Is there value in audition extramurals?

It has become common for fourth-year medical students interested in surgical careers to leave their parent university to take extramural elective rotations in surgery at other institutions. These "audition extramurals," while of some educational value, are often repetitions of prior clerkships and may not broaden the student's educational horizons. Instead, they are intended to enhance a student's competitiveness in the match. While recent opinions and questionnaires have suggested that such extramural rotations are not valuable in general surgery, no study has formally evaluated the effect of extramural electives on the residency match.

Over a 6-year period, the authors reviewed the outcome in 99 students who took extramural elective rotations in surgery. Of the 99 students, 28 were from the authors' institution who left to do extramural rotations elsewhere and 71 were outside students who came to the University of South Florida for an elective. While the elective rotation increased the probability of an interview, it did not alter ranking or probability of matching.

For general surgery students, the elective rotation may actually decrease competitiveness, while for specialty students, it appears necessary but not sufficient to improve match outcome. The elective might facilitate placement for students who did not match, but did not do so predictably.

The authors conclude that extramural elective rotations should be taken for educational value only and not as auditions for residency.