Availability of Emergency Medicine Away Rotations

Residency directors in emergency medicine (EM) have been placing increased value on the Standardized Letter of Evaluation to evaluate the escalating numbers of residency applications received each year. This has placed added significance on EM away rotations (ARs). We sought to determine the overall availability of ARs in EM.

We surveyed clerkships sites at the end of 2018-2019 application season. The survey requested data about maximum rotation spots available, actual number of students that rotated, and data about application processing and rotation offer decision making.

We received 190 responses, of which 129 (49% of 262 clerkship sites surveyed) provided data regarding available positions and student rotators. A total of 3,472 ARs were completed at the responding sites. The average capacity ratio (CR; maximum available AR spots divided by AR completed by students) for responding sites was 1.57. AR availability varied by time and geography. Most AR positions were filled during peak season (CR = 1.22); however, many went unfilled outside of this time frame (CR = 2.41). Geographic data showed some locations had significant unfilled AR availability.

Our survey data show that there are at least 1.5 AR positions per applicant. Students can be reasonably expected to complete one AR and, in select cases, a second. CR during peak season indicates nearly saturated AR positions. Flexibility of rotation timing and tools to link open AR positions with students needing to complete a rotation will help optimize filling available AR positions. Continued effort in application advising from home clerkships and processes to ensure equitable distribution of AR positions among students will help ensure interested students obtain a position.