It’s the beginning of the year, which means if you are a third year medical student, you may be wondering what you need to know about VSLO, or visiting student learning opportunities. These are away or audition rotations that students can complete at other programs. If you’ve never heard of VSLO, or have heard of it, but still have questions, I am going to attempt to answer them in this overview. I will also be writing spin offs regarding other topics related to VSLO in the next few weeks.
My entire fourth year has been VSLO and non-VSLO away rotations, so I will be sharing everything I have learned through the process. VSLOs can be intimidating, but also very fulfilling. Continue reading this post to learn more about the process and how to be successful in attaining your rotations!
What is VSLO?
VSLO, or visiting student learning opportunities, are rotations that fourth-year medical students can complete at institutions other than their own. There are two ways to do away rotations, either through the AAMC VSLO website or directly through the program. A majority of the programs offer away rotations through the VSLO website, but there are some exceptions. Check their website for more information.
During these rotations, you will join a team of other residents and medical students who work at that program. You will be able to feel the vibe of the program and see if they are a good fit for your goals. These programs will also use this opportunity to assess you and see if you are a good fit for their program. VSLOs generally require Step 1 and/or Comlex 1 to be completed prior to beginning the rotation. They also will request a transcript to ensure that you are in good academic standing.
There are aspects of your application that you are responsible for completing, and there are other aspects that your school is responsible for submitting. You should have someone at your school who is responsible for VSLOs.
What is the differences between Away Rotations vs. Sub-Internships/Acting Internships?
As you are applying for VSLOs, you may see opportunities labeled as sub-internshps (sub-Is) or acting internships (AI). Other opportunities will not have this label, but they still may be considered sub-Is or AIs. These labels are important because away rotations may be to programs/specialties in which you are not interested or applying.
For example, I did a rotation in Cardiology that was not considered a Sub-I or AI. This is because, as a fourth year medical student, I cannot apply directly into Cardiology. Therefore, it was just an away rotation in a medicine specialty. I was evaluated as a visiting medical student, but I wasn’t there to get a job.
Sub-Is and AIs are rotations that students do because they are interested in that specific program and specialty. Preceptors are evaluating students to see if they would be a good fit for the program or not. Residents also get the opportunity to work with medical students who may be their co-residents in the future. If you apply for an AI or Sub-I, it is because you want to match into that program. The evaluations are higher stakes, and you get the opportunity to meet with the program director, hopefully before residency applications are submitted.
Ideally, aim to do your AI or Sub-I in July/August before you submit your ERAS applications. You may do them in September/October/November, but after applications are submitted and interviews are sent, they may not hold much weight in terms of receiving an interview.
Who Should do VSLOs?
There are varied opinions about who should do VSLOs. Are they required? No. Are they recommended? Depends.
Less competitive specialties – family medicine, internal medicine, psychiatry, pediatrics – may not emphasize audition or away rotations the way more competitive specialties – surgical specialties, interventional radiology, OBGYN, dermatology – may. Some programs or directors may even discourage audition or away rotations for less competitive specialties because a poor performance could negatively impact your ability to match at that program.
However, you should strongly consider doing an away rotation if you:
- Are apart of a new program
- Would like to practice in a different region than where your school is
- Are applying to a competitive program or specialty
- Want more experience in an academic or rural setting
- Would like to work in a specialty that is not offered at your program
- Want a change of scenery
This list is absolutely not exhaustive, but is a starting point for those who are on the fence. If you need more guidance, speak to your advisor or counselor who will offer you more specific advice or visit this AAMC website.
How many VSLOs should I do?
This question is also a personal choice depending on your goals. Those who attend reputable programs with many rotation options for fourth-years and have a strong application may not feel like VSLOs are necessary.
Those with similar conditions who are applying to competitive specialties or programs may opt to do one or two to get recommendation letters and meet with the program directors.
However, those who are not confident in their applications or are dissatisfied with their fourth year rotation options may opt to do most, if not all, of their fourth year electives as VSLOs.
These decisions are very individual and depend on your ability to travel to different programs. Some schools have limits on the number of VSLOs their students can do. Again, this depends on what your career goals are, if your current program meets those, and if you feel the need to relocate to get the experience required for where you want to go.
Where should I do VSLOs?
The beautiful thing about VSLOs is that you can do them anywhere you want. However, the time, money, and energy spent to acquire a VSLO means that you may want to consider applying for VSLOs at programs in which you are very interested. Begin considering to which programs you will be applying for residency, then see if they have VSLOs. If you are applying for something general – i.e. internal medicine, general surgery, OBGYN – then also consider applying to rotations in subspecialties (i.e. rheumatology, vascular surgery, maternal fetal medicine respectively).
Do VSLOs have to be with specialties/programs to which I’m applying?
This question is complicated because it depends. Sometimes the answer is yes, and sometimes the answer is no. The programs decide who they want to visit. The more competitive programs may only want applicants and visiting students who plan on applying to their specialty/program. However, there are programs that make an exception if you can make a good case for yourself. I have rotated in specialties to which I did not plan on applying, but was able to relate it to my future career goals. That helps the program directors know that you are not wasting their time and you can get something out of the rotation.
If you are rotating at a program to which you are not applying, I would recommend waiting until the end of application season so students who are interested get priority. I also would recommend making sure to continue working hard, even if you’re not going into that field. You still want a good evaluation at the end of the rotation. Therefore, respect the work they do, learn what you can, and attempt to apply it to your future career.
How do I apply to VSLO?
In order to apply to VSLO, you will need a AAMC account. Once you have your login, visit the VSLO AAMC website where you will see the dashboard. This gives you a snapshot of the statuses of your applications.
After reviewing this page, you click on “My Application” and begin filling out your personal and academic information that all VSLO programs require.
After completing all of the required information, click on “Add Electives” to begin adding electives from your saved list or from search.
To find available electives, click “Find Electives”. There are filters available to help you narrow your search. Then, when you identify a program, select either “Learn More” or “Save”. See an overview of the program by clicking “Learn More”. Click “Save” to add electives to which you want to apply. This adds those electives to “Saved Electives”.
If you click “Learn More” and the program is accepting applications, you may choose rotation dates. Some programs have pre-chosen dates that you cannot alter. Others have the option for you to choose the dates. You can submit as many dates as you need. The more, the better chances you have of being accepted.
After choosing your available dates and selecting “Apply Now”, you will return to your application where you will see all of the programs to which you applied and their requirements. Upload the requirements from your computer or your saved documents, including:
- Recommendation letter
- Test scores
- Immunization (Click here for the AAMC immunization form that is accepted by most programs)
- Titers (HepB, MMR)
- Personal statements
Submitting your VSLO
After uploading all the requirements, you will move on to the next page to rank your preferred dates at each program. Each individual application costs $15, so you will pay the total before submitting the application.
You do not have to submit every single application at the same time. If you would like to delay your application to some program, simply save them for later.
The application will go to the VSLO coordinator at your school soo they may complete the remaining requirements (transcript, home school permission, etc.). Then, when all is complete, they will send it to the VSLO program coordinator for the residency to be reviewed. They may accept or reject your application, but sometimes you may not receive an answer. So, it’s important to apply to many VSLOs for the same dates to give yourself a competitive chance.
How do I accept a VSLO opportunity?
Once you submit your VSLO application, you will wait for it to be accepted. I would not recommend bombarding the director with questions about your application. Most acceptances or rejections will be sent within 1-3 months so start applying for them early!
Once a program accepts your application, you will receive an email, and the status of your application will change on your dashboard under “Pending Offers”. You have two weeks to accept it and complete the post-decision requirements. After submitting those, you will wait for the program to accept them and finally approve your application.
What if I have been accepted to more than one at the same time?
This is a good problem to have because you have choices. Since you have two weeks to accept a VSLO and complete the post-decision requirements, you have time to wait to hear from other programs. I would not recommend accepting a VSLO and then withdrawing to go to another program. It is bad form and takes away the opportunity from another student. Once you have committed, then you need to follow through.
If you are in a situation where you haven’t heard back from a program to which you would like to go, but you have a pending offer from another institution, you may email the director or coordinator to inform them of the situation and see if they can give you an idea of your status. At the end of the day, you have to prioritize yourself and your goals. If you just want to get a VSLO no matter where it is, then take the opportunities you have. If you have a specific program at which you would like to rotate, then hold out until you get that opportunity.
One other option, if you have two VSLO offers at the same time, is to email the program coordinator for a set of alternate dates. They may not be able to accomodate you, but you can explain that you would really like to rotate there, and you have a conflict with another program. Again, they can reject this option, but it gives you a chance to advocate for yourself so your fourth-year schedule is what you want it to be.
Costs of a VSLO
After you have secured your VSLO, it is time to focus on logistics and costs. VSLOs can be a great learning experience but expensive. Each VSLO application is $15, which quickly adds up depending on how many you apply to. Once a VSLO program accepts you, some have program fees that can range from $100-$300. This information is in their overview on the VSLO webpage. In addition to those initial costs, some VSLOs require lab work and vaccinations that are not covered by insurance and must be covered on your own.
Other costs to consider are:
- Housing
- Food
- Transportation (to VSLO and daily travel)
- Parking
- Badge
- Lifestyle (gym, self-care, appointments, etc.)
Anything you can do to mitigate costs, such as staying with a friend or roommates, eating the free meals at the hospital, walking to work, will help. Affordable housing options for VSLO are:
Always read the reviews and try to stay in safe locations near the hospital. Longer commutes can make your rotation more challenging, especially if you rotate in a busy city.
What should I expect on VSLOs?
When you get to your VSLO, the first couple of days will be hectic. There is a lot of onboarding, orientation, and a steep learning curve. Expect to get lost and feel behind. However, most residents and attendings are happy to help you. The best thing you can do is be attentive, try to learn quickly, and watch the team dynamic so you know how to work with the team.
Sometimes, there are other medical students. If they are visiting students, try to work with them so you both can have a successful rotation. Sometimes, it feels like a challenge or competition. However, at the end of the day, we’re all medical students trying to match. So, volunteer to take some opportunities and volunteer to give some opportunities. The goal of working with others is to show that you can be part of a team because that’s what a resident will have to do.
What should I do and not do on VSLO rotations?
VSLO rotations can be intimidating, but once you get comfortable with the team, you will realize that most residents are down-to-Earth, relaxed, and very helpful, especially if you are doing a good job. Below are a few Dos and Don’ts to help you be successful on your rotation:
- Do read all emails and complete all pre-rotation tasks.
- Don’t ask questions to the coordinator without ensuring it hasn’t already been answered in their emails.
- Do show up early on the first day to give yourself extra time.
- Don’t show up late or right on time throughout the rotation.
- Do take ownership for your own learning by reading about cases prior to speaking with the attending.
- Don’t sit around and wait for someone to tell you what to do after the first few days. Once you have your daily schedule and tasks, begin to take initiative at an appropriate pace.
- Do communicate with your team about their expectations and how you can best meet your goals.
- Don’t be overly aggressive in trying to get in on cases or participate in patient care.
- Do respect the totem pole (unfortunately med students are at the bottom!) and chain of command.
- Don’t look idle or disinterested. Use free time to read, catch up with patients, review patient charts, and talk with residents who are free about questions or topics related to the field/program.
- Do ask for feedback often and be coachable.
- Don’t gossip with or about any employee or patient. Others will and include you. Smile politely and refrain from engaging.
Before the rotation ends, meet with the program director if you can. Get to know them, inform them of your intentions to apply, and discuss the next steps for you to submit a successful application.
How do I get a recommendation letter on my away rotation?
What types of letters do I need?
Recommendation letters are vital for ERAS or residency applications. The types of letters that are normally recommended/required include:
- Department chair
- Program director
- SLOE, standard letter of evaluation, (emergency medicine only)
- Clinical faculty or preceptor
What is the best way to ask for a letter?
Getting a recommendation letter on an away rotation can seem intimidating and you may not know the best way to go about it. You can choose one of two approaches:
- During your introduction, discuss your intentions to receive a recommendation letter and ask if they would be willing to evaluate you throughout the week and write you a good letter.
- Work really hard and wait until the end of the week before asking your preceptor for a letter.
Each approach has its advantages and disadvantages. The first approach helps your letter writer appropriately evaluate you throughout the week. When you spring this request on them at the end, they may not have been watching you closely enough to feel comfortable writing a good letter of recommendation.
However, the disadvantage of this approach is you may not feel like you clicked with that preceptor enough to want them to write your letter. On the contrary, by waiting, you can see if a good relationship naturally develops and feel more comfortable asking them to write you a letter.
The hardest part about working on away rotations is that you often work directly with the residents and the attendings change rapidly. Therefore, it can be hard to spend enough time with a physician to feel comfortable asking them for a letter. You get about a week to make a good impression with most rotation schedules.
When asking them for a letter, get their email and their phone number in case you get separated from them or the rotation ends. Physicians get busy, and the longer you wait, the more challenges you may face getting your letter from them. After you get their okay, email them the ERAS electronic upload document, your CV, and include a due date in your email. The due date should be much earlier than when you actually need it to give yourself some leeway. At the end, include when you will be following up with them so they expect to hear from you.
What happens if I can’t get my recommendation letter?
Asking for a recommendation letter repeatedly was probably the worst part about Year 4. However, you have to have these letters in your application, so if you have to be a bug-a-boo, then do it. I would recommend two to three POLITE follow ups spaced two to three weeks apart before moving on to another letter writer. To ensure you have wiggle room for incomplete letters, ask for more letters than you need in each category. This will save you a headache in September. Recommendation letters can be submitted after the ERAS open date, but it’s much more reassuring to submit a complete application.
If you end up with more letters than you need, then that is a good problem to have! You can assign up to four letters per program to which you are applying. Therefore, get as many letters as possible so you can use them how you feel is most beneficial.
Do not forget to thank your letter writers both at the time of completion and after you match!
Key Takeaways
Applying for VSLOs can be daunting and challenging. However, once you begin receiving acceptances and rotating in different environments, the learning is so fulfilling. I will have completed 7 away rotations by the end of my fourth year and I could not have asked for a better schedule. Some of the rotations were challenging. However, I was able to learn something from each one of them that will make me a better resident and physician. So, I encourage you to take as many opportunities as you want, but have fun and get excited about completing your final year of medical school!