Strategies to improve medical student visiting rotations.

We have read with great interest several recent contributions concerning optimizing the residency application process and medical student education during the COVID-19 pandemic.1., 2., 3. It is our opinion that lessons learned could be applied to improve postpandemic medical student visiting rotations (VRs).

Visiting rotations

VRs are an excellent way for residency programs to evaluate the “fit” of an applicant and are cited among the most important factors for resident selection by program directors. Similarly, VRs allow applicants to evaluate residency programs, experience dermatology in different settings, and access educational opportunities not available at their home institutions. Because VRs are an integral part of the medical school curriculum and the dermatology application process, opportunities for improvement should be pursued (Table 1 ).

Table 1

Recommendations to improve virtual rotational experiences.

Critique	Suggestion for improvement
Disjointed scheduling	• We urge programs to issue acceptance and rejection notifications in a timely, transparent manner well ahead of anticipated rotation start dates to facilitate arrangement of travel and lodging.
High costs	• We encourage institutions to provide subsidized housing and travel grants for students of lower socioeconomic status.
	• Virtual rotational experiences may be used to involve students who are unable to attend in-person experiences.
	• Program directors should account for disparate opportunities to pursue visiting rotations among students of different backgrounds.
Variable student experiences	• We encourage programs to actively involve visiting students in clinical care and research.
	• Promoting faculty mentorship may help students form meaningful relationships with residency programs.
Lack of transparency	• We suggest that the criteria by which students are evaluated and graded during VRs should be made more transparent and students should be given feedback.
	• We suggest that residency programs publish criteria they seek in rotators and future residents to increase transparency.

Current scheduling for VRs is disjointed. Acceptances may occur at any time in the year and sometimes materialize close to anticipated rotation start dates. This makes coordinating travel and housing difficult and may dissuade students from pursuing other educational opportunities. This year, the Association of Professors of Dermatology urged programs to release residency interview invitations in a coordinated fashion. This could be applied to VR acceptance notifications as well. Timely, transparent VR acceptance notifications would improve the scheduling process for students.

VRs are also expensive, with students routinely spending thousands of dollars on travel, housing, and institutional fees. This financial burden disproportionately affects underrepresented minorities (URMs) and students of lower socioeconomic status. Some schools offer subsidized housing or other assistance to mitigate costs, but the majority do not. We encourage schools to increase aid to disadvantaged groups to promote participation in VRs. We also urge program directors to review applications equitably and account for factors such as student background or home institution schedule that may limit VR attendance. Virtual experiences may be another way to involve students who are unable to attend in-person rotations.

Student experiences at VRs are variable. Although some institutions involve students actively in the delivery of clinical care, others offer primarily shadowing experiences that may be less educational. We encourage institutions to promote student engagement in rotational experiences by (1) encouraging students to participate actively inpatient care, (2) involving students in research, and (3) creating mentorship opportunities especially for underrepresented minorities and other disadvantaged groups. This would hopefully result in meaningful connections with programs and promote dermatology residency matriculation.

Transparency between residency programs and students is also lacking. Many students use VRs to audition for residency. Many programs do not enumerate their criteria for evaluation of the rotators and offer little feedback to students. Additionally, many programs are not always clear about what characteristics they value in residents. We encourage programs to publish criteria for residency selection and make quantitative metrics publicly available to help students decide which rotational opportunities to pursue.

Conclusions

VRs are an excellent way for residency programs and students to assess each other and for students to access educational opportunities not available to them at their home institution. Taking steps to address current shortcomings in the VR process will improve the experience for all and enhance undergraduate medical educational experience.

Disclosure

Hao Feng is a consultant for Cytrellis Biosystems Inc. and Soliton Inc.