Everything You Need to Know About Audition Rotations

So, you’ve finally chosen to pursue your dream specialty – congratulations! Maybe you’re considering various specialties or curious about the fourth year of medical school in a competitive surgical field. Regardless, you’ve probably heard the phrase “audition rotations” before. This term is often used to describe one of the most important aspects of applying to certain medical specialties. In this guide, I’ll go through everything you need to know about audition rotations and provide insight from my own experience of completing them to explain how you can succeed in these crucial aspects of the residency application process.

What are Audition Rotations?

Audition Rotations, also referred to as “away rotations” or “sub-internships (sub-I’s)”, are electives completed in a student’s specialty of choice following completion of the core clerkships. As the name “sub-internship” implies, these additional rotations are an opportunity for medical students applying for residency to demonstrate their clinical acumen and ability to function like interns over two to four weeks. In the process, the student is “auditioning” for a spot in the residency program at whichever institution they are rotating. Students complete audition rotations at their home program as well as multiple “away” programs across the country. 

Audition rotations have become one of the most important components of the residency application process. Indeed, residency program directors in dermatology, neurological surgery, orthopaedic surgery, and otolaryngology all consider an applicant’s rotation in their department as one of the top 3 most important factors used in selecting which applicants to interview according to the NRMP’s At-A-Glance Program Director Survey. Ultimately, your standing in The Match is influenced by your interactions with faculty, residents, and program staff during your rotation. However, audition rotations are also a tremendous opportunity for students to gain immersive, first-hand exposure to their desired specialty at their top choices for residency across the country without the added stress of shelf exams. 

What Specialties Require Audition Rotations?

Certain competitive specialties essentially require applicants to complete audition rotations to have a high probability of matching in that specialty. These specialties include:

• Cardiothoracic surgery
• Dermatology
• Emergency medicine
• Neurosurgery
• Ophthalmology
• Orthopaedic surgery
• Otolaryngology
• Plastic surgery
• Radiation oncology
• Interventional radiology
• Urology
• Vascular surgery

While specialties like emergency medicine and ophthalmology may only expect applicants to complete one audition rotation, other specialties like orthopaedic surgery expect applicants to complete at least three audition rotations at away institutions in addition to one audition rotation at their home program. Luckily, you can find audition rotations in nearly any specialty through the AAMC Visiting Student Learning Opportunities (VSLO) tool,

Are Audition Rotations Necessary in Other Specialties?

Although other specialties not listed above do not require audition rotations, some students pursuing specialties ranging from family medicine to diagnostic radiology may choose to complete audition rotations for a number of reasons. For instance, if you have a preference for a specific geographic area, you might opt for multiple audition rotations at your top programs, even if your specialty of choice doesn’t require them. Some students view audition rotations as a great chance to gain specialty exposure while exploring different regions. No matter your motivation, you should discuss your interest in completing an audition rotation with your residency advisor. Audition rotations can showcase your skills, but a weak performance may jeopardize your chance to match with that program.

How Many Audition Rotations Should I Apply For?

Once you have decided to complete audition rotations in your specialty of choice, you will need to access VSLO through your home medical school to view and apply to residency programs offering audition rotations. Before applying, schedule a meeting with your residency advisor and mentor(s) in your desired specialty.

It’s important to discuss your interest in their specialty and the competitiveness of your application. Often, your advisor and mentors can provide you with specialty-specific recommendations. For example, they can advise on how many audition rotations you should apply for, which programs you should check out, and which programs to steer away from. A good rule is to apply only to as many programs as you’re willing to complete until you’ve accepted or declined the rotation. Many students apply to numerous programs and then decline accepted rotations. This may result in the programs automatically denying you an interview because you declined their rotation offer.

How to Do Well on an Audition Rotation?

While completing four audition rotations (one at my home program and three at other institutions across the country) in orthopaedic surgery, I picked up several pearls from faculty, residents, and other rotating medical students on how to succeed on these important rotations. 

1) Be excited to learn!

This is your first opportunity to function as a member of the healthcare team in your desired specialty without the added stress of shelf exams and clerkship grades. This opportunity comes with greater responsibility than your role as a third-year medical student, including more chances to shine in the OR through suturing or seeing more patients and generating diagnoses independently in the clinic. If you lack enthusiasm for the daily work of your program, faculty and residents may perceive it, potentially questioning your interest in matching there. Importantly, unhappiness on an audition rotation may signal that you are pursuing the wrong specialty. During audition rotations, many students change specialty preferences, offering valuable insights into their goals and work-life balance priorities.

2) Be ready to work hard!

A common mantra to medical students on away rotations is, “be the first one there and the last one to leave.” Even though you may feel like a quiet observer during parts of your audition rotation, the faculty and residents are always paying attention to auditioning medical students. Residency is arguably the most difficult and time-intensive portion of training in one’s medical career. The program leadership and residents want to select potential residents who they believe are resilient enough to withstand the challenges of residency without becoming burnt out. Being fully present on rotation, including waking up early to get to the hospital or clinic before the faculty and residents arrive and staying late to finish the last surgical case or see the last patient in clinic, will make you shine.

3) Show up prepared!

Preparation is one of the most crucial components to a successful career as a physician. If you or your loved one were in the patient’s shoes, how would you react if your surgeon did not know what procedure was being performed or which side of the body was being operated on? Being prepared includes reading up on pathologies relevant to the cases you will be seeing in the clinic or OR, knowing how to perform basic procedural or surgical tasks like suturing and knot tying, and having any materials on hand that the faculty or residents may need for dressing changes or even a pen.

In conclusion, audition rotations are some of the most enriching and exciting rotations of medical school. Despite nerves, this guide’s steps can help you shine on rotation and match successfully at your preferred residency program. Succeeding on an audition rotation may best be remembered by the 3 A’s: Be Available, Able, and Affable. And remember, you’re one step closer to embarking on the medical specialty of your dreams!