Setting up Non-ADT Rotations and my experience at WPAFB

Pediatric Clerkship at WPAFB
I just recently completed my pediatric clerkship at Wright Patterson AFB and I thought I’d take a moment to discuss my experience with you. I should preface this by saying I am very fortunate that my medical school is very lenient with their military students when it comes to rotating at military bases. My school allows us to do any core rotation at any military site that is willing and able to host us. I took advantage of this and set up my pediatric clerkship at WPAFB during winter of my 3rd year. One of the reasons my school encourages non-ADT rotations is to “work out the kinks” of how to wear the uniform, military customs and courtesies and exposure to military medicine prior to your audition rotations. Admittedly, even though I had completed both COT and AMP 101 prior to my pediatric clerkship, it took me a several days to get back in the “military mindset” and I’m thankful this rotation was relatively “low stakes” when it came to making an impression.

 
Wright Patterson AFB has an integrated pediatric residency program with Wright State University Boonshoft School of Medicine. This partnership is the only fully integrated military and civilian pediatric training program in the nation. I strongly encourage anyone who is interested in pediatrics, whether they are a civilian or military applicant consider this unique integrated program as it provides excellent exposure to a wide variety of patients. While military medicine is unique in that the patient population tends to be very healthy and compliant with their healthcare plan, without a civilian medicine component one would miss out on working with patients from different ethnic, socioeconomic and geographic backgrounds.

 
Now full disclosure, I assumed that a military base wouldn’t have a very robust pediatric program, but man was I wrong! My first week at WPAFB was spent in the pediatric outpatient clinic and despite eight providers seeing patients, the clinic was packed from morning to night. I was encouraged to jump in on my first day and begin seeing patients before the resident. As it was winter time, most of my patients that I saw were there for a Sick Visit, but there were enough Well Child Visits to get me racking my brain trying to recall immunization schedules and developmental milestones from Step 1. Although I did not request to spend any time in the subspecialty clinics, I think it is important to note that WPAFB has an Adolescent clinic, a Pediatric Cardiology clinic, a Developmental clinic, and a Pediatric Neurology Clinic on base.

 
My second week of my rotation was spent in the newborn nursery at WPAFB. The Family Birthing Center at WPAFB strongly encourages family-centered care so each patient had an integrated team of pediatric and OBGYN physicians, midwives, nurses and lactation consultants on their team. On the afternoons when we weren’t as busy we were able to go to the Patient Simulation Center to practice neonatal resuscitation and intubation. As the pediatric residents had to attend any C-section delivery I was fortunate enough to catch a couple babies and assist with newborn physical exams during this week.

 
My rotation happened to fall over Christmas and New Years, so my schedule was adjusted for the holidays. To accommodate for the days the clinic was closed my 3rd week and half of my 4th week of my rotation was spent at Dayton Children’s Hospital (DCH). At DCH I spent a day rotating with Heme Onc, NICU, PICU, ED and inpatient teams.The medical student coordinator was very accommodating and he encouraged me to pursue shifts in departments that caught my interest. The remainder of my 4th week I was in the outpatient clinic at WPAFB.

 
One of the things I enjoyed the most about my rotation at WPAFB is that the schedule was designed to provide some free time to explore the Dayton area. I spent my free time exploring the hiking at the Glen Helen Nature Reserve and exploring the United States Air Force Museum, but there are plenty of restaurants, shops, and museums to keep one busy while exploring the area.

 
I also really appreciated receiving daily feedback. At the end of each day I would sit down with the resident or attending I worked with and they would go over my strengths and weaknesses. This gave me very specific things to work on and improve during my time at WPAFB and I felt I had the most professional growth of all of third year during this rotation.

 
Should you set up a non-ADT rotation?  

If you’re like me and would like to pursue a military residency, exposure to the military medical system is invaluable. While I really enjoyed my month at WPAFB there were some pros and cons to deciding to do a rotation at a military base.

Many physicians assumed since I was rotating with the program that I had a desire to pursue pediatrics. While this is not inherently a bad thing, I felt like it put me in an awkward spot as many physicians went out of their way to introduce me to program directors or highlight benefits of their residency program. I greatly appreciated how welcoming the program was to allowing me to rotate, but I sometimes felt that I was utilizing resources that should have been reserved for a student with a desire to go into pediatrics.

Another thing to consider is the financial burden of doing an away rotation. As this is non-ADT, none of your expenses will be covered via your HPSP stipend. In addition to having to pay for room and board in a new city, I found that my daily expenses were also increased compared to a rotation at my core hospital. Keep in mind, most military sites will not provide free food as students on ADT receive a per-diem to cover their expenses.
So the big question is, is a non-ADT rotation worth the hassle? In my opinion, absolutely yes! If your school allows for you to set up a non-ADT I highly encourage you to pursue that opportunity.

 
Tips on setting up a non-ADT rotation

  • Be cognizant of the timing of your rotation. For students going into their third year, be aware that 4th year auditioning students will be given priority June through September/October. If you desire a non-ADT rotation during this time, you may have more luck setting up a rotation at a base that does not have a residency program in the specialty you are planning on rotating in. If you are unable to set up ADT audition rotations in your desired specialty, you could potentially do a non-ADT prior to June of your 4th year and still be considered as a candidate.
  • Utilize the resources available at the base. Although I knew I didn’t want to apply to a pediatric residency, I knew that WPAFB was one of the locations that offers a residency in the specialty I am applying to. I took the opportunity while at WPAFB to meet with the residency coordinator for that program and she was kind enough to introduce me to the residents and program director in my desired specialty. It’s never too early to get your foot in the door!
  • It’s a small world… in the military. I was given this advice while at COT and the saying rings true 3 years later. Not only do I bump into students I met at COT while on rotations or at military conferences, but occasionally I bump into higher ranking officials that I had the opportunity to meet during COT or AMP 101. Because it is a very small network of people, it is crucial that you are cognizant of how you are behaving while on base. The last thing you need is to be remembered for snapping at someone because you had a bad day or being out of regs because you forgot a piece of your uniform.
  • Act as if you are on an audition rotation. As I mentioned above, it is a very tight-knit community in the military medical system and you want to take every opportunity you can to prove that you will be an excellent residency candidate. The Air Force still meets in person to discuss residency candidates, so utilize any time spent on base to wow potential residency directors. The hope is that when they say your name at their residency meeting, someone will be able to vouch for your work ethic and abilities regardless of which specialty they observed you working in.
  • Use your network! This should be fairly obvious by now, but utilize the resources you have available to you. I reached out to other members of my class who are in HPSP to get contact info for programs that they had been able to rotate with. I was able to find housing at my non-ADT rotation by reaching out to the people I met while I was at COT. Additionally I strongly encourage you to attend the military residency meet-and-greet nights that are hosted by USUHS every fall as this is an excellent place to exchange contact information with residency directors, residents, and other medical students. Additionally many medical professional organizations have an “Armed Forces” division, so try to become a member of a medical association in the specialty you are interested in pursuing. Many of these associations have Armed Forces District meetings in Fall that afford students an opportunity to meet with leaders in their career field and potentially even set up last minute residency interview.

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