I only have one month of research left! Thank god. I can’t wait to get back to clinical medicine.

Medical school is a fascinating place. It’s bound to be; you’re taking 100 or so of the highest-stress, maximum type A personalities that exist and forcing them to attend class, scrap for grades (sometimes), and cohabitate for four years. If we had time for lives and drama, it would make a fantastic reality TV show.

(USA Network tried the resident physician version of this with a show called Vanderbilt MDs, but the results were terrible since residents have even less of a livelihood than even med students. The highlight of the one and only season was when an internal medicine resident got off work on a Saturday thirty minutes earlier than expected and cried with joy.)

Because of this environment, medical school is, in some ways, best defined as “worrying about the next step.” When we first arrived, we worried about adjusting to school and to our first test. We worried about our first 12-week block exam, about our first time seeing real patients in physical diagnosis, and ruminated about the last exam of first year.

Then, of course, it was time to worry about clinical rotations and shelf exams. After that, The-Test-That-Shall-Not-Be-Named and its successor, Step 2.

But now what? Halfway through the 3^rd year, it seems like most of the worries are in the rearview mirror. Residency applications are more than six months away, which even for med students is a little far away. There are no more major exams, no more critical evaluations, no more—

What’s that? There’s something to be worried about!?

Oh thank god.

Welcome to the next rat race: away rotations.

Away rotations are a great idea. These are typically month-long blocks where you can spend time at another hospital anywhere in the country to see what your specialty looks like in a totally different setting. For me, trying out a couple of different emergency medicine experiences is invaluable: my school is a large, academic Level 1 trauma center, which means that every support you could possibly ask for is here. It’s great. It is also the exact opposite of your everyday ER practice.

There are great reasons to do “aways” no matter what your desired specialty. You might be interested in family medicine, but your school may not have the residency program to experience. Or maybe you like pediatrics but your home school’s program isn’t that strong. Maybe you really want to do residency in Utah but don’t have any great background or family there; doing an away rotation can help establish some credentials.

The process for applying to aways works kind of the same as applying to medical school, just with way more steps, much more confusion and misinformation, and deadlines that run all over the place. I won’t go into the gritty details except to highlight a few key things that I think will give those interested grandmothers (hi grandma) a decent snapshot of how absurd the process is.

• In general, you apply for one or two away rotations from June through November. There are lots of exceptions, especially in fields like neurosurgery where doing as many as three aways is not unusual. This is because neurosurgery, as a field, likes to know that there is nothing else on this planet that their applicants enjoy more than neurosurgery. If you manage to do three separate away rotations in this field and do not flee for the hills to live a life of simplicity and subsistence farming, you’ve passed the test.
• We’re instructed to apply to about 4-6 rotations for every one we actually want to do. This is, obviously, because you’re fighting for a spot with 20,000 of your closest Type A friends. So if you want to do two aways, you’re looking at eight applications at a minimum. No big deal, right? It’s a common app… isn’t it?
• Each school may or may not have its own application. Each school definitely has their own immunization form, which is amusing since the requirements for entering medical school are basically the same everywhere. Each school charges its own, different application fee and each school may or may not have extra requirements, like a letter of recommendation or a personal statement or a blood sample.
• That last one was a joke. In actuality they only ask for a sworn declaration of lifelong fealty.
• Time-wise, we apply for these from around February through May. Otherwise known as right now. They’re usually first-come first-serve – it doesn’t usually matter how good your test scores are, just how high you are in the queue – but some programs will do things like accept applications starting in February but not make decisions until May. You can see how this would be stressful for most students registering for classes in April. Like, say, us.

Anyway. It bears mentioning that doing away rotations is not for everyone. Let’s say you really want to match for residency at, say, my alma mater – UNC Chapel Hill. You manage to snag an away rotation there in your desired specialty. This is great! You can now treat your month in North Carolina as an audition for residency; in fact, some schools will even conduct your formal interview while you’re there.

You can see how this can backfire if you are not the most social or personable human (of which, you will be shocked to learn, there are a few in medical school). If you show up for your rotation/audition and the residents begin to suspect you are, in fact, a robot… well, this bodes poorly for your chances of matching there. This can be a legitimate concern: my home school asks us to meet with our faculty advisor before deciding on aways, presumably so that advisor can recommend to those of us with the social tact of a Roomba that away rotations might be a bad idea.

couldn’t resist.

Even if you don’t intend to match to that institution, if you have the personality of a slice of baked ham your letter might not be as stellar as it could be otherwise – regardless of your clinical skills. Finally, if you rub the wrong person the wrong way – as I most likely will – it can torpedo your chances of matching there, and in extreme cases jeopardize your overall application. People talk.

The benefits sure do outweigh the risks, though. Fingers crossed for the summer!