Three keys to crushing audition rotations: Notes from inside ‘the room where it happens’

If you are an osteopathic medical student and you are so nervous about audition rotations you are hardly able to steady your gaze enough to even read these words, let me assure you that I have been right where you are. In fact, just about every reader who is perusing this article besides a terrified about-to-be-on-rotation medical student has been there; preceptors, fourth years and residency program directors alike.

If you are facing audition rotations, rest assured: You will get through this. Take a deep breath into your belly, run in place for 90 seconds, talk out your fears to a beloved pet (who will not have anything to say but will blink back lovingly) and keep reading.

I have been where you are. Since then, I have served as an attending in multiple osteopathic universities, as an interviewer of candidates for residency program selection committees and career advisor for hundreds of medical students. Here are themes I have seen, from an insider’s view, with three keys to success on audition rotations:

1. Prepare before you get there: The 80/20 rule

Medical knowledge: Most things in life follow the 80/20 rule. This is likely true even of your closet—20 percent of items are used most of the time, and 80 percent very little. The same tends to be true in any specialty and particular practice within medicine. While board review books and medical texts will outline hundreds of conditions and chief complaints per specialty, in real time, each specialty and setting will have a top eight to ten high-yield, most-often-seen conditions/presenting symptoms.

Don’t get so caught up in the weeds and details that you end up missing the big-picture themes. I have seen countless students memorizing oncologic gene markers and gene deletions who did not know the basic workups for DKA, maintenance treatment of hypertension or a thorough list of differentials for chest pain. Every discipline has a top eight to 10, and some of these will vary based on clinic/hospital community and resources. Your job is to be sure you are well-versed in the top 10 and that you have an idea of what those are before you get there.

Ask before you arrive: Ask other students who have been on the rotations, look at program websites and ask your networks of mentors and preceptors about the highest-yield topics you want to focus on. No joke, on an inpatient psychiatric unit, I’ve worked with students who could name all the different neuroreceptors impacted by specific medications but could not name the minimum time required for symptoms to diagnose depression. Focus most of your prep work on the high-yield topics.

Program coordinators can also be very helpful with inside information on the culture and expectations for the rotation before you begin. It is OK to ask them about things like dress, hours and expectations.

Once you’re there, line up your support team: When you get there, ask the nurses for any suggestions they have for you as a student, including most commonly seen diagnoses/cases. This one question of nursing staff, if asked respectfully, has paid off in spades for students later in their rotations. You will likely spend 80 percent of your clinical face time with nurses/support staff and 20 percent or less with your attendings. Get to know fellow medical students also on the rotation, the medical residents and program staff. Know your “team” and treat them well.

2. Read the room

Once you arrive, start learning how to read the setting you enter. Once you hit residency, you will again likely be in a different rotation every month for at least the first year, so this is a good skill to develop.

Every specialty and residency program has its own culture and subculture. Your goal is for the program preceptors, resident physicians and staff to feel like you are already a member of the program by the end of your rotation (if you like the program).

Find out as much as you can about the program’s culture: hours, dress, who talks first and structure of the team. Some programs will have rounds of students and residents citing literature articles during rounds to debate next treatment steps. Other programs will have long hours in clinic and meetings for dinner and drinks to decompress. In some programs, especially in psychiatry, students do well observing all the details of a patient, and then asking a thoughtful question.

This isn’t about changing yourself to fit each program; it’s very much like visiting a different country and being deeply respectful of the cultural norms. For example, on some surgery rotations, everyone is expected to wear scrubs, including in clinic. Some programs and disciplines are very personable, and people are comfortable speaking about their personal lives as a form of team bonding. In other disciplines and settings, the same conversation may be viewed as unprofessional.

3. Be yourself

Above all else, be yourself. I have fielded countless phone calls from medical students during audition rotations or after residency interviews, sobbing that they “said the wrong thing” or “should not have said …” Inevitably, my next question, each and every time is, “Well, were you being honest?”

If the answer is yes, then whatever that student said or did was, big picture, the right answer. They may not have been in an interview with the right program for them, but the bottom line is, above all else, be yourself. Trust that if you do your best and are true to your authentic self, your destiny will find you. Your job is to do your best and stay true to yourself.

As an attending who has served on residency selection committees and interviewed dozens of candidates, it is crucial that when you interview, you express who you are authentically. When I see an applicant who is genuine, I can tell that they have a sense of who they are with a bright confidence that shines. These applicants rise to the top of interview rankings as the “star” applicants. This is the key to being ranked highly and accepted into any residency program.

Even though it may not feel like it, things have a funny way of working out. It just takes time to get through the process.

Related reading:

Audition rotations: Successful residents share 6+ tips

Why I chose a rural hospital for my clinical rotations—and why you should too