Great Seeing You in San Francisco! See You Next Year in Boston!

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1 Student Editor Kristina Betters, Med 4 University of Florida School of Medicine AAP Medical Student Subcommittee Ruth Chiang, Med 4 University of Arizona College of Medicine - Phoenix Lisa Costello, Med 4 West Virginia University School of Medicine Shanlee Davis, MD The Children s Hospital (University of Colorado - Denver) December 2010 MEDSTUDENTNEWS Lenore Jarvis, MD Nationwide Children s Hospital (The Ohio State University) Ashley Lucke, Med 4 Florida State University College of Medicine Hailey Nelson, Med 3 University of Washington School of Medicine Dan Schumacher, MD (chair) Pediatric Emergency Medicine Fellow Cincinnati Children s Hospital Medical Center Great Seeing You in San Francisco! See You Next Year in Boston! Thank you to everyone who attended the National Conference and Exhibition (NCE) in San Francisco! We are proud to announce our programming for medical students exceeded its previous high marks, and we hope you all enjoyed the programming as much as we did. We would also like to thank all of our speakers and organizers for all their time and dedication to make the event a success. As always, we are open to your comments and suggestions for improvement. Feel free to any of the medical student subcommittee members or myself with ways we can make next year even better! On that note, mark your calendars for next year s NCE. It will take place October 15th-18th in Boston at the Boston Convention and Exhibition Center. Our keynote speaker will be Dr. Ted Sectish, the program director at Boston Children s. Advanced registration will begin success June 1, 2011 and is FREE FOR MEDICAL STUDENTS! We hope to see everyone again, and for those of you who could not make it this year we hope to see you next October as well! Inside This Issue Becoming a Pediatrician publication NCE Recap: Another successful year! Subspecialty Spotlight: Peds ID Child Abuse Elective Team Healthy: Our National Advocacy Project PIG Service Spotlight Concussion: A Case Review Away Rotations AAP Legislative Conference

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3 AAP NCE: We Had the Time of Our Lives! By Hailey Nelson, Med 3, University of Washington School of Medicine I just returned from a whirl-wind weekend packed full of all things pediatrics! The 2010 American Academy of Pediatrics National Conference and Exhibition (AAP NCE) took place in San Francisco, CA and surpassed all expectations! Medical student programming included a keynote talk by Dr. Gilhooly on applying to residency and a panel of residency directors from small, medium, and large programs. The next day featured topic tables on a variety of subjects including personal statements, excelling in clinical clerkships, and international pediatrics. The session wrapped up with pediatric physical exam pearls. The following is what I learned at the conference: The first hurdle when applying to residency is to write your personal statement. Students should remember that programs have a lot of applications to read. Try to make your personal statement short with lots of content and depth. Treat your personal statement like a resume and highlight what is important in your application. Do make sure to spell check! Don t write kids are the future, why you like pediatrics, or what you are looking for in a program. If there is a specific feature you are looking for in a program it is alright to mention it, but understand that the readers only have a short amount of time to read your statement and are looking to find out more about you. If you had a significant hiccup in medical school it is important that you explain it in your personal statement. You need to include what happened, what you did about it, and what you learned. Programs understand that things happen and consider it more of a red flag if you don t mention why there is a gap in your training. With your personal statement complete, the next step is to complete your ERAS application. The biggest piece of advice is to know your application! Everything that you put on ERAS is fair game for discussion during your interview. The more complete your application is when you submit, the more control you will have in obtaining early interview invites. Letters of recommendation matter most when they are written by the people who know you best! With your ERAS complete it is then time to start on the interview trail. When you do go to interview, applicants should remember that it is a two way conversation. Programs are trying to recruit you, which is very different from medical school interviews. Never run out of questions! Think about what you want to ask the residents versus the faculty. Ask your questions to different people. For example, a good question to ask the program director and the residents is Could you give me an example of what role the residents play in making decisions? When trying to decide if you want to be at a residency program in a free standing children s hospital, or a hospital within a hospital, know that they all have the same program requirements so go with what feels right for you. I hope you enjoyed my notes and the fantastic pediatrics advice I ve shared from the medical student programming at AAP NCE If you want to find out even more, the best way to get connected is to become a student member of the American Academy of Pediatrics. In addition to great resources like the Young Peds Network ( and the YPConnection ( ypn.aap.org/), you also get to attend AAP NCE for free! So why wait? Join now and make plans to attend AAP NCE 2011 in Boston, MA from October 15 th through the 18 th. I ll see you there! Go Peds! Article author and Medical Student Subcommittee member, Hailey Nelson, Med 3 (far right), with other Subcommittee members Lisa Costello, Med 4 (left) and Dan Schumacher, MD (center).

4 AAP NCE: We Had the Time of Our Lives! By Hailey Nelson, Med 3, University of Washington School of Medicine Above: Students asked questions of our expert panel of residency leaders to learn how to be a successful residency applicant Right: Students get personal with two experienced program directors at our topic table discussions

5 Subspecialty Spotlight: Pediatric Infectious Disease By Kristina Betters, Med 4, University of Florida School of Medicine During my microbiology course in second year of medical school, I distinctively remember being overwhelmed by the vast presentations of infectious diseases. As I began clerkships in third year it never failed that some of our most interesting and difficult cases were solved with the help of the infectious disease team. Patient with persistent fever of unknown origin consult ID. Patient with odd rash consult ID. Patient in shock with no response to antibiotics consult ID. When choosing my fourth year electives, I decided that if for nothing else but the interesting cases, I should spend a month on pediatric infectious disease. As I completed my month long elective, I learned much more about the field of pediatric ID than microbiology. Not only was the team consulted on about a third of all inpatients, we had the opportunity to participate in a myriad of outpatient clinics including a tuberculosis clinic, HIV/AIDS clinic, and general ID clinic for follow-up of inpatients and referrals from outside practices. For a subspecialty, our scope of cases was extremely diverse- I saw everything from osteomyelitis to HSV encephalitis to multi-drug resistant latent tuberculosis. Similar to the other pediatric subspecialties, pediatric ID requires a three year fellowship after completing residency. About 6% of all pediatric subspecialists in the United States are within the field of infectious disease according to the American Board of Pediatrics. The field offers various opportunities beyond clinical care including research, public service (working with groups like the CDC), global health work, and industry jobs (helping develop vaccines or antibiotics). Most pediatric ID physicians practice within an academic setting, with only 5% in private practice. Beyond the team-work nature of pediatrics ID, many physicians are drawn to the field due to the challenge. Dr. Mirza says one reason she decided to pursue ID was, [because peds ID is a] very cerebral subspecialty, your mind is constantly being challenged by all kinds of pathogens, the infections they cause, and the way different hosts respond to the same pathogen/infection. As an ID physician your focus is not just on one system but on the entire individual. One of the fellows also commented, It is also a challenge (and takes courage) to not use or stop antibiotics. I think the courage comes from knowledge and experience. What advice does Dr. Mirza have for those interested in the field? Get a good solid general pediatrics education in your residency! Her other suggestions included a microbiology degree or masters of public health if you decide early enough in your career, pursuing scholarly activities or international work which may serve as a stepping stone for future research within your fellowship, and lastly find a mentor who can help guide you in choosing your residency and fellowship. For more information on a career in pediatric ID check out the Pediatric Infectious Disease Society career opportunities brochure: stories/pdf/pids_careeropportunitiesinpediatricid.pdf Special thanks to: University of Florida Jacksonville Pediatric Infectious Disease Department Dr. Ayesha Mirza Dr. Haidee Custodio Dr. Saran Valdez-Johnson One pediatric ID fellow told me her favorite aspect of the field was, It s a subspecialty not confined to one organ/ system, it challenges you to constantly think of differential diagnoses/possibilities and then rationalize your management decisions. Another fellow commented on her favorite aspect, It would be the fact that I get to interact with all the other subspecialties because infection is almost always on the differential diagnosis. Another aspect that I like is that I still have a lot of opportunity to continue my practice of general pediatrics. Beyond working with other subspecialties, the ID community itself is also very proactive in maintaining relationships within the field to exchange information amongst one another. Dr. Ayesha Mirza, a pediatrics ID attending, told me she stays current by constantly reading, maintaining memberships on list-servs like the Emerging Infections Network, and discussions and interactions with colleagues including other ID doctors but also microbiologists, pharmacists, public health officials, and other biomedical researchers. I had the opportunity to experience this networking first hand during my rotation when I attended the ID city-wide meeting in Jacksonville. Attendance included pediatric ID faculty/fellows, adult ID faculty/fellows, microbiologists from local hospitals, pharmacists from local hospitals, and representatives from the local Health Department. Behind Article: Strep pneumoniae (a common peds bacteria!) on Gram stain of sputum Above: The Red Book - the most respected reference for pediatric infectious diseases - published by the AAP!

6 Child Abuse Elective: Finding Some Protected Time in Fourth Year By Ruth Chiang, Med 3, University of Arizona - Phoenix Most of us choose pediatrics because we love kids. Kids make us smile and laugh, and we want to spend our lives helping them. Child abuse cases are difficult for us. It s hard for us to see kids suffering unnecessarily and hard for us to face the reality that not everyone loves kids as much as we do. Being aware of child abuse is taught to us during medical school through those classic multiple choice questions on our shelfs or Step I/II: A 6mo old male presents to the ER for leg pain. X-ray shows a transverse fracture of the femur. What is the most likely diagnosis? It s easy to choose, C: child abuse. But, what about in the real world? Things are definitely not as straightforward. To get a better understanding of child abuse, I took a Child Abuse elective. I worked with 2 forensic pediatricians and 2 nurse practitioners at Childhelp, a community center. The clinic was housed in the same building as the police and child protective services (CPS), allowing for an integrated team approach to child abuse. The pediatric team s role was to examine suspected victims for physical signs of abuse. Most children were referred from outpatient pediatric clinics, but we also saw consults in the hospital. It was incredible to see the amount of detail that has to be paid to each history and each exam. It was also a great experience to talk to police officers and CPS workers about their experiences with child abuse cases. Even in my very short months on this elective rotation and my core pediatric rotations, I have seen such variable presentations of child abuse/neglect cases. There are the obvious cases that our Step I questions are based off of. Then there are others that catch you by surprise I met a spunky 9 year-old boy who presented with severe constipation and was admitted for a bowel cleanout. When a detailed history was taken, a case of child neglect was revealed - he had been taking care of himself for 3 months, eating only mac n cheese and ramen. Ironically, towards the end of my child abuse elective, I encountered a child abuse case while volunteering at our student-run night clinic. I was taking a history for a 14yo girl presenting with cold symptoms. I noticed some bruising on her legs and thighs. When I first asked her about them, she attributed them to falls. She didn t participate in any sports so it didn t seem quite right. I started taking a more detailed social history. When I got to the Do you feel safe at home? question, she opened up and began telling me about her older brother. He had a bad temper, and when things didn t go his way he would physically abuse her and her younger siblings and threaten to seriously injure or kill them. Her parents were aware of the situation, but were unable to control her brother. They were afraid for their own safety as well. Panicking on the inside, I stayed relatively calm (I think) on the outside, and went to the attending for help. After describing the situation to him, he asked me if I thought we should report the case to CPS. Umm yes? He agreed, and encouraged me to take responsibility and make the call. It was funny, even after spending almost a month working with child abuse cases, being on the first line was frightening. My first CPS call was made with a shaky voice and worries about wrecking this girl s family. I think for firsttime reporters this is a common deterrent. What if I m wrong, I get CPS involved, and I make the family situation worse? As my attending reminded me, we are mandated reporters. If we are genuinely concerned about the safety of a child, it is our duty to report it. Secondly, reporting to CPS does not necessarily mean that we are breaking up a family. It means that we are getting other people involved to help make a decision about the safety of a child. While child abuse is still scary, I m glad that I was able to get an intro experience to help me with my future career. There are many opportunities for us to learn more about child abuse. Most pediatric hospitals have dedicated faculty or teams for child abuse cases. Most pediatric residency programs offer formal child abuse education through a required or elective rotation or lecture series. In a perfect world, we wouldn t need to learn about child abuse, but we do so why not get started through a 4 th year elective rotation? Hopefully you ll learn as much as I did! Want more information? Check out these great resources: Leventhal J, Asnes A. Managing Child Abuse: General Principles. Pediatrics in Review. February (2): Kellogg, N and the Committee on Child Abuse and Neglect. Evaluation of Suspected Child Physical Abuse. Pediatrics. June (6): Vol. 119 No. 6 June 2007, pp

7 Go Team Healthy! Our National Advocacy Project By Lisa Costello, Med 4/Public Health Track Student, West Virginia University School of Medicine Each year the American Academy of Pediatrics Section on Medical Students, Residents, and Fellowship Trainees (AAP SOMSRFT) selects an advocacy issue to work on throughout the year. The advocacy subcommittee works to develop projects and resources that may be used to advocate and bring awareness to the topic. Past advocacy topics have included ImmuneWise, mental health, and tobacco cessation to name a few. This year in combination with the AAP collaboration with the White House, Bright Futures, and other national organizations fighting childhood obesity, the SOMSRFT advocacy issue is childhood obesity. As you will see, there are plenty of opportunities for medical students to get involved, and we hope you join the Team Healthy movement! This year s advocacy project, named Team Healthy, will be released in multiple phases. In October, the AAP SOMSRFT launched the first phase of the 2010 advocacy project at the NCE in San Francisco, CA. The initial phase is focused on raising awareness. This first phase includes a PowerPoint presentation and handout which may be used to present at grand rounds, morning report, or a PIG meeting. The second phase is designed to provide ways to reduce childhood obesity in academic and community practices. All of the resources and more information are available at the Team Healthy website: obesity.html. In addition to the PowerPoint and handout, the Team Healthy website contains links to multiple resources for childhood obesity. It is the subcommittee s goal to make the projects easy, straight forward, and time-efficient. Use our resources or your own ideas to inspire a project or event, and then blog about it on the YPConnection. Tell others how you are tackling the childhood obesity issue by joining the SOMSRFT Obesity Campaign group on the YPConnection ( by searching obesity campaign under the groups tab. Obesity is a growing problem across the United States and the world, but as a medical student you can help reverse the trend. This past September was the first National Childhood Obesity Awareness Month. In his proclamation, President Barack Obama urged all Americans to take action to meet our national goal of solving the problem of childhood obesity within a generation. 1 With the help of the AAP SOMSRFT advocacy project, Team Healthy, you can take action to help reach this goal. Consider giving a childhood obesity lecture at your PIG meeting, planning an interactive activity with local youth, or creating healthy resource packets for your academic or community pediatric practice. Beating the obesity epidemic will take a grand effort, but remember we are all in this together. Be on the look out for future phases and more ways you may utilize the advocacy project and its resources to tackle the childhood obesity problem in your area. Help play your part to raise awareness and start reversing the childhood obesity epidemic. Go Team Healthy! SOMSRFT Advocacy Sub-Committee Kate Roberts Marissa DiGiovine Tyler Smith Lase Ajayi Ashley Lucke David Tayloe Kristina Betters Julio Bracero Hava Haischer-Rollo Pattie Quigley Jennifer Concepcion Ruth Chiang Lisa Costello Julie Hui AAP Staff Katie Crumley Amy Kephart Jeanne Lindros 1. Obama, B. (2010). Presidential Proclamation--National Childhood Obesity Awareness Month. presidential-proclamation-national-childhoodobesity-awareness-month.

8 Service Spotlight: FSU PIG Wine and Cheese Fundraiser to Benefit Dreams Come True By Ashley Lucke, Med 4, Florida State University College of Medicine Every year on a breezy Saturday afternoon in October you ll find the faculty and medical students from the Florida State University College of Medicine sitting on the front porch of Chez Pierre, sipping wine and nibbling on artichoke dip. Jazz music plays in the background as raffle ticket numbers are called out every fifteen minutes for great gifts like salon packages, diamond and pearl jewelry, and gym memberships. It sounds pretty amazing right? Actually the most amazing part is the guest of honor each year. This year it was Trenton, a seven year old boy with a sinus tumor, who dreamed to go on a Disney cruise. He came with his parents and younger sister Chloe to enjoy an afternoon on the deck and help call out raffle ticket numbers. Thanks to the fourth annual Wine and Cheese Fundraiser to benefit the Dreams Come True Organization he will get to cruise the open seas this spring on Disney cruiselines. Brittany Jackson, current president of the Florida State University College of Medicine Pediatric Interest Group, said the event was a great success. We had lots of attendees and wine thanks to a donation by the Office of the Dean. We had appetizers from Chez Pierre and auctioned prizes every 15 minutes. Since it is only the fourth year this event has taken place, support and attendance continues to grow exponentially each year with nearly fifty people present this year and many others who donated. and movies passes, along with many other similar prizes. Admission for students was $10, faculty $20, and guest tickets $20 each. This admission ticket is good for unlimited appetizers and unlimited wine. The price of admission included one raffle ticket but additional tickets could be purchased before and during the event. Drum roll please? The grand total fundraised this year was $795 (net profit) ensuring a wonderful cruise for Trenton and his family. Dreams Come True was also able to subsidize the cost of additional cruise tickets for Trenton s extended family so they could participate in his dream also. Congratulations to his family and the dedicated Pediatric Interest Group executive board at the Florida State University College of Medicine: Brittany Jackson (President), Emile Barreau (Vice President), Labake Bankole (Treasurer), Roxanne Samuels (Secretary), Rachel Russell (Exec at large), Holly Klopfenstein (Service Chair), and Taylor Smith (Medical Student Council Representative). The event is consistently a great success and very popular among students and faculty, winning the Best Student Organization Fundraiser of the Year award at the annual College of Medicine Gala last year and Best Student Organization of the Year award two years ago. Students clearly enjoy the fundraiser itself but also getting to meet the child they are fundraising for and their family. It is nice to know that the students and faculty recognize our hard work and believe in and support or desire to make a difference in a child's life, said Brittany Jackson. Michelle Harper, a current third year medical student from Florida State and former president of the Pediatric Interest Group, said I m so glad to see the tradition of this event building each year as more students and faculty attend and more children s dreams come true. It really is a wonderful event and I would highly encourage other pediatric interest groups to consider something similar for their philanthropic event. Chez Pierre is an upscale authentic French bar and bistro in Tallahassee, Florida who has graciously committed to help fundraise with the Florida State College of Medicine for Dreams Come True each year. The strong community support is also evident in the wide array of raffle prizes given away each year ranging from $20 to $500 in value. In addition to those items listed above students and faculty also won free massages, dance studio lessons, many restaurant gift certificates

9 Case Presentation and Discussion: Concussion - A Common Diagnosis By Lenore Jarvis, MD, Nationwide Children s Hospital This patient was seen in the ED. Details have been altered for HIPAA purposes. CHIEF COMPLAINT: Head Injury, Headache HISTORY OF PRESENT ILLNESS: 16 yo healthy male presents after a direct blow to the right side of the head at football practice 3 days prior to ED visit. He was wearing a helmet. No loss of consciousness (LOC) & no memory loss. Has had intermittent throbbing headaches (HAs), 5/10 intensity since that time with associated photo- and phonophobia. No visual disturbance noted. Patient denies nausea/ vomiting. No numbness/tingling & no focal weakness. No bowel/bladder incontinence. The patient does not have a history of head trauma previous to this event. He has been behaving normally. MEDICATIONS/ALLERGIES: None PAST MEDICAL & SURGICAL HISTORY: None FAMILY HISTORY: No family history related to presenting problem. SOCIAL HISTORY: Lives at home with mom & dad. 11th grade. Plays football. Denies smoking, EtOH & drugs. REVIEW OF SYSTEMS: Positive for neck soreness and headaches. Negative for dizziness, tingling, focal weakness, seizures, loss of consciousness, weakness, lightheadedness and numbness. Negative for memory loss. PHYSICAL EXAM: Vital Signs: BP 119/70 Pulse 65 Temp 36.2 C (97.2 F) Resp 16 Wt kg (187 lb 1 oz) Normal PE except neck muscles tender to palpation. Neurological exam is normal. IMPRESSION: Concussion without LOC PLAN: - Pt with no LOC, no memory loss. CN 2-12 normal. Alert and oriented to person, place, and time. Imaging not indicated. - Tylenol/Motrin PRN for HAs and muscle soreness. - NO return to play until asymptomatic and cleared by a physician. - Educate about signs/symptoms for further concern. Unfortunately concussion is a common diagnosis, especially in the fall with the initiation of football season. Thankfully, just as fall sports commenced this year with subsequent concussion diagnoses in our pediatric patients, the AAP released a great article summarizing current concussion guidelines. Highlights from this article are found below. Halstead, Mark E., Walter, Kevin D., THE COUNCIL ON SPORTS MEDICINE AND FITNESS, Clinical Report--Sport-Related Concussion in Children and Adolescents Pediatrics : peds Intro: Brains are still developing and may be more susceptible to the effects of a concussion Definition: A complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces and includes 5 major features: 1. Caused by a direct blow to the body with an impulsive force transmitted to the head. 2. Results in the rapid onset of short-lived impairment of neurologic function that resolves spontaneously. 3. Acute clinical symptoms largely reflect a functional disturbance rather than a structural injury. 4. May or may not involve loss of consciousness (LOC). 5. No abnormality on neuroimaging studies (if obtained). Epidemiology: 300,000 sport-related concussions occur each year, up to 3.8 million recreation & sport-related. 8.9% of all high school athletic injuries. Girls higher rates than boys. Football>soccer>basketball. Signs & symptoms: HA most frequent. LOC in <10%. (continued on next page)

10 Case Presentation and Discussion: Concussion - A Common Diagnosis By Lenore Jarvis, MD, Nationwide Children s Hospital (continued from previous page) Initial Assessment: On the field: ABCs + stabilize the C-spine. Symptoms, neuro exam, cognition. Sideline assessment tools are available. Office/ED: thorough history, including signs and symptoms as well as details of any previous head injuries; head and neck examination; neurologic examination, including gait and balance assessment; and assessment of cognitive function. Monitored for any deterioration of condition. If concern for a structural brain abnormality, neuroimaging should be considered. Conventional neuroimaging is typically normal in a concussive injury. Signs and symptoms worrisome for more serious injury include severe headache; seizures; focal neurologic findings on examination; repeated emesis; significant drowsiness or difficulty awakening; slurred speech; poor orientation to person, place, or time; neck pain; and significant irritability. Patients with LOC for more than 30 seconds. CT is the test of choice during the first 24 to 48 hours after injury MRI is more appropriate 48 hours or longer after an injury Functional neuroimaging will likely provide a more accurate picture of the injury and may help predict recovery better than structural neuroimaging, but further research and wider availability is needed Neuropsych testing: a means to provide an objective measure of brain function does not independently determine if an athlete has experienced a concussion or when he or she may safely return to play ideally a baseline or preinjury test should be obtained many teams and schools will administer tests if an athlete is suffering from postconcussive symptoms over several months or has had multiple concussions, formal assessment by a neuropsychologist may be beneficial, specifically to identify areas for which the athlete may need academic accommodations. Management: The athlete should not be allowed to return to play that same day!!! Avoid activities and situations that may slow recovery. There is currently no evidence-based research regarding the use of any medication in the treatment of the concussed pediatric athlete. It is commonly recommended that NSAIDs or aspirin be avoided immediately after a suspected head injury for fear of potentiating the risk of intracranial bleeding. This remains more of a theoretic risk. Before considering a return to play, any medications used to reduce symptoms must be stopped and the athlete must remain symptom-free off medication with rest and sportsrelated activity. Cognitive rest: concussion is a functional rather than structural injury of the brain Temporary leave of absence from school, shortening of the athlete s school day, reduction of workloads in school, and allowance of more time for the athlete to complete assignments or take tests Communication with school nurses, administrators, and teachers to be sure they understand these recommendations Activities that require concentration and attention (playing video games, using a computer, and viewing TV) may exacerbate symptoms May need to avoid driving temporarily due to slowed reaction times Physical rest: broad restrictions of physical activity should be recommended Return to play: No athlete should return to play while still symptomatic at rest or with exertion. Although the vast majority of athletes with concussion will become asymptomatic within a week of their concussion, numerous studies have demonstrated a longer recovery in younger athletes Long-term Effects: persistent deficits in processing complex visual stimuli athletes with 2 or more concussions demonstrate statistically significant lower grade-point averages

11 Away Rotations: A Guide for Third Year Students Planning Fourth Year By Ashley Lucke, Med 4, Florida State University College of Medicine It certainly is a busy time for medical students. If you re a fourth year medical student, you re right in the heart of interview season, traveling across the country and trying to find out in 10 hours or less if this could be the program for you. If you re a third year medical student, you re finishing up a semester of clinical rotations and starting to think about making your fourth year schedule. With all the possibilities for electives how can you narrow it down to only a few? Many people advise fourth year medical students to do electives in areas outside of what they plan to match into. One important exception is that third years should consider doing an away rotation at a program they are considering applying to for residency. By no means is an away rotation expected to guarantee a match in pediatrics, but it can offer a valuable opportunity for a medical student to further assess a program. There are many different names for away rotations (subinternship, audition elective, acting internship, sub-i) but the concept is the same: spend four weeks at a program to develop your clinical skills and make connections with key faculty within the program. In addition, it gives you more than a 10 hour interview bubble to really decide if that program is for you. Choosing, applying, and succeeding on your away rotation is a lengthy and stressful process but hopefully after reading this article you ll be that much more prepared. The first step is deciding where to go. It seems simple, but many people don t know what kind of residency program they are looking for (tertiary academic center vs. community based vs. intermediate size). I suggest first making a list of potential programs you re considering for residency. This can be completed with the help of FREIDA, viewprogramsearch.do, an online search system to help navigate all of the residency programs that exist. There are various ways to narrow your search (geographic location, fellowships available at that program, if they use ERAS, number of positions available, program setting, etc) so if you have more specific desires you can hone in your results even more. For example, if you know you re interested in PICU, Heme/Onc, and Cardiology at an academic center select each of these criteria to only include programs that have all three fellowships in the search results. This should give you a solid list of programs you can take to a mentor or pediatric clerkship director to start a more thorough discussion of what you re looking for in a residency. Also read through their website to get a sense of the size of the program and city it is located in, these are also important criteria. For example, if there is a great program in an area of the country you re not too sure about, doing an away rotation there will give you a very accurate idea of what life would be like. Every program should have a website with the core information about its residency program. Look through their composites of current residents to see where they come from, how many are MD/PhD, how diverse the class is, what special opportunities are available at that program, etc. Use these small hints to decide if this is a program you are interested in. Choosing the programs to apply to is probably the most difficult step of this process. Many people elect to do two rotations at different types of programs to help them make their Match decision: one at a program they know they will like (mostly to make an impression) and one at a program that is more of a reach, whether that be from the applicant or the program s perspective. Read through their information and look for a section about visiting medical students to learn how to apply. A majority of programs use a central application service called VSAS (Visiting Student Application Service) at VSAS electronically distributes your application to all schools you select (similar to AMCAS when you applied to medical school). Most programs do not upload their course catalog (list of electives you can apply to) until February/ March. However, that doesn t mean you can t get started now! There is a list of documents you ll need for most schools so if you prepare early (now!) you ll be able to submit the application on the day it opens, which only increases your chances of getting the rotation you really want. Many schools have an extensive list of requirements (see the check list below). So how does it work? You collect/complete all the required forms and turn them into the student coordinator at your medical school. This person (usually in the office of student affairs) will scan your photo and most documents into the system so it becomes an electronic application. Then you select which programs and which elective courses you would like to apply to and send your file to that institution. It is not uncommon that some paper documents are required also, which you would mail in separately. Not all residency programs use VSAS, in which case you ll have to download the application materials from their respective websites and fulfill the requirements as specified in the visiting student section. While you re cruising around on the VSAS website, note application deadlines for each program. While all your information is centrally uploaded to VSAS you must individually choose when to apply to each school. Many begin accepting applications at different dates, and upload their course catalog at different times also (February and March are the most popular months). Note these dates and be sure to return when the catalog opens to read more about each elective. What do I mean by this? Although you ve chosen a pediatrics elective at Program X, you have to pick specific rotations just as you would at your home school. For example, within the department of pediatrics you will rank in descending order of preference the specialty (general wards, PICU, NICU, cardiology, Heme/Onc, Infectious Disease, etc you get the point) and also the time slot. You can peruse the options from the VSAS website by going to the institution s page, then opening the Course Catalog, selecting the specialty (Pediatrics) and then the rotation subspecialty. It will give a brief description of the rotation, the dates available, a sample daily schedule, supervising faculty, responsibilities, and who is eligible for the rotation. (continued on next page)

12 Away Rotations: A Guide for Third Year Students Planning Fourth Year By Ashley Lucke, Med 4, Florida State University College of Medicine (continued from previous page) Specifically pay attention to the dates offered because other schools might not have the same academic calendar as your home institution. Also ensure the elective you re considering is offered to visiting medical students (not always the case). So now you ve researched, gathered your materials, and applied! It s time to hurry up and wait. The average time until notification varies from one program to another. Some will wait until 6-8 weeks prior to the start of the rotation to notify you while others notify everyone by the end of April. The important thing is to apply as soon as the application opens to improve your chances of getting the exact rotation and time slot you rank first. Now life isn t perfect, it is possible a program will send you an stating none of the rotations or time slots you requested are available. If this is your favorite/#1 program I recommend immediately calling or ing this person back and saying something like I am extremely interested in this program and am willing to do other rotations, do you have anything else available? It is very likely something else will be open, which might not be exactly the subspecialty of your dreams but is still a critical opportunity to make a name for yourself at that program. rotations in the time slots that fit into your fourth year schedule. There is no perfect time of year to do the rotations either. See the table below for pros/cons to each time of year for rotations. There are many resources available to you if you have more questions about applying for away rotations. Your best information will come from the current fourth year students and advisors at your campus. Also ask your Student Support Coordinator/Dean of Rotation Month Pro Con June - July Useful for deciding Interns are starting, a career choice programs have less Doesn t interfere time/energy to with interview devote to visiting scheduling MS4 students Could interfere with CK studying time if you have August - October Interns are adjusted Doesn t interfere with interview scheduling Close to interviews, could influence interview offer if you are at the program during ERAS offers. November - January Could influence getting an interview offer if you had not been contacted February March More time slots available because less popular lower Step 1 scores May want to ensure Step 2 CK is completed by October if your Step 1 score was lower Interferes with interview scheduling Might be too late to help you get an interview (if interview slots already filled) Program will have already completed ranking/match Day Student Affairs for the protocols/deadlines pertinent to your institution. Additional websites are listed below. Good luck with your search, and I hope this article will take some of the mystery out of it! Checklist of application materials: Up to date immunization records (Tetanus, PPD, etc)* Passport size photograph Curriculum Vitae Current ACLS/BLS certification at time of rotation Background check* Letter of good standing from your school Completion of HIPAA training Completion of bloodborne pathogen training Profile sheet* Photocopy of driver s license Letter of recommendation + Physical exam+ Child abuse clearances+ *specific form for each program +required by some programs How to Use VSAS Website - how_to_use_vsas/117180/how_to_apply.html The last option to consider is how many programs to apply to? This obviously depends on how many different rotations you want to do, which is dictated by how many your medical school allows. If you complete your application early and provide multiple elective/time options I recommend applying to your desired number of rotations plus one or two more at the most. For example, if you want to do two rotations total, apply to three or four programs. This ensures you will be offered

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14 Want to be Featured in a Future Issue? Let Us Know! This newsletter is designed to let you know what is going on within the AAP and also to let you know what is going on with medical students across the nation. Do you have a great idea for a newsletter article? We want to know! Have you been involved in something noteworthy for children? Tell us about it! We know that our section has strong students at great medical schools, and we want to share the outstanding things you are interested in and are doing with the other medical students in the AAP. So, if you want to be featured in one of our future newsletters or if you know someone that should be featured in one of our future newsletters, please send any of us an . All of our addresses are listed below. We look forward to hearing from you! MEDSTUDENTNEWS Student Editor: Kristina Betters, Med 4 University of Florida School of Medicine kbetters@ufl.edu AAP Medical Student Subcommittee: Ruth Chiang, Med 4 University of Arizona College of Medicine - Phoenix rchiang@ .arizona.edu Lisa Costello, Med 4 West Virginia University School of Medicine costello.lisa@gmail.com Shanlee Davis, MD The Children s Hospital (University of Colorado - Denver) shanleedavis@odinbox.net Lenore Jarvis, MD Nationwide Children s Hospital (The Ohio State University) lenorejarvis@yahoo.com Ashley Lucke, Med 4 Florida State University College of Medicine amo07c@med.fsu.edu Hailey Nelson, Med 3 University of Washington School of Medicine hailey22@u.washington.edu Dan Schumacher, MD (chair) Pediatric Emergency Medicine Fellow Cincinnati Children s Hospital Medical Center daniel.schumacher@cchmc.org