Should you do Telerotations? How do residency programs look at telerotations?

​Are telerotations of any use? Do they actually help you match? How do they compare to the onsite rotation and most importantly what do programs look for in your ERAS CV and during the interviews as they discusss the teleroation experiences? In this blog we will discuss all aspects of telerotation and which type of applicants should consider telerotations.
 
Ofcourse we all know that One impact of the COVID 19 pandemic has been on the US Clinical experience- electives, externship, observerships for IMGs and even the AMGs. So all this also impacted the conventional clinical rotations of for IMGs and online tele-rotations have been adapted by many U.S. hospitals and affiliated clinics

At Sarthi we had more than 150 of Sarthi students completed tele rotations in 2020. Additionally we had extensive discussions with physicians and preceptors providing tele rotations. We then analyzed the interview invite data and the interview experience of our students who did tele rotations. Using these  set of information we wanted answer some very important question that applicants are asking us.
 
But first what are the PDs looking for in the rotations in general and tele in particular
They want to make sure
  1. You have a good strong understanding of the US heathcare system
  2. You can follow the concepts of evidence based medicine and show the execution of these concepts in a patient care situation including for example in case discussions and presentations
  3. You know how the patient centric approach works
 
What do programs look for in telerotations?
our students who have done telerotation actually reported no issues during interviews. Many of them actually also received pre match offers. A couple of them have not done any onsite rotation but only 3 telerotations

In the interviews the program focus was mostly on learnings of the student
  1. How was it structured?
  2. How many hours/week
  3. Have you had patient interaction?
  4. Examples of case presentations and discussions
  5. What did you learn about evidence-based medicine in the tele rotation?
  6. Did you have EMR access?
 
Once you understand what programs are looking for and what they are likely to focus on in your ERAS application/Interview then it becomes easier for you to assess if you should do the tele and if you have the opportunity, how to evaluate if it is worth it

So now lets understand  what are the types of telerotations? Are these useful? What are the drawbacks? Which applicant should consider these tele rotations?

First lets discuss what exactly are the various types of tele rotations. Our students have experienced mainly two common type of tele rotations. Then there are variations of these.

The first one is where you will have access to patient data/ information on video calls, and talk to patients, note their history and discuss the case with the preceptor or the team. This is very similar to an actual onsite elective or externship which you will be assigned patients- about 10-12 daily, you will interact with them, you will be responsible for patient management, enter updates into the EMR and present cases to the team. Many of our partner physicians do offer it. So if you are interested, click here to check these.
 
The other most  common tele rotations are didactics based and in these you may not have direct patient interaction. This includes a lot of critical thinking, and case presentations. You will review the literature around a case, discuss protocols and so on. Some of these rotations  also combine a SIM lab experience, where while you are remote, you can participate in these labs with attendings and other students who may be onsite and using simulation modalities such as high‐fidelity mannequins, task-trainers and standardized patients. Many of our partner physicians follow this model very successfully as well
 
Now which type fits you well?

At a high level if you have no US electives, have not had any patient interaction, not even CS, it may be a good idea to go for the first one. Ofcourse remember you will have to work US times if you are outside US. Many of our students which extensive experience though- for example those will home country residencies and those who may have had good exposure to the US healthcare system already do very well in the didactics based second approach. There are ofcourse some other considerations that will be come to shortly.
 
 Now lets talk about some pros and cons of these rotations.

First lets understand that in many cases now telerotations may be unavoidable for the next couple of seasons- with restrictions on travel, hospital restrictions on onsite student elective rotations and even patients avoiding onsite visits.
  1. The first obvious advantage is the living expenses- if you are doing tele rotation, you don’t have to relocate, spend money in travel, housing in that city so you end up saving quite a bit.
  2.  The biggest advantage though, turns out to be flexibility. We have many student working full time- an Obgyn physician in India, a researcher at Stanford, other physicians doing COVID duty in their home country. They all welcomed tele with open arms and were able to get acquainted with the US healthcare system without compromising on their duties.
  3.  For those of you who may be preparing for the Step exams, tele rotations may have some other benefits. It will free up your time for studying.
  4.  Also remember that a typical tele rotation does not last the whole day- it is about 3-4 hours a day on weekdays. So many students tend to do two different rotations simultaneously. So if you think you need more Letters of recommendations in limited time, tele rotations are a good option.
  5.  Finally tele rotations give you the opportunity to dive deeper into case discussions, literature reviews and build a stronger foundation.
 
Now what are the disadvantages?
 
  1. Ofcourse all the drawbacks you can think of, if you are not physically present in the hospital- The team work aspect tends not be as strong in tele.
  2.  Networking could be an issue, since you are not onsite and you may not be able to meet other attendings, residents informally and get guidance- which otherwise in an onsite setting is much easier.
  3.  If you are looking for a rigorous 8 to 10 hour schedule- that’s not happening in tele- and some students may not like it from that perspective.
 
Now what about the quality of LOR? Well turns out that even in tele you can get strong personalized LOR. The quality of LORs is no less than that of any other equivalent rotations in most cases.
 
 How to evaluation a telerotation opportunity?

As you review any tele opportunity, the type of questions you should be asking
  1. Most importantly the affiliation of the clinic or the facility- is it affiliated with any program?
  2. Type of experience you will get- patient interaction/ didactics- both are ok. You need to know what you will get into
  3. Access to EMR?
  4. Hours/week
  5. Opportunities to present cases
 
So who benefits the most from tele rotations?
 
First is the recent graduates- our recent graduates who could not do on site electives or externships are finding tele rotations quite useful and most of them got interview invites based on only tele USCE. Infact some of them also got prematch offers. The reason recent graduates benefit from tele is simple- they have either just finished their internships or are in the middle of their internships- they already have the clinical experience. Their goal is to understand the US healthcare system, the physician-patient interaction, the use of EBM, EMRs and almost all of this can be done in tele rotations.
The other category of applicants who benefit from the tele may surprise you. These are applicants with strong home country experience- may even be working full time- given the extensive clinical acumen, these students also benefit from learning the intricacies of the US healthcare system which they may be missing in their home countries- the EMRs, case discussions, EBM etc. These students have been getting interviews even without any onsite USCE- in Obgyn, Neurorlogy, pediatrics and IM
 
Now who does not benefit from the tele? If you are an applicant with long gaps, have been away from clinical work for a while- then only tele rotations may not benefit you. In this case you need to look for some strong onsite externships as well. A hybrid approach may work for you better- so do a few months of onsite externships- not observerships before you transition to telerotations. This is ofcourse if you are in the US. If you are in your home country- there is no substitute for full time work in busy facility to hone your clinical skills. In that case ofcourse tele supplement your experience very well.