As we continue through the summer months, medical students are putting the finishing touches on their elective rotations for their fourth year.

These rotations, also known as audition rotations or sub-internships, enable students to “showcase” their talents, meet faculty and residents and put their best foot forward prior to submitting their electronic application.

A 2016 study showed that rotating improved a student’s chance of matching at that program by a factor of 1.5. With the transition to virtual interviews, this is likely significantly higher at present. This verifies the importance of these rotations, albeit most can be costly.

Outside elective rotations occur at an institution other than one’s home academic site. They frequently require travel and boarding expenses not incurred by students when they stay local. These costs can add up quickly and involve housing, transportation, and meals.

Students choose these rotations to strategize their application process and get a feel for residency programs where they wish to apply. By doing so, they can interact with the current residents and staff who they may work with in the future and also learn about the location they may call home for the next five years, at a minimum.

This facetime serves the programs, as well. Program leadership and faculty members obtain a first-hand view of an applicant through this interaction. Program directors and faculty see these rotations as a preview of what it would be like to work with that student as a resident for five years. For example, a program director can get a sense that if there was an emergency at the hospital in the middle of the night, would you trust this student to be the one to communicate with you and be able to help in that situation. Professional behavior, interpersonal skills, and teachability are all important characteristics that residency faculty members look for yet cannot be evaluated through an electronic paper application or board score report.

While the partnership is mutually beneficial, it’s the students who are less experienced at choosing the right program. Here’s some advice to consider as you navigate this process:

1. Faculty reputation/society involvement. One may gather the faculty involved in the residency training program through the Accreditation Council of Graduate Medical Education (ACGME) or the institution’s website. With that, one can search for their specific involvement in local, state, and national orthopedic and subspecialty societies.

2. Research productivity. PubMed, PubMed, PubMed! Search for the faculty and the residents alike. Also, find out if they focus on a specific area. Are they publishing content on joints, spine, or pediatrics? How about basic science research? Is there a vehicle to perform biomedical engineering projects? All good questions to ask, as this will help build your portfolio as you prepare for the next stage of your educational career.

3. Board score passing rate. All residents must pass their boards to complete their certification process. An important fact to understand is the program’s board examination pass rate on their first try. Most jobs post-training will require board certification. It is critical to know the first-time board pass rate for a program to see if the program will help prepare you for the next phase of your career.

4. Location/family support. The location of the program is vital. How close will you be to friends and family and other support? Being close to loved ones provides an outlet after stressful times and can provide backing as you navigate challenging times.

5. Fellowship match rate/status. Where do residents match for fellowship? Are they flocking to places or locations where you want to continue your training? Are the current residents earning fellowships in subspecialties that you are interested in?

6. Residency/faculty relationship. What’s the overall vibe among the residents, staff, and faculty physicians? This is not a marriage but instead a longstanding professional relationship. The goal of residency is to build your armamentarium with tricks to solve any orthopedic problem you may encounter in the future. In addition, you want to be able to call your mentor or former residency faculty member for advice on orthopedics, life, jobs, career progress, or hobbies. Be sure to explore the interactions and longstanding relationships among residents and faculty. Residents will be colleagues for a lot longer than they will be my residents. Treat them accordingly!

Residency training is a vigorous and challenging time in one’s life. It is a critical component of one’s academic career and must be chosen wisely. There is no perfect program as one size does not fit all. Be sure to understand the important aspects of residency training and find an institution that fits you best. Your career path may be influenced by this time, so never take the good times for granted.

Adam Bitterman and Randy M. Cohn are orthopedic surgeons.

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