Away Rotations in Medical Education: Student Perspectives on Cost, Equity, and Scheduling

Introduction: Away rotations are a critical part of the medical student path to residency, but the application, scheduling, and financial aspects remain highly variable across institutions and specialties. This causes concern about the equity and accessibility of the rotations. The study presented here surveyed medical student perceptions of the away rotation process across specialties and institutions. Methods: A cross-sectional survey was released to fourth-year medical students at five U.S. allopathic (MD) institutions. Survey content addressed demographics, advising, application complexity, scheduling, and financial considerations. Chi-square tests were performed for categorical data, and qualitative analysis was used to assess free-response items. Results: 1,665 full-time fourth-year medical students completed the survey. Students with home residency programs received more advising, but this did not affect the number of completed rotations when compared to students without home programs. Most students felt the application process could be streamlined, as over half of the survey respondents spent more than 20 hours on applications. Nearly two-thirds of survey participants declined at least one rotation due to scheduling conflicts. More than half of respondents declined a rotation due to cost, and African American, Hispanic, and Asian students were significantly more likely than White students to turn down a rotation for financial reasons. Discussion: Away rotations present significant time and financial costs for medical students, with some differences disproportionately affecting underrepresented groups. Standardized advising and applications, increased financial support, and consistent application and offer timelines are necessary to improve equity in the away rotation process.