How to Ace the Sub-Internship and Audition Rotation

I have had the opportunity to observe and work with many fourth-year medical students on their sub-internship and audition rotations. Within the first week of working with a student, it becomes easy to understand their work ethic, communication skills, medical knowledge and overall personality. Many students perform on maximum capacity and are generally on their best behavior during this process. However, this experience could be a double-edged sword if done poorly. I have discussed this topic with residents and program directors from California, Utah, Texas and several programs on the East Coast. The following are common themes, tips and suggestion for future sub-interns or students on an audition rotation.

Your first impression will contribute to your last impression, which will be lasting.

Many residents from a variety of programs have shared their stories about medical student first impression successes and failures. Generally, components of a good first impression is multifactorial, but there are a few specific aspects that are important to highlight. Let’s get the obvious (but important) ones out of the way: have good posture, dress nice, have good hygiene, maintain eye contact, show up early (or at least on time) every day, ask intelligent questions and come prepared. Other unique, high-yield suggestions that can solidify a favorable lasting impression include:

Know your audience. As I have asked many program directors if there is any one factor that will drastically move an applicant up or down the rank list, I’ve learned that valuing direct feedback from the residents, nurses and staff is critical for the student’s success. Positive and negative feedback from residents may have the potential to significantly change a student’s spot on the rank list. In order to know your audience, strive to solidify a good impression with the program’s residents, interns, nurses and staff.

Be authentic. It is human nature to try and exceed one’s own capabilities, which can often turn someone into something that they are not. Many directors have expressed that this lack of authenticity can negatively affect an applicant because they aren’t sure what type of potential resident they would realistically be working with. In general, it is easy to identify if somebody is not being authentic, maybe not initially, but over a 4-week rotation, that person’s true colors will likely surface. There is a clear distinction between being your best self and not being authentic. At the end of the day, you don’t want to be in a program for 3-5 years if you feel like you can’t be yourself.

You can overcome weaknesses by being willing to work hard.

Sub-interns come in all metaphorical shapes and sizes. As a heterogenous group, life experience, academic background, medical training and clinical capabilities vary widely. It is important to start the sub-internship or audition rotation as prepared as possible. Many students arrange their third and fourth-year schedules to peak in performance during the sub-internship rotation. Every student has weaknesses and it is important for them to realize these weaknesses early, and to make efforts to improve and compensate for them. Unless a weakness shows significant potential for disaster, many program directors and residents have commented that students that show initiative can compensate with hard work and teachability. On the contrary, low work ethic or a lack of teachability is a potential kiss of death in the ranking process. In summary, work hard, be willing to improve and be teachable.              

Residents and directors are looking for a colleague.

Grades, board scores, extracurriculars, publications and letters of recommendations are all very important in the ranking process. Program directors in most specialties that I have spoken with have mentioned that there is significant importance to team chemistry and fit. Residency is taxing, long and extremely challenging. However, it is also rewarding, fun and exciting. Programs are looking for potential residents that will be well-rounded colleagues. A sub-internship or audition rotation provides a wonderful opportunity to show other residents and faculty that a student could be a great asset.

I learned an important lesson about the far-reaching influence of a poor sub-intern performance while speaking with a group of internal medicine residents from New York. Residents from a certain program had a sub-intern who had extremely high board scores, multiple publications and a near flawless application. However, during this sub-intern’s rotation he would occasionally speak poorly of others and had multiple conflicts with the nursing staff. The sub-intern’s reputation spread among neighboring programs which ultimately limited the amount of interview invites he received. In summary, be the type of colleague you hope to have in the future.

A good program “fit” goes both ways.

A three to five year investment of time is significant because there are many factors that should be considered when searching for the ideal residency. Sub-interns should take the time during the rotation to figure out if the program is right for them. It is easy to become ultra-focused on performing at the highest level and miss the chance to get to know the resident dynamics, potential mentorship opportunities, extracurricular support, family and personal support, wellness, social scene, and any potential red flags of the program. The match is a two-way street; a very busy, winding street. Invest in efforts to ensure the potential resident-program relationship is a good fit.

The overall concept of a sub-internship or audition rotation brings many important and priceless academic, clinical and social experiences. If done correctly, it can provide a tremendous opportunity to display talents, characteristics and skills on a personal level which may result in a significant advantage in the ranking and matching process. If done poorly, there is potential for negative and possibly detrimental effects to a student’s ranking. In the wise words of Benjamin Franklin, “by failing to prepare, you are preparing to fail.” Prepare to perform at a high level during your sub-internship or audition rotation and set yourself up for success.

Dr. Tyson Schwab is a physician at Intermountain Healthcare. He practices at Utah Valley Hospital and the Utah Valley Family Medicine Residency program. His medical interests includes primary care, innovation, technology, health policy and improving medical quality.

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