Dr. Leila Javidi and Dr. Shelby Wood contributed to this post.

Much like every other piece of advice you receive 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.

However, what remains true for every student 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.

The Difference Between Away Rotations and Out-of-Network Rotations

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 around the country, as 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 tedious, 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?

The Benefits of Away Rotations

1. Varied Clinical Experience

If you are an IMG, you know that our hospital placements might not be ideal since we are working with limited options. Oftentimes, 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 richer learning experience and that you have experienced the type of practice environment for which you are interviewing. 

Securing away rotations at other hospitals, especially more well-known/”big name” institutions can really help make your case to program directors during residency interviews.

2. Letters of Recommendation

We all know how uncomfortable it is to ask for letters of recommendation when you feel like you never got solid one-on-one time with an attending physician. 

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 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!

3. 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. 

If you are applying to certain specialties that are considered “backup” specialties to some, take note that program directors are especially meticulous in weeding out the “backup” candidates. 

This is why it is extra important that you demonstrate your commitment to your specialty, which is difficult to do by only rotating at one institution. Show your commitment by going out of your way to schedule (and excel in) away rotations in your preferred specialty.

4. 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.

It is essential that you schedule at least one audition elective to improve your chances of landing an interview and eventually a match into your preferred program!

Sometimes programs will even extend a “courtesy” interview to individuals who 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! 

Additional Questions to Consider When Planning Away Rotations

Okay, 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 challenging. We all know that med-ed coordinators are extremely busy and can be difficult to get ahold of. You must plan ahead. 

Think about when and where you want to do these away rotations and do your research:

What information do they need? 

In what timeframes are you 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, which can cost hundreds or even thousands of dollars. If this is the case, it may be worth it to reconsider or choose another elective that won’t be as costly.

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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