Preparing to Get the Away Rotations You Want

Shelby Hoebee, MSIV, University of Arizona College of Medicine - Phoenix
EMRA MSC West Coordinator, 2019-20

Students hoping to match into emergency medicine (EM) are expected to do at least one away rotation in addition to their home EM clerkship in order to secure two Standardized Letters of Evaluation (SLOEs). Where you decide to do away rotations may be influenced by a variety of factors. Geography is one. For example, perhaps you are on the East Coast and would like to move to the West. Or perhaps you’ve done all your schooling in one state. In such a case, it may be helpful to secure a rotation in another region to demonstrate to programs that you’d be willing to move. You may also have a specific program at which you’d love to match; securing a rotation at that site can act as a month-long interview. In this case, caution is warranted. This strategy can backfire if you don’t perform as well as you’d hoped. On the other hand, it can get your foot in the door and show the program what a rock star you are. Wherever you end up, make sure you go into your rotation committed to making the best impression you can by working hard and being enthusiastic and friendly. Most programs offer a courtesy interview for students that rotated with them. This can be a great way to secure a spot at your top program or even a “reach” program.

One of the keys to getting the away rotation you want is applying early, especially if programs accept applicants on a rolling basis. In addition, be smart about the timing of your away. Many programs’ block dates will not line up with your school’s block dates. Some programs will take students that start at any date, but some will strictly require that all away rotators start on certain dates. For the latter programs, you can try emailing to see if they will accommodate your schedule, or you might need to pad your away time with a short elective. In the end, being inflexible with your dates will make it harder to secure the away you want.

Preparation for VSAS

In January or February – and even before you begin thinking about actually applying for away rotations – it is important to begin gathering the materials necessary to apply. The key to securing an away is applying early, so any delay in gathering your documentation can hurt your chances of getting the away rotation slot you want. That being said, the most helpful thing you can do in preparation for away rotation applications is to create a folder containing the following items:

• BLS/ACLS certification
• CITI training for blood-borne pathogens and HIPPA
• AAMC standardized immunization form
• N95 mask fitting certification
• Updated CV/resume
• USMLE/COMLEX score report
• Criminal background check
• Cleared drug screen
• Photocopy of your state ID

The criminal background check, immunization titers, and cleared drug screen are things that take time, may cost money, and get forgotten by many students, which then cause delays in their application. Have these things completed even if not every program you apply to requires them; you will likely find one that does. Also be sure to keep your vaccines up-to-date and entered on the AAMC form. You may find programs that want them in a different document, but most will accept the AAMC form. In terms of titers, some programs will want proof that you have antibodies against certain illnesses, and may want them as recently as within a year of your rotation date. That being said, it may be smart to get varicella, MMR, and hepatitis B quantitative titers drawn in January or February in anticipation of programs requiring them. If you are shown not to be immune, you'll need another vaccine (and possibly a set of three in the case of hepatitis B) and to wait four to six weeks before drawing another titer. It is recommended to start getting these in order around November ready to have titers redrawn in January, if necessary.

Affiliation agreements are another component of applying that many students forget and which can also take time to put in place. These are agreements between your school and the away program that allow you to rotate there. Even if you submit your application and do everything correctly, if there's no affiliation agreement, you won't be able to rotate at that site. Therefore, if you have a particular program in mind, it is smart to reach out to your school administrators to inquire whether there is an affiliation agreement in place. If there isn’t, this will give your administration time to begin working on one.

​Programs may also ask for a letter of interest or intent that may take some time to create. Do not use this as an opportunity to talk about why you like emergency medicine, instead talk about why you want to specifically be at the program you're applying to. This is the way to convey that you may have personal connections to that location. This is another reason why it can be helpful to research the necessary requirements for the rotation and begin writing your letter as soon as possible.

​There are other documents that will be requested by programs that your school will upload once you submit your application. These documents include things like: malpractice insurance proof, transcripts, letter of good standing, and affiliation agreements. If any program requires you as the student to upload these, just reach out to your registrar, rotations coordinator, or whoever it is at your school that usually assists with these documents.

Using VSAS

When you go to the Visiting Student Application Service (VSAS) website, begin on the home page by entering all of your information, including personal information and home institution contact. You do not need to add a brief bio, but it may be helpful if there is something you would like to add about yourself that was not apparent on your CV.

Next, you can begin adding electives, which are the away rotations you are hoping to apply to. The easiest way to search for a program is under the "Find electives" tab on the top menu. You can then select "emergency medicine" as your specialty or type in a specific program to which you are hoping to apply, then apply the filter. You will be presented with information about the length of the rotation and start and end dates. Clicking “Learn more” will take you to a page showing the requirements for applying to the rotation. There may, however, be hidden requirements that aren’t listed on these pages. We recommend that you search for the visiting student page on the program’s website and read it thoroughly.

Additionally, you can click on the link of the school name under "Institutions," which may also give you additional information on the rotation. Information here pertains to the program as a whole rather than the EM sub-internship specifically. It is important to look at this information, however, because it includes the date when electives offered by the program are posted, when you can start applying, and when you will be notified of their decision. It will also provide you with the name and email of a contact person for further questions. Make sure to search for everything yourself before contacting this person in order to avoid bothering them with unnecessary questions.

​Currently, it is recommended that you should apply to between five and seven programs total as a safe bet to secure one or two away rotations. There are caveats to this, however. If you are applying for a spot early in the year (in May or June), if your score on USMLE Step 1 was less than 215-220, or if you're coming from a smaller institution that may not be well known to other institutions, you may wish to apply to more programs. Conversely, if you are a highly competitive applicant, you may be able to get away with applying to just three or four programs in order to secure one to two aways, though this may not be the case if you are focused on “top” programs, however defined.

​EMRA Clerkship Match and SAEM Clerkship Directory are incredibly useful tools when searching for various programs and researching what they’re all about. They can help give you an idea of what programs are out there and what type of programs you may want to apply to. It is also advisable to speak to your advisor or EM Clerkship Director to seek their advice for away rotations. They may also have contacts to help you secure a spot. You want to find a place that fits what you're looking for in a program, where medical students have had a positive experience at in the past, where you can get a solid SLOE, and where SLOEs are uploaded to ERAS in a timely manner.

Once you have selected some programs to which you'd like to apply, I recommended you list all of the important dates for each program. This will help you decide the order in which you plan to apply. The away application system is not perfect, and not every program opens for applications or gives decisions at the same time. This can put students in a tough spot if their first-choice program notifies students of their decisions really late. Therefore, it is recommended to apply to multiple aways with the knowledge that you may be accepted by a program that is not your top choice.

In order to apply, click on the “Available dates” on the right side of the “Electives” page and select the date range to which you’re hoping to apply. Then select “Apply Now”. This will add your elective to a list of electives that you’d like to apply to. You may add multiple electives at one time before moving to the next step. Once you have all of your electives added, click “Save and Continue” to move to the “Requirements” page. To add the document for each requirement, click the “Edit” action. Note that some requirements are to be completed by your home institution once you fully apply for that elective. You may not need to reach out to your institution as they will automatically receive a notification to upload these documents once you apply. Some school administrators, however, will need to be notified once you apply. Be sure to check which category your school falls into. After submitting the requirements, you will be brought to the “Preference” page. This page allows you to rank different electives at the same institution by priority. For example, if you are trying to apply for an ultrasound elective, wilderness medicine elective, and sub-internship at a specific program, the preferences page allows you to convey to that program your priorities. Be sure to review your application in the “Application Summary” page to ensure your information is correct. 

Once you “Pay and Submit,” your application will be sent to the program for review. It costs $40 for your first three applications and $15 for each application after that.

Note that even though there are dates listed for when applications can be submitted, some programs do open VSAS submissions a day or two early. So if you have your application complete before the date (which we strongly advise), it is worth trying to submit electronically ahead of time, though you should not email the coordinator to ask if you can apply early. The dates are there for a reason.

Withdrawing your application before a decision will not hurt your chances with that program. For example, if you receive an acceptance to a program that you’d like to rotate at, but still have three applications elsewhere pending, it is perfectly fine to withdraw those applications. If you choose to decline an acceptance after it is given, however, know that you may be burning a bridge with that program for interviews and matching. The best way to avoid such fiascos is to be deliberate in the programs you choose and write down all of the important dates. This will allow you to organize your applications in a way that is less likely to burn you in the long run.

If you must cancel an away, do your best to do so as far out as possible (months in advance, if possible). This is considered common courtesy toward the program and towards your peers, as it gives the program time to fill your spot. In most circumstances, canceling is still frowned upon. If you have to cancel at a program you’re considering as a top choice for residency, it would be wise to write an email explaining your circumstances for why you needed to cancel. Most programs reserve spots early in the year for their own students, so be aware of this when applying for rotations in May, June and July. Once you receive an away rotation acceptance that you are going to confirm, it is critical that you withdraw all other applications immediately.

When looking for possible open dates that programs may be offering, CDEM has a list of programs updated by program directors (PD) and program coordinators (PC) to show what dates they may have available.

If you have applied to multiple programs and are not getting the decisions you want, you may have to settle on accepting an away later in the year, perhaps in September or October. While this may seem stressful, it can be a good thing for your application. Programs initially download the files of all of their applicants at the beginning of the season, but since you won't have both of your required SLOEs in yet, yours will be considered incomplete by many programs. Despite this, more than half of program directors will still extend interview offers to applicants with only one SLOE uploaded. Once you do have your second SLOE, this gives you an opportunity to reach out to programs and let them know your application is complete, which will allow them to re-download your file and may bring attention to you if you've not yet received an interview.

As an absolute last resort, you may consider reaching out to programs to inquire about the status of your away rotation application after a month or two of not hearing back. This is not recommended since you can come off as overbearing. However, it may be considered in a last ditch effort to secure an away. If the program explicitly states to not reach out, then of course respect that request.

​Troubleshooting VSAS

Of note, you do not have to do an away rotation at the institution you’d like to match at. There are many, many residents that match at their program of choice without doing an away there. So do not be discouraged if you don't secure the away spot of your dreams. Many programs simply don't have the capacity to take all of the students who wish to rotate with them, so don't take it personally. 

USMLE Step 1/COMLEX score is another element that factors into whether or not an away rotation spot is offered. If you have a lower Step 1/COMLEX score, be prepared for this. Some programs may also only accept Step 1, so students that choose to take only COMLEX may be limited in the programs that they can apply to.

​A direct, personalized message from your institution’s clerkship director or coordinator may help you in securing a spot. It also can be helpful to attend conferences such as ACEP or SAEM because you never know who you may meet or what connections they might have.