Audition & Sub-Internship Rotation Advice

19 Sep

Audition & Sub-Internship Rotations:

  • Audition rotations are great for 2-4 weeks of trying out a program while still getting school credit for it.  You complete a rotation at a residency you’re applying to and they get to meet you, you meet them, see their program (didactics, clinic, surgery, procedures, etc) and see if you’d be a good fit.  I’d recommend trying for 4 week rotations, allowing for more interaction with the residency.  Do 2-4 audition rotations, you’ll want to do more auditions if you are looking for more competitive residencies or field of residency.  If you are more competitive in person than on paper, audition rotations are a great way to show your strengths!
  • Sub-Internships are where a 4th year medical student (or a group of 4th year students) are assigned to be “acting” interns.  They will have patient assignments and given the same responsibilities of a 1st year resident (intern).  Sub-Internships take place at residencies and can or cannot be used as an audition rotation, depending if you are interested in the program or not.

Setting Up a Rotation:

  • I recommend setting a goal of applying for and booking all of your audition rotations by Jan-March of 3rd year for most residencies (specifically: surgery, ortho, ob/gyn, neurosurg, ER, etc).  You can probably get away with later dates for less competitive spots, but if you’re set on a specific residency program, book it early!  If you haven’t decided on what type of residency you want to apply for yet but are considering more competitive spots, set up these audition rotations for both types of residencies you’re considering and cancel the other one once you figure it out.
  • Start contacting the program coordinators in December/January to figure out if you can set up audition rotations and how.  Make this personal contact by email or phone even if it’s just to confirm instructions that are listed on their website because some websites are out of date, and program contacts may have changed.
  • Be as pleasant but concise as possible in your emails/phone calls because the coordinators are often overworked and some can be pretty short with students. You want to keep the coordinators on your good side as they can have a lot of influence on your application also.
  • Lock Facebook if there’s anything on there that you wouldn’t want your future program to see, residents, program directors, other students, interviewers will check this out!
  • Some programs you will need to know exactly what day they start accepting applications for rotations and get your application in at that exact time or day or all of the spots will be booked… it depends on the program and it’s competitiveness so it’s good to do your homework on this stuff.
  • If I were to do it all over again, I’d start auditions in August because July is the first month for interns and the programs are struggling just to get everyone up and running.  Everyone’s attention is on the interns and you most likely won’t get any procedures that month.  I’d do Aug, Sept, Oct, Nov and be done.  I went into mid Dec and hated every minute of it because by that point I was just ready to be home.
  • I would try to strategize when you book spots at the programs you are most interested in.  You may not want to book your first audition rotation at the program that you think is your top choice.  You might reserve this for one you are not sure about so you can get the hang of how auditions work and brush up on your clinical medicine for that month.
  • If you can set up rotations with your general program vs. the sub-specialties that will give you the best exposure to what the residency will really be like there.  If all the spots are filled but you still really want to rotate at the residency, set up a rotation with the sub-specialties and see if you can spend some time (weekends, evenings, during rounds) with the general residency service and residents too.
  • I really like this ob/gyn clerkship guide by the Association of Professors of Gynecology and Obstetrics (APGO).  A lot of it applies to all rotations, along with some ob/gyn specific stuff.  Some of it is old news and some of it doesn’t really make sense as a 3rd year student with smaller schools but once you get to rotations that are with residencies and larger academic centers it may come in handy.
  • There’s a lot more hierarchy at some institutions versus others and I found it helpful to pay attention to this stuff.  Some are really open to students being just like residents and integrate them well, others have more of a place that students are to be.

Rotation Do’s & Don’ts: 

I’d say most of the following bullets are on the more strict/hierarchy side of residencies and may not apply to the residency you’re looking at.  However, I don’t want anyone to be caught off guard if they do end up rotating at a more strict place… you’ll have to be the judge of what type of program you’re at, once you’re there.

  • Be early! Always get to your audition early, round early (before the residents), stay late (after the residents). Period.
  • If you are on with a junior and senior resident the junior resident is probably going to be working all the time, follow this resident unless told otherwise.  It may be more fun to sit at the desk and bullshit with the senior resident or nurses but as an auditioner you’re there to see the program and the best way to do this is to follow the junior resident everywhere they go and help them out!
  • When you go into a patient’s room you can always make sure the door is shut if it was when you entered, and the tv is off or muted.  If you are doing a procedure (like a cervical check), you can help position the patient, get gel out, etc.  If you are going in for a delivery you can always help hold legs if you’re not scrubbed in and clean up afterward, all of this makes you look like a super star.
  • Don’t sit in a resident or attending’s chair unless told it’s okay, and even then it may be okay with that one but not the next one that walks by.  Same goes for computer work stations, please don’t sit in the work station or jump on the computer unless the resident has okayed this.  The resident will eventually need to use that space and it’s nice to just start from where you left off, e.g. logged on and not having to ask for their spot back.
  • Always sit in the front row at a conference or teaching didactic session (this is really important to some residents – they use students to deflect questions from them…)
  • Another one that’s important to some is not asking an attending questions when a resident is nearby, this almost always makes the attending ask the resident the question first and it puts them on the spot if they don’t know it which in the end makes them not appreciate your questioning that just made them look bad; just ask the resident the question later.
  • Which leads to, always make the resident look good.  They will usually take all the credit for whatever you do to help them but many residencies give the residents a lot of say in who gets ranked so this can be helpful to you in the end.
  • If you’ve had a lot of hands on training during 3rd year clerkships, you may find that some audition rotations can be weird because the residents are all trying to get their numbers in so they don’t really let students do a lot very often.  If you find a resident allowing you to do exams and procedures, it could be a significant gesture and always be grateful for the opportunity.
  • Most residencies have some sort of list they have created with their service’s patients and updates about them.  This may be something they let students update and something I recommend asking about.  If they give you access to “The List” please notice the patterns of how things are added and what is actually added to the list when you’re updating it.  Maintaining the list as a student can often be a super helpful job that really allows you to shine if you do it well.  If you do it poorly though it can be really annoying for the resident that has to go back through it and clean it up after.
  • Sometimes you’ll find yourself doing nothing on rotations so find little ways to be helpful.  I always had my Epocrates app available on my phone to look up diseases and medication names and dosing, Shots app for immunization schedules, Mediquations for various disease scoring calculators, and gUnit for unit conversions. I also had ob/gyn specific apps such as Perfect OB Wheel to help with gestational age dating.  You can also help by taking notes on patients if you hear something that needs to be done in case it gets forgotten.
  • If you’re starving but know the resident is starving too and you can get away – offer to go get them something (and you can get something too). It’s never really nice to have your food out when everyone else hasn’t gotten away to lunch yet.  If you’re going to eat make sure everyone else is taken care of too by at least offering what you can.
  • Always having something to read, a small reference book, up-to-date article or journal article work great. (for Ob/Gyn the American Congress of Obstetricians and Gynecologists (ACOG) publishes Practice Bulletins that work great for this since they’re small and can fold up in your white coat pocket.  If you haven’t gotten your ACOG student membership yet, do this! It’s free and you’ll have full access to all of their publications).
  • If you want to do a surgery residency, always be ready to tie knots and suture, with instruments, right handed, left handed, one-handed, two-handed.
  • Keep positive during these rotations!  The world of medicine is a small one and word travels fast throughout residents/attendings/program directors/other students/interviewees/nurses/clerks/etc.  Always try to “be on” and engaged during your audition as this really is an extended interview and everything you do is noticed.
  • Another blog resource that’s internal medicine specific, Internalize Medicine’s How to Excel on an Internal Medicine Sub-Internship Rotation.
  • And another post, A resident’s guide to being a medical student by Dr. Alexandra Friedman posted on KevinMD by another Ob/Gyn resident with some great tips!

OR Specific:

  • Read about the patient and surgery before going in to the surgery, know your anatomy and have a general understanding of how the surgery will go.
  • Meet the patient in pre-op or you may not be allowed into the surgery at many residency programs.
  • In any OR it’s usually a medical student and resident’s job to help position the patient, make sure the lights aren’t all tangled (elbows out) – let the resident take the lead on this – if it’s something they do at their program then help out.
  • Always bring a pen and scratch paper in your pocket as I can’t even count the number of times I’ve been the only person in the room with a pen.
  • It never hurts to ask if you can just observe the surgery if there are too many people scrubbing.  Usually if it’s a 1st year resident as surgeon a 3rd or 4th year will assist and then the attending may scrub or watch so sometimes 3 is enough at the table.  If it’s a 3rd or 4th year resident as surgeon you’re more likely to be able to scrub for that one and most likely just retract and get asked questions.
  • At the end of the case – help clean up the patient, move the patient to their bed, etc.  Do not leave the room until all of the residents/attendings leave; if a resident is still helping do something you should be helping too.

Ob/Gyn Specific:

  • Never walk in to a delivery if you haven’t met the patient.  If she is up in stirrups or actively pushing that is NEVER the time to meet a patient and ask if it’s okay you’re in the delivery.
  • Also, never ask if you can do a procedure when you’re in the actual delivery room or OR.  Ask the resident or attending before the delivery/surgery if you can do part of the procedure, e.g. deliver the placenta, etc.
  • If you’re in a delivery that turns into a stat C Section there’s usually so many people around that it’s difficult to say that you’ll actually scrub.  There are things you can do to be helpful though in an OR then like grabbing hats and masks for everyone, tying gowns, etc – just make sure to watch your sterile field extra closely in this case as this is probably the worst possible time ever to break sterile field. This stuff shows that you’re not just going to be someone in the way and will probably not get kicked out of the room… then you can remain a fly on the wall for the rest of the time.
  • If you find your self in a spot where you don’t know what you’re supposed to do: always ask!  

Happy Rotating!

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