It’s that time of the year when medical students across the country are doing “audition” medical electives. I still remember my medical electives and how I tried to make a good impression and get a great reference letter. Elective time can be stressful but it doesn’t have to be. With a bit of planning and inside knowledge, electives can go from being a stressful time to almost vacation-travel time. There’s a bit of work that should be done before, during and after your elective to ensure you get the most out of it. Hopefully this guide can make this pre-CaRMS ritual less daunting and more enjoyable.
Before Your Elective
- Start Planning Early – Setting up the electives you want requires early preparation. On average, I would say you should submit your application at least 3-4 months before your actual elective dates. For schools like UBC with more limited spots, you might need to submit your forms at least 6-9 months ahead of time. Basically, as soon as you find our your 3rd and 4th year schedule, you should start arranging your electives. I found booking all these electives more tedious than residency applications, so start early to save yourself some stress.
- Booking your Elective Requires Persistence – Setting up your elective should be as simple as submitting your forms with your requested specialty and dates. Unfortunately, the process is often much more frustrating. Different schools require different documents, some require vaccination records, others want bank drafts. There’s no standardized process and often the school’s elective students website can be confusing. You might even have to wait months to get a reply. The only thing I can advise is be persistent. You might have to email the visiting elective’s office several times. It might require a few phone calls to help your application get approved. You might have to email different departments to find your own elective spot. Remember, as long as there is a preceptor/department willing to take on students, your elective can be approved, regardless of what the administrative office might say.
- Do a minimum of two weeks, aim to do three to four week electives – You need at least two weeks for schools to know you and you to get to know each program. Longer electives are to your benefit, especially if it’s a program you want to rank highly. You have the advantage of more time to meet people and show your interest in the program. You can also get a better feel for each program and can make a more informed choice when it comes time for CaRMS. If you’re doing an elective to explore a specialty, two weeks is more than sufficient. For programs that you are seriously interested in aim to do three to four weeks. Any longer and you might be putting all your eggs in the same basket.
- Try to Book your Electives with the Right People – Certain preceptors hold more weight when it comes time for residency selection. Program directors, department heads and senior staff are people you want to impress during your elective. When you book your elective, ask the elective administrators if they have a schedule of who is working on what weeks. Ideally, you want to get face time with these people who can right you a strong letter of support. Ask specifically if you can work with certain preceptors.
- STUDY STUDY STUDY beforehand – The best way you can prep before an elective is to do the required readings. Know key topics, landmark articles and answers to commonly pimped questions. Know the basics of each specialty. Reading the Toronto Notes section on that specialty is often a good first start. Follow it up by reading an in-depth textbook and knowing the bread and butter cases extremely well. For example, if you’re doing an orthopedics elective make sure you know all the common fractures and basics of managing them. I did an ortho elective and found Netter’s Concise Orthopedic Anatomy and TO Notes was a good base to start out with. To see a list of recommended IM materials, check out my books page.
- Get in Contact with Residents – It’s extremely important to get in touch with the residents of the program you are doing your elective in. They can often provide invaluable advice before your begin your elective. From providing you with resources to study from to figuring the daily ins-and-out logistics, residents are a underutilized resource. Plus, if you do match into that program they will be your senior colleagues and getting to know them early is to your advantage. Some even sit on the admissions committee, so always be on your best behavior.
During Your Elective
- Meet the Right People – For any audition elective, the most important aspect is that you meet the right people and make a good impression on them. A lot of residency selection is who you know and how much that person can vouch for you. Your goal for any audition elective is to excel and get support for your residency application. People you should meet if you can include the program director, chief and senior residents, established faculty members and administrators. One of the best ways to meet the program director is to send their office an email to see if they can take time out of their busy schedule to meet with you. Make sure you do your homework and come prepared. Ask questions about their program that you can’t easily find elsewhere. Let them know your interest in their program. Especially with smaller programs like subspecialty surgeries, it’s crucial to get in as much positive face time.
- Talk to the Residents – Current residents can provide you with lots of advice and pearls that you can’t find anywhere else. Especially PGY-1’s who have just gone through the CaRMS process, they will be best people to ask for application advice. These connections are also super helpful when it comes time for preparing for interviews.
- Know the Expectations – The difference between average, above average, excellent and outstanding performance is knowing what’s expected of you. Establish early on what’s expected of a learner at your stage and than set out to exceed it. If you’re expected to be able to gather relevant clinical information and summarize it, try to take it one step further by formulating your own management plans too. Aim to meet and exceed expectations during your elective.
- Make Your Intentions Known – From the get go, it’s very important that talk with your preceptor about your interest in their program. Ask for a meeting early during your first week. Let them know that their program is one that you will be ranking highly and at the end of this elective you want to get a good reference letter. Request if they are able to take some time to observe your clinical skills and evaluate you more closely than other trainees. I find that whenever preceptors know that I’m keen and ready to do more, opportunities present themselves more frequently.
- Get Feedback – Around the halfway mark, it’s a good idea to sit down with your senior resident/staff to get feedback. See which areas you can improve in and then go an excel in those areas. Preceptors like learners that are teachable and getting feedback is something you should try to get in all your rotations.
- Be on Your Best Behavior – Show up on time. Don’t slack off. Don’t skip out on educational sessions. Act professionally. Treat everyone nicely, administrators, nurses and colleagues. Your elective time is as important as your interview, be on your best behavior.
- Be Keen – Volunteer to take care of extra patients. Ask for opportunities to r organize a teaching session. Always show up on time and ask if there are any things you can help with at the end of the day. Ask to do call even if it’s not required of elective students. If there are chances to do CATS (critical appraisal topics) or other presentations be sure to seize it. These are easy chances to stand out from the crowd. Be a team player and be easy to work with.
- Put in the Extra Effort– There are a lot of small things that you can do during your elective that can make you stand out a bit more. Be sure to read around your cases and any topics discussed during the day. Even more importantly, be sure to report back to your team and preceptor when do find those answers. Make sure your case presentations are polished (See my advice on presenting effectively). These are often the only times you can impress your preceptor on your clinical abilities. Write your notes legibly and in an organized fashion. Even if you’re not the smartest or most charismatic person on your team, you can make up for it with diligence and dedication. Programs want residents they can work well with, not people who know it all. They can teach you clinical knowledge but they can’t teach you to be hardworking.
- Enjoy Your New Surroundings – If you’re visiting another city for your elective, be sure to take time to explore the area and see local attractions. Ask for food recommendations and things to do. See if you can imaging living there. Not only will it give you relaxation during your elective, it also shows preceptors that you are actually interested in spending the next several years there. Plus when it comes time for residency program interviews, you can answer the question of what attracts you to their city easily.
After Your Elective
- Have a Formal Meeting – Be sure to have a proper sit down discussion with your preceptor at the end of your elective. Get feedback and give feedback too. Re-express your intentions and if they haven’t offered already, request if they can write you a STRONG letter of reference. If you were worked hard during your elective, preceptors are usually more than happy to support your application.
- Provide Your Credentials ASAP – After you’ve requested your letter, try to provide your credentials right away. Send your referee a cover letter expressing your intentions, an updated CV, other rotation evaluations and personal letters if you have them. Ask if it’s possible that they write a preliminary letter while your elective is still fresh in their memories, so that when it comes time for CaRMS they can provide a more accurate letter. Give them a timeline of when they should expect to hear from you again.
- Follow-up – If you’ve done your elective more than half a year before CaRMS, it’s a good idea to send your referee an update email in between so they remember you. When it comes time for them to write you a letter, be sure to make it as easy as possible for them. Provide them with clear instructions on what to write about and pre-paid postage if they’re going to send snail mail. Be sure to ask them to comment on specific traits that programs want to see – including your clinical abilities, why you would be good for their specialty and what will make you a successful resident.
- Thank You Letters – Make sure to thank everyone for their help with your elective and residency application. Thank you cards are cheap and simple but make good impressions on people. They don’t hurt your application and everyone likes to be appreciated for their work. Be sure to send them to program directors that take time to meet you, administrators that helped you arrange your electives and your preceptor who will be writing your letter.