To away, or not to away?

Mr. Madison, what you've just said is one of the most insanely idiotic things I have ever heard. At no point in your rambling, incoherent response were you even close to anything that could be considered a rational thought. Everyone in this room is now dumber for having listened to it. I award you no points, and may God have mercy on your soul.


Do at least 1 away (IN ORTHO).

So, when reading this, keep in mind it is coming from another 3rd year, and I probably know just as little about this whole process as you.

Having said that, I am sure your advisor is great, but according to the people i know who are already in ortho, it is a different world than other specialties, and most people outside this world don't necessaily know it well. Every Ortho attending and resident I have spoken to has said it is expected that, as an ortho applicant, you will probably do at least one away SubI (and often 2, since the field is so competitive)... people who don't do aways are in the minority. An away is considered one of the top factors in choosing residents (read Bernstein AD, Jazrawi LM, Elbeshbeshy B, Della Valle CJ, Zuckerman JD. Orthopaedic resident-selection criteria.
J Bone Joint Surg Am. 2002 Nov;84-A(11):2090-6.). This seems to be particularly important in the following situations:

1) The site is one of your target programs.
Some attendings have explained that a good fit can give a mediocre paper applicant a much better shot of matching to a program... its hard to rank an unknown student over one you know well and respect. The calculated risk here is that, if you fit in well, it can really help you. If you don't fit in well or you really suck it up, it can be a death sentence (but then again, if you don't fit, its probably best if you don't end up there anyway)

2) The site will help you get a "big" letter.
"Big" can mean moe than one thing... A) a well-known surgeon, someone impartial (v. home program faculty) with a strong opinion of you, or C) "someone who knows someone" at other programs where you are applying.

3) The site is in a region other than your home school where you plan to apply.
Everyone I have spoken to, in multiple programs, has made this point... first, it proves you are willing to move to this new area, and second, it gives schools in that region an opinion from a program they can better relate to

4) Regarding rotations in other specialties- not to be negative, but I don't think any ortho attending I've spoken to would care one bit what the guy in anesthesia has to say, and doing an away in another specialty doesn't get you any contact with residents (whose opinion can play a big role in defining rank lists)...
Of course, if you want to do another away in adition to your ortho, it can give you a better feel of the hospital, but its not going to have much effect on your chances of matching there

As far as the city/ hospital/computer system/faculty knowledge mismatch, consider the following (and this is just my opinion)...
1) You have probably been learning new systems during every 3rd year rotation, and I am sure you did fine... there isn't any reason this should be different.
2) People will know you are new to the system and will probably take that into consideration as long as you try hard and figure things out at a reasonable pace.
3) Few programs would want to match their entire residency class (or even most of it) from their own med school... they want the best students. In fact, home students as a group are probably at an overall disadvantage, because only so many spots will go to home students.

So, that's pretty much the entirety of what I have learned by talking to a bunch of residents and attendings... take from it what you will. Good luck! Hope to see you around on interviews!

Ya your advisor is blazin the crack pipe a lil too much....thats really bad advice....

The only caution that I will give you is that you might not get an interview at a place you dont click after you rotate there....but thats what I call ruling out...

Pick your aways wisely....ortho is so competitive I would STRONGLY urge you to do 2 away....one away could even be a 2 week rotation but you need to give yourself advantages as this process is so dam competitive.

Seriously, if your advisor is giving you this information they need to be fired, without question or at least reported for incompetency! Where on earth to you go to medical school. What other students is this person leading down the path to the scramble. That is perhaps the most stupid thing I have ever had the displeasure of reading on this board. The entire point of medical school is learning to rise above being lost around the hospital!
Actually, instead - do no aways and do no ortho in general. This way you will always look like to the ortho residents that you know what's goin on and they will say man, "that guy in anasthesia really knows his stuff, just wish we could get some students like that on our teams".

Without question, do at least 1 away. But also, if you do that away rotation, work your ass off. Take call as often as possible. Read when you can, but also know that a good work ethic is sometimes more desirable than being the med student who knows all the fracture classifications. The way I see it, residents and faculty know that we can always learn about ortho during residency, but the only way that they will know if you will work hard for them and not leave them hanging is if you prove it to them during your rotation. I rotated with some people with great numbers (one guy had 258 on Step 1, honors up the ass, and AOA) who didn't work hard. They took weekends off and took as little call as they could. I, on the other hand, have 218 on Step 1, no AOA, very few honors, but I worked hard. I took 12 calls during the 26 days I was there, rounded early, and did as much as I could to show them that I am a hard worker. The bottom line is that I got an interview and have been told that I am a desired candidate (not sure if that is just them blowing smoke at me) and the other guys weren't even offered an interview. Now, I haven't matched yet, but I think that I am in a better position because of that time that I put in.

I agree that your advisor is giving bad advise, so it may be a good time to look for an advisor in the ortho department. It is a good way to get to know some people and possibly get a letter. Anesthesia is not the way to go. From now on, when looking for advice, go to residents and faculty in the ortho department.

A word about call on these away rotations is that unless you are on trauma it is tuff to take call q2-3 because the visiting med students or home students on trauma sort of have precident and are always around more. Everyone wants to take calls on aways because it's your time to shine but you have to be considerate of the other visitng students on spine, sports, joints, hand, and foot and ankle (or you look like a tool). If you rotate at a place with tons of rotators you will be luckly to get 4-5 calls. You probably could take more but you would be doubling or even trippling up with other students on call and that sort of sucks. Because call is usually with at least 3 residents. If you add three students there is not much for you to be doing. One student can be in the OR helping, one student can be in the ER slapping on plaster but what is the thrid student doing?. Don't underestimate clinic, it sucks hard arse but be aggressive in clinic. If you can clearly articulate a plan for a patient (which you can't always think straight if you are post call in the clinic and you had better be in the clinic post call if you want a shot at matching and this stuff is not yet second nature for most and requires burning some neurons) that goes a long way. Actually, much farther towards helping you than 12 hours of holding retractors and it's better face time with the attendings.
Also, for most of us applying now it was the first time you dictate notes (there is a real learning curve), when you get to an away the first thing to do is find some cool residents that will give you their dictation codes and learn the computer system (as a visitng student you will not get dictation access which is a real pain because it would be super helpful) and help on clinic dictations it shows that you want to pitch in. UNless you sound like an idiot on the dictaphone.

I agree with madukrainian. You want to work hard while rotating, but you don't want to step on toes. It is a delicate balance. I was fortunate to rotate at a program that didn't have home students rotating at the time, had several hospitals and many teams taking call throughout the city. It was very conducive to taking lots of call and I was never on with another student. I would suggest looking for a rotation in a place where you have a lot of say in your call schedule. It makes the month much more valuable.

As important as working hard is, so is being a team player. Help out where you can, but allow others the opportunity if there are multiple students. Don't try to make others look bad just to make yourself look better. By that I mean don't take call for the sole reason of accumulating hours and then bragging to the residents about how much more you are working than the other students (believe me, I have seen this done before).

Rotating is a chance to get to know the program, the residents, and the faculty. If you approach it with an open mind, a good attitude, a willingnees to work hard, and play well with others, you will do just fine.

I wish I had done more aways. I did an away at one of my top choices and I think I have a MUCH better shot of getting a spot there because I did the away. Besides, there really isn't to to much to learn about how a place operates when you go there.

Thanks for the advice everyone. I'd like to clarify just a couple things. I do have an ortho advisor (who unfortunately is nearly impossible to get ahold of), who suggested I do an away. The advice I was speaking of came from the medicine chair who does sort of small group advisor sessions for all JMS's during their medicine rotation. So basically I had planned on doing an away without question, then was told this was a really bad idea by someone who has alot of experience advising students. I realize that it may not be the best advice, which is why I posted my question on this forum. I was just wondering what people closer to my situation think about his "theory."
So I guess my clarification is that I wasn't really seeking advice from this person, it was just sort of thrown in my lap and I wasn't sure what to make of it. Hence, the thread here.

By the way, the billy madison post was freakin' hilarious. I laughed for like 3 minutes straight.

While I understand where everyone here is coming from, I will try to be the devil's advocate here. Let's take a moment to be rational and not swayed simply by an article that was written or what we've heard from various orthopedic residency program directors. The honest answer to this man's question is this... is there somewhere you REALLY want to go? If so, then do an away. If not, and you have about 10 places you'd like to go, then how are you going to decide where to go? And let's look at it from the other side of the coin. Do residency directors really expect you to take an away rotation at their site or you can't come to their program?

The average applicant applies to between 20 and 30 programs. By my count, there are only 6 or so away rotations (assuming you made every rotation an away rotation from 4th year until interviews) that you can take. That leaves between 14 and 24 programs that you did not visit, at a minimum. Most people get more interviews than places they do an away rotation at as well, otherwise, at most, you would expect to get 6 interviews, which is not the case for many applicants.

I guess what I'm trying to point out is, don't get caught up in the hype of an away rotation. If you are a "borderline" candidate, or if there is no obvious reason why you would go to X residency, you need to make your case in your application and possibly might need to take an away rotation. Otherwise, come to the realization that it is impossible to do an away at every school you might be interested in and realize that program directors are not "out to get you". They are intelligent and compassionate people who understand the logistics involved in away rotations. Are there some programs that you "must" rotate at? I'm sure there are. I'm just trying to point out that while his advisor may not have come up with all the right reasons for not doing an away, he was not totally wrong in his answer that you don't have to do an away.

Like I said, I understand where everyone is coming from, but I think there is more than one perspective on this issue. I'm just trying to give the poster food for thought.