found that 71% of students who did away rotations matched at one of their top three choices (Higgins et al., 2016).  Interestingly, 84% of students who did not do away rotations matched at one of their top three choices (Higgins et al., 2016). The same study showed that 39% of students matched in an institution at which they performed an away rotation (Higgins et al., 2016). If participating in away rotations does not increase an applicant’s chances of matching at their preferred programs, then why do so many students choose to participate in them?

 

As applicants, we would like to bring attention to the need for specialty-specific data to accurately advise students interested in particular fields. The study mentioned above showed no correlation between away rotations and matriculation into their preferred program, but it is unclear if this holds for highly competitive specialties. Due to the lack of comprehensive data on the topic, it may be possible that some students are attending away rotations based on unsupported expectations. A comprehensive understanding of the benefits and disadvantages of away rotations should be a priority because the decision to do an away rotation requires significant time, money, and, for some, higher levels of stress.

 

Regardless of the lack of information available on the subject, intangible benefits of the face-to-face interactions that away rotations provide would be difficult to replace with other methods. Benefits such as the building of relationships and the feeling of belonging to a program will continue to be valuable to both applicants and residency programs alike. 

Take Home Messages

  • There is an increasing number of medical students performing away rotations, particularly in competitive specialties.
  • Both advantages and disadvantages exist for students participating in away rotations that should be evaluated on an individual basis.
  • There is insufficient data on the impact away rotations have on residency matching outcomes.

Notes On Contributors

Jeremy Light is a third-year medical student at the University of Arkansas for Medical Sciences. ORCID: https://orcid.org/0000-0002-2533-4336

Santiago Gonzalez is a third-year medical student at the University of Arkansas for Medical Sciences. ORCID: https://orcid.org/0000-0003-1190-0218

Michael Franzetti is a third-year medical student at the University of Arkansas for Medical Sciences.

Acknowledgements

None.

Bibliography/References

Benson, N. M., Stickle, T. R. & Raszka, W. V. (2015) 'Going ‘fourth’ from medical school,' Academic Medicine, 90(10), pp. 1386–1393. https://doi.org/10.1097/ACM.0000000000000802

 

Higgins, E., Newman, L, Halligan, K., Miller, M, Schwab, S., et al. (2016). 'Do audition electives impact match success?', Medical Education Online, 21(1), p. 31325. https://doi.org/10.3402/meo.v21.31325

 

King, K. & Kass, K. (2017) 'What do they want from us? A survey of EM program directors on EM application criteria', Western Journal of Emergency Medicine, 18(1), pp. 126-128. https://doi.org/10.5811/westjem.2016.10.31496

 

Nagarkar, P. & Janis, J. (2018) 'Eliminating geographic bias improves match results', Plastic and Reconstructive Surgery, 142(1), pp. 82e-88e. https://doi.org/10.1097/PRS.0000000000004485

 

Results of the 2018 NRMP program director survey (2018). National Residency Matching Program. Available at: https://www.nrmp.org/wpcontent/uploads/2018/07/NRMP-2018-ProgramDirector-Survey-for-WWW.pdf (Accessed: 27 December 2018).

 

Winterton, M., Ahn, J. & Bernstein, J. (2016) 'The prevalence and cost of medical student visiting rotations', BMC Medical Education, 16(1). https://doi.org/10.1186/s12909-016-0805-z

Appendices

None.

Declarations

There are no conflicts of interest.
This has been published under Creative Commons "CC BY-SA 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)

Ethics Statement

No ethics statement was required as this article is a personal view.

External Funding

This article has not had any External Funding

Reviews

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David Bruce - (25/01/2019) Panel Member Icon
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This opinion piece written by medical students considers the value of away rotations taken in the 4th year and makes a call for more information to be available as to which away rotations will be of most value to students in their applications for specialty residency programmes. The authors give a balanced view of the pros and cons of away rotations and reference previous studies on the subject. This is a well written piece and deals with an important topic that is clearly a concern to students.

I feel this paper could be improved in a number of ways. As a reader from outside the USA, a short description of the four years of medical school and the purpose in particular of the third and fourth years would have been helpful background. The authors comment on the paucity of literature, but the studies that they have discussed have up to 30 references including a literature review of the purpose of the fourth year. Perhaps a wider look at the literature would be helpful to readers.

The aims of the year (which I am surmising from my reading of the references) are to allow students to explore career interests, broaden their educational experiences and prepare for residency working. This then seems not fully congruent with the students’ main concern that the only way to positively influence their chances of selection into the residency programme of their choice is by undertaking what has been called audition electives. The plot thickens further when the literature does not give a clear correlation between away elective and success in selection to residency programmes. This then gives the student body a real dilemma which could be explored further - perhaps a case study or vignette to illustrate. Cost to the students could likewise be further explored as this does influence who can do what.

Finally, having highlighted the problem, I would have liked to have heard the students’ views on how to take this forward. Their piece is well balanced - but an opinion piece perhaps could offer practical suggestions. The students are to be congratulated however for this very readable and balanced article covering an area of concern. I look forward to seeing how this discussion moves forward.

Trevor Gibbs - (25/01/2019) Panel Member Icon
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As my co-reviewer points out, I was also a little confused as to the maening of away-rotations, assuming them to be what others might describe as electives. However, it was good to read a paper from medical students on the subject and how they understand the concept.
Prior to the 1993 version of the Tomorrow's Doctors document, electives during the undergraduate medical curriculum were very variable. After being taken over by Student Selected Modules (SSMs) , which eventually were described as Student Selected Components (SSCs) it was perhaps an assumption that Electives took a back seat within curricula. How and where they exist now in the global variation of curricula I feel is poorly understood as well as the benefits they bring to student learning. Hence this paper, which describes the perception of what the learning outcome of these electives are, is a paper worth reading. It could have been greatly enhanced by explaining electives more fully and looking at whether this model was common among other schools, but I do feel it is a paper that curricula developers should read.
P Ravi Shankar - (23/01/2019) Panel Member Icon
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I read this manuscript by three third year medical students with great interest. The authors could define the term ‘away rotations’ initially in the manuscript. Are international electives also considered as ‘away rotations’? The authors rightly mention about the scarcity of data with regard to the impact of away rotations. Availability of this data could guide students with regard to the feasibility and impact of doing away rotations. The article will be of interest to a broad range of educators and students.