Clinical Rotations

What I wish I knew in medical school about away rotations

Brendan Murphy , Senior News Writer

Away rotations aren’t typically a necessity. But for medical students who are on the fence about a specialty, a residency program or the geographic preferences they have for their future, they can be an asset.

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As a prospective emergency medicine applicant in 2018, Christopher Clifford, MD, knew he wanted to move into a research-focused academic setting for residency. But where that would be, and what specific attributes he sought in a program, remained hazy.

Dr. Clifford—now an attending physician at George Washington University Hospital—used away rotations at Yale and Stanford to help get a feel for the types of programs that might be a fit. 

“Looking back at my two aways, both taught methings that I wanted in a residency,” Dr. Clifford said during an interview for the AMA’s “What I Wish I Knew in Medical School” series. 

“When I found the right residency and interviewed there, I really knew it. So, as you get ready for aways, be open-minded. When I was going through my interviews and away rotations, it was really a period of discovery at the end of the day.” 

Dr. Clifford did not ultimately end up as a resident at either program—matching instead with his top choice, Mount Sinai Health System in New York City —but the experiences during his two visiting rotations helped inform his rank-order list. Looking back on the away rotations he experienced during his fourth year of medical school, Dr. Clifford offered insight into what he wishes he knew in medical school about away rotations. 

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“Coming from the University of Nevada School of Medicine, there's less of an academia vibe,” said Dr. Clifford, an AMA member. “I definitely liked my school, and I liked my education, but I knew for a residency program I was looking for programs with strong research and education components. I wanted to be on the front edge of emergency medicine. I was looking for exposure to different types of programs. That’s why I decided to do aways at Yale and Stanford. They are very academic-heavy programs.” 

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“Yale showed me that I like the structured academic component of the learning for emergency medicine, ow journal clubs are run and how the education is presented, how the sims go, how the ultrasound is taught. 

“Stanford taught me more about the environment I wanted. It showed me that EM residency should push you and give you stories and cases that you can look back on over the course of your career. 

“Therefore, I realized when I was applying for residency positions: I really wanted a hybrid. I wanted that academia component with expert faculty making sure material was taught very well, but I also wanted a county site that ensures you’re seeing intense cases.”

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As applicants embark on the residency-selection process, no online resource contains as much information as FREIDA™, the AMA Residency and Fellowship Database®, which includes more than 13,000 Accreditation Council for Graduate Medical Education-accredited residency programs, and offers a streamlined user experience.

“Being a good away student comes down to a couple of things,” said Dr. Clifford, who has served on AMA Resident and Fellow Section Governing Council. “No. 1, I would say is to show initiative and enthusiasm. No. 2 is always shine academically via your clinical reasoning skills. No. 3, you need to know what sick and not sick looks like. If someone has a low blood pressure and looks unstable, then forget about looking good academically. It’s important to let the attending know ASAP since the window to intervene could be quickly closing. Showing you're trustworthy as well as a team player are also important attributes.

“People are also trying to see if your personality is a fit, if they would potentially get along with you in a residency moving forward. Being a kind, helpful person always goes a long way.

“What I tried to do was figure out where some of the pain points were for my attending and anticipate those coming up for the next shift and stepping in before someone potentially asks about them. That can be a hard thing to do; it takes attention to detail.” 

“When I went to Yale, I was coming from the West Coast,” Dr. Clifford said. “I'd never been at an academic medical center before. There were a couple things that I was a little bit new at, looking back. The way that they ran their journal clubs and ultrasound education, for example, were completely different. What I would suggest for away students is to identify a resident that's already in the program, contact them early on during the rotation and ask them frequently for advice. It’s very helpful to have someone walk you through things when you’re first starting. 

“Use your connections to find mentors at the place you plan to rotate at. I'd be willing to bet if you're looking at an away rotation or a potential site for residency, you can find a connection through the AMA. It just takes a little bit of digging. For instance, I was coming from Nevada and going to Connecticut, so I went to the New England caucus and introduced myself and told them of my intentions to come out for an away rotation. These people can help you make contacts in a program.”

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“There's sort of two components of the away rotation,” Dr. Clifford said. “One is the true academic component, pushing you to get better in emergency medicine or in your specialty of choice. 

“Then the other is to try on the program for fit and see how you like it. I ended up putting Yale No. 2 on my rank list. That was a hard decision for me. I really enjoyed the away rotation, liked a lot of the people there and how they ran things. In terms of applying and putting together the final rank list, I thought for a long time that I was going to put Yale No. 1 until I made this chance encounter with a friend at an AMA meeting and he told me to give Mount Sinai a try.”

“It wasn't until I did that interview at Mount Sinai, which was my last interview, that I realized: Oh, this is the nail on the head that I'm trying to hit. This is that specific fit that I was looking for." And at that point it wasn't a difficult decision.

“Away rotations aren't binding, and at the end of the day, you're going to be the person that's doing the residency. It’s a big commitment—most EM academic programs are four years now. So you really have to put yourself first. 

“If you feel, ‘I like this program, but I think there is another program that could be better for me,’ I would really listen to that gut feeling,” Dr. Clifford said. “You are the only one that knows what that feeling is telling you and it is your responsibility to listen to it, no one else will. People understand that you can chose another program when you're going through the process, it is not binding for a reason.”