BTK Episode 6_Final-esv2-49p-bg-10p

BTK Episode 6_Final-esv2-49p-bg-10p

[00:00:00] Howdy everyone, and welcome to the sixth episode of The Behind the Knife Podcast series, brought to you by the collaboration of Surgical Education Fellows or sef. My name is Josh Roch. I'm a general surgery resident at the Brigham in Boston and a surgical education research fellow at the branch in Galveston, Texas.

In our last episode, we talked about professional development time and professional identity formation and surgical training. In this Journal Club episode, we're gonna be talking about something that may be on many a trainees mind this spring, and that's away rotations and sub internships. Today I'm happy to have two awesome SEF members joining the show.

First off, we have Dr. Sophia Williams Perez. Texas is being represented quite well today. Thanks, Josh. Hey everyone. I'm Sophia and I'm a general surgery resident at Baylor College of Medicine, and I'm also a former health profession scholarship program or HPSP recipient in the US Navy. So I'm currently serving in the reserves during my civilian residency.

Glad to have you on the show. And we also have Dr. Colleen McDermott, who actually led the [00:01:00] charge on the paper we're gonna be discussing in this episode. Welcome to the show, Colleen. Thanks for having me again. EF and I wrote an editorial that's available in Annals of Surgery, open Access that shares our framework for thinking about away rotations in general surgery.

We'll discuss that piece today and more in terms of generally talking about sub eyes and away rotations. The paper will also be linked in the show notes of this episode. Wait, wait, wait. Before we get started, for all of you new listeners out there, you might be wondering what the heck is cef? Well, we're a multi-institutional organization of surgical education research fellows.

Working together to foster peer mentorship, networking, and scholarly collaboration. We meet every week to discuss ongoing research efforts by individuals or by smaller groups within cef, and we collaborate with larger groups like the Association for Surgical Education and the American College of Surgeons.

Put it simple. We're by residents for residents, so if you're a surgical education fellow or a surgery resident who's just interested in education and you want to join cef. Email us at cef [00:02:00] connect@gmail.com. That's C-O-S-E-F connect@gmail.com. You can also learn more about us on our fancy new website, cef.org.

You know Josh, I think Maya did tell us that there would be advertisements on this podcast. Respect the hustle. Am I right? Okay. Well, speaking of trainees from multiple institutions, something we aimed for when writing the paper was to share multiple perspectives on this nuanced topic. So I wanted to make sure that we have a diverse amount of perspectives on this podcast too.

Wait, Colleen, what do you mean by that? Does that mean you brought friends again? Who'd you guys bring this time? Us. Oh, wow. We should really put better locks on the doors. Josh, we're on Zoom. Hi, I'm Nicole Santucci, a general surgery resident at WashU in St. Louis. Hey everyone. I'm Reagan Collins. I'm a fourth year medical student at Texas Tech, currently in the general surgery match this cycle and recently completed three away rotations.

Hey y'all. I'm Steve Thornton, one of the second year general surgery residents at Duke. Hi everyone. I'm Annie Hurl and I completed my first two clinical years at Indiana University and now I'm at MD Anderson doing my two [00:03:00] year research fellowship. And my name is Jorge zte. I am a chief general surgery resident at Washington St.

Louis and one of the incoming colorectal surgery fellows at Mount Sinai in New York. So I think we've probably got listeners at a lot of different levels in their medical school journey. A lot of MS Fours, but I'm imagining younger students as well. Should we clarify exactly what we're talking about?

What is an away rotation anyway? And for that matter, what's a sub internship? Josh? Wow. Steven knows that I'm a sucker for a good who, what, when, where, why, and how. Discussion. Colleen, do you want to kick us off? Yeah, great question. So in a way, rotation is when a medical student goes to a different institution for a temporary clinical experience.

Usually this is in their fourth year of medical school and they do it to get a sense of the program to learn from different faculty and maybe even show up some of those intangible skills that don't show up well on the electronic residency application service or as we know at ERAS. And for you, zoomers out there away rotations can be virtual.

You're kidding. How you know, back in my day, we had to actually show up in [00:04:00] person, scrub in, and prove we knew which way was up on a laparoscopic camera. Oh, don't age yourself too much here, Josh. Away. Rotations can be done virtually. Now there are still plenty of traditional in-person away rotations, but some programs offer remote experiences so students can attend conferences, case discussions, and even some mentoring all through the magic of Zoom.

Or teams or whatever your flavor of video-based conferencing is. Talk about democratization of access to surgical education. Exactly. In the terms of way rotation and sub internship or even acting internship are sometimes used interchangeably, but they aren't always the same thing. A sub I or a sub internship is basically a rotation where a fourth year medical student is expected to function as close to an intern as possible.

So a sub intern or subi is a medical student who is carrying the service pager, calling consults, and generally working more independently. This is a big step up from just following your patients and presenting them on rounds during your clerkship. And so the subs expected to know the ins and outs of the service just as the intern would.

Subs can be aware rotations if they're done at another [00:05:00] institution, but not all aware. Rotations are structured with subs. Similarly, not all subs need to be done as away rotation. Many are done at your home institution and that distinction can really matter. So some programs expect you to do a sub-I if you're rotating there, well.

Others offer more observational experiences where you're more of a shadow than really an intern, so you gotta check the fine print. So for our listeners who are thinking about applying, or even in the thick of applying to away rotations, when is the best time to actually apply for these experiences? So applications for way rotations usually open the spring of your third year of med school, and most programs are use the visiting student learning opportunities platform, also known as v SLO, to manage applications.

Ah, yes, V slo. Just when you think you're done for paying for the privilege of going to work. There's always something else they can get you on between tracking different requirements, getting your paperwork in order and choosing programs to apply to V SLO can be a lot of work while you're already busy on clinical rotations.

Some programs start reviewing applications as [00:06:00] early as March or April, while others don't even look at them until May or June. But if you're aiming for rotation at a popular time, apply as early as possible to help ensure there are options still open. Be mindful that some requirements, including vaccine records and health forms may require a trip to student health to complete.

So be sure to give yourself plenty of time. Yes, exactly. I ended up doing three away rotations, but applied to a couple for each month. I wanted to rotate. I applied as soon as applications opened and having all your documents ready to go really made a huge difference. Some programs require personal statements or letters of recommendation, which can take time to put together and even if the current year's application wasn't visible invis yet, I looked at the previous year's application to get a sense of any of those very specific requirements that the program might have in order to start putting those materials together early.

Great points. I remember v SLO getting overloaded on popular program relief states and would crash. That's why it's so important to have everything organized and ready to go beforehand. And don't forget some specialties like orthopedic surgery and ENT, they tend to fill their spots super early, while others like general [00:07:00] surgery may have some more flexibility.

So regardless of your specialty, most rotations end up happening between July and October of your fourth year. Another pro tip to try to apply as soon as applications open. If you save the rotations, you're interested in belo, you'll get an email notifications when they open. I found that not all dates on websites were accurate, and those notifications helped me apply as soon as spots opened, even if that meant I was in the middle of another rotation at the time.

And seriously get your paperwork together early. I cannot stress this enough. Every school has different requirements and you don't wanna get accepted. Only to realize that you can't start because you didn't submit something in time. Yeah, nothing screams like I'm a highly competent future surgeon. Like missing a deadline because you forgot your TB test expired.

Exactly. You'll probably need an up-to-date vaccination record. Letters of recommendation transcripts, roof of malpractice insurance and HIPAA training. But what's medical school without some paperwork nightmares. So we've got the what and the when down. Now, how do we actually apply? Like I [00:08:00] mentioned, most programs use V slo, which is a centralized application service that I think existed back in my day, but didn't used to be called that.

But some like military hospitals, osteopathic programs, or even smaller community hospitals have their own application portals. Typically, the first step is to find the rotations that you're interested in, and V SLO is a great place to look and filter by rotation in school, and most schools have their options listed on their website as well, but there's some hidden gems if you dig around a bit.

Next, you'll want to submit an application through vs. O. Usually includes your CV or USM, least step one score or personal statements. Sometimes a letter of recommendation, but don't let the application standardization temp you to just blindly apply to a ton of places. It could be really tempting to throw applications everywhere, but you need to be strategic first.

You should know that each application costs money and those fees can really add up fast. Second, if you apply to too many programs, you might get stuck choosing between multiple acceptances. And while this isn't necessarily true for all programs, some programs might view a student turning down a rotation opportunity unfavorably later on in the interview [00:09:00] season.

And finally, you need to plan around your home institution's curriculum schedule. So if your school requires you to do a home sub-I or capstone, you don't want it overlapping with an away rotation. So are you saying there's a downside to applying to every rotation? It's important to be thoughtful about where you apply and maybe pick one or two programs for each time slot.

Give those programs some time to respond and then apply to more. This way, you'll lower the likelihood of having to turn down rotation opportunities. Again, some programs might not have any communication between the away rotation coordinator and the residency program director's office, but some may see you withdrawing an application as a sign of disinterest.

So if you have to cancel a rotation. Be sure to be really gracious and give at least six weeks notice so that the program has the time to fill the spot. That's a great point. So I'm assuming they can't just move the dates around in order to make rotations work? Yeah. Some schools might be flexible with start dates, but most will say no, especially for popular rotations.

You're usually applying for a specific set of dates and programs expect you to be there [00:10:00] for the full duration. That said, if your home sub-I has a little more flexibility, you might be able to work something out on that end instead. Sometimes it just takes a bit of creativity and communication, so talk to your school's administration early to see if adjustments are possible.

You could also take advantage of shorter rotations, online electives, independent study, or even vacation time to fill the gaps. And don't forget about travel time. If you finish a rotation on a Friday in Texas and start an away rotation on Monday in New York, you better have a solid travel plan or Taylor Swift's private jet.

You can turn your EAS tour into the Aris tour on the PJ ah Gotti. Anyway, once you consider all of this and submit your application, you wait. Some programs do rolling acceptances, meaning they fill spots as they go, while others review all applications at once and send out decisions later. And if you don't hear back right away.

Don't panic. Some schools take their sweet time, but if you're waiting on a response and it's been over a month, reaching out to the coordinator can work wonders. You also may not [00:11:00] necessarily hear back from every rotation you applied to. Yeah, that's so true. These folks can get super busy and it might not be that you were denied.

Maybe your materials are just sitting on their desk under a bunch of other messages, or they've gotten buried in their inbox. And sometimes sending a personalized message demonstrating your particular interest, your connection to the program can also help move your application out of the abyss and into review.

Definitely been there. Okay. Now for the million dollar question, who actually needs to do an away rotation? Great question, Josh. I. So for some folks it may be a necessity like the HPSP military match. Applicants HPSP medical students are often actually expected to fulfill their annual active duty training requirements by completing in a way rotation at one of the military hospitals at least once during medical school.

It also provides these military applicants with the opportunity to actually experience military medicine firsthand as well as apply for the given residency while. On that rotation for certain competitive specialties such as plastics, orthopedics, ENT, [00:12:00] neurosurgery, vascular surgery, away rotations, can help you get that golden interview invite.

Some programs really only interview applicants who've rotated with them, but it's important to note that doing an away rotation does not in and of itself guarantee that you'll get an interview. Well, it looks like we're somehow getting another live caller on the show. Oh, shoot. Josh, I knew we shouldn't have left that Zoom link open again.

Go ahead caller, you're on with ef. How can we help? Hey ef, this is a boss Kareem calling. I'm a medical student at the University of Texas Medical Branch and I have a quick question. Should I do an aware rotation if I'm applying to general surgery? It depends, and this question doesn't have an easy answer, which is one of the reasons we wrote the paper in the first place.

The short answer is that for some people it may be a great addition to your application and experience for you, but for others it may not make the most sense. There's no one right answer in general surgery, but we hope that the discussion in the paper and here will help provide a framework for students to think about all the pros and cons.

I'll start off by mentioning [00:13:00] that away. Rotations aren't just about impressing people. They're also about you getting a feel for the program, a region of the country, or a new system. It can also help you make a more informed rank list and even match decisions. Exactly. It's like speed dating, but instead of dinner and drinks, you're getting paged at 3:00 AM for a surgical consult.

You get it. Reagan? I guess in addition to asking, should I do an away rotation, students should really be thinking, what do I hope to get out of this? Wow, that's so deep. Steven. Thanks. I try, but I now have a few follow up. So since away rotations aren't actually required for everyone, why would I wanna do an away rotation?

What benefits are there? First? One of the considerations you may have in doing it away rotation is geography and being able to explore in different area can be big. Why would someone want to go somewhere else just for a rotation? Well, according to data from the A MC, many students only receive one medical school acceptance, and they may end up enrolling in a medical school outside their home state.

This means that for a lot of students, the dream of being a Dr. May take them away from friends and family for support. It's true. I think even if you are close to home for [00:14:00] medical school, one reason could be wanting to experience a new region or break away from whether they grew up and went to school.

It could also be a way to bring them back to a specific location they want to be in, whether that's for personal or professional reasons. For me personally, a big motivator was that my husband had moved to another state for a job, so I chose to do an away rotation there to be closer to him during that time.

Fortunately, there were great programs in that area that also provided opportunities that aligned with my career goals. So it all worked out to be the perfect scenario for me. Yeah, those are great points, Annie, and they all really resonate with my experience too. I also stayed with a partner during my away rotation.

The residency applications can be so stressful. It's really nice to be able to stay close to your support system for a few months. Speaking of residency applications, another reason you might wanna do an away rotation is to learn more about the field and make more informed decisions about the programs you'll end up applying to surgery is pretty broad and your medical school may not have everything that you wanna see.

For example, once upon a time, I was really interested in surgical oncology, so I used an [00:15:00] away rotation to see a high volume hepatobiliary center with different subspecialty oncology services than what we had at my medical school. This helped me learn more about the field than I thought I might be interested in.

So it was a great opportunity to learn at away rotation. Great point, Colleen. I got the chance to in away rotation at a community hospital, which was a totally new experience for me. Since I hadn't worked in that kind of setting during medical school, this actually ended up having a big impact on my residency research.

I realized how much I valued having a mix of different training experiences were like those at the va, hospital, community hospitals, private practice, and academic institutions. That variety became something I really wanted in my residency program. It also gave me the opportunity to learn a new EMR system and adapt to new teams and environments since I'll be doing that a lot as a resident.

So let's say you're accepted for an away rotation at your dream program. Do you get paid to be there? Dream on Josh away. Rotations aren't just a time commitment. They're a financial commitment too. You've got a budget ahead, or you might find yourself eating granola bars for dinner by week two. The classic away [00:16:00] rotation diet, one protein bar or one cup of coffee and whatever.

Free food you can come across in the lounge pretty much, but seriously, you really do have to plan for travel, housing, basic living expenses. It really all adds up fast. If you're flying, that's already a chunk of change. But even if you're driving, gas is not cheap these days. And if you need a rental car, that's a whole other cost to consider.

Don't forget, you may have to buy a parking pass or access to daily parking for the month, which can add up. Not to mention Uber and Lyft, which are great until you realize you just dropped 40 bucks. Getting home from a late night call. I'd made a spreadsheet where I actually priced out the cost of driving my car to the rotation, parking it in the friend's building I was staying at, and parking at the hospital every day.

And it turned out that it didn't make sense to bring a car at all. I got the Uber Pass that protected me from surge pricing and usually would Uber to work since it was a dutiful subway. I was arriving well before Dawn, but then I would often take the bus or walk home in the evening if it was still light out, which helps save money on Ubers.

So don't be afraid to get to know the city's public transit system if you're able. And then there's housing, [00:17:00] which is a whole other thing in itself. Some programs are great and they offer student housing, but a lot don't. So you might have to figure something out yourself. A lot of medical students use rotating room, which is like Airbnb, but specifically for people doing clinical rotations, sometimes you can find a really good deal on an actual Airbnb, especially if you split with other students.

Some hospitals have dorm sale housing, but availability is really hit or miss. So you have to check early. Great point, Nicole. But let's not forget about the best option. You can crash from family or friends if you're lucky enough to have them in the area, which is definitely the most budget friendly and fun option.

Plus home cooked meals, elite move. Exactly. And speaking of meals, food's, another sneaky expense. You'll probably be eating at the hospital a lot, and trust me, those cafeteria swipes add up. It's easy to spend more money than you realize, especially if you're too tired to cook after a long day. Not to mention all the coffee.

You think that you drink a lot of it now, just wait until you're in a new hospital on a new team, trying to prove yourself. You'll basically [00:18:00] have an IV drip of caffeine, or in my case, a central line delivering a steady rate of monster energy. There's also other random expenses like laundry. If your place doesn't have a washer and dryer, you're either dragging scrubs to a laundromat or rewiring them one too many times.

Nothing says I'm ready for this residency spot, like showing up in scrubs that look like they've been through a war zone. Also, maybe consider getting that white coat dry cleaned to get the pen stains out before you start at a new place. And same for clinic clothes. The bottom line is you have to plan ahead so these costs don't catch you off guard away.

Rotations can be pricey, but if you're smart about it, you can make it work. And while financial concerns are something that all students have to consider, they can certainly be a bigger barrier for applicants that are historically and in medicine. Some programs actually have funded opportunities for away rotations and will offer reimbursement for travel and accommodations while others have full scholarships to help offset costs.

These types of programs typically involve an application process with many essays and additional recommendation letters. So make sure you get started on this process early. Unfortunately, [00:19:00] this area probably is rapidly evolving in light of some recent legislative changes pertaining to diversity, equity, and inclusion, and the ensuing funding of such initiatives, but hopefully there are still opportunities this year that students can take advantage of.

Yeah, I hope so. Honestly, for minority applicants waiver rotations aren't just about funding. There're also an important way to evaluate a program and its environment are truly inclusive. The residency program might look diverse on paper, but that doesn't necessarily tell you what it feels like to train there.

It's one thing to see a statement about diversity on a website, and it's another thing completely to actually be in the hospital, interact with the residents and faculty, and get a sense of whether you'd feel comfortable there. Right, because residency isn't just about where you work, it's about where you live for five to seven years.

Exactly, and that's something that can be especially important for minority applicants. A program might offer great training, but if you don't feel supported, included or like you belong, that's going to have a huge impact on your experience. And it's not just about the hospital, the city itself matters too.

Some people rotate somewhere and realize, I love this program, but I could never really live here. Others [00:20:00] find a place that feels like home and it ends up being at the top of their rank list. That's why a lot of institutions have DEI funded away rotations, not just to cover costs, but to provide mentorship, networking, and professional development.

When I was a medical student, I did one of these D-E-I-O-A rotations, and it was so much more than just working at a different hospital. They had after hours mentorship sessions with minority faculty, helped us navigate the residency application process and introduced us to URM residents across different specialties.

It gave me a real sense of what the community was like at that institution, and that was something no website or interview could really have shown me. That's amazing. And we lean for the demo. Of high quality surgical education. And one last thing, these DEI funded away rotations aren't always listed under the Department of Surgery.

Some programs run them through the medical schools' Diversity office or even the GME office. So if we don't see one listed on their surgery, you gotta dig deeper. There might be opportunities you don't even know exist. That's such a great tip. So if you're thinking, I'd love to do an away rotation, but I'm not sure I can afford it.

Or I really wanna see if this program is a good fit for me as an underrepresented in medicine applicant. [00:21:00] Don't let those concerns stop you from applying. There are opportunities out there, you just have to start looking early. Oh, wow. Another caller. We're really running a hotline now. All right. You're live.

What's your question? Hey, uh, it's me again. No way. A boss. Is that you? Guilty. Look, I had another question. I couldn't let go. I'm really excited to do an away rotation, but I'm also feeling pretty nervous about performing well. What advice do you have for making a good impression during my away rotation?

That's a great question, aba, and it totally makes sense that you'd be having a lot of feelings about such a big experience. In broad strokes, I tend to advise students about away rotations. They should really focus on two domains, RSST, clinical performance, and second, building their network. From the clinical perspective, many of the same things that have applied to your rotations at home will be true at the visiting program as well.

Work hard, be a team player, care deeply about your patients and study the content area that you're working in. There may also be some unique institutional expectations that you need to consider. Touch base with the visiting clerkship [00:22:00] director and the residents whom you'll be working with to get some clarity.

For example, what roles does the student have in documentation? Will you participate in night call? Is there a dress code for rounds? How does the team like to communicate updates with one another? These things might change from institution to institution, and getting a sense of these cultural variables can help you to hit the ground running on day one.

You might also ask the clerkship coordinator for contact information for the student who is just on the rotation before you enter. To meet with them ahead of time. I met with a current medical student the day before the rotation started, and she showed me around the hospital, set up my list in Epic, made sure my scrub code worked, which is fantastic.

And then you can pay this forward for students rotating at your institution. It helps to learn details of the service that you may be afraid to ask the resident who's evaluating you during the month. Also, try to be really present and focused on the rotation while you're there. So have step two outta the way, if possible.

Have your ERAS application ready to go so you aren't being pulled in a lot of directions during a rotation. Those are all really great points. Another big piece of doing well on away rotation I think, is being situationally aware. While clinical knowledge is important, how you [00:23:00] carry yourself and interact with team members can really set you apart.

I think that looks like paying attention to what's happening around you. So how the team communicates, how decisions are made. And how you can contribute without disrupting the flow. I think it goes without saying to treat everyone with respect, but that goes all the way from scrub techs to residents, to attendings, and then seeking feedback at the right times, like after a case or during a downtime.

Knowing when to speak up and when to step back is just as important as what you say. And when it comes to the floor, a huge part of making a good impression is figuring out how you can make the intern's life easier. The goal is to be helpful without needing to be asked. Pending progress notes in the morning can make things more efficient, so all you have to do is fill in the finalized plans after rounds, offering to assist with tasks like pulling drains, removing staples as long as you feel comfortable doing so and being ready with supplies for dressing changes on rounds, there's always gonna be things that the intern has to oversee, but showing that you're proactive can really go a long way.

I think one last thing that's really important is to never overstate what you know how to do. This is a learning experience and you're not expected to know everything. It's much [00:24:00] better to be safe than ask for help or someone to watch you do something once you feel comfortable doing so. And this should also go without saying, but being a good member of the community goes a long way.

Offer to let the intern use the last computer in the workroom rather than taking it for yourself. Make more coffee if you took the last cup in the resident lounge. Proactively check in with nurses and communicate the team's plan. Don't be on your phone during grand rounds. Pull the residents gloves for them for the case, help position the patient, et cetera.

Being a good team player doesn't go unnoticed. I see. That's all really helpful. You also mentioned networking. Can you elaborate on that a little? Yeah, of course. The relationships you build during an away rotation are really a core part of the experience. You're not there just to learn surgical skills.

You're also really getting a preview of what life might look like. If you were to be a resident at the program, would you fit in with the teams? Does the faculty support trainees? Is this a place where you can really see yourself thriving for the next five to seven years? I always advise medical students to meet with several faculty during their sub internships.

The chair program director and associate program director are great people to connect [00:25:00] with because they can give you a high level of view of what the program's vision is and their training philosophy. But their schedules fill up fast, sometimes a month or more in advance. So if you want to meet with them, plan ahead and reach out early.

Don't just focus on the leadership. You should also seek out mentors in your areas of interest. So if you're an aspiring cancer surgeon, it's worth getting to know the surgical oncologists at that program. Maybe you'll rotate with them, but maybe you won't. Regardless, even a quick chat over coffee can give you valuable insights into what that program offers.

If you're drawn to a specific academic or service initiative, like community outreach for marginalized populations. Take time to meet with the faculty and the residents who are involved in those important efforts. These interactions can help you to find your people and to see how you might contribute to that culture outside of the operating room.

I totally agree, Steven. It can be tough to figure out which staff to approach. As a visiting student, I always recommend asking the residents. They usually know who would be a great mentor, and sometimes they'll even help set up a meeting because this is also a perfect time to ask for a letter of recommendation from an attending you work with during the month.

[00:26:00] That's another reason to plan your rotation between July and October so you can get your letter back in time for EAS applications. The residents may also be able to set up a meeting with the program director while you're there, which can be really helpful as well. And here's something people don't always think about.

Talk to residents and other specialties too. If you're chatting with an anesthesia resident, an OB GYN resident, or even internal medicine intern, ask them what their perception of your intended program's culture is. They'll give you an outside perspective on the work environment, attendings and hospital culture that you might not pick up from general surgery residents themselves.

Sometimes you get the most real insights from people who aren't in the trenches with you every day. Exactly. All of this serves two key purposes. First, it shows folks that you're really serious about their program. And you're genuinely interested in what they have to offer. Second, it helps you to figure out if the program aligns with your professional and personal goals.

And while you're there, don't forget to explore the city. It's easy to get caught up in the hospital, but residency is more than just where you work. It's also where you live. Try to get a sense of if that [00:27:00] area fits your lifestyle. Because at the end of the day, this is a place that you might be making a home.

That's such a great point. And away rotation isn't just about showing them you're a good fit. It's also about figuring out if they're the right fit for you. And one of the biggest ways to do that is by meeting with the right people when you're there. Yeah. And it's also worth saying not everyone needs to do in away rotation.

People here that wear rotations can help in certain competitive specialties and assume that this applies to everything. But for general surgery, it's not always necessary. And in some cases it could even actually hurt you. If you don't perform well, don't mesh with the team or just don't stand out. You might actually lower your chances that program instead of improving them.

And like we talked about, OAS are really a big investment between the cost, the time, the travel. It's important to really ask yourself if that month would be better spent at your home program. During that time, you could strengthen relationships, get another solid letter of recommendation, advance some of your research.

These are important things to consider, so bottom line, a boss and listeners don't do an away rotation just [00:28:00] because you think you have to do it because it makes sense for your application, whether that's showing interest in a specific program. Getting exposure to a specialty or establishing connections in a new geographic region.

And that just about wraps up today's discussion on aware rotations and sub internships. We've covered a lot when to apply, how to maximize your experience and whether or not aware rotation is even the right move for you. And if you liked this conversation, COF has. Plenty more where this came from. We're putting together a live debate on educational value of double scrubbing in the operating room.

You know that moment where you're third or fourth assist holding a retractor, contemplating your life choices. Some say it's an essential part of surgical training. Others think it's a glorified spectator sport. We'll be bringing in experts from both sides to go head to head. You won't wanna miss it. And for all the surgical education nerds like myself out there, we're also hosting a webinar on where to publish and present your education research because.

Let's be real. Your work out there is half the battle. We're bringing in editors in chief from major journals to give you the inside [00:29:00] scoop on what they're looking for, how to improve your chances of getting published and where to showcase your work. So if you wanna stay in the loop and not miss any of this, definitely give us a follow on X at Surge Ed Fellows and Blue Sky Social.

Sef. Oh wow. I'm definitely gonna tune in for both. Before we go, a huge thank you to all our contributors today for sharing their experiences, advice, and a few hard-earned lessons. If you wanna dive deeper into what we discussed, you can find the journal article behind this episode linked in the show notes.

Thank you for listening to The Behind the Knife Podcast, and as always, go forth and donate the day.

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