To the Editor:
On April 24, 2020, the Visiting Student Learning Opportunities (VSLO) program extended its closure due to the COVID-19 pandemic, and uncertainty continued to plague medical students who had planned on completing rotations at other institutions. For some, the potential cancelation of away rotations or “aways” was bittersweet. On one hand, the opportunity to impress future colleagues and program directors was lost. On the other hand, not being able to travel for these rotations potentially saved students thousands of dollars in double rent, application fees, and travel expenses.1 Students who are unable to rely on financial help from family members may have released the largest sigh of relief.
Similar to our society at large, a socioeconomic gap exists among medical students. More than 50% come from the top income quintile, a trend that has minimally changed in the past 13 years.2 While this gap is largely hidden by the availability of loans for tuition and rent, it reemerges when extra funds are needed, including for aways. Some students, specifically those who are financially stable, likely feel more comfortable spending the required amount of money to complete these rotations. In turn, these students may have greater access to competitive specialties, which traditionally require, or highly encourage, students to complete at least one away rotation.3 Since the average cost of an away rotation is $2,000, those who complete upwards of 4 could easily spend far more than they are comfortable with while auditioning at other institutions.1 Many students simply cannot afford this additional cost.
Scholarships do exist for disadvantaged students, but their availability varies by institution and sometimes by department within the same institution. We do not propose the elimination of all aways, as they provide the benefit of career exploration, especially for students whose home institution does not offer certain rotations. However, continuing to promote away rotations without consideration of how to financially support students will only continue to hinder financially disadvantaged students. Relieving students’ financial burden or limiting the number of aways students are pressured to complete are possible avenues of reform. The COVID-19 pandemic has caused great tragedy and disrupted medical education. Nonetheless, it has presented an opportunity to reevaluate how we approach residency applications by allowing students to focus on other academic pursuits that do not require extra monetary support.
1. Winterton M, Ahn J, Bernstein J. The prevalence and cost of medical student visiting rotations. BMC Med Educ. 2016;16:291
2. Youngclaus J, Roskovensky L. An updated look at the economic diversity of U.S. medical students. AAMC Analysis in Brief. 2018;18:1–3
3. Higgins E, Newman L, Halligan K, Miller M, Schwab S, Kosowicz L. Do audition electives impact match success? Med Educ Online. 2016;21:31325