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The Coalition for Physician Accountability’s Work Group on Away Rotations — FAQs

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Last Updated May 6, 2021.

General Questions

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 July?
The work group sought to balance learner safety with the desire of both learners and program directors to have in-person away rotations in some form. Upon review of current environmental data and feedback from the community, reentry for away rotations was moved from August to July. Although the data are promising — vaccine distribution and administration is improving across the country, many medical schools are reporting that students have had or will have the opportunity to receive vaccinations before June 2021, and the country is opening up — there are still uncertainties and many, including the Centers for Disease Control and Prevention (CDC), have encouraged caution.

Given the importance of away rotations, how did the work group determine that each learner would be limited to only one rotation per specialty?
While the work group recognizes the important role away rotations serve for both learners and residency programs, ongoing challenges in the clinical environment resulting from the pandemic have reduced away rotation opportunities this year. The compressed timeline for completion of electives, paired with the goal of equity for all learners to have an opportunity to secure a rotation, also makes it challenging to support more than one rotation. The primary goals remain of meeting educational needs and enabling as much exploration as possible while supporting equity in distribution of opportunities.

Do you have any guidance for dealing with students who are pursuing competitive specialties with program directors balking at the “one away rotation” recommendation? Do you anticipate this guideline will be refined based upon official specialty announcements?
The guidance from the Coalition work group remains unchanged as it relates to the number of recommended away rotations. While the date to resume away rotations was moved to July, it is unlikely that this change will result in additional rotations sufficient enough to justify increasing the number of electives for all students. Furthermore, some students are still trying to schedule their first away rotation, which July additions may remediate. We are hopeful that specialties and medical schools will adhere to the work group guidance to limit approved away rotations in any specialty to one per specialty per student.

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 hand surgery departments are within orthopedic departments, are you planning on letting students do an additional away rotation in a field that is a subspecialty (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 and the goal of 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 rotations 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.

However, the Coalition guidance is intended to add to, but not supersede, the independent judgment of a medical school. Medical schools that do not have a home residency program should consider including the specialties they offer in graduate medical education (GME) programs (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 (MSPE) or adding it to the transcript appendix in the ERAS® application. They should also 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.

Students should be able to explain why it was necessary to complete multiple away rotations if asked.

Did the work group intend for this guidance to indicate that no away rotations may be taken before the date of July 1, or did it intend to suggest that no away rotations may be taken before a July offering? Our July elective runs from June 26 to July 20, 2021. Given that institutions vary in their rotation dates, the recommendation is for a “July elective” rather than strictly adhering to July 1.
The guidelines have been updated to allow learners to apply for and schedule in-person away rotations with a date concluding in July or later. This update recognizes that not all rotations are aligned with the calendar month. Rotations may have a start date in June if the end date is in July. The rotation block must conclude in July.

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 July 1?
Students who do not have home programs and rely upon regional clinical partners to provide opportunities for their students meet this exception: “Learners for whom away rotations are required for graduation or accreditation are exempted from this guidance.” Students at medical schools with regional clinical partners are exempt from the one away rotation per specialty per student guidance.

However, students whose medical school resides within a region with other medical schools should consider completion of an away elective at one of these regional medical school systems (that are not one of their regional clinical partners) as their one away rotation.

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. It was not meant to be used as a punitive measure against students who have valid exceptions to the guidelines for one away rotation or whose schools have made policy exceptions based on their local context. Medical schools might consider supporting their learners who may need to explore a specialty not present in a GME program at their medical school by including this information in the Medical Student Performance Evaluation (MSPE), 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.

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 why a learner completed more than one away rotation. There are tools within the ERAS application for learners to explain why they completed more than one away rotation; for medical schools with policy exceptions based on their local context, they should explain in the MSPE and/or highlight the lack of residencies in the appendix of the medical school transcript. When contacted by AAMC staff, several program directors have expressed understanding of the unique circumstances experienced by learners during the pandemic.

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. This is why the Coalition work group guidance is intended to add to, but not supersede, the independent judgment of a medical school.

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.

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 and are uncertain about the needs of new interns arriving in July. While key indicators are trending positively, the CDC is asking all to remain cautious and vigilant in adhering to safety protocols (e.g., wearing masks, washing hands, staying 6 feet away from others). The AAMC is in communication with specialty societies; many plan to provide additional information in the May/June timeframe.

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Osteopathic Community

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 (refer to the ERAS list of specialty statements). For academic year 2021-2022, each College of Osteopathic Medicine (COM) can allow all students to do one away rotation, regardless of 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 work group recommends that students be permitted to do one away rotation, beginning Aug. 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. The American Association of Colleges of Osteopathic Medicine 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 applications. 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 work group’s recommendations. The ERAS program 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 rotation that a student is permitted to do after July 1, 2021. The 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 the VSLO FAQs or, to get your specific questions answered, contact them using this contact form or at 202-478-9878.

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Military

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 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.

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Schools Without Academic Medical Centers

My medical school does not have a 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 July 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, they may consider supporting learners who may need to explore a specialty not present in a GME program at their medical school by including this information in the MSPE, adding to the transcript appendix in the ERAS application what specialties the medical school offers (or including 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.

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?
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. Students should be able to explain why it was necessary to complete multiple away rotations if asked.

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 in GME programs (or indicating that the medical school has a community-based/primary care emphasis and does not include all specialties at the institution) in the MSPE 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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Read the latest recommendations on medical student away rotations from the Coalition for Physician Accountability. If you have additional questions not addressed here, please contact aciccone.coalition@gmail.com.

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