I’ve read a few of the 2007 posts regarding sub-i’s but was wondering about current input from the M4 veterans here. At my institution, it’s generally expected to do a home sub-i, followed by away sub-i #1, then away sub-i #2. Would you guys recommend doing the top choice school during away #1 (less risk of burnout) or during away #2 (higher risk of burnout but better rockstardom)?

galen - 08 March 2009 05:33 PM

I’ve read a few of the 2007 posts regarding sub-i’s but was wondering about current input from the M4 veterans here. At my institution, it’s generally expected to do a home sub-i, followed by away sub-i #1, then away sub-i #2. Would you guys recommend doing the top choice school during away #1 (less risk of burnout) or during away #2 (higher risk of burnout but better rockstardom)?

your logic sounds solid. but one of the downsides of doing an away during the first block, is that your co-SubI’ers will probably be from that institution. it makes sense that the residents/attendings might pay more attention to kids from their own program first. I’m still planning my 4th year, but i think im gonna go with 1) Home, then 2) where I really want to go, 3) where I also really want to go, but not as much.

Just my 2 cents: I did my home sub-I super early (January of 3rd year) - just the way my schedule worked out. Felt a bit ill-prepared, having not done much medicine by that point, but won enough points on enthusiasm, hard work, and suturing/knot-tying alone. Did a sub-I at Mayo in July, took 2 weeks for research, then visited Johns Hopkins from mid-August to mid-September. Burn-out was not an issue at all with this schedule, facilitated by both programs allowing you to start and end on whichever week you would like. There were lots of other Sub-Is at both of my aways - ~6 at a time at Mayo, and up to 8 at a time at Johns Hopkins, including JHU students. At Mayo, 6 was fine, as we were all on different attending’s services (though a couple missed out on rotating with Meyer). Eight students at JHU was a bit of a zoo, but overall still a very positive experience. If you can go in May or late-September, you may have better access to attendings/cases, balanced by more call. I know one person who rotated at Columbia in October and had the place to themselves. October is probably fine if you would really like to match at that place, but rather late for getting a key letter.

As I’ve mentioned before on this forum, I am a big fan of doing the sub-I early.  I did my away in April and home in May.  It wasn’t how I had originally planned it, but I think it worked out great.  I had both places to myself and think it was better that way.  As for the question of order, I think that the general advice to do home first, then top away is generally good advice.  I did 3 sub-Is back-to-back, and I was definitely out of it by the end.  Luckily, the last one was vascular surgery, which I was just doing for fun (and graduation req) by that point.  If you can’t swing home first, then I would not shy away from doing an early top-priority away.  They’ll like your initiative and you’ll get great exposure and teaching.

I did my home first for only 2 weeks due to a time constraint, (but had already done an elective with the PD and another attending, plus I had met with the chairman multiple times before starting) so wasn’t worried about the truncated AI.  Anyway regardless of the order you do them in be sure to know your home institution well.  People know who’s at your home institution and kinda expect that you built a relationship with them.  Afterwards took 1 week off (because the away rotation schedule differed from my med school calendar) and started Away 1 in August.  Then took 2 weeks off in September (got my second date choice and had to start in Mid September rather than 1st week).  I used this time to A) recover from burnout--slept and ate and B) finish that ERAS, I took a while to write a personal statement, nagged my home chairman and PD for letters, asked my 1st away for 2 letters (just to be sure in case someone didn’t pull through).  Away 2: mid september to mid october (My Top choice school).  I really liked that I took breaks between my AIs which helped with burnout.  Besides practically memorizing Greenberg’s, try to be proficient in the OR (i.e. tying, burr holes, putting in screws with electric or handheld etc).  I did my away 2 at my top choice with the idea I would be smarter.  I was definitely smarter but also better with my hands and could actually be of use during closing.  I thinked this order worked for me because I had ample recovery time.

Thanks for all the responses, I appreciate it.  I have a chance to save on rent too if I do my top choice as my last away, but money isn’t a consideration if I’m going to be falling asleep on my feet!

I ended up performing best during my 2nd rotation (of three).  The first was done at home, which was useful to get up to speed on neurosurgical knowledge without having to figure out where everything and how the system works.  rocked on the 2nd rotation.  3rd rotation: too tired to care about shining.

i also did a neurorads rotation before the 2nd rotation which was immensely helpful and me look smarter than i really was.

Whatever you do, make sure you don’t end up doing your top choice Sub I with a bunch of other medical students.  Find out if there will be others before you go, because it’s hard to shine if you’re a face in the crowd. 

I had a bit of an unfair advantage.  My first rotation was at the end of my second year because I took step 1 early and called up an attending I knew from before medical school and joined him and his team for two months.  My real rotation was at my home institute a year later followed by my top choice.  This allowed me to get more experience from my home dept, get groomed and work my greenberg knowledge.  Then i went to my top choice and (unfortunately had two other medical students start with me and had another join me at the end of my rotation) worked my butt off and got a great chairman letter.  Then went to my last sub-I, man was I burned out.

Seems like Home +2 is standard around here. My school has a research requirement and a non-surgical SubI that I have to do, squeezing my schedule—I can easily do Home +1, but wouldn’t be able to do a second away until November or later.

Is Home + 1 so bad? I will have plenty of LORs without an extra rotation.

Penn2011 - 22 March 2010 04:24 PM

Is Home + 1 so bad? I will have plenty of LORs without an extra rotation.

No, that should be fine. That said if you DID want to do another late away in Nov, I did that and was able to make it work with interviews, though obviously it’s not ideal.

Penn2011 - 22 March 2010 04:24 PM

Seems like Home +2 is standard around here. My school has a research requirement and a non-surgical SubI that I have to do, squeezing my schedule—I can easily do Home +1, but wouldn’t be able to do a second away until November or later.

Is Home + 1 so bad? I will have plenty of LORs without an extra rotation.

Most UH posters have letters from neurosurgeons. Though the data set is biased, this is something to consider. Also, interview season starts heating up in November. The later the rotation, the fewer the number of programs that would know about the results.