Leveraging Your P4 Rotations

Recently, I wrote a series of articles aimed at helping students secure a residency position.

Many of those tips pertained to P4 students already on their clinical rotations and in the process of applying to residencies.

However, what about the P2 and P3 students that already know post-graduate training is the right path for them? What can they do to better market themselves as attractive candidates?

First, take a look at this resource for crafting your CV.

Many of the extracurricular activities that would go on a CV (tutoring, research, or club involvement) should be started early in the professional years.

P4 clinical rotations can also be a great residency booster—you get to put all your didactic knowledge to the test, get a taste for what the pace of residency can be, get exposed to areas of pharmacy you may want to specialize in, and potentially find your letters of recommendation writers.

So, how can you make the most of it?

Most schools give the student some say in what his or her rotation preferences are. You can provide a list of your overall top preceptors or sites for each type of rotation. However, it is not guaranteed that you will get all, or even some, of your preferences.

If you feel a residency is the right training path for you, here are some tips on making your P4 year impress residency-selection committees.

1. Select faculty members.

Faculty members know your school curriculum inside and out. They know what you were taught in-depth, and what was lacking. They will potentially tailor the rotation to fill in the gaps.

Generally speaking, faculty-member rotations are usually more labor intensive. Faculty members may have more time to dedicate to students on rotation compared with adjunct faculty (eg, hospital-based pharmacists not employed by the college) who take students on the side.

That said, you can expect to do more projects, journal clubs, presentations, and other activities that look good on CVs.

Most faculty members completed residencies themselves, so they know the pace and requirements one entails. They may also be able to serve as a contact for a letter of recommendation.

2. Select areas you are interested in.

If you are lucky enough to know that you want to specialize in a certain field of pharmacy, select rotations offered in that area. For example, if solid-organ transplantation or critical care caught your attention during classes, select rotations with preceptors in those areas.

When it comes to writing your letter of intent or providing examples of patient care activities, you can highlight why you are passionate about those areas.

Projects or presentations in those areas will also appeal to the specialty programs. Additionally, when it comes time to apply to post-graduate year 1 (PGY1) and PGY2 programs, you can use that preceptor as a mentor and sounding board about which residency programs provide good specialty training calendars.

3. Select teaching rotations.

It is no secret that teaching and facilitating is a large component of any residency program. In fact, many participate in and provide residents with a teaching certificate during the year.

Any type of teaching rotation (didactic teaching, facilitating a skills lab, or helping coordinate a course) appeals to residency programs.

You are already learning the 4 preceptor roles that would be taught during the residency year.

Additionally, you may have unique opportunities, such as delivering a formal didactic lecture, preparing a manuscript for publication, or peer reviewing manuscripts.

All these “scholarly” activities look great on residency applications.

4. Select rotation sites where you want to do your residency.

If you know which institution is your first choice for post-graduate training, select rotations available at that institution.

You will become familiar with the preceptors and current residents. You will get a feel for the pace and demands of that particular residency and also get experience using the institution’s computer systems.

All of these skills will come in handy if you ultimately match with that program, as you will not require as much orientation or training as brand-new individuals.

Additionally, since you already have exposure to some of the institution’s needs and opportunities, you may have ideas for projects that you can work on. The rotation can serve as a prolonged interview for that particular residency.

Be warned though: if you do not perform well or up to the institution/preceptor’s expectations, it may hinder your chances of interviewing.

However, if you do well, that preceptor can serve as an excellent reference letter, considering he or she knows how your capabilities match the residency’s demands.

5. Select “longitudinal” rotation sites.

More sites are offering “extended” or “longitudinal” rotations at their institutions.

The concept is that you do multiple back-to-back rotations at the same site. Some may only be 2 rotations, while others may be the entire year of rotations.

Depending on the set up, you may need to apply and interview for this type of rotation. The institutional advantages for this type of rotation is that they only have to fill out paperwork/clearance once, orient the student once, and minimize the amount of lost productivity time.

On average, it takes about 1 week at each rotation site for the student to be fully productive and become familiar with the flow and policies. Removing the barrier of changing institutions and taking a student for multiple rotations will increase the return on investment.

The benefits for the student are similar: by decreasing the amount of lost time, the student may be able to squeeze in extra rotations. For example, instead of doing 2 6-week rotations at 2 sites, they may be able to do 3 4-week rotations at the same institution.

They may also be able to accomplish more longitudinal projects, boosting his or her CV. Many of these types of rotations are faster paced and billed as “mini residencies,” so they are usually recommended for highly motivated students.

6. Coordinate an external rotation site.

If your school allows it, setting up a rotation outside the contracted and available sites can be a way to guarantee obtaining that rotation. Many schools can manually reserve rotation sites, however, this only occurs in special cases, such as outside sites.

Setting up such a rotation takes weeks or months of early planning, so initial inquiry should ideally take place in the fall, prior to rotation selection.

However, the benefits of setting up such a rotation can be numerous:

1. It shows the candidate’s initiative to plan in advance and coordinate with preceptor availability.

2. It can potentially fulfil a specialty area you are interested in that your institution does not offer.

3. It may be a vastly unique experience that will help you stand out.

Selecting rotations can be a stressful time, particularly if you are hoping to continue with post-graduate training. It can seem like a lot rests upon the rotations you complete.

As much as you try to prepare and strategically select rotation sites and preceptors, you may ultimately end up with none of your top choices. This is life.

However, you can still make the most out of the rotations you do get. In fact, I challenge you to.

Many times we receive applications from candidates who have less-than-stellar rotations on their CV. We understand that the assignment process is a bit of a mystery.

However, rather than present a “woe is me” persona, embrace the situation and make the most out of it.

When candidates complain about a particular rotation not being what they imagined it to be, 2 of my favorite questions are: “how did you make it better?” and “what did you do to improve it?”

Take ownership and make the rotation what it can be. Volunteer for projects, ask for specific experiences (journal clubs, topic discussions, case presentations, or patient counseling), or see if you can shadow other pharmacists for a day.

Remember, residency isn’t always going to be what you imagined it to be either. It will be up to you to ask for more if you are not getting what you need.