Before you head out of town, ask youself:  What’s really the purpose of doing a sub-I?

First and foremost, your goal should be to go out and get a really good sense of what another program’s all about. This is your chance to learn what aspects of a program are really important to you.  For example, are you ok with a place where the residents aren’t all the best of friends, if you get great technical experience?  Or are you ok with having less operative experience in the junior years if the attendings are great mentors and the department is really tight?  The sub-I is a time to get a sense of what you want, and to learn how to look for it in a program so you can judge others on interview days.

Second, of course, the sub-I is a chance to make a great positive impression on an individual program.  It’s a chance to “audition” at a place you are genuinely interested in.  This means you need to choose a place where you have a chance in hell of matching based on your objective application that’s in a city where you would consider living.  If Rochester Minn isn’t for you, don’t waste a month there just to get a good letter...there are plenty of strong programs out there; pick one you’d actually consider ranking at the top of your list.

Finally, you need to get one letter from each place you rotate.  This obviously needs to be from someone with name recognition, generally the chairman.  This is the safest choice.  If you choose someone other than the chairman, consider the fact that he may wonder why you chose someone over him and other programs may wonder this as well.  Establish who you are planning to ask before even hitting the ground at your away month, and spend plenty of time reading up on their area of expertise.  Scrub with them whenever possible and DEFINITELY attend their clinic.  The worst case scenario is that they don’t really know you at the end of the month, so work on getting face time in an unobtrusive way. Do NOT hog their time if there are multiple students on the rotation...this will not win you any friends, and will be obvious to the powers that be.  Of course, all this goes out the window if something happens to make you think that this person’s impression is truly not favorable...in that case, abandon the ship and start concentrating on someone else.

So, what are the rules of engagement?

Most importantly, a sub-I’s success comes down to personality.  Someone who gels with the residents, charms the attendings, and gets along with the staff will be remembered much more fondly then the gunner who knew every answer and never left the hospital but was antagonistic to the other students, rude to the nurses, tried to show up the intern, etc.  This seems like it would be obvious, but as a resident AND a former sub-I myself, I can say it is not.  So how do you avoid this trap?  A few things I would keep in mind:

1. This is not a race. You are not there to “beat” the other sub-I’s.  Taking care of patients is not a competition.  Help your fellow students when they need it, and make an effort to get along. Try to succeed on your own merits rather than by making someone else look worse.

2. Be professional.  This means never, ever talking bad about another student, patient, resident, attending, even if everyone else is.  NONE of us follow this rule all the time, but for one month, make it your mantra.  You never know who is listening, and all it takes is one attending who wasn’t amused by the joke you made about the high-on-crack-white-trash spine injury from last night to completely sink you. Do not get baited; be a politician. When the chairman says, “You know, I’ve always thought the chairman at your program is a real ass” say “well, some say he does have that reputation but he has been a great mentor to me.”

3. Be politically correct. Do not offer up your various fascinating views on women, affirmative action, or George Bush.

4. Be thick-skinned.  If someone treats you rudely or gets angry at something you did, let it roll off your back. You can bitch about it when you get home.

5. Do not complain. Ever. If you’re falling asleep standing up (you will be) sneak away when you’re not needed and take a nap.  When you take a break for coffee, get one for the resident on call.  You don’t have to be glued to the side of whoever it is you’re working with...just don’t make a big deal out of taking a moment to review for a case or grabbing some lunch.  And always be available if they need you.

6.  Even if you are miserable beyond belief and already suffering from PTSD, when someone asks, “are you interested in coming here?” say “absolutely. I hope I have a shot.”

Good luck and happy hunting!