How to impress on a sub-i / away rotation
Fourth year is an exciting time for medical students, as they are presented with the opportunity to do several rotations in their specialty of interest. Many of these rotations will be sub-internships, sometimes also called away rotations, and are used as a way to make a good impression, and show interest in a specific residency program. So the question that consistently arises each year is “How do I make a good impression on a sub-I?” In this article we will provide you with everything you need to know to make a lasting impression at your desired program.
The classic recommendation: “Don’t be weird”
All throughout the fourth year of medical school, the age old piece of advice to do well on away rotations was simple, don’t be weird. But nobody could ever explain just what this meant exactly. So, after several years of working with auditioning medical students, and after having been one myself, let me give some more insight. I think this advice should really be changed to “Read the room”. Every program and group of residents has their own community, and in this community there are preferences for how things should be said, what jokes should be made, and basically just how things should be performed in general. Once you have “picked up” on what the vibe is for your program you need to play within their rules and act the way they act. Those who do not do things the way they prefer will be the ones traditionally seen as “weird”.
For example, there are many programs, usually in academic settings, that are very strict, hierarchical, and simply want to get their work completed on time. When auditioning at a program with this environment, the way you will stand out is by doing the tasks assigned to you on time, not by making jokes in your downtime, or making small talk about sports. There are also programs on the opposite end of the spectrum that are more collaborative, welcome input from anyone, and enjoy chatting during downtime. Joining in the conversation and asking relevant questions to a resident’s story would be a great way to leave your mark on a program with this culture. Neither environment is better than the other but note that a cold, quiet and focused attitude in one setting would be celebrated as being a good resident, while it would be seen as being antisocial in another. This is what is meant by reading the room.
Do not wait for direction
One reason many students struggle on away rotations is not because of gaps in medical knowledge, or lack of enthusiasm, but it is because many programs do not know how to manage a medical student. When a medical student joins a program for a month it is usually not announced to the residents who this person is or sometimes that they are coming. Because of this there can be a sense of feeling lost as there is no direction provided on how to see patients or write notes, etc. This is why we recommend not waiting around for a resident or attending to give you a task as you will be sitting there for awhile doing nothing, which will not look good during a time where you are trying to impress. Instead you need to be proactive about getting involved with the resident team. If you are on a surgery sub-i, go to the OR and ask how you can help, and if you are allowed to scrub in. Do not simply wait around for someone to ask you if you would like to scrub in because odds are that will not happen often. If you are on a medicine sub-i, get a hold of the patient list from another resident and start seeing patients and typing notes without being asked. The more you can jump in and function as a resident without being asked the better an impression you will make. It is often intimidating for a medical student to just start practicing medicine without direction, especially in a new hospital you are unfamiliar with, but the more you are able to function independently the better your rotation will go.
Other miscellaneous tips:
Spend as much time as you can with upper level residents and attendings. While you may feel more comfortable around the interns (because they were med students only a few months ago), they rarely have any say in who gets accepted to their program while the upper level residents and attendings do.
If the residents meet up outside of work and invite you, you need to go. This is usually where you will make an even better lasting impression.
Expect to stay late, and do not ask to leave early.
Work well with other rotating students. There is nothing worse than a student who is rotating through a program and talks poorly about other students on the rotation. We understand they are your competition, but this will only reflect poorly on yourself.