The COVID-19 pandemic has uprooted many of the carefully crafted plans set out by neurosurgery applicants this year. Sub-internships have classically been a time where students explore neurosurgical programs across the U.S. However, the COVID-19 crisis has resulted in this year’s cancellation of sub-internship experiences. Without sub-internships, students lost opportunities to obtain letters of recommendation, gauge the cultural differences among the neurosurgical training programs and demonstrate character and competence in clinical and OR settings.
Exposure to neurosurgery in medical school has traditionally been limited as it is often not a required part of the curriculum. When applying to neurosurgery, it is essential to get as involved as possible to learn about the specialty and understand the responsibilities of being a neurosurgeon. Sub-internship experiences show students the complexities of neurosurgery and what life would be like as an intern/resident. As in years past, students were excited to see programs directly and find how they differ to find the best fit. With the exposure gained from away rotations, it would have given a realistic view of the next seven years of a student’s career. With the inability to view programs first-hand, applicants will have a less personal view of unspoken nuances essential to aid in reaching personal and professional goals.
Without away rotations, students are losing out on experiencing various cultures. It is difficult to get a real feel for and exposure to the realities of the cost of living in another city without away sub-internships. Those from the Midwest did not get to experience any programs in different parts of the country. For those who have not been able to travel and see different geographical regions within the U.S., they may not know what lies in store in these other areas. Applicants may not fully understand the financial implications of living in certain cities and may end up in a large city with an elevated cost of living and increased financial stress throughout residency.
Additionally, sub-internships offer many networking opportunities with attendings from various institutions. Although Zoom is starting to feel like the new normal, cold video chats are not the same as casual OR conversations. In such a small medical field, these critical relationships can open doors and create unique opportunities. Attendings can share personal experiences and how they navigate challenges.
Sub-internaships are also a great way to meet medical students who share common interests and passions about neurosurgery. Success requires a combined effort and that’s when unbreakable bonds and lifelong friendships are formed. The life-long friendships and career connections made along the way are crucial for future institutional partnerships to grow the field of neurosurgery.
Programs also lose out on the opportunity to see applicants from other institutions. Historically, sub-internships were seen as extended interviews and could allow programs to see how various applicants work under pressure and assimilate into the group dynamic of the program. For example, residents can create multiple opportunities for sub-interns to get together and get to know them better to determine if they would be a good fit for the program. Programs now have to decide on candidates without getting these extended opportunities to really test the cohesiveness of the group. This becomes exceedingly important for applicants without home institution neurological surgery programs. Although mitigation methods have been implemented, the reduction in opportunities puts students from schools without affiliated residency programs at a significant disadvantage. The personal connection made at away rotations is lost for individuals with these circumstances, and these applicants can be overlooked in a large application pool.
Because of the loss of networking opportunities and ability to see programs first-hand, it is difficult for applicants to think about where they may be the best fit. This is leading to many of this year’s applicants to apply to more programs and more broadly than they would have otherwise. Current residents and academic advisors have even encouraged the money saved from not having away sub-internships be put towards applying to more programs this cycle. This is not only increasing the overall competitiveness of each program, but also driving up the cost of ERAS applications for this year.
Overall, the decision to cancel away sub-internships this year due to the pandemic was necessary in order to decrease the spread and create a more level playing field for applicants. However, this has made choosing which program is the right fit more challenging as well as more costly. Even though this year’s applicants are missing out on many of the traditional experiences of this process, they are still undergoing an alternative process. The adaptability of this cycle has allowed this generation to become trailblazers and has allowed programs to reach more students through a virtual process.
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The Impact of No Away Rotations: Pros
References
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2. https://www.mededpublish.org/manuscripts/2170
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7241400/
5. https://pubmed.ncbi.nlm.nih.gov/25868779/
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908064/
8. https://neurosurgerymatch.org/application-process/away-rotations-sub-internships/
9. https://pubmed.ncbi.nlm.nih.gov/27184179/
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7288790/
11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7229732/
12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239096/
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