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Pros and Cons of the Away Rotation

Thomasrobey72x721Thomas Robey -- Many public medical schools have a specific mission to train physicians to work in their state or region where they complete medical school. In the United States, this could present itself as improving graduates’ chances at residency in a home state or even deferring some students’ tuition if they promise to work in an underserved area. Many of the larger state schools go one step further. They actually train their students in the cities and towns where students could one day return to practice.

Such is the situation at my school. I’ve spent only 10 weeks of my third year in Seattle, Washington. I’ve also been to a small fishing and logging town on Puget Sound, Spokane, a medium sized city near Idaho, and now Fairbanks, Alaska. Since the University of Washington is the only medical school for Washington, Wyoming, Alaska, Montana and Idaho (WWAMI) and it focuses on excellent primary care training, Step 2 is followed every year by a medical clerk diaspora. We affectionately refer to placement outside of Seattle as being WWAMIed...

Anna has written tips about how to survive an away rotation. I’m focusing today on why you might want to do an away clerkship in the first place and what some of the drawbacks might be. Do you remember the city mouse/country mouse fable? It’ll be hard to get the city out of my veins, but when it comes to clerkships, I am definitely a country moose -- I mean mouse.

In favor of away clerkships are the following:

* In surgery and obstetrics, the medical student is the first assist. Without residents, the hands-on learning occurs both in quantity and quality. On my first day in the OR, I cut out an appendix, drove a colonoscope, and tied a seton drain to maintain a fistula. In many instances parents are happy to have the student in the room. This is a stark difference to the urban academic setting.

* For male students, it is best to get out of the urban centers for Ob/Gyn. There is still a balance between male and female providers, so women tend to be more comfortable with students learning exams.

* Free food. Many of these hospitals see away clerkships as a way to recruit young doctors to come back after residency. As such, there is often plentiful free food.

* The student-teacher ratio is stacked for you. There may be only one or two students learning from 10 doctors, 15 techs, 25 nurses and hundreds of patients. If there are residents, you can often pick and choose which folks teach in a way that matches your learning styles.

* Students in small towns have the potential to be a sort of hospital celebrity. More people know my pager number in Fairbanks than anywhere else. I don’t even know my pager number. This all adds up to your seeing interesting cases.

* It’s easy to maintain continuity of care with the "build your own schedule" setup many away rotations have. I can see a surgical patient’s initial presentation, a pre-op clinic appointment, assist in the procedure, manage the post-op hospital stay, and participate in follow-up care.

* Free time exists in the community. You can use this to read (medical topics or otherwise), exercise, sleep or take on extra shifts in the community ER.

* Travel! I’m not sure when I’d ever be able to get to visit Denali National Park. It’s a lot easier when your medical school arranges transportation and housing 2 hours up the road.

It’s not all gravy away from the mother ship. Being a city moose does have its benefits.

Moosecrop * There’s a lot to be said for the stability of home. Living in a new city every 4-8 weeks is a drag. It’s hard to get in a study groove when you have to figure out where the grocery stores are!

* Residency letters sometimes need to come from department big shots. There are not many of these folks in Laramie, Wyoming. You will be able to get a letter from someone who really knows you, but unfortunately, residency programs will probably not know the writer.

* Administration issues and scheduling run a lot smoother when you are able to drop in for your appointment, rather than doing it by phone or email.

* Didactics are rare outside of the academic medical center. If you prefer learning in a lecture hall (I happen to not), it is a good idea to stick around town. Most schools have online streaming lectures, but as helpful as they are for remote students, it often just isn’t the same.

* Friendships are harder to maintain across distances. Significant others, classmates, friends and family may wonder where you are off to this month. When you’re as busy as a third year student, it’s easier to grab coffee if you’re in the same hospital!

* Are you considering a career in a medical or surgical specialty? Good luck finding a cardiologist or urologist in private practice willing to take time out for a student. Away rotations can be useful for the bread and butter of medicine, but there’s a reason why people travel to academic medical centers for care. That’s where the specialists are!

In the end, there is something to be said for having a touch of city and a bit of country in your medical education, but wherever you are, it’s important to identify the strengths and weaknesses of your location. And stay away from the moose calves this time of year... unless you want some medical student on an away rotation in Alaska to chronicle another tourist vs. moose story on his blog.

May 18, 2008 in Thomas Robey | Permalink


Good comparison of the benefits and drawbacks of away rotations. Although it's a different ballgame, I actually had this list in mind when deciding to first do my basic science education in a developing country, and then come to Baltimore (and surrounding cities) to get my clinical training. I actually feel like I'm getting the best of both worlds.

And on the topic of moose, my sister used to live in Moose, Wyoming, and I once stayed with her for a few days. I'll never forget opening the front door in the morning only to find out that a huge moose was standing inches away and blocking my exit!

Posted by: Kendra | May 20, 2008 8:58:47 AM

This is an awesome rundown. I'm just getting ready to put my third-year rotations together and I'm pretty sure I want to be rural, and it's good to know that the "downs" aren't really things about which I worry anyway!

Posted by: Amy | May 20, 2008 4:20:50 PM

just to add to the list of comparison...
in the rural you will be able to do more procedural stuff and the cases tend to be more undifferentiated and it is therefore more challenging and interesting! not everyone you see will have the answer... this can be fun but also annoying as you may never find out until ages after if at all whatever happen to patient A...

city... although it's known to be crowded with seniors above you but being a referral centre or larger academic centre... you do see more of variety of cases than the rural places and you tend to see more rare cases. Having that breadth of experience will be important as it will help you learn to think about other possibilities that a presenting problem can be due to.... although not helpful to think of less common causes but it's important skill to have .... as in medicine you never know when a rare case may drop on your lap ... it's a skill to sort out the bread and butter but it's also important to know the silent killer case from just your average non-life threatening situations....

so all in all... a balance of the two is better and how much of that mix is good.... well that's up to you... but also remember in the rural... there's nothing to do and enduring your other fellow partnering medical student 24/7 may just prove too much!

Posted by: Michael | May 22, 2008 1:56:29 AM

Away rotations are those that Caribbean medical students do throughout their 3rd and 4th years. Imagine living in a new city as many as 10 times during those crucial clinical years. It's all about adaptation. It's a nice perk to be able to see many different hospitals in many different parts of the country. Treatments are generally the same throughout, but there are subtle differences that you start to notice, as well as trends in disease process--especially ID. Nice article!

Posted by: JP | Jun 3, 2008 2:55:04 PM


Posted by: moose | Mar 17, 2009 10:47:54 AM

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