I think this is a very important topic to discuss. Here is my opinion. I am currently a PGY-4.

I think one month at home and one month away is enough. Aways are very hard. You dont know the city or the hospital. You have no support system (ie GF, friends, family) so its very hard. You are compared to the home medical students who already know the hospital, computers, and logistics. Also aways are VERY expensive.

I would do NO MORE THAN 2 aways with a break between the aways. If you push yourself you will be very burned out by the end of the rotations. As a resident, if I show up 10 minutes late its not looked favoribly upon but it is not a career ending move like for a rotator. You are judged by a very high standard and it takes a lot of energy and "politeness" to keep up the stamina needed to be a good rotator.....

I think you should be cautious about doing this...
Here would be my advice
1. Home rotation (july) -- kick but get awesome letter
2. Away where you want a letter (aug or sept)
3. Away where you dont need a lettter just trying to get a spot at that progam (maybe like a community program without big name letter writers) =--- do this later like in November when you have had time to rest

I would only do 3 aways if you have a weak application and you need to prove your work ethic. If you have a solid app.....3 aways can potentially harm you if you are burned out and have a poor showing or become "tired"

I think this is a very important topic to discuss. Here is my opinion. I am currently a PGY-4.


I think you should be cautious about doing this...
Here would be my advice
1. Home rotation (july) -- kick but get awesome letter
2. Away where you want a letter (aug or sept)
3. Away where you dont need a lettter just trying to get a spot at that progam (maybe like a community program without big name letter writers) =--- do this later like in November when you have had time to rest

This is exactly the way I set up my aways, and I've been questioning myself for doing the last one in late oct/nov (smaller program but somewhere I have a decent shot at and would like to go). I have a month between each of my ortho rotations that way though. Nice to see that you think it's a good idea.

so here is what I did.
I did a 4 week block balls to the wall at my home program---very trauma heavy and har working. I loved it and worked as hard and as long as I could.

Than I did an away about 800 miles from my home next with only a weekend inbetween my home and first away. This was at a moderatly busy community program....

I drove to the aways..then I packed my car and drove to a third rotation in the weekend between the second and third rotation.

The third place I went (shall remian nameless) was not a good fit for me personality wise....which made for a very long month....I was very burned out and I didnt seem to fit very well with about half of the residents....I got a really weird evaluation from the third place...but I didnt ask for a letter....I ultimately had 15 interviews and did not even interview at the theid place.....

perhaps this is multifactorial....but if I had to do it all over again....I would not do all three months of ortho in a row.....

I would rotate at one place you think you may want to go, and at one place that is unlike your home program so you know what you like.

My home (where I matched) is very trauma heavy...so I rotated at a community place to see what I liked better....for me the busy trauma place seemed to fit my personality and interests better....so the aways is a chance to sample different kinds of programs

I would advise against trying to rotate at the biggest name places just to try to impress some "god" and get a letter....pick places you think you may want to live and program personalities that seem to match your own......the most important factor is being happy and getting along well with the residents and staff.....that will make for a nice working and learning environment....

It is easy to get caught up in the name game.....but really pay attentiion to how the resident operate and how the staff treats the residents in cases......

Just cause some guy logged 3000 carpel tunnel or knee scopes dosent mean he is a better surgeon....there are days where I may spend 6 hours putting a blasted distal humerus back together.....and I get to log one case.....but thats the kind of cases I enjoy doing.....

I did a rotation at my home program and 3 aways. I was only planning on doing 2 aways and spending 2 weeks at a 3rd program because I had some extra time in my schedule. My home rotation was in June/July, an out of state away in Aug, an in state away in Sep, then an out of state away in Oct. I was definitely tired by the end of September, but I am the type of person that would rather take everything all together and work really hard then enjoy a nice vacation at the end. I worked just as hard on the last one than the first away and was obviously on top of my game by the end. If you are worried about being too tired to perform well if you do 3 aways-then don't let the tiredness mess you up. If this is something you want, suck it up because you'll be doing this for the rest of your life. However it is not necessary to do 3 aways, just make sure you do really well at the ones you do decide on.

So would it be ill-advised to only do 1 away rotation? Due to an illness in my family, I've decided I'm going to take off 1 month that I had originally scheduled for an ortho month, leaving me with only 2 ortho months... is this a bad idea? The rest of my app is solid (all H, >245 step 1, 2 abstracts and 1 pub in ortho, former athlete)...

My school limits us to 1 home sub-I and 1 away sub-I in a given field. Additionally, we can only take 1 home course within a given field. For example, I have an ortho sub-I scheduled and thus I can't take any other course listed under orthopaedic surgery.

BTW, if I had all honors and a 245 I would lose one away rotation and use the money to buy something expensive. On one hand it has to be good to see a bunch of different programs but by #3 you'd run the risk of falling asleep at the wheel, so-to-speak.

I have seen a lot of people saying that doing three aways in a row is setting you up for failure because of being to tired by the last rotation. I did basically 5 months in row of ortho rotations and while i was extremely tired by the end it wasn't very difficult to show up, be interested, and work hard. The number of aways you will do is a personal decision and many people wont be able to do 2-3 becuase of personal or financial reasons. However, if you look back to last years match a lot of people with a great application on paper ended up not matching. Last yeat while going through the match process i didnt want to end up not matching and have things i could have done more of that i had not. So regardless of your scores I would encourage you to take advantage of every oppertunity you can. Sure the majority of people with stellar applications will match anyway, but if you dont match those stats dont mean anything. Good luck with everything

the best answer imho is a combination of what you all were saying.

1. Your school will limit you on how many you can do. I could only do two. When you can take step 2 will take this into account. We had to take step 2 by january. I wasn't going to take step 2 during an ortho month, or while I was interviewing.
2. Your personal preference for number of aways will come next, financial, family etc.
3. There is no formula after that. Aways can help you, hurt you, and be enlightening.

Expansion on #3:
1. If you're a positive, energetic person, and get along with everyone, all of the time...You'll be okay on any away rotation.
2. The problem with any away rotation is that your job there is to leave an impression. So that means stand out, but don't be anxious and pushy. Don't stand out for bad reasons (you were late, etc.) During 4 weeks it's hard to do that as a medical student, that is, leave a good impression. The main thing that the program gets from the away rotation is: I can work with this guy, or i cannot. If no one knows who you are, and you don't stand out... that can hurt you.
3. You can get away with doing NO rotations.. It only helps when you're interviewing at the places you rotate at, for something to discuss if asked, and to get letters.

I was enlightened. I realized I didn't want to goto the places that I rotated in. Go figure.

The problem with that realization is, that once you realize you don't want to go somewhere.. it's hard not to show it.

Bottom line is, if you're going to be tired.. and out of steam.. forget doing as many as you can. Goto aways that you want to learn about the program that you have no idea about, but maybe are interested. Aways at big institutions are not the biggest bang for your buck, because you are going to be lumped in with folks that are all going there.

the best answer imho is a combination of what you all were saying.

1. Your school will limit you on how many you can do. I could only do two. When you can take step 2 will take this into account. We had to take step 2 by january. I wasn't going to take step 2 during an ortho month, or while I was interviewing.
2. Your personal preference for number of aways will come next, financial, family etc.
3. There is no formula after that. Aways can help you, hurt you, and be enlightening.

Expansion on #3]

I did well on my first (home rotation), rocked the 2nd (where I matched as my # 1 on rank list), and was completely burned out for my 3rd and was not able to give it my best. My 2nd was at a trauma heavy program where I was on trauma-- worked 30 days straight without a day off, never left before 4 pm when I was post-call, and we never got a single night of sleep on call nights. I would say that if you plan on working very hard on your second, I would do only 2. By the time I was on my 3rd away, I got sick, and definitely felt more run down than I ever have (even more than I have ever been as a resident-- and as a junior on the trauma service, I never left before 3-4 pm post-call.)

I am doing 4 ortho rotations. 1 home and 3 away. I wouldn't worry about being burned out. It is all about how much you want somthing in life. You can push yourself....if you really want it. That is what I am doing. If you have doubts it will set you back...its all mental baby!

I am doing 4 ortho rotations. 1 home and 3 away. I wouldn't worry about being burned out. It is all about how much you want somthing in life. You can push yourself....if you really want it. That is what I am doing. If you have doubts it will set you back...its all mental baby!

Since you haven't even started you're rotations yet, you're not really in a postion to comment.

While I understand that I have not endured these rotations yet and it will be very taxing.....there are people who quickly want to put people down< are negative and take away drive. This may or may not be you. However, I know myself and I understand the capacity of the human mind when it puts itself to the test. You can do 4 rotation and bust ass on everyone if you put your mind to it. I know I am that kind of person. It is good to know your limitations though.

This mind over matter is an interesting debate.
I think you are both right. I agree four rotations done back to back will be overwhelming and you will see changes in yourself by the fourth month. I would say that an away rotation is more like a sprint...and residency is more like a marathon. YOu have to set a good pace or you will burn out. YOu cannot sprint through reseidency working like an away med studenct for 4 weeks...you would be hospitalized by the end of month 7.

I also think as a med student you arent really sure what you are signing up for....if you end up at 4 trauma heavy up all night kinda call places...you will be burned out sprinting four months......not to mention you have to be incredibly polite, and deal with a new city and hospital every 4 weeks....like it or not this will take a toll on you no matter how much of a "bad a$$" you think you are.

So my adcive to all MS 3 would be to look at waways as a sprint for 4 weeks.....you are not there to cruise but to set the world record for the 100 M sprint.....that is run with a differennt intensity than a longer race which is more like residency.....

I also think a strong desire and drive will enable you to accomplish many things....but the human body does have physical and mental limitations and you must plan your race accordingly.....as burn out on an away can be devistating.....\

I have also learned that most medical stidents think they know everything....and what I tell them has to actually happen before they believe me.....but thats much the personality of the physician,,,,,,,,,