User login
Guidelines on Away Rotations in Dermatology Programs
Medical students often perform away rotations (also called visiting electives) to gain exposure to educational experiences in a particular specialty, learn about a program, and show interest in a certain program. Away rotations also allow applicants to meet and form relationships with mentors and faculty outside of their home institution. For residency programs, away rotations provide an opportunity for a holistic review of applicants by allowing program directors to get to know potential residency applicants and assess their performance in the clinical environment and among the program’s team. In a National Resident Matching Program survey, program directors (n=17) reported that prior knowledge of an applicant is an important factor in selecting applicants to interview (82.4%) and rank (58.8%).1
In this article, we discuss the importance of away rotations in dermatology and provide an overview of the Organization of Program Director Associations (OPDA) and Association of Professors of Dermatology (APD) guidelines for away rotations.
Importance of the Away Rotation in the Match
According to the Association of American Medical Colleges, 86.7% of dermatology applicants (N=345) completed one or more away rotations (mean, 2.7) in 2020.2 Winterton et al3 reported that 47% of dermatology applicants (N=45) matched at a program where they completed an away rotation. Prior to the COVID-19 pandemic, the number of applicants matching to their home program was reported as 26.7% (N=641), which jumped to 40.3% (N=231) in the 2020-2021 cycle.4 Given that the majority of dermatology applicants reportedly match either at their home program or at programs where they completed an away rotation, the benefits of away rotations are high, particularly in a competitive specialty such as dermatology and particularly for applicants without a dermatology program at their home institution. However, it must be acknowledged that correlation does not necessarily mean causation, as away rotations have not necessarily been shown to increase applicants’ chances of matching for the most competitive specialties.5
OPDA Guidelines for Away Rotations
In 2021, the Coalition of Physician Accountability’s Undergraduate Medical Education-Graduate Medical Education Review Committee recommended creating a workgroup to explore the function and value of away rotations for medical students, programs, and institutions, with a particular focus on issues of equity (eg, accessibility, assessment, opportunity) for underrepresented in medicine students and those with financial disadvantages.6 The OPDA workgroup evaluated the advantages and disadvantages of away rotations across specialties. The disadvantages included that away rotations may decrease resources to students at their own institution, particularly if faculty time and energy are funneled/dedicated to away rotators instead of internal rotators, and may impart bias into the recruitment process. Additionally, there is a consideration of equity given the considerable cost and time commitment of travel and housing for students at another institution. In 2022, the estimated cost of an away rotation in dermatology ranged from $1390 to $5500 per rotation.7 Visiting scholarships may be available at some institutions but typically are reserved for underrepresented in medicine students.8 Virtual rotations offered at some programs offset the cost-prohibitiveness of an in-person away rotation; however, they are not universally offered and may be limited in allowing for meaningful interactions between students and program faculty and residents.
The OPDA away rotation workgroup recommended that (1) each specialty publish guidelines regarding the necessity and number of recommended away rotations; (2) specialties publish explicit language regarding the use of program preference signals to programs where students rotated; (3) programs be transparent about the purpose and value of an away rotation, including explicitly stating whether a formal interview is guaranteed; and (4) the Association of American Medical Colleges create a repository of these specialty-specific recommendations.9
APD Guidelines for Away Rotations
In response to the OPDA recommendations, the APD Residency Program Directors Section developed dermatology-specific guidelines for away rotations and established guidelines in other specialties.10 The APD recommends completing up to 2 away rotations, or 3 for those without a home program, if desired. This number was chosen in acknowledgment of the importance of external program experiences, along with the recognition of the financial and time restrictions associated with away rotations as well as the limited number of spots for rotating students. Away rotations are not mandatory. The APD guidelines explain the purpose and value of an away rotation while also noting that these rotations do not necessarily guarantee a formal interview and recommending that programs be transparent about their policies on interview invitations, which may vary.10
Final Thoughts
Publishing specialty-specific guidelines on away rotations is one step toward streamlining the process as well as increasing transparency on the importance of these external program experiences in the application process and residency match. Ideally, away rotations provide a valuable educational experience in which students and program directors get to know each other in a mutually beneficial manner; however, away rotations are not required for securing an interview or matching at a program, and there also are recognized disadvantages to away rotations, particularly with regard to equity, that we must continue to weigh as a specialty. The APD will continue its collaborative work to evaluate our application processes to support a sustainable and equitable system.
- National Resident Matching Program. Results of the 2021 NRMP program director survey. Published August 2021. Accessed May 17, 2023. https://www.nrmp.org/wp-content/uploads/2021/11/2021-PD-Survey-Report-for-WWW.pdf
- Association of American Medical Colleges. Away rotations of U.S. medical school graduates by intended specialty, 2020 AAMC Medical School Graduation Questionnaire (GQ). Published September 24, 2020. Accessed May 17, 2023. https://students-residents.aamc.org/media/9496/download
- Winterton M, Ahn J, Bernstein J. The prevalence and cost of medical student visiting rotations. BMC Med Educ. 2016;16:291. doi:10.1186/s12909-016-0805-z
- Dowdle TS, Ryan MP, Wagner RF. Internal and geographic dermatology match trends in the age of COVID-19. J Am Acad Dermatol. 2021;85:1364-1366. doi:10.1016/j.jaad.2021.08.004
- Griffith M, DeMasi SC, McGrath AJ, et al. Time to reevaluate the away rotation: improving return on investment for students and schools. Acad Med. 2019;94:496-500. doi:10.1097/ACM.0000000000002505
- Coalition for Physician Accountability. The Coalition for Physician Accountability’s Undergraduate Medication Education-Graduate Medical Education Review Committee (UGRC): recommendations for comprehensive improvement in the UME-GME transition. Published August 26, 2021. Accessed May 18, 2023. https://physicianaccountability.org/wp-content/uploads/2021/08/UGRC-Coalition-Report-FINAL.pdf
- Cucka B, Grant-Kels JM. Ethical implications of the high cost of medical student visiting dermatology rotations. Clin Dermatol. 2022;40:539-540.
- Dahak S, Fernandez JM, Rosman IS. Funded dermatology visiting elective rotations for medical students who are underrepresented in medicine: a cross-sectional analysis [published online November 15, 2022]. J Am Acad Dermatol. 2023;88:941-943.
- Council of Medical Specialty Societies. The Organization of Program Director Associations (OPDA): away rotations workgroup. Published July 26, 2022. Accessed May 18, 2023. https://cmss.org/wp-content/uploads/2022/08/OPDA-Work-Group-on-Away-Rotations-7.26.2022-1.pdf
- Association of Professors of Dermatology. Recommendations regarding away electives. Published December 14, 2022. Accessed May 18, 2023. https://www.dermatologyprofessors.org/files/APD%20recommendations%20on%20away%20rotations%202023-2024.pdf
Medical students often perform away rotations (also called visiting electives) to gain exposure to educational experiences in a particular specialty, learn about a program, and show interest in a certain program. Away rotations also allow applicants to meet and form relationships with mentors and faculty outside of their home institution. For residency programs, away rotations provide an opportunity for a holistic review of applicants by allowing program directors to get to know potential residency applicants and assess their performance in the clinical environment and among the program’s team. In a National Resident Matching Program survey, program directors (n=17) reported that prior knowledge of an applicant is an important factor in selecting applicants to interview (82.4%) and rank (58.8%).1
In this article, we discuss the importance of away rotations in dermatology and provide an overview of the Organization of Program Director Associations (OPDA) and Association of Professors of Dermatology (APD) guidelines for away rotations.
Importance of the Away Rotation in the Match
According to the Association of American Medical Colleges, 86.7% of dermatology applicants (N=345) completed one or more away rotations (mean, 2.7) in 2020.2 Winterton et al3 reported that 47% of dermatology applicants (N=45) matched at a program where they completed an away rotation. Prior to the COVID-19 pandemic, the number of applicants matching to their home program was reported as 26.7% (N=641), which jumped to 40.3% (N=231) in the 2020-2021 cycle.4 Given that the majority of dermatology applicants reportedly match either at their home program or at programs where they completed an away rotation, the benefits of away rotations are high, particularly in a competitive specialty such as dermatology and particularly for applicants without a dermatology program at their home institution. However, it must be acknowledged that correlation does not necessarily mean causation, as away rotations have not necessarily been shown to increase applicants’ chances of matching for the most competitive specialties.5
OPDA Guidelines for Away Rotations
In 2021, the Coalition of Physician Accountability’s Undergraduate Medical Education-Graduate Medical Education Review Committee recommended creating a workgroup to explore the function and value of away rotations for medical students, programs, and institutions, with a particular focus on issues of equity (eg, accessibility, assessment, opportunity) for underrepresented in medicine students and those with financial disadvantages.6 The OPDA workgroup evaluated the advantages and disadvantages of away rotations across specialties. The disadvantages included that away rotations may decrease resources to students at their own institution, particularly if faculty time and energy are funneled/dedicated to away rotators instead of internal rotators, and may impart bias into the recruitment process. Additionally, there is a consideration of equity given the considerable cost and time commitment of travel and housing for students at another institution. In 2022, the estimated cost of an away rotation in dermatology ranged from $1390 to $5500 per rotation.7 Visiting scholarships may be available at some institutions but typically are reserved for underrepresented in medicine students.8 Virtual rotations offered at some programs offset the cost-prohibitiveness of an in-person away rotation; however, they are not universally offered and may be limited in allowing for meaningful interactions between students and program faculty and residents.
The OPDA away rotation workgroup recommended that (1) each specialty publish guidelines regarding the necessity and number of recommended away rotations; (2) specialties publish explicit language regarding the use of program preference signals to programs where students rotated; (3) programs be transparent about the purpose and value of an away rotation, including explicitly stating whether a formal interview is guaranteed; and (4) the Association of American Medical Colleges create a repository of these specialty-specific recommendations.9
APD Guidelines for Away Rotations
In response to the OPDA recommendations, the APD Residency Program Directors Section developed dermatology-specific guidelines for away rotations and established guidelines in other specialties.10 The APD recommends completing up to 2 away rotations, or 3 for those without a home program, if desired. This number was chosen in acknowledgment of the importance of external program experiences, along with the recognition of the financial and time restrictions associated with away rotations as well as the limited number of spots for rotating students. Away rotations are not mandatory. The APD guidelines explain the purpose and value of an away rotation while also noting that these rotations do not necessarily guarantee a formal interview and recommending that programs be transparent about their policies on interview invitations, which may vary.10
Final Thoughts
Publishing specialty-specific guidelines on away rotations is one step toward streamlining the process as well as increasing transparency on the importance of these external program experiences in the application process and residency match. Ideally, away rotations provide a valuable educational experience in which students and program directors get to know each other in a mutually beneficial manner; however, away rotations are not required for securing an interview or matching at a program, and there also are recognized disadvantages to away rotations, particularly with regard to equity, that we must continue to weigh as a specialty. The APD will continue its collaborative work to evaluate our application processes to support a sustainable and equitable system.
Medical students often perform away rotations (also called visiting electives) to gain exposure to educational experiences in a particular specialty, learn about a program, and show interest in a certain program. Away rotations also allow applicants to meet and form relationships with mentors and faculty outside of their home institution. For residency programs, away rotations provide an opportunity for a holistic review of applicants by allowing program directors to get to know potential residency applicants and assess their performance in the clinical environment and among the program’s team. In a National Resident Matching Program survey, program directors (n=17) reported that prior knowledge of an applicant is an important factor in selecting applicants to interview (82.4%) and rank (58.8%).1
In this article, we discuss the importance of away rotations in dermatology and provide an overview of the Organization of Program Director Associations (OPDA) and Association of Professors of Dermatology (APD) guidelines for away rotations.
Importance of the Away Rotation in the Match
According to the Association of American Medical Colleges, 86.7% of dermatology applicants (N=345) completed one or more away rotations (mean, 2.7) in 2020.2 Winterton et al3 reported that 47% of dermatology applicants (N=45) matched at a program where they completed an away rotation. Prior to the COVID-19 pandemic, the number of applicants matching to their home program was reported as 26.7% (N=641), which jumped to 40.3% (N=231) in the 2020-2021 cycle.4 Given that the majority of dermatology applicants reportedly match either at their home program or at programs where they completed an away rotation, the benefits of away rotations are high, particularly in a competitive specialty such as dermatology and particularly for applicants without a dermatology program at their home institution. However, it must be acknowledged that correlation does not necessarily mean causation, as away rotations have not necessarily been shown to increase applicants’ chances of matching for the most competitive specialties.5
OPDA Guidelines for Away Rotations
In 2021, the Coalition of Physician Accountability’s Undergraduate Medical Education-Graduate Medical Education Review Committee recommended creating a workgroup to explore the function and value of away rotations for medical students, programs, and institutions, with a particular focus on issues of equity (eg, accessibility, assessment, opportunity) for underrepresented in medicine students and those with financial disadvantages.6 The OPDA workgroup evaluated the advantages and disadvantages of away rotations across specialties. The disadvantages included that away rotations may decrease resources to students at their own institution, particularly if faculty time and energy are funneled/dedicated to away rotators instead of internal rotators, and may impart bias into the recruitment process. Additionally, there is a consideration of equity given the considerable cost and time commitment of travel and housing for students at another institution. In 2022, the estimated cost of an away rotation in dermatology ranged from $1390 to $5500 per rotation.7 Visiting scholarships may be available at some institutions but typically are reserved for underrepresented in medicine students.8 Virtual rotations offered at some programs offset the cost-prohibitiveness of an in-person away rotation; however, they are not universally offered and may be limited in allowing for meaningful interactions between students and program faculty and residents.
The OPDA away rotation workgroup recommended that (1) each specialty publish guidelines regarding the necessity and number of recommended away rotations; (2) specialties publish explicit language regarding the use of program preference signals to programs where students rotated; (3) programs be transparent about the purpose and value of an away rotation, including explicitly stating whether a formal interview is guaranteed; and (4) the Association of American Medical Colleges create a repository of these specialty-specific recommendations.9
APD Guidelines for Away Rotations
In response to the OPDA recommendations, the APD Residency Program Directors Section developed dermatology-specific guidelines for away rotations and established guidelines in other specialties.10 The APD recommends completing up to 2 away rotations, or 3 for those without a home program, if desired. This number was chosen in acknowledgment of the importance of external program experiences, along with the recognition of the financial and time restrictions associated with away rotations as well as the limited number of spots for rotating students. Away rotations are not mandatory. The APD guidelines explain the purpose and value of an away rotation while also noting that these rotations do not necessarily guarantee a formal interview and recommending that programs be transparent about their policies on interview invitations, which may vary.10
Final Thoughts
Publishing specialty-specific guidelines on away rotations is one step toward streamlining the process as well as increasing transparency on the importance of these external program experiences in the application process and residency match. Ideally, away rotations provide a valuable educational experience in which students and program directors get to know each other in a mutually beneficial manner; however, away rotations are not required for securing an interview or matching at a program, and there also are recognized disadvantages to away rotations, particularly with regard to equity, that we must continue to weigh as a specialty. The APD will continue its collaborative work to evaluate our application processes to support a sustainable and equitable system.
- National Resident Matching Program. Results of the 2021 NRMP program director survey. Published August 2021. Accessed May 17, 2023. https://www.nrmp.org/wp-content/uploads/2021/11/2021-PD-Survey-Report-for-WWW.pdf
- Association of American Medical Colleges. Away rotations of U.S. medical school graduates by intended specialty, 2020 AAMC Medical School Graduation Questionnaire (GQ). Published September 24, 2020. Accessed May 17, 2023. https://students-residents.aamc.org/media/9496/download
- Winterton M, Ahn J, Bernstein J. The prevalence and cost of medical student visiting rotations. BMC Med Educ. 2016;16:291. doi:10.1186/s12909-016-0805-z
- Dowdle TS, Ryan MP, Wagner RF. Internal and geographic dermatology match trends in the age of COVID-19. J Am Acad Dermatol. 2021;85:1364-1366. doi:10.1016/j.jaad.2021.08.004
- Griffith M, DeMasi SC, McGrath AJ, et al. Time to reevaluate the away rotation: improving return on investment for students and schools. Acad Med. 2019;94:496-500. doi:10.1097/ACM.0000000000002505
- Coalition for Physician Accountability. The Coalition for Physician Accountability’s Undergraduate Medication Education-Graduate Medical Education Review Committee (UGRC): recommendations for comprehensive improvement in the UME-GME transition. Published August 26, 2021. Accessed May 18, 2023. https://physicianaccountability.org/wp-content/uploads/2021/08/UGRC-Coalition-Report-FINAL.pdf
- Cucka B, Grant-Kels JM. Ethical implications of the high cost of medical student visiting dermatology rotations. Clin Dermatol. 2022;40:539-540.
- Dahak S, Fernandez JM, Rosman IS. Funded dermatology visiting elective rotations for medical students who are underrepresented in medicine: a cross-sectional analysis [published online November 15, 2022]. J Am Acad Dermatol. 2023;88:941-943.
- Council of Medical Specialty Societies. The Organization of Program Director Associations (OPDA): away rotations workgroup. Published July 26, 2022. Accessed May 18, 2023. https://cmss.org/wp-content/uploads/2022/08/OPDA-Work-Group-on-Away-Rotations-7.26.2022-1.pdf
- Association of Professors of Dermatology. Recommendations regarding away electives. Published December 14, 2022. Accessed May 18, 2023. https://www.dermatologyprofessors.org/files/APD%20recommendations%20on%20away%20rotations%202023-2024.pdf
- National Resident Matching Program. Results of the 2021 NRMP program director survey. Published August 2021. Accessed May 17, 2023. https://www.nrmp.org/wp-content/uploads/2021/11/2021-PD-Survey-Report-for-WWW.pdf
- Association of American Medical Colleges. Away rotations of U.S. medical school graduates by intended specialty, 2020 AAMC Medical School Graduation Questionnaire (GQ). Published September 24, 2020. Accessed May 17, 2023. https://students-residents.aamc.org/media/9496/download
- Winterton M, Ahn J, Bernstein J. The prevalence and cost of medical student visiting rotations. BMC Med Educ. 2016;16:291. doi:10.1186/s12909-016-0805-z
- Dowdle TS, Ryan MP, Wagner RF. Internal and geographic dermatology match trends in the age of COVID-19. J Am Acad Dermatol. 2021;85:1364-1366. doi:10.1016/j.jaad.2021.08.004
- Griffith M, DeMasi SC, McGrath AJ, et al. Time to reevaluate the away rotation: improving return on investment for students and schools. Acad Med. 2019;94:496-500. doi:10.1097/ACM.0000000000002505
- Coalition for Physician Accountability. The Coalition for Physician Accountability’s Undergraduate Medication Education-Graduate Medical Education Review Committee (UGRC): recommendations for comprehensive improvement in the UME-GME transition. Published August 26, 2021. Accessed May 18, 2023. https://physicianaccountability.org/wp-content/uploads/2021/08/UGRC-Coalition-Report-FINAL.pdf
- Cucka B, Grant-Kels JM. Ethical implications of the high cost of medical student visiting dermatology rotations. Clin Dermatol. 2022;40:539-540.
- Dahak S, Fernandez JM, Rosman IS. Funded dermatology visiting elective rotations for medical students who are underrepresented in medicine: a cross-sectional analysis [published online November 15, 2022]. J Am Acad Dermatol. 2023;88:941-943.
- Council of Medical Specialty Societies. The Organization of Program Director Associations (OPDA): away rotations workgroup. Published July 26, 2022. Accessed May 18, 2023. https://cmss.org/wp-content/uploads/2022/08/OPDA-Work-Group-on-Away-Rotations-7.26.2022-1.pdf
- Association of Professors of Dermatology. Recommendations regarding away electives. Published December 14, 2022. Accessed May 18, 2023. https://www.dermatologyprofessors.org/files/APD%20recommendations%20on%20away%20rotations%202023-2024.pdf
Practice Points
- Away rotations are an important tool for both applicants and residency programs during the application process.
- The Association of Professors of Dermatology (APD) recommends completing up to 2 external program experiences, or 3 if the student has no home program, ideally to be completed early in the fourth year of medical school prior to interview invitations.
- Away rotations may have considerable cost and time restrictions on applicants, which the APD recognizes and weighs in its recommendations. There may be program-specific scholarships and opportunities available to help with the cost of away rotations.