Written By: Sarah Benich
With the establishment of Integrated IR/DR residency programs, interest in interventional radiology continues to rise among medical students. As competition grows, more and more medical students are considering away rotations. Anecdotally speaking, older residents, fellows, and attendings have told me they have noticed more visiting students in the past few years. The premise is simple: do an away rotation at XYZ University, the love is mutual, and you match there and head off into residency. However, this important topic can be much more nuanced, and this post is designed to provide some thinking points.
Q: First things first. Why should I consider (an) away rotation(s)?
Many schools only offer one full or partial rotation in interventional radiology for their home students. Many students find that they need more experience to confidently pursue IR as a career. Away rotations also help foster intelligent conversations about IR during residency interviews and help clarify important factors to consider when creating your final rank list.
Q: Are away rotations in IR only for those who plan to apply to the integrated IR/DR residency?
Doing an away rotation with interventional radiology by no means requires application to the integrated IR/DR pathway. Medical students chose to do an IR away rotation for many reasons. They may plan to pursue IR through DR residency with ESIR and want to increase their understanding of the program’s interventional radiology department. Others may elect to do an IR rotation regardless of their true interest in pursuing IR as a career because doing an away rotation in diagnostic radiology is often passive and therefore difficult to positively stand out.
Q: When should I do an away rotation?
Conventional wisdom dictates that away rotations should be completed after a rotation in one’s home department first, if at all possible. This provides exposure to basic wire and catheter skills in a “safe” environment before “auditioning” at another program. At a minimum, you should know how to don your own sterile gown and gloves, hold and coil a wire, and have a basic concept of what it means to run the table. While you can technically do away rotations up until the winter of your 4th year, I would recommend finishing by early October. Students have described post-October away rotations as logistically challenging and, honestly, awkward to ask for time off during an away rotation to interview at other programs. Anything is possible, but not all situations are ideal.
Q: Will doing an away rotation guarantee me an interview with a particular IR/DR program?
A: No, as an away rotation can either help or hurt you. Different IR/DR programs place varying degrees of emphasis on the importance of visiting students in their interview invitation list (and eventual match list). Some programs look very fondly upon those who chose to spend a month with them, provided they work hard and show enthusiasm. Other programs use different criteria when deciding whom to interview, and may not give interview preference to their visiting students due to a lack of geographic regional ties, board score cut-offs, DO/IMG status, or other factors.
According to the 2018 NRMP Program Director survey1 , 73% (N = 15) of IR/DR PDs cited “audition elective/rotation within your department” as a factor in selecting applicants to interview. For comparison, this percentage was 51% (N = 164) for Internal Medicine PDs and 82% (N = 87) for Emergency Medicine PDs. In regards to ranking of interviewees, 71% (N = 15) of IR/DR PDs cited the rotation as a factor in ranking the applicant. The average rating of importance for this item was 4.4 (out of a total of 5). If we are to take these numbers at face value, “perceived interest in the program” and “feedback from current residents” each scored a 5 while volunteer experiences only scored 3.6 in importance of ranking an interviewee in the IR/DR survey.
While the data is interesting, the small sample size makes it difficult to draw definitive conclusions. Students who complete away rotations may love the program, and thus rank it very highly, influencing where they match. Some programs abide by the concept that an excellent visiting student would likely be an excellent resident at their program.
Q: What are factors to consider when deciding where to do an away rotation?
Doing away rotations helps you elucidate what factors are important to you and prioritize when applying for residency and creating your rank list.
· Geographic Region: If your residency goal is to stay on the West Coast, consider doing West Coast away rotations. If you spent your whole life in small towns and want to match in a larger city, consider this. If you want to return home to competitive areas such as California, Boston, or Texas, consider doing rotations here.
· Size of program: Consider the size of the DR program, not just the size of the IR/DR program. Your experience during your first three years of diagnostic training will be different if you have three co-residents versus if you have 13 co-residents. Each type of program has pros and cons. Larger programs also typically have more diagnostic radiology fellows, so be sure to consider how the number of trainees will affect your experience.
· Scope of IR: You may want to consider doing a rotation in pediatric IR if you think this may be something you look for in a residency program. You may want to do an away at a program with a strong interventional oncology section or PAD presence. No med student will become an interventional oncologist by the end of 4 weeks, but this will help you to establish your priorities in applying for and ranking residency programs.
· Cost: The cost of an away rotation can vary from $25 to several hundred dollars. Some institutions charge tuition and processing fees, while others do not. This information can be found on VSAS or individual program websites. You can decrease lodging costs by living with a friend or family member, though websites such as rotatingroom.com have emerged as cheaper alternatives to Airbnb for those with no personal connections in the area. Some programs offer housing suggestions or discounted on-campus housing affiliated with an undergraduate institution, etc. Keep in mind that wherever you elect to live, you will need to account for driving, traffic, food, transportation fees, Uber costs, etc.
Q: How many away rotations should I do in IR?
On the interview trail, I personally have heard numbers ranging from none to five, though more than three is the exception rather than the norm. According to data provided in 2017 by DePietro, et al2, most medical students applying to IR/DR programs completed at least one away IR rotation. Of those who completed away rotations, the average was about 2. This number may be higher in the 2018-2019 application cycle, but there is no conclusive data to date.
Q: Are there any reasons why I shouldn’t do an away rotation?
· Cost. As mentioned above, some students may find the cost prohibitive.
· Lack of elective time. Another school’s block schedule may conflict with your own school’s schedule (i.e., completing a month-long rotation at a different institution may take up two entire blocks at your school).
· Concern about “ruining your chances” or matching at said away institution. Away rotations can be stressful and exhausting. You may be trying to navigate a city that you have never been to before. You may be trying to complete your ERAS application and secure letters of recommendation during the away rotation. Away rotations require you to stay late, display enthusiasm, and try your best to impress. This can become significant if fatigue settles in as the rotation wears on. Finally, a common rebuttal against doing an away rotation is that if your supervisors do not like you, you will obviously hurt your chances of matching there.
Q: Should I get a letter of recommendation from an away rotation?
You can, although you do not need to. I personally chose to ask for all my letters from my home institution. For students without a home hospital system or home interventional radiology program, you may want to get 1-2 letters from IRs this way. Students who rotate at another institution where they work closer with their SIR mentor may also elect to get to get a letter. Some students opt to get a letter from a recognizable name in the IR community during an away rotation.
Q: What is the difference between an away rotation and a rotation at your home institution?
Essentially nothing, since you are treated as a medical student wherever you are. However, it is likely that the attendings and fellows will be watching you more closely, since you took the extra time and effort to come to their specific program. Doing away rotations gives you the unique opportunity to get an inside look into a program, possibly live in a different area of the country for a month, and network with those who may serve as mentors for years to come.
- National Resident Matching Program, Data Release and Research Committee: Results of the
2018 NRMP Program Director Survey. National Resident Matching Program, Washington, DC.
- The 2017 Integrated IR Residency Match: Results of a National Survey of Applicants and Program Directors. DePietro, Daniel M. et al. Journal of Vascular and Interventional Radiology, Volume 29, Issue 1, 114 – 124.