Overcoming Regional Bias Through Aways

I was hoping the strategy of rotating in different areas of the country would "open up" those areas for me. I rotated in the southeast and chicago areas. Only got one interview in the southeast outside of the program at which i rotated. Struck out in chicago. Now whether those chicago programs were out of my league or not is open to debate. Nonetheless, it was highly disappointing. I ended up getting interviews at places I rotated at, places I had some connection with (alumni), or places that had residents from where I was from. Maybe I had a weaker application and that hurt me, but getting interviews seems unpredictable.

Just out of curiosity, did you get LORs from those rotations?

Yes, I did. My application had some flaws though. So it was surprising, but at the same time it wasn't.

I had a very similar experience, TKEP.

For context, I'm an "above average" midwest applicant (relative to NRMP data). I did an away rotation at a big name program in the Southeast, got a good letter from the chair there (was able to read it at one of my interviews), and I received only one other interview in the Southeast.

Meanwhile, two of my classmates, who rotated only in the midwest, got about 3-4 Southeast interviews each. And by all accounts we are similarly qualified applicants. Another one of my classmates, who did undergrad in the Southeast and is an "average" applicant, did TWO rotations in the Southeast and only got two other Southeast interviews.

I don't really care, because I never had a specific desire to end up in any particular region... It's just funny. Maybe the programs/reviewers saw something in our respective applications that stood out to them on a personal level, or maybe it's all completely random. Who knows.

In the end, you really just need to do your aways at programs where you think you'll want to train, so that you can get an interview at that particular program; if you have any expectation beyond that you may find yourself disappointed in the end. Admittedly, it's pretty difficult to determine where you want to train at this point in your education... I thought I was gonna stay in-state for my training, but currently have all out-of-state programs in my top 7ish programs on my preliminary rank list... and I'm still not 100% sure what I want in a program... but do your best to talk to your attendings/mentors, residents, etc. and read reviews and opinions on Orthogate, but do so with caution. Away rotations are gold and absolutely the best weapon in your arsenal in this process.

Also, regarding the idea of doing two away rotations in a single region outside the region where you're doing medical school...

Anecdotely, I recently met a really nice applicant on the trail who did just this and it kind of backfired. He/She was going to medical school in one region, but did both of his/her rotations in another region. The programs in the region where he/she attends medical school seemed to question the applicant's desire to stay local. Meanwhile, this individual received only a couple interviews in the region where he/she rotated, likely because they only looked at the location of the applicant's medical school and questioned his/her desire to relocate.

Take this for whatever it's worth. Obviously, I'm not aware of the strength of this individual's application, and I have no idea if this is typical. I just felt bad for the person. Ultimately, if you are interested in going to another region I don't know what more you could do... other than maybe writing two different personal statements and somehow indicating your desire to be in a particular region.

Since this is the time of year that the 3rd year students start coming by my office for advice and counseling about this topic I thought I would weigh in on this one. I understand fully all the angst and concern that everyone has about sub-internships but am concerned that it has started to get a bit out of control with respect to trying to out-think and over-analyze the particular strategies.

My best advice to all of you (as I tell all of the Columbia students as well) is to pick the 3 programs (your home program and 2 aways) that you think with whatever limited information you have available to you are the residency programs that you want to match at and complete your residency. Remember as we have indicated on this website many times your sub-internship is a 1-month extended interview. No other programs will know you as well and that is why so many programs are matching an increasing percentage of rotators each year.

So, in the end if you really want to stay in Chicago (and that's the most important issue for you) do all of your rotations in Chicago. If you're a competitive applicant you'll likely get interviews from many other regions anyway. If you're not as competitive then you may or may not get those interviews and you want to maximize your chances at the your top 3 choices.

If, on the other hand, you truly would go anywhere in the country and want to explore other regions by all means you should do so.

Bottom line: do your homework now - understand how "competitive" you are (your Dean can usually help with this); understand what type of program you would like in the ideal world (academic, community, large, small, etc...); understand what area of the country you would like to live in (don't be hypothetical about this - if you really can't see yourself living in NYC for example it doesn't matter how good the program is or it's reputation, etc...); and finally speak to this year's 4th year students from your school (who haven't matched and gone on to residency yet!) as they are the best "hot off the press" reporters of what the various programs around the country are like right now! Programs change, faculty change, chairmen change, etc... but the current students have just interviewed at all of these programs so before you decide to do a rotation at a program based on a former student from your school who finished residency 5 years ago make sure you speak to your colleagues ASAP!

I hope this helps some of you who are struggling with this issue because it seems to get more angst-producing each year that I've been involved with this process.

Good luck everyone --

wnl

I agree with the above...and it is true that everyone seems in this day to over think and analyze everything. I myself was/is guilty of that.

Speaking from the thick of it all, residency is difficult, it's a lot of time, and during whatever free time you have.. you want to be able to be happy. If that means spending time with your family, playing out in a field, or hitting up the meat packing district in nyc, etc. etc. the most important place to be is where you can do that.

Sure, residency reputation, training, etc. etc. is very important, but at the end of the day, what you put into it is what you get out, and the truth is, it's hard to gauge what is going on when you do the interviews.. I can tell you having interviewed at various places twice you definitely get varying opinions about the program. I felt differently about the program I am at now the second time I interviewed.. go figure. It's all biased.

I learned from one of my away rotations that although I loved the program, the people, etc. that it wasn't a fit for me.. go figure.

The regional bias is based purely on how well a program knows you. If you seemed interested and are going beyond 'checking the box' at the interview, having communication, doing aways, visiting weeks, etc. etc.. that will allow you to be known by the program.

The best strategy you can implore is to do the best on any rotation, and make sure you present a positive, enthusiastic attitude. With that said, I would choose an away based on 1. location, and 2. a program that you are really interested in.. Then do your best...That's pretty much it.

-iliiz.

I just wanted to reiterate what has been said. I am from the south and rotated at a northeast program. That was the only northeast interview I received. I'd been told before I applied that it is hard to break into/out of the south. That was definitely my experience.

tldr; Interview bias exists and is huge for certain areas.

I put aways on my ERAS application and almost every program has thought that I've been to 3 medical schools.

Programs have no idea where you did your aways so I doubt it'll help you unless you get letters from those aways. I think it'll help if it's from a big name and if it's a good letter b/c faculty members will know your letter writer personally.

I did not get many interviews at my home state, none in the region at one of my aways, and only one in the region of my other away. However, I received multiple interviews from regions I had no ties to (undergrad, family, friends, etc).