Last Updated April 7, 2021.
Medical students are eager to schedule away rotations, and typically, many occur over the entire summer. How did the work group decide to delay reentry until August?
The work group sought to balance learner safety with the desire of both learners and program directors to have in-person away electives in some form. In December 2020, the Coalition work group sought data to support decision-making, including clarity around the spread of COVID-19 strains, the distribution of vaccinations to third- and fourth-year medical students, and the condition of the clinical environments given the increasing number of COVID-19 deaths. There was insufficient data to provide clarity regarding when to resume in-person away rotations; however, the work group made the best possible decision given the available data and its desire to return learners and provide equity to the extent possible.
Given the importance of away rotations, how did the work group determine that each learner would be limited to only one rotation per specialty?
As referenced in the Compendium of Resources released in May 2020, away rotations serve multiple important roles for applicants and residency programs. Applicants use them for career exploration, for support in the residency application process, and for prioritizing geographic preferences. Residency programs use away rotations to assess applicants’ capabilities, showcase the benefits of their program and facilities, and preview potential applicants to their programs, which is particularly important to those programs not affiliated with a medical school.
While the ongoing challenges in the clinical environment resulting from the pandemic has reduced away rotation opportunities this year, the primary intent remains meeting educational needs first and enabling as much exploration as possible while supporting equity in distribution of opportunities. Priority in distribution should still be:
Learners who have a specialty interest and do not have access to a clinical experience with a residency program in that specialty in their school’s system.
Learners for whom an away rotation is required for graduation or accreditation requirements.
One possible interpretation is that students are limited to a total of one away rotation. Another is that students can do multiple away rotations as long as they are in different specialties. Which is correct?
The interpretation of one away rotation per specialty per student aligns with the work group’s guidance allowing a student to complete multiple away rotations in different specialties. If a student is exploring different specialties to determine which one is best suited for them, this may be appropriate. This means, for example, that one student may complete an away rotation in orthopedic surgery and another in hand surgery. Students should be able to explain why it was necessary to complete multiple away rotations if asked.
Since many hand surgeons are fellowship trained orthopedic surgeons and some Hands Surgery departments are within Ortho departments, are you all planning on letting students do an additional away rotation in a field that is a sub-specialty (like Hand Surgery) on top of an away rotation in the primary field?
The intent of the guidance was to allow for the rare instance when a student was truly conflicted about deciding on a specialty for residency training, not to collect away rotations to bolster their residency application. Learners will have the opportunity to explore sub-specialization during residency. Given the limited number of opportunities for away rotations as well as the goal for fairness and equitable distribution for students, school advisors are encouraged to hold to the spirit of the recommendation to allow one away rotation per student per specialty as appropriate for most circumstances.
It looks like students will only be able to participate in one away rotation. Therefore, students with home programs for their specialties will most likely participate in two programs (one home and one away) while students who do not have home programs will only be able to participate in one program (away)?
The work group guidance is for one away rotation per specialty per student. While the community has expressed a desire to have in-person away electives in some form, there is a limited number of away rotations available for completion prior to the residency application cycle. The work group wanted to support opportunities for as many students as possible within the limited timeframe.
The work group’s away rotation recommendations that were released in May 2020 will end on June 30, 2021, and the new recommendations that were released in January 2021 will begin on Aug. 1. What happens during the month of July?
In consultation with the Liaison Committee on Medical Education, the academic year 2020-21 ends on June 30 and the academic year 2021-22 begins on July 1. Per the work group’s guidance released on Jan. 25, 2021, away rotations would resume on or after Aug. 1.
How was the reentry date of Aug. 1 determined? With the ERAS® service keeping the 2022 timeline of previous years and not anticipating delays, this gives students only six weeks, and they will all be competing for away rotations in a very condensed timeline.
With the continued impact of the pandemic leaving many unknowns, the work group carefully considered this timeline, along with available data, and keeping equity for students and programs at the forefront of decision-making. The data available at the time suggested that Aug. 1 was a date by which learners could safely return to their away rotations. The information available in December did not provide clarity around the spread of COVID-19 strains, the distribution of vaccinations to third- and fourth-year medical students, or the condition of the clinical environments given the increasing number of COVID-19 deaths. While we now have additional data and information, there are still concerning unknowns. Although we remain optimistic that Aug. 1 will be a reasonable date to begin away electives, much remains in flux related to the pandemic. In the forthcoming April 15 update, the work group will reconsider whether to recommend that away rotations are not held this academic year. Control of the pandemic must be our prime objective, with equity being highly important as well.
Did the work group intend for this guidance to indicate that no away rotations may be taken before the date of Aug. 1, or did it intend to suggest that no away rotations may be taken before an August offering? Our August elective runs from July 26 to Aug. 20, 2021. The next elective runs from Aug. 23 to Sept. 17, 2021. Given that institutions vary in their rotation dates, the recommendation is for an “August elective” rather than strictly adhering to Aug. 1.
The December decision to start away rotations on or after Aug. 1 was based on the information the work group received from infectious disease experts, a polling of state distributions of the vaccine to third- and fourth-year medical students, and the rising number of COVID-19 deaths in hospitals across the country. There was no certainty regarding when all students could be inoculated or when they could safely return to clinical environments. Aug. 1 was chosen under the assumption that more data by the end of March would support reentry.
The decision to use an Aug. 1 date was based on the work group’s desire to safeguard the health of learners reentering the clinical environment. Regarding rotation schedules, Aug. 1 was provided based on the work group’s best judgment at the time the recommendations were developed. As stated in the recommendations, “this guidance is intended to add to, but not supersede, the independent judgment of a medical school.”
Is an “away rotation” at a medical school in our region different from the work group’s recommendation of “one away rotation per specialty” across the country after Aug. 1?
In both the May 2020 and January 2021 recommendations, the exception applies to medical schools that rely upon regional clinical partners to provide opportunities for their students. Away rotations at regional clinical partners are addressed in the latter part of the third bullet in recommendation #2: “except in cases where additional rotations are needed to complete graduation or accreditation requirements.” Medical schools with regional clinical partners are exempt from the one away rotation per specialty per student guidance.
The recommendations state that “this guidance is intended to add to, but not supersede, the independent judgment of a medical school.” However, we also must consider the following statement: “Residency programs are encouraged to take into consideration if a learner exceeded the one-away-rotation limit during the residency selection process.” In summary, the updated recommendations say that we can “use our judgment” but that residency programs should “take into consideration” those who do. How are we to best advise our students who find themselves in this situation?
The residency program statement was established to level the playing field for all learners, to encourage accountability for learners’ actions, and to encourage program directors to consider how learners responded to the recommendations.
Medical schools might consider supporting their learners who may need to explore a specialty not present at their medical school by including this information in the Medical Student Performance Evaluation, adding to the transcript appendix in the ERAS® application what specialties the medical school offers (or indicating that the medical school has a community-based/primary care emphasis and does not include all specialties at the institution), or encouraging learners to include in their personal statement why they had to complete more than one away rotation. Many programs have expressed interest in this information.
Do the guidelines impact students from nonelite schools?
The primary intent of the recommendations is to meet the educational needs of all learners while enabling as much exploration as possible and supporting equity in the distribution of opportunities. Equity and fairness was the goal, not favoring elite schools.
Limiting away rotations to August through October creates a domino effect on other parts of the process. Has there been any thought to allowing away rotations in July or delaying the opening of the ERAS® service to ease the stress on away rotations?
We’re hearing from the clinical partners that they are also stressed. July is when the new interns arrive, and the level of concern regarding the readiness of interns is also very high. The work group will receive and evaluate new information before an update is provided on April 15.
Residencies are being told that they should disqualify applicants who have done more than one away rotation. Is that the message that the Coalition wanted to convey?
The wording is important. It does not indicate that learners should be disqualified for completing more than one away rotation; however, programs should consider whether a learner completed more than one elective. There are tools within the ERAS® application for learners to explain why they completed more than one elective; for medical schools that need to, they should explain in the Medical Student Performance Evaluation (MSPE) and/or highlight the lack of residencies in the appendix of the medical school transcript.
We are being told that emergency medicine requires two letters from two different sites where there is an emergency medicine rotation. Our school, which does not have an emergency medicine residency, has no choice but to allow two rotations for these students.
Emergency medicine has not released any recommendations for the upcoming cycle. The specialty was much more flexible last year than it had been in previous years. We’re reaching out to all specialty societies that released recommendations after the Coalition released its recommendations last May to determine whether the specialty will update their requirements from last year.
We had a number of students who complied with the first guidelines last year by setting up a July rotation. If they complete the rotation, they could be considered "unprofessional." If they don't complete the rotation, they may not be able to reschedule. So now what do they do?
There are a couple of places where the applicant can share their intent with programs. Also, programs have access to the transcript appendix and the MSPE, where medical schools can share information about itself. When contacted by AAMC staff, several program directors have expressed understanding of the unique circumstances experienced by learners during the pandemic.
When the May 2020 guidance was released, graduate medical education (GME) followed up with guidelines. Is anything coming out from GME regarding away rotations and interviews?
Some specialty associations have indicated a desire to provide specialty-specific guidance on away rotations and interviews after the work group releases its away rotations update on April 15.
I understand the Coalition received a letter from the American Orthopedic Association (AOA) against the limitation of only one away rotation. Have you received others?
The AOA communication is the only one that the Coalition has received. As leaders of medical schools, you are encouraged to engage with program directors to understand where the specialties are with regard to aligning with the Coalition recommendations. Some hospitals remain concerned about bringing in students when they are just getting back to normal operations. Information about broad vaccination of students is currently unclear, so caution is warranted. The AAMC is in communication with specialty societies; the few we’ve spoken to so far are likely to provide additional information in the May/June timeframe.
Will the work group reconvene and come out with additional guidance?
The work group plans to reconvene in late March to review current data and information. Any updates will be shared on April 15.
How many away rotation opportunities will exist this year?
For the academic year ending June 30, 2021, the guidance remains the same as the guidelines published in 2020, and the number of available away rotations will vary widely by institution, specialty, and program. Each program decided, based on its own community’s experience with COVID-19 and the changes that experience brings to the clinical learning environments, whether it could offer any rotations to visiting students at all this past year. Under some conditions, students from one geographic location who are invited into a facility in another location could increase the likelihood of carrying an infection into the host institution or community, or from the host institution to the student’s home site and community. It is likely that the number of away rotations offered to students this past year was less than in the past. In addition, guidance from several specialty and program director groups urged limitations for away rotations for this cycle (see the ERAS list of specialty statements). For academic year 2021-2022, each COM can allow all students to do one (1) away rotation, regardless the specialty or availability in-system, as long as travel is safe. A student can be permitted to do more than one rotation if the additional away rotations are necessary for the student to meet curricular, graduation, or accreditation requirements as determined by the COM.
How many away rotations are recommended?
To prioritize the safety of the community, patients, and learners, the Coalition WG recommends that students be permitted to do one (1) away rotation, beginning August 1, as specified in the final report. Students are encouraged to work closely with their medical school advisors to determine how many, if any, additional away rotations are recommended for their individual circumstances. Programs are encouraged by the guidelines to ask students about additional away rotations.
Does this guidance limit the number of weeks per away rotation?
No, it only affects whether a student is approved to do the rotation at all, not how many weeks a student can be or should be permitted to complete an away rotation. The decision about the length, format, and content of the rotation remains with the program offering the rotation.
How will schools verify eligibility?
Each school will develop a policy and plan for communicating to their students and faculty how they will implement the away rotation recommendation, including eligibility, once they have considered the recommendation in the context of their individual in-system offerings and curricular, accreditation, and graduation requirements. AACOM has developed a flow chart to help with the decision process.
What are alternatives to away rotations?
Some residency programs will plan virtual events to allow students to have some of the experiences they may have had during an in-person rotation at their site. Students should work with their medical schools and advisors to make sure their knowledge, skills, and attitudes are well-documented in their application. Applicants and programs should also share information on desires and expectations for program culture and priorities. More information and links to specialty resources are available in the compendium document accompanying the recommendations.
What is available regarding specific specialty guidance related to away rotations?
Last year, many specialty societies gave guidance to residency programs about the use of away rotations; this year we expect the same will happen following the release of the Coalition WG’s recommendations. ERAS is again collecting a list of specialty statements; check back often for updates.
What if a student already has rotations scheduled ― do I have to cancel them?
Because the guidance is being released much earlier this year (January 2021 vs. May 2020), this will not be a common problem. Rotations taking place prior to June 30, 2021 may be completed by the student and do not affect the one (1) rotation that a student is permitted to do after July 1, 2021. Visiting Students Learning Opportunities (VSLO®) service released guidance for medical schools and students. Students can begin applying to programs on April 15, and programs are encouraged to notify students of decisions promptly, beginning May 1. We suggest that you review VSLO’s FAQs or, to get your specific questions answered, contact them using this contact form or at (202) 478-9878.
We have students with military obligations through the Health Professions Scholarship Program (HPSP scholars). They are contractually obligated by law to perform temporary duty at the military hospitals before applying for residency training at military graduate medical education (GME) programs. Does this meet the exception outlined in the Coalition’s recommendations?
The requirement that HPSP scholars must complete active duty training at military facilities prior to applying for residency does align with the work group’s recommendation exception of “learners who have a specialty interest and do not have access to a clinical experience with a residency program in that specialty in their school’s system.” Therefore, these learners meet the exception for completing away rotations at military GME facilities. As stated in the guidance, these students may complete away rotations for the remainder of the 2020-21 and 2021-22 academic years.
Schools without AMCs
My medical school does not have a graduate medical education (GME) enterprise that can support adequate learning experiences to prepare our students for graduation and residency training. Do the Coalition’s recommendations support away rotations before Aug. 1 for our learners?
The work group’s recommendations include an exception that supports medical schools that do not have clinical experiences in specialties that learners have an interest in pursuing within their system. As stated in the guidance, students at these schools may complete away rotations for the remainder of the 2020-21 and the 2021-22 academic years.
Brand new schools without home residencies are in a difficult position. Our students are expected to do away rotations; if they are unable to complete them, residency programs might not consider them. Did that arise in the work group discussions?
The work group’s intent was to assist the community as best it could by balancing multiple priorities. As stated in the work group’s guiding principles, medical schools must prioritize meeting core competencies anchored in accreditation and graduation requirements for their own students. If a medical school truly does not have residency programs its learners desire, students may complete away rotations for that reason under the established exceptions within the recommendations.
Students at medical schools without a GME enterprise accessible to learners must complete more than one away rotation in a given specialty or subspecialty. Do the work group recommendations support this interpretation?
The work group does not specify the number of away rotations that students at medical schools without a GME enterprise may schedule. However, students and schools are encouraged to carefully balance between safety, education, and specialty program requirements in deciding whether students should be scheduling more than one rotation in a given specialty or subspecialty.
Since our students meet the exception for completing away rotations, how can we mitigate against negative impacts from program directors who might misinterpret multiple away rotations completed by our students?
Medical schools should consider including the specialties they offer (or indicating that the medical school has a community-based/primary care emphasis and does not include all specialties at the institution) in the Medical Student Performance Evaluation or adding it to the transcript appendix in the ERAS® application, and they should encourage learners to include why they had to complete more than one away rotation in their personal statement. When contacted by AAMC staff, several program directors have expressed understanding of the unique circumstances experienced by learners during the pandemic.
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