Externship choice

I had an important question about picking externships that I have not seen addressed in other places so far:

In general (and specifically for Dr. Levine), would it be more beneficial to perform an away 4th yr externship /sub-I at a prominent institution such as Columbia/HSS/ Mt. Sinai and hope to score a good letter from there, or is it better to perform an away at a less competitive school with the hopes of maybe impressing that staff a lot, but then maybe obtaining a letter that carries less weight to the rest of the schools in that region.

To clarify, I would love to obtain a residency in the state of NY, and of course prominent schools are my top choice, but being realistic I might not be the most competitive candidate out there. I know that while it is impossible to do aways at every single school in New York state, performing at least one away in the region indicates a regional interest, and obtaining a strong letter from well known people in the region carries more weight than say a letter from someone in Cali. I'm not likely to get even an interview from a Columbia or Sinai, realistically speaking, but should I still externship there in order to maybe obtain a strong letter to impress the other schools in that area, or should I just do the externship at the Downstate/NYMC with the risk that a letter from there will only impress their faculty while possibly carrying less weight to the other 18 New York ortho programs.

I would love to get everybody's opinion, esp Dr. Levine because his program and similar programs are of particular relevance to my dilemma.

As far as I'm concerned you should look at the externship as your 1-month interview for that program. If you do well, you will likely get a strong letter of recommendation and obviously if you do not you will be less likely to get anything meaningful.

It is difficult to know how competitive one will be but generally speaking there are 2 types of students who perform externships: the 1st group are the absolute rock stars who look great on paper and are rotating at many top programs and will definitely get tons of interviews at the top tier programs; and the second group includes the students who may be solid (it's difficult to be average or below average any longer and realistically match in any Orthopaedic program - remember, I said difficult not impossible!) but need the subintership to "leap off the paper" so they can compete with the paper "water walkers".

This 2nd group is where I see most students seize the opportunity and knock it out of the park. There are a few students from this group who unfortunately for some reason "don't get it" and don't knock it out of the park during their externship and these are students who will likely have a more difficult time matching.

So, if your desired goal is to match in NY state - you need to honestly review your application and pick the programs that you feel you will be most competitive (not based on where you think you'll get the "high profile" letters of recommendation necessarily) so that you can increase your odds of matching.

Good luck

wnl