A Guide to Otolaryngology Away Rotations: From Applying to Post-Rotation Communication

Ryan C. Higgins, MD, Beatrice R. Bacon, MD, Priyanka Shah, BS, and Michele M. Carr, DDS, MD, PhD, on behalf of the Credentials and Membership Committee

Otolaryngology is one of the most competitive surgical specialties, with an overall match rate of 67.4% in 2026.¹ Completing an away rotation can increase an applicant’s chances for a successful match, and may be particularly important for medical students without a home otolaryngology program.^2,3 Applicants who have completed at least one away rotation have significantly higher match rates compared to those who have not (84.8% vs. 72.1%, respectively), with 30.9% of applicants matching to a program at which they completed an away rotation.⁴ By completing an away rotation at a specific institution, applicants are more likely to receive an interview (86.2% vs. 21.5%) and subsequently match (14.9% vs. 0.8%) at that institution.⁴ Furthermore, completing an away rotation can increase the number of interview offers from surrounding programs within that geographic region.⁴ 

Despite the importance of completing an away rotation, the application process is unclear for many medical students. Although over 80% of otolaryngology programs offer away rotations, significant variation exists in rotation application release dates, costs, and application platforms.⁵ Additionally, medical school core competency requirements can vary, limiting the number of away rotations a student can complete. This lack of consistency can lead to significant stress for applicants when considering how many programs to apply to, managing conflicting release dates, and securing financial support.^5,6

To help alleviate some of the concerns medical students have during the away rotation application process, we provide a guide detailing the application process for away rotations, pre-rotation responsibilities and resources, and the general expectations for making a positive impression at a new program.

Away Rotation Application Process

The average number of away rotation applications per applicant was 5.2 as of 2022,⁵ with the number of completed away rotations increasing from 1.8 in 2018 to 2.7 in 2024.⁷ The number of applications and away rotations completed by an applicant can vary based on the home program’s academic calendar and number of required rotations. Furthermore, each applicant is unique in the timing of USMLE Step 2 examination completion, the costs associated with travel, and personal/family obligations that impact the number of away rotations that can be completed. Talk to your faculty advisor before submitting your away rotation applications to ensure compliance with your home institution’s requirements.

The Visiting Student Learning Opportunities™ (VSLO®) program is the primary tool used by residency programs for away-rotation applications. Your home institution may provide you with VSLO access several months before your away rotation application cycle, typically during the winter of your third year. Most programs do not accept away rotation applications until late February, with applications opening on a rolling basis. As of 2022, 103 programs offer away rotations through VLSO, with 23 using their own separate application process.⁴ It is important to review each program’s website regarding their specific away rotation application process and send in your completed application as soon as possible.

Program Considerations 

• Does the program offer away rotations through VLSO?
• Does the program offer away rotation dates that are in line or overlap with your home institution’s rotation schedule?
• How large is each residency class?
• Does the program offer comprehensive exposure to all otolaryngology subspecialties?
  • Head and Neck Surgery, Otology/Neurotology, Pediatric Otolaryngology, Rhinology & Skull Base Surgery, Facial Plastic & Reconstructive Surgery, Laryngology, Sleep Medicine & Surg
• Does the program have fellowships?
• Does the program offer dedicated research tracks? Is it a National Institutes of Health (NIH)-sponsored R25 program?
• For DO/IMG applicants: Does the program accept DO and/or IMG applicants?

Personal Considerations 

• Do I want to go to a program with a large (>4) or small number (1-2) of residents per class?
• Do I envision a career in private practice or academics?
• Do I envision pursuing a specific fellowship program?
• Where do I ultimately want to practice? In a rural or urban setting?
• Where do I ultimately want to live regionally in the United States?
• Am I participating in the Couple’s Match? Are there program options for my significant other at the same or nearby institutions?

Program-specific application requirements can vary significantly. Prepare yourself for these requirements before the application cycle opens.

Common Application Requirements

• Curriculum vitae (CV)
• Unofficial transcript
• USMLE Step 1 and/or Step 2 scores
• COMLEX Level 1 and/or 2 scores
• Letters of recommendation
• Personal Statement
• Program-specific letters of interest
• Basic Life Support (BLS) certification
• Advanced Cardiovascular Life Support (ACLS) certification
• Health Insurance Portability and Accountability Act (HIPAA) training
• Occupational Safety and Health Administration (OSHA) training
• Association of American Medical Colleges (AAMC) Immunization Form
• State and federal background checks
• N95 mask fitting
• Urine drug screening
• Professional headshot
• Health insurance
• Letter of good standing

During the application process, it is important to understand that acceptances are given on a rolling basis. While programs may provide an application deadline, you should apply as soon as the application opens. If you need to contact a program coordinator regarding an away rotation application, ensure that the program’s website does not already have the requested information. Frequently, acceptances are accompanied by a timeline by which the applicant must formally accept them. Review your application portal and email daily to ensure that you do not miss any correspondence. If you choose to accept an offer for an away rotation, promptly withdraw applications for other rotations in the same time period. Once you have accepted an away rotation, this is a commitment that should be upheld unless an emergent/unforeseen situation develops, preventing completion of the away rotation. If that occurs, please contact the program coordinator as soon as possible to reschedule or cancel your rotation.

Suggested Timeline for Away Rotation Applications

• November-December:
  • Identify five to seven potential programs, at least two to three for each rotation timeframe
  • Identify and obtain program-specific requirements
• January:
  • Obtain access to VLSO or a program-specific application program
• February-April:
  • Apply to programs as applications open; apply to multiple dates, if able
  • Accept application offers and withdraw pending overlapping applications for the same time period

Preparing for Your Away Rotation

Preparation for the away rotation is essential. Upon acceptance into an away rotation, it is important to secure housing, arrange reliable transportation, and explore financial support opportunities as soon as possible. When identifying housing options, consider safety, proximity to the rotation sites, availability of public transportation, parking accessibility, and recreational opportunities in the surrounding area (e.g., restaurants, parks, markets). The total costs accumulated during an away rotation average around $ 1,500 and can be a significant source of stress for rotators.^5,8 Opportunities for scholarships are available on a program-by-program basis; as of 2025, up to 37.4% of programs offered away rotation funding to medical students from groups underrepresented in medicine (URiM).⁸ 

Housing Resources 

• Rotating Room
• Housing Anywhere
• Airbnb
• Vrbo
• Medical student sublet Facebook pages
• Family and friends

Financial Support Resources 

• URiM funding
  • AAO-HNS Diversity Endowment URM Away Rotation Grant
• External scholarships
• Loans

An away rotation provides a two- or four-week opportunity for the rotator to showcase their best self. It is an opportunity to work alongside residents and faculty with diverse backgrounds, learn various medical and surgical approaches to otolaryngology conditions, and compare your home institution with a new program. Nevertheless, it also serves as an opportunity for the program to assess you as a potential resident by seeing how well you work in a team, assessing your fund of knowledge, and getting to know you as an individual. 

While your overall understanding of otolaryngology and surgical acumen will not be judged at the same level as the resident physicians, you should aim to put yourself in a favorable position as a potential candidate. Leading up to your away rotation, use the provided textbook and online resources to familiarize yourself with common otolaryngology pathology and both medical and surgical management. These resources will serve as excellent reference tools as you navigate your clinical and operating room assignments during your away rotation.

Study Resources 

• Textbooks
  • ENT Secrets⁹
  • Pasha’s Otolaryngology – Head and Neck Surgery: Clinical Reference Guide¹⁰
• Online Resources
  • AAO-HNS Medical Student Resources
    • Surgical Videos, Learning Modules, Webinars
  • University of Cape Town Open Atlas of Otolaryngology Head and Neck Operative Surgery
  • Iowa Head and Neck Protocols
  • Mayo Clinic Surgical Videos
  • Sinus Videos
  • Headmirror Survival Guide
  • Headmirror's ENT in a Nutshell podcast
  • OtoChautauqua Online Summer Program and Question Bank
  • National Otolaryngology Student Association (NOSA) Hot Seat ENT webinars

Finally, in the weeks leading up to your away rotation, ensure that you have access to the program’s electronic medical records (EMR). This process can take longer than anticipated. Complete your onboarding as soon as you are instructed to do so by the program coordinator. Contact the resident physicians that you will be working with before beginning your rotation to coordinate when and where to arrive on your first day. Inquire about rotation expectations, ideally before starting your away rotation.

During Your Away Rotation

Arrive early on your first day. Being in a hospital setting, let alone in an unfamiliar city, can lead to unforeseen delays. Try to familiarize yourself with the patient list if you have EMR access. Every interaction you have is an opportunity to make a good impression, whether with faculty, residents, program leadership, nursing staff, or other hospital employees.

You will likely be tasked with assisting residents in updating the patient list before morning rounds. Depending on your resident team’s preferences, pre-rounding list updates often include basic information regarding overnight events, vitals, labs, drain outputs, and plans for the day. Ask your team prior to making updates or changes to their list. Away rotators commonly assist with gathering and/or carrying supplies necessary for rounds. If you are unsure which supplies to carry, you can ask any resident on the team for a basic list of helpful supplies. As you gain rounding experience, you will be able to better anticipate what supplies your team will need each morning. 

Basic List of Helpful Supplies

• Tongue depressors
• Flashlight or headlight
• Suture removal kits
• Gauze pads
• Tape
• Rolled gauze (e.g., Kerlix^TM)
• Surgical lubricant/jelly
• Non-adherent petrolatum-based gauze (e.g., Xeroform^®, Adaptic^TM)
• Abdominal (ABD) pads
• Tracheostomy ties
• Syringes (e.g., 10 cc)
• Elastic bandage wraps (e.g., ACE^TM wraps)

Following rounds, offer to help with progress notes using the note templates provided by the resident team. Following morning rounds, ensure you know where to go for your assigned clinical and/or operating room duties.

Clinic Duties 

• Arrive early
• Introduce yourself to the attending physician, advanced practice providers, nursing staff, medical assistants, and any remaining clinic staff
• Inform team that you are a visiting away student who has been assigned to their clinic for that day
• Determine clinic responsibilities
  • Offer to write clinic notes
  • Ask the team if they would like you to see patients alone or with the attending or resident
  • Determine the length of clinic visits
  • Ask for note templates, if available
  • Get permission from the attending and/or resident prior to seeing a patient
• Clinical exams and presentations should be focused

Operating Room Duties

•  Arrive early
• Introduce yourself to the attending physician, advanced practice providers, circulating nurse, scrub nurse, and any remaining operating room staff
• Inform the team that you are a visiting away student who will be assisting in their operating room that day
• Write your name on the whiteboard, if present
• Offer to grab your surgical gloves and gown
• Ask if you should introduce yourself to the patient in the pre-operative waiting room
• Offer assistance with moving the patient to and from the operating room bed, getting warm blankets, placing or removing sequential compression devices, etc.
• During the case, you may be asked to suture, retract, hold supplies, or adjust lighting
• If you are unsure about what is being asked of you, ask for clarification

Throughout your time in the clinic and the operating room, faculty and residents will undoubtedly ask questions to test your fund of knowledge and highlight teaching points. Adequate preparation can help you stand out as an away rotator. When preparing for clinic, it is important to understand the chief concern listed for each patient scheduled for clinic that day and the possible management that may be suggested. For the operating room, prepare yourself in advance by learning the indications for the procedure, relevant anatomy, general surgical steps, and possible complications for each procedure. You are not expected to have a correct answer for every question! Showing clear effort, evidence of preparation, teachability, and interest can be just as meaningful as arriving at the correct answer. Remember what you’re told and make notes. After completing your clinic or operating room responsibilities, reach out to your resident team to ask how you can be of assistance. It is your responsibility to assist the team as needed. You are expected to stay until you are dismissed.

Call Shifts

Depending upon the institution, you may be asked to cover a weekend or weekday call shift. Call shifts provide rotators with the opportunity to see common otolaryngology consults and to connect with individual residents. Ask your resident team in advance if they would like you to assist with taking call.

Grand Rounds

Many programs expect rotators to present at Grand Rounds toward the end of the rotation. Make sure to clarify the expectations of the presentation: amount of time allotted and the typical content presented (i.e., personal research vs. clinical case). If you choose to present a clinical case seen during your rotation, ask the faculty member involved in the case for permission prior to presenting. The faculty member may ask to review your presentation; therefore, ensure it is complete and allows adequate time for their review. When selecting a case, use the most up-to-date references and, if applicable, incorporate relevant research from faculty members. Be intentional about how you plan your talk. Practice your presentation in advance, making sure that you are within the allotted time and that you are not reading from the slides. 

During your presentation, wear business attire, speak clearly, and make eye contact with your audience. Provide a brief slide with pictures and/or fun facts to show off your personality and to introduce yourself to faculty members and residents with whom you did not have the chance to work. Allow adequate time for questions at the end of your presentation and provide your contact information for any further questions or comments. This may be the last time you see several residents or faculty members, so be sure to thank everyone for the time, attention, and support they gave you throughout your rotation.

Letters of Recommendation 

Early on in your rotation, it is important to identify faculty members who may serve as potential writers for your letter of recommendation. Once you have identified a letter writer, reach out to them in advance to confirm their willingness and ability to provide you with a letter. Send an updated CV as soon as possible. The program may indicate who typically writes letters of recommendation for visiting away rotators. This is typically the program director or department chair. Expect your letter writers to reach out to the resident teams and faculty who have worked with you to request feedback on your performance during your rotation. 

Post-Rotation Communication

Unless you are instructed against doing so, send thank you emails to the program coordinator, program director, or select faculty at the completion of your rotation. Once you leave your rotation, it is unlikely that you will hear from the program until interview invitations are released. During pre-interview meet-and-greet events and the program’s interview day, remember that you are still being evaluated in the same manner as the other applicants.

Conclusion

Every interaction you have on an away rotation is an opportunity to make a good impression, regardless of whether you are speaking to faculty, residents, program leadership, nursing staff, or other hospital employees. Treat every person you meet with kindness and respect. Be on time, prepared, motivated, and a team player! These rotations are undoubtedly stressful, but they are also wonderful opportunities to explore different programs and expand your network within our field of otolaryngology.

References

1. National Resident Matching Program. Results and Data: 2026 Main Residency Match. Published online 2026.
2. Tu LJ, Benjamin WJ, Lenze NR, Mihalic AP, Kupfer RA, Malekzadeh S. How Does Lacking a Home Program Impact Otolaryngology Applicants? The Laryngoscope. 2024;134(11):4494-4500. doi:10.1002/lary.31571
3. Wang JC, Pillutla P, Tello N, et al. Competitiveness of Otolaryngology Residency Applicants without a Home Program. Ann Otol Rhinol Laryngol. 2020;129(5):462-468. doi:10.1177/0003489419892016
4. Benjamin WJ, Lenze NR, Mihalic AP, et al. Does Geographic Region of Away Rotations Predict Otolaryngology Match Outcomes? Otolaryngol--head neck surg. 2024;170(1):92-98. doi:10.1002/ohn.475
5. Cyberski T, Tatineni S, Shogan A, Baroody FM. Otolaryngology Away Subinternships: An Analysis of the Application Process and Survey of Current Applicants’ Perspectives. OTO Open. 2023;7(1):e49. doi:10.1002/oto2.49
6. Thomas CM, Cabrera‐Muffly C. Otolaryngology Externships and the Match: Productive or Futile? The Laryngoscope. 2017;127(10):2242-2246. doi:10.1002/lary.26639
7. Hatley MG, Wang RS, Garcia Morales E, et al. How Changing Signaling Volume Impacts the Importance of Away Rotations in the Otolaryngology Match. OTO Open. 2026;10(1):e70190. doi:10.1002/oto2.70190
8. Abend AM, Man ST, Man L. Promoting Diversity in Otolaryngology Residency Programs: Underrepresented in Medicine Funding for Visiting Medical Student Electives. OTO Open. 2025;9(2):e70109. doi:10.1002/oto2.70109
9. Scholes MA, Ramakrishnan VR. ENT Secrets E-Book: ENT Secrets E-Book. Elsevier Health Sciences; 2022.
10. Pasha R, Golub JS, Chern A. Otolaryngology-Head and Neck Surgery: Clinical Reference Guide. Vol 1. Plural publishing; 2025.