home rotation required before aways?

It would be nice to have a "warm-up" rotation before hitting the road but I don't think it's essential. Most places will adjust their expectations if they know it's your first. Every place that I went asked me how many ortho rotations I had done. All you really need to know is anatomy anyway. Anything above and beyond is gravy.

I must disagree with last poster. Doing a "home" rotation 1st gives you ample time not only to learn the book material but more importantly to advance your knowledge of ortho in the hospital and clinic as well as expectations on an ortho service.

If you can't do this, I would suggest your first away at a smaller, less competitive school that will be a little more laid back so you can really get your feet under you before your next 1-2 rotations.

Let me be clear. If you are planning on doing aways at highly competitive places, knowing only anatomy will not be enough. You will be expected to come in on day 1 and know the basics of not just anatomy but surgeries for that day as well as basics for common ortho problems, fractures etc., as well as basics for reading xrays, etc.

hope this sheds some light.

ditto Tkep.

Doing your home rotation first is preferred, but not mandatory. I don't think ortho knowledge matters very much for a 4th year medical student.
At least, it's less important than knowing anatomy cold (and knowing the surgical anatomy for that case). Also more important than ortho knowledge is not being a douche on your rotation. Some people struggle with this one. My opinion is that the most important reason for your spending a month with a program is to get to know them and demonstrate that you would make a great resident, not through ortho knowledge but by working hard and not complaining. Also, do not stab anyone, people remember that.

Agreed. At my program, initiative and general get along with-ness is far more important (in terms of ranking) than general knowledge... I mean, most junior residents aren't anatomy aces. Of course, we don't do a lot of pimping here... but places that do may have higher expectations.

Be present, have energy, and never ever:
1) sound like you think you know what you're talking about. we had one guy who was super-smart on paper, but was always letting us know how smart he was. One of the attendings asked how he did on Step 1 and his answer was: "260's...I think that'll play". Wow.
2) talk bad about patients (residents can do that, but students shouldn't)
3) ask "are we done for today?" We axed a guy who did this almost EVERYday. We were like, you're on an away, you don't know anybody in town, what the hell do you have to get away and do at 4:30pm??
4) piss-off any ancillary staff. we axed a guy (see #1) because several nurses, OR staff, CLINIC workers, and patients said was rude

thanks all, really good input. well it seems the home dept isn't going to let me move my rotation date any earlier, so i'll be doing an away before the home rotation. any other tips for a guy in my position?

I would agree more so with the immediate above post than anything else.

You're expected to not know much.. but you're expected to be helpful, eager, and ready to rock. There's really nothing more to it than that. Having to know anatomy cold, surgeries, etc, is not nearly as important as above (<10%). Those are helpful.. but the main thing is that you want to appear to be willing to learn, able to be taught, and humble of what you don't know.

I can say that I made the mistake on some rotations trying to show that I knew stuff.. that was bad bad bad. Why? Because you're expected to know little, and even if you know something, you're expected to be wrong - and not a reliable source. And the biggest problem is if you show off, and upstage the residents. That's also really bad. I knew that, but didn't really understand it until now. As a resident, you're pissed off because you're working too much, and you don't know as much as you would like, because you don't have time to read.. that's generally the feeling. When a medical student comes in and starts spouting out stuff, yeah it may look good to the attendings, but it makes the resident feel cruddy...and as a result, they may not recognize your accolades, rather, sandbag you to the attendings when asked about you. Now, personally, I would feel stupid, but I wouldn't hose the medical student for that.. but I certainly would think about putting into light that maybe the medical student wasn't a team player or what have you. See how easily you can sandbagged?

Also, don't try to be 'one of the boys'.. you're not. Always be conscious about that. That goes along with not making fun of patients or what have you.

So, again, to reiterate.. just be there to be helpful, with a smile on your face.. that's all you are there for
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That's a good point about showing up the residents. I was put in that situation a couple of times on the chairman's service. He would pimp the resident (pgy-2) on something and he didn't know the answer so then he turned to me. I was torn between trying to impress the chairman and not trying to show up the resident. So when I answered I tried to sound unsure about it even though I was not.