How to do well on virtual away rotations

The COVID-19 pandemic has ushered in a new era of virtual away rotations for fourth year medical students applying this year. Virtual away rotations present a challenge on numerous levels as they have not been universally adapted by residency programs, and some medical schools are not acknowledging virtual away rotations as course credit. Despite these issues, many students across the country will be participating in virtual sub-internships. Here, we discuss how you can put your best foot forward in various activities you may encounter on virtual away rotations.

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Grand Rounds

Many programs have offered virtual students the opportunity to virtually attend department or division grand rounds. Be on time, and be sure to mute your microphone. Dress business casual, but only turn your video on if everyone else in the call also has it on. In general, no one wants anyone asking questions during grand rounds, and this is amplified in virtual formats. As a virtual visiting medical student, I would listen attentively and take notes. Your attendance is about all you can do here.

Presentation

I would expect to give at least one, if not multiple, presentations on a visiting virtual away rotation. Depending on the program, they may ask you to give a case presentation, a talk on your research, or assign you a topic. I would make this the best presentation you have ever given. Your presentation may be the only item they have to objectively evaluate you on. Put in the work, time, and preparation to deliver as good of a presentation as you can.

Reverse Classroom Activities

Programs may assign readings or videos to be watched on your own time, then ask you to synthesize your takeaways from the materials and teach the other medical students and residents about what you learned. Learn whatever was assigned to you backwards and forwards so that you have a strong grasp of the material. You may need to use outside resources to supplement your preparation. It is helpful to make a visual aid or provide your audience with a (virtual) handout sheet with an outline. While it requires just a little more effort, it can be helpful to guide the discussion that ensues and also demonstrates your engagement with the activity.

They may also assess your knowledge of the field by asking you to walk them through a patient case. Try to show them your clinical reasoning skills and lean towards being extra thorough. The first answer when asked about what you would do with any patient is: a thorough history and physical exam. They may have you walk them through the history and provide you with details based on what you ask. Try to synthesize the information as you go along and don’t rush to give an answer. Trust the diagnostic process and be sure to collect all data from the patient history before moving forward.

  • Example:
  • Prompt: A 37 year old patient presenting with a chief complaint of a 2 week cough. What do you want to do?
  • Your Answer: First, I would take a detailed history and physical exam. Starting with the history, I would want to better classify the chief complaint by asking…”

Journal Club

Journal club format translates well to a virtual format. There are assigned articles that usually no one reads, and a resident typically presents one by one the article they were assigned to present. You should have read each of the articles and be able to give a brief summary of them if called upon. Print out a hard copy and take notes on the articles. Prepare insightful questions on each article and ask them if it seems appropriate to do so. Useful items to investigate when reading each article include the methodology, primary data points, and applicability of the study to the field.

Meet and Greet

There may be the opportunity to have a resident or faculty meet and greet or question and answer session. Given the format this year, you will see many students trying to dominate the conversation and driving attention to themselves in group settings. Do not do that. Residents and attendings quickly pick up on that behavior which is repulsive. Do give your opinion and speak up, but do so at appropriate times and places.

Prepare thoughtful, specific questions about the program. Study the program website before your rotation. Ask what a typical day is like for the residents on the services they are on. Ask about the rotations and the clinical volume. Inquire about living in the city. Brainstorm a list of 10-15 questions and be sure to ask at least one. Make these good questions. I would try to state your name and what school you are from as to introduce yourself prior to asking a question if it feels appropriate.

Telemedicine

Some programs also mention that students will participate in telemedicine patient consultations. While it is easy to list that on your program website for recruiting students, I am curious as to the logistics of making it come to fruition. If you have the opportunity to participate in telemedicine consultations, I would be prepared to take a very well polished patient history applicable to the specialty you are working in. You may have to describe what your physical exam would be to the attending. Try to formulate a diagnostic plan when applicable and suggest potential follow up imaging or labs that may be warranted. Be respectful and dress appropriately. If there are technical difficulties, have patience throughout.

Virtual away rotations will be an interesting endeavor for all parties involved. Do your best with whatever activity or problem you are presented with. Have patience with the process. Just being present goes a long way.

Are you participating in a virtual sub-internship? Why or why not? What will you be doing on your virtual away rotation? Share your thoughts below.

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Carter J. Boyd, MD, MBA
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