During your fourth year, many students plan on doing one or more rotations outside of their home medical school. Often termed "Aways" or "Audition" rotations, these months can help you show interest in programs that may otherwise not grant you an interview invitation. Most allopathic (MD) students do one or two away rotations, while Osteopathic (DO) students often do 3-5. However, it is difficult to know when or how to set these rotations up. After doing a combined 11 audition rotations, we have written a small guide that should help you get started. If you are interested in doing residency in a region outside of your medial school, doing several away rotations is an effective way to break into the area. Being able to do 4 or more auditions is a unique opportunity that Osteopathic students have. You can spend a lot of your 4th year near family/friends if you plan ahead of time. I did 4 away rotations in Los Angeles, and two in Philadelphia and ended up with several interviews I would not have otherwise gotten. How to Apply: Essentially all allopathic/ACGME programs require students to apply through VSAS, an online application system to help coordinate your visiting rotations. This is not the case with DO auditions. To set up away rotations at an Osteopathic program, you should email the program coordinator to inquire about scheduling. The coordinator's information can usually be found on the medical education section of a program's website. Start reaching out to the Osteopathic programs near the middle of December of your third year, but don't expect to have everything set up quickly. Most residencies are busy interviewing and ranking their future residents at this time, but you need to start making the initial contacts early. VSAS has an early March deadline, so plan to start getting the paperwork together and submitted during February. If you plan to apply through VSAS you will fill out general application info, upload a picture (you can use yours from white coat ceremony or take one with your white coat with a camera or phone), transcript, USMLE/COMLEX scores and (the part that will take the most effort by far) medical forms. Unfortunately, almost every hospital will require their own unique medical form. This is in addition to the medical documentation required by your medical school, and is separate from the standard form that VSAS will require. In fact, very few programs will accept the standardized medical form. The advice I received was to print out all the forms from each institution you may want to apply to and bring them to the doctor all in one visit. Try to fill out as much of the form as possible before your appointment. It is far better to annoy your PCP once with 15 forms, than with a few forms two-three times. Plan to apply to 2-3 away rotations on VSAS per month of rotations that you plan on going to. Programs will not get back to you or will reject you without reason, and it is far better to have to decline one than not to go at all. Unfortunately, declining a rotation can cost you an interview. It may not be fair, but it's true. For this reason it's best not to apply to two or more programs that you really like per month. Print out all the forms and get them signed, even if you later decide not to attend. What kinds of rotations should I do? For internal medicine as an Osteopathic student, I would recommend doing as many “sub-I’s” (or sub-internships) as possible. Most MD students don't need to do more than one sub-I, but I have found that it is the best way to really get to know a program (and get them to know you). A sub-I is an opportunity to act like an intern on the general medicine floors (carrying 2-4 patients, writing orders, calling consults etc). You will work with an R-2 (or PGY-2), several interns (R-1’s), and usually a 3rd year medical student on a team running a group of patients on the hospital floors with one attending. By doing this, you get to work with attending’s/current residents, go to didactics, and get to know the program directors (PD’s) as they tend to be around. Sub-I's in the Osteopathic world run significantly different than those in the Allopathic world. At the programs I visited, the amount of responsibility given to their fourth year students was almost identical to third year. At most you would write a note or two, but rarely would you be allowed to enter orders or create treatment plans. Where should I do audition rotations? In general, MD students should rotate at programs that they want to go to. I would advise using the FREIDA website to see if you are in their USMLE score range. For Osteopathic students, I would also look at FRIEDA to see who has accepted DO’s in the past and what kinds of scores (USMLE and COMLEX) the program requires. However, I would also take the cut offs listed on FREIDA as a guideline and not absolute. Many people get interviews who fall below the numbers listed, and having a high score never guarantees you an interview. What if I don’t hear back from program after applying through VSAS? Advice I got during 4th year which made a huge difference is to call the program coordinators directly to follow up if you do not hear back in a few weeks. I had several program coordinators approve my VSAS application, change dates, inform me what I was missing, etc. while I was on the phone with them. If you are missing a form or piece of information, don’t plan on hearing back from the program. Always call if you don’t hear from them. Other general advice: Asking for days off to interview while on an away rotation: It happens. Ask your resident directly, they understand. I would recommend not taking more than 2-3 days though. It’s best not to plan your rotation at your favorite program during November or December in case you do need to take time off. Asking for an interview while on an away rotation Some programs have policies where they interview every visiting student, others don’t. I would recommend waiting for a few weeks to get to know the residents and then tell your senior that you are loving the program and would really appreciate the opportunity to interview for the program. Preparing for rotations: I got my butt kicked on my first rotation. It's very difficult to learn a new hospital system, interact with a new team, and perform well. What I recommend to best prepare is show up early at first (1-2 hours before AM sign out) to see patients, write your note, and review topics that are relevant and any recent updates/reviews of the medical literature. Don’t feel discouraged if you struggle on for first rotation (or two). Programs care more that you are able to learn and improve, than if you are a superstar on day one. This process can be difficult and frustrating. Don't forget to thank everyone you interact with. If you're rude or difficult to work with (even on your worst day), word will get around. Keep at it! Do you have any tips for planning away rotations? Let us know in the comments!