Hopefully by late third year to early fourth year you have come to a fairly sound decision regarding your interest in the field.  Once you have “locked-in”, the next step is to find an advisor in the field.  When deciding on whom to ask, make sure the person has up-to-date practical insight regarding the match process; someone who has had recent experience on the residency selection committee is ideal.  Look for an advisor that is not over extended with clinical duties, research and 20 advisees, otherwise you may be fighting an uphill battle to even meet, much less get any good personalized advice.  Use your advisor to get ideas for your personal statement, letters of recommendation, research projects and to answer any other questions that you may develop about your application.  Residents at your program and medical students a year ahead of you may be able to offer additional guidance regarding that match process and may also be able to point you to the best advisor.   

Second to only a few other things, your sub-internship performance carries considerable weight in your overall application.  Doing well on this rotation will not only grant the all-important “honors”, it will also help get good letters of recommendation.  You must do well on this rotation!  Plan to eat, sleep and breathe otolaryngology for 3-4 weeks!  We have included a list of pearls that will help you do well on your sub-internship (and away rotation(s) if you choose to attend one or more).  

1. Know your stuff.  Make sure to study for the rotation well before you start.  Read every chance you get.  Know everything about the patients that are on your service.  Read in advance about every OR case so you know the indications, complications, and post-operative considerations for each.  Know your anatomy cold since this is one of the most commonly pimped subjects.      

2. Be prepared to work!  If you are not working harder than everyone else on your service, something is wrong.  Even if you are assigned to the least glorious task, accept it with a good attitude and no matter what, NEVER COMPLAIN!  Always arrive early and stay late.  Volunteer to scrub out of cases to help out the team with scut when appropriate.  Even if you are told it is optional, preround on all of the patients on your service, and if you are permitted to, write notes on each.  If you are assigned to give a presentation, make sure you spend the time to give an outstanding talk.    

3. Always look professional, even if the residents or attending do not.  Even if you know that you will be in the OR all day, wear a shirt and tie (or a comparable wardrobe for females) to the hospital and change into scrubs just before the first cases start.  After the OR cases are finished, change back into your mortician costume for the rest of the day.

4. Show sincere interest and ask intelligent questions when they come up, but do not be annoying or a brown noser – there is a definite difference.

5. Never talk bad about attendings, residents, other medical students, nurses… or anyone!  

6. Be a team player.  The most important thing that you can do is to make your team look good.  If the attending asks a question in the OR, do not blurt out the answer before the residents, wait for your turn.  When you are on morning rounds and the staff asks for particular information regarding a patient, give the information to a resident to make them look good.  Bottom line: if your team likes you, you are golden.  If they don’t, it’s going to be a long month.

Great books to get for your sub-I and away rotations:

Like other surgical subspecialties, it is generally recommended that serious applicants complete an additional sub-internship at another institution.  Away rotations may help solidify your interest in the field and can also serve as a way to get your foot in the door at one of your top choice programs.  

There are two schools of thought regarding away rotations.  Some believe that if you look really good on paper, it is better that you do not pursue a visiting rotation at one of your top choices since you only have room to go down.  If you agree with this logic, you might opt to visit a well-known institution, but one which is not high on your list.  Others feel that if you are very interested in a particular program, you may increase your odds of matching there if you have a visiting rotation and perform extremely well – this option might be particularly helpful for applicants feel that their CV is not strong enough to guarantee an interview at their desired program.  Most programs give strong preference to students that have visited their program and auditioned well.  All programs have been burned at some point in the past by “dud applicants” with unbelievable resumes and would obviously prefer a “proven applicant”.

“If you do it, you best do it right”.  No matter how you decide to play it, it is extremely important that you nail the rotation!  If you are ambitious, a letter of recommendation from a prominent figure (i.e. the chairman, or PD) of another institution can be a strong addition to the application.

Ideally, applicants should aim for scheduling their away rotation(s) between the months of May and early September.  Timing the visiting rotation this way allows students to hopefully have gained enough clinical experience from earlier rotations to do well in a less than familiar setting. It also allows enough time for the grade and possible letters of recommendation to be submitted for the application.  Apply to at least a couple different programs, and apply early!  This is a hot time for away rotations and if you wait too long to apply, you may find yourself without a rotation at the institutions you want! If you are an underrepresented minority student, several programs offer opportunities for scholarships.

The short answer is no, but it definitely helps.  With the exception of a few programs, most programs give preference to applicants that demonstrate interest in a career in academic medicine.  Having a track record of research involvement is one of the best ways to show interest.  

Having research experience does a number of things for your application.  First, it tells the selection committee that you have intellectual curiosity and are self-motivated.  Secondly, it gives you something to talk about with the interviewer.  Many, if not most programs have at least one designated interviewer to specifically grade your knowledge of past research experience and gauge your potential for future quality research.  Not having any research to talk about will make for a long 10-15 minutes!  You will be surprised at how the interviewer lights up when they see that you have researched something they are interested in – instant rapport!  Finally, nearly every single person on each selection committee is an academician.  Everyone wants to recruit people that are similar to themselves.  Give them what they want.

If you decide to pursue research, make it meaningful and productive.  Ideally you should get a journal publication, oral presentation or at minimum a poster presentation at a national meeting.  Unfortunately, even if you worked hard but have nothing to show for it, on paper you look the same as the student that slacked off and never showed up for single day of the rotation.  Field-specific research is preferred over other clinical research, but if you have already completed research in other clinical areas, this will of course be helpful.  We have included a list of hints to help those that are interested in research to get the most for their time:

1. Seek a research lab/ research advisor that is very productive.  You are much more likely to get your name on a publication from a lab that pumps out a couple articles a month.

2. Meet with your prospective research advisor ahead of time to layout expectations.  Make sure that you will not just be just a lab gopher and will be given first or second authorship if you work hard and significantly contribute to the project.

3. Choose a topic that is meaningful but doable in the allotted time frame.  Make sure the project has merit and is potentially publishable, but realize that you will not be able to cure AIDS during an 8-week rotation.  When deciding how long a project will likely require, take the estimated time and multiply by 2; this will be more realistic as projects always hit snags and never run perfectly smooth.

4. Do all of the background reading and project design before you start your research block.  Since time will already be tight, you need to hit the ground running once you start your research time.   

If you are absolutely opposed to any research, you should apply extra time and energy to other important areas of your application.  Again, research is helpful, but you do not have to have it to match; there are plenty of applicants that do match to great programs without significant research experience.