Overview of Away Rotations

July 11, 2020
Program Highlights

Away Rotations

It’s the start of a new year, and the start of M3 students trying to decide which specialty to pursue and how to pursue it.  For those students interested in EmergencyMedicine (EM), there is a lot of groundwork to cover and though it may seem early, now is the time to begin! Let’s start by discussing away rotations.

What are away rotations?

To match in Emergency Medicine, it is critical to obtain an away rotation.  An away rotation is generally a four week rotation at an institution other than your own that has an EM residency program.  It is essentially a month long interview process where each side assesses your compatibility for the program and concludes with a Standardized Letter of Evaluation (SLOE).  The SLOE is a crucial piece of your application and cited by most program directors as one of the most important components of the application to help them decide who to invite for an interview.

How many away rotations do I need?

Almost all EM programs require two SLOE.  For most students, this will be a home institution SLOE and an away SLOE. Generally speaking, most students need just one away rotation in addition to their home institution rotation. Students who are perceived at risk for matching (perhaps a low Step 1 score or prior failures) may want to consider a second away rotation to strengthen their application.  And students who do not have an Emergency Medicine residency program at their homeschool will also need two away rotations. Completing multiple away rotations (i.e. more than 2) is generally frowned upon, especially when this practice impedes less competitive candidate from finding an away spot.

Where should I apply?

Where to apply is student dependent and an individual decision. The general rule is to apply somewhere you would consider matching, but there are a lot of factors to consider.  Geographic location frequently plays a role.  Consider academic versus community programs and urban versus rural programs.  In addition, you should consider the cost of housing, transportation, and how closely the school’s academic calendar matches your own.  Some institutions will be flexible with dates, but most (including ours) are not.  In the end, your overall performance on the rotation (reflected in your SLOE) is much more important than where you chose to rotate.  If you happen to fall into the category of “Underrepresented in Medicine,” it would be prudent to see which programs offer scholarships to cover the expenses of your away rotation.  Society of Academic Emergency Medicine (SAEM) has a list of programs that provide these scholarships, ours included:  https://www.saem.org/cdem/resources/medical-student-resources/underrepresented-minority-scholarships

How do I apply?

There is unfortunately not one answer to this question. The vast majority of programs utilize the Visiting Student Application Service (VSAS/VSLO) (https://students-residents.aamc.org/attending-medical-school/article/visiting-student-learning-opportunities/), but not all.  It’s best to start with the residency website and look at their clerkship information.  In addition, Society of Academic EmergencyMedicine (SAEM) has a clerkship directory: (https://member.saem.org/SAEMIMIS/SAEM_Directories/Clerkship_Directory/SAEM_Directories/P/ClerkshipMap.aspx?hkey=6e036991-166b-4eb0-9ddf-2e536a8ba40f)

EMRA also has a clerkship directory: https://webapps.acep.org/utils/spa/match#/search/map

When do I apply?

When to apply is institution specific, but many programs will start opening up VSAS as early as the first of March and start extending offers as soon as mid-April through May. Refer to the residency website and above referenced SAEM and EMRA resources for the specifics of each institution. Ideally, you want to do your away rotation early on in the summer months so that you have two SLOE is uploaded by the time ERAS opens for applications on September 15th. If you are unable to get an away rotation completed this early, be assured that most programs will still extend interview offers with just one SLOE uploaded. However, you then need to make sure that you have a second SLOE uploaded well before programs start determining their rank list.

At how many places do I apply for an away rotation?

Again, how many places to apply is student specific. EMRA gives the general advice of applying to 5-7 programs for 1-2 away rotation offers. This is sound advice; I generally tell my own students to apply to roughly 4-8 programs.  The more competitive you are as an applicant, the fewer places you will need to apply. Pay attention to requirements. Some of the more competitive academic programs mandate minimum Step 1 scores.  If you are applying to a place that is geographically remote from your school, then it is prudent to submit a professional letter of intent in addition to your application explaining your interest in their program and region.  If you are having difficulty finding an away rotation, approach your clerkship director early on. He/she may have contacts that they can utilize to assist you in finding an away rotation, although you may not get your first choice of program. It is also acceptable to express your continued interest in your top pick away rotation to the respective clerkship coordinator/director at that program, although overuse of this strategy can be detrimental, and different clerkship directors respond differently to this tactic. I personally appreciate knowing if a student has a keen interest in our away rotation and am more likely to extend an offer knowing this. Meet early on with your EM specialty advisor to determine your competitiveness, interests, and strategy and map out the pathway that is right for you!  See you on VSAS….

Melissa Janse, MD

EM Acting Internship Clerkship Director

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