Sub-I advice

I only did one Sub-I and I was definitely a minority on the interview trail this year. However, doing only one did not have a negative impact on my interview offers (attended 15 of 25 offers). I was asked at nearly every interview where I rotated. Never once was I questioned for only doing one sub-I. Honestly, no one cares.

Almost everyone I met on the trail did two sub-I’s, with a solid number of applicants doing three. There is a strong trend for everyone to do more and more, but I don’t think it really helps. That said, doing two or three isn’t necessarily a bad thing as long as you're doing them for the right reasons:

1. To see if you like the program and would want to go there
- Only choose a program you think you might actually want to attend. Don’t waste your time, money, or energy. Don’t rotate at Harvard because Dr. Famous is there and you think he can get you interviews to other places. You probably won’t work enough with him and he likely doesn’t care.

2. To possibly get an additional interview
- If you’re competitive/semi-competetive, consider doing one at a reach program. If they like you, it’s no longer a reach.
- If you’re not competitive, doing an additional sub-I can help you potentially increase your total number of interviews by one. These may be the only people that actually need to do three.

3. To get a solid letter
- As fourth year med students, we don’t know who the well-connected orthopedic surgeons are. Ask the residents.
- Don’t waste your time at a program where you will not be able to get a letter in time to submit it on ERAS. Rotating in November is worthless. Without a letter, other programs will never know you rotated there and it will not increase your chances of getting more interviews.

4. To show regional diversity
- I’m a Western guy. Born, raised, undergrad, med school. I did my sub-I in the Midwest and got lots of Midwest love during interview season. Some regions (the South especially) still don’t care. Be sure to check out the websites of the programs you’re considering rotating at to see where their residents went to med school/undergrad. If they have never taken someone from your region, you’re likely wasting your time. Also, look at the websites for the caliber of schools the programs tend to pull from. If you attend a state school (like me), and the program only has guys from Ivy League schools, you’re probably not likely to buck the trend.

Last but not least, if you’re an awkward/weird person (ie someone who didn’t honor a single rotation due to consistently receiving poor evaluations), one sub-I will suffice. In fact, one may be too many.

Conclusion:
- Do at least one away at a place you would actually want to go.
- Get a letter or don’t go.
- Don’t kill yourself to do multiple sub-I’s. Very few people need to do 3.
- If you’re awkward, (n)one is enough.

Great post, thanks for that.

What if you rotate someplace (ie Midwest in your case), but don't get a letter from them? Then other programs won't know where you rotated, so what sort of affect do you think it has in that situation?

Also, being a West-coast guy, did you feel that once you told people where you rotated, that it had some affect on how they felt about you? For example, if you had rotated only on the West coast, that they would feel that you don't even want to come out East?

If you don't get a letter, there will be no way for other programs to know you rotated there. There is nowhere on ERAS to mention where you rotate.

And rotating out in the Midwest definitely made it so programs thought I would be willing move to a different region. It was mentioned in almost every Midwest interview I had. There is no reason that a PD would think a guy from CA, AZ, etc. would want to move to Indianapolis without having rotated or lived somewhere near there previously. Admittedly, you will find examples of this not being the case. However, in general, its usually going to be the case.

What made you choose 1. the Midwest, and 2. That specific program?

I'm in a somewhat similar situation, and I'm trying to pick the two places I would like to rotate. I obviously would love to just rotate at my top two west coast schools in hopes of matching at one of them, but I also don't want to ruin chances at all of the top programs on the east coast/Midwest. Any advice?

I think this is a great post. I would counter the summary point about you must get a letter or it is worthless with the following: if it is one of your likely top choices and falls under the "wanting to check the place out" or "increase my odds of an interview at this one place" you can do a late (i.e. October is probably more sensible than November) rotation to gain an edge. Especially at a program that favors rotators. I did this for one of the programs I expected to (and did) enjoy and have no regrets even though it did not get me letter.

October is not too late for a program you want to go to. It is too late for a letter, so it will help you nowhere besides that program. As for no spots at a program until October, that seems crazy given that it's still January. Have you called the program coordinator? They should be able to let you know what the odds of getting an earlier spot would be.

If you do 3 aways before apps are do you will have at least 2 home letters (chair and a close attending) and hopefully 1 from each away. If you had good rapport with multiple attendings you can ask for multiple letters at an away, but generally you would not submit two away letters to a program besides that program to demonstrate that you got along well with multiple attendings.

I would not tell an attending ahead of time. They all know the deal, just make sure they will be around your last week with them and ask if they have time to meet with you (when you can give them a CV and personal statement) and review your rotation. They will get the hint and expect you to ask for a letter. Beware that some attendings may say no (supposedly) if they don't feel they can write you a good letter. I would recommend asking specifically for a "strong letter of rec" in the meeting.