Largely canceled for students in 2020, there is some optimism that away rotations—a chance for medical students to get exposure to different medical specialties and institutions late in their training—could resume in 2021.

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Recent guidance from the Coalition for Physician Accountability, a cross-organizational group of medical education stakeholders of which the AMA is a part, offers some insight on how that could happen.

The fact that the coalition is laying the groundwork for potential away rotations in 2021 is a significant departure from the prior year, when the group called for away rotations to be discouraged because of pandemic-related travel restrictions.

The coalition’s new recommendations for 2021 away rotations call for aways to be on hold until at least August, meaning students now in their fourth year of medical schools would not have the opportunity to pursue them. But it could open them up away rotations to a large swath of those now in their third year of medical school..

“The group looked at how this situation is different than where we were a year ago,” said Kimberly Lomis, MD, the AMA’s vice president for undergraduate medical education innovations and a member of the workgroup that formed the recommendations. “There is hope on the horizon. We have vaccinations underway, know better how to manage COVID-19 patients, and clinical settings have more established protocols of care—all making it safer for students to be involved.”

The coalition wants learners to return to aways only if they can be an active part of the clinical environment, Dr. Lomis said.
“The other piece we very intentionally added was a guiding principle to better acknowledge the contributions that learners make,” she said. “Learners last year were treated as visitors in the system. That’s a short-sighted response. We believe students really add value and should be incorporated appropriately.”

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Often referred to as audition rotations because they allow students to work in institutions they may want to apply to for residency, the lack of aways for 2020 was seen as one less opportunity for medical students to gather information for residency selection. Bringing aways back for 2021 will be met with fanfare from students, but the process will still be limited.

Under the recommendations, which are subject to change with the COVID-19 pandemic evolving, the process of applying to away rotations would begin in April. By not beginning away rotations until August, as the coalition recommends, two months that have traditionally been reserved for aways—June and July—will be off the table. That means there will be fewer spots available for students seeking away rotations, which are typically completed before residency applications go out.
“Think about equity,” Dr. Lomis said. “Will everyone have as much opportunity? The most competitive candidates typically get the most choices for aways.” The coalition report asks residency programs and schools to “think about how to do this in the most equitable way possible.”

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The limited availability for audition rotations may leave some medical students with fewer options than they hoped for. But it doesn’t mean it’s a reason to panic. If a student’s away rotation opportunities aren’t as plentiful as hoped, Dr. Lomis recommends working with a dean for student affairs.

“Many times, the value of aways has been overemphasized by the word on the street,” she said. “Students should think through their other options. Are there more advanced local experiences that you can pursue that speak to how you are getting yourself ready for residency and distinguishing yourself? That’s not the same thing as experiencing a given program firsthand, but GME [graduate medical education] programs will likely continue virtual opportunities to interact with candidates knowing that fewer of them got to do aways.”

The AMA has curated a selection of resources to assist residents, medical students and faculty during the COVID-19 pandemic to help manage the shifting timelines, cancellations and adjustments to testing, rotations and other events at this time.

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