Thought I'd post about my experience at the Barrow and regarding recent rumors about the chairmanship. The overall rotation was the best I've been on so far. It's tailored to get med students in the OR as much as possible. The day begins with rounds at 6 and you're expected to present 2 patients. Then you spend the rest of the day in the ORs until cases are done. Volume was impressive. 11 dedicated OR's with an average of over 20 cases per day - the lightest day I saw was 10 cases because half of the attendings were out of town. The residents have tremendous autonomy and it shows is how good they are in the OR. Most of the 4/5's were doing complex cases comfortably that I've seen chief residents at other centers just watch their attendings do. During the cases, the residents and attendings also teach you to do a lot as a med student beyond just opening/closing like placing spinal instrumentation and helping out under the scope. Despite being so busy, the residents were extremely nice, patient, and just positive - you could tell that they were happy to be training there and it really contributes a lot to the culture. The residents and staff were also very open about the recent leadership changes - Theodore leaving for hopkins and spetzler stepping down. Its now confirmed that Lawton will be taking over after Spetzler steps down. They're also interviewing several big name spinal guys, a lot of deformity and minimally invasive names to fill in for Theodore's role. Even with these changes, I think the BNI is still going to continue being the powerhouse that it is.

Overall a light subinternahip without much responsibility and low case volume, often with multiple medical students in the same OR. Call responsibility mostly involves shadowing a resident and staying up not doing much - very few opportunities to stand out.
Pros: Boston is pleasant and the location of the hospital is great, despite being expensive. Residents are nice and laid back, overall very nice to be around. Subi has teaching sessions for students although many are canceled. Good for basic science research. Cafeteria is above average.
Cons: Chair is leaving this year and position is being advertised, so uncertainty as to whom will take his place. Program director not really invested or interested. Very low clinical volume across the board, most cases at least double scrubbed. Almost no vascular. Very little spine, and almost no complex spine. Lots of attendings don't let the residents do more than open and close which leaves very little for Subi to do.

I rotated at Baylor as my first away. I had a pretty good time overall. If you perform well, they really favor you as an applicant. I wasn't required to do any grand rounds presentation. However, they interviewed us while we were there, which can be a good or bad thing for some folks. I guess one bad thing was I never knew how exactly I stood on their rank list since all rotators were interviewed. Dr. Yoshor is a really cool guy. I know he gets some backlash because of his direct personality sometimes, but he was very nice and beyond welcoming to the rotators. The PD is also a very genuine guy - you'll meet with him during your interviews. If you do rotate there, I would recommend requesting time at Ben Taub, their huge county hospital. Some rotators were not placed there and it's a real shame since that's where most of the residents' training is done.

Rotation at Duke. Here's a summary of the experience.
Hours/Workload: Very heavy workload for medical student rotators. Depending on the service (Vascular, Tumor, Spine, Peds and VA), you either get there at 5:30 or 3:30 am (really only one service is 3:30 am and the rest are 5:30-5:45am). Easily worked 80-90 hours a week. Call Q4, usually go home after call. Honestly, the service is saturated with students so you should go home to make room. Wednesday is Academic Day with lecture in the morning and again in the late afternoon, which can make it hard to get into the OR. There is also Brain School which is every two weeks where you have to present and discuss part of a research paper with Dr. Friedman. In addition, you get a packet of papers to read on your first day.
Hospitals: Duke Hospital is HUGE. It has a large coverage area and due to its reputation, lots of patients flock to it. You can also do a week at the VA which is super chill and they let you do a lot.
OR: You came to Duke for tumors, and tumors you will find. Dr. Friedman usually runs 2 ORs at a time for about 4-6 cases a day 4 days a week. You also get to see some endo/open vascular, function, spine and peds. Honestly, I felt crowded on service since we had too many students on at a time (junior + senior students). What you get to do in the OR is very, very resident dependent, but only when the attending isn't around/looking. There usually aren't enough cases for the residents so they are typically double scrubbed which limits your participation.
Clinic: You get a chance to work in Friedman's clinic weekly, which is a great experience and lets you get 1 on 1 time with him.
Overall Impression: The residents seem pretty close overall and were generally fun to work with. The rotation is busy and you spend a lot of time learning to manage patients. You also get a taste of academic nsgy with lots of lectures and journal club. The OR experience was less than what I was used to.

Honestly, an amazing experience. 1 week at CHOP, 1 week at Pennsylvania hospital (the outpt hospital) and 2 weeks at HUP (the main hospital). They also try to send you once a week to the trauma hospital or clinic. Call at HUP Q4 and they expect you to stay till around 10 am the next day. You usually get a few hours of sleep in a chair per call. The residents are very nice and will go out of their way to buy you lunch/dinner. The attendings also go out of their way to talk to you and get to know you. The hours are great. Honestly, the best experience I had of any Sub I. The operative experience was top notch and I was allowed to do more than at my home institution. I plan on ranking them very highly.

Format: There are 4 major services that subIs rotate through: Vascular, Tumor, Spine/Functional, and Pediatrics. I heard that some months when there were more than 4 subIs, it was an option to rotate at the county hospital in San Jose (tons of traumas), but I did not get that experience.

Call: q4. Basically spend the night with the PGY2. I typically stayed in the ORs until cases ended, and then hung out with the PGY2 seeing consults, taking care of ICU patients, bedside procedures, etc. You have the options to stay post call for clinic or first case, or you can go home and sleep after AM rounds.

Expectations: This was my favorite subI mainly due to the responsibility I had as a subI. I pre-rounded on the ICU patients for the team that was rotating on each week, presented those patients on morning rounds, and wrote the progress notes. The rest of the day was spent in the OR (first priority on any case on your team, but flexibility to scrub into any case not covered by another subI). There were between 4 and 6 first start cases each day (plus 1 or 2 more at the children's hospital, and 1 or 2 more at the county hospital). Impressive open vascular volume (seems like there was an aneurysm being clipped almost daily), and unmatched tumor volume. Between cases, I helped out with consults and management of ICU patients. One day a week, I was assigned to clinic with one of the attendings - saw patients independently, presented them to the attending, wrote the H&P. Good opportunity to get some face time with the senior faculty.

Residents: Overall a great group of residents. Operatively, the senior residents were some of the most technically skilled that I encountered throughout the application process, and juniors got great exposure to both complex as well as "junior-level" cases. The senior resident classes seem a bit fragmented, but still get along well and seem to be very supportive of their junior residents. The junior and mid level residents were a very tight-knit group and incredibly supportive of one another. Definitely a family/life-style friendly program - most of the senior residents are married and many have kids

Pros: Great group of residents, case volume (and case complexity) is on par with anywhere else, research opportunities at Stanford are unparalleled. Palo Alto is one of the most amazing locations to live - beautiful weather all year long, 30 minutes from SF, 30 minutes from beautiful beaches, just a few hours from Tahoe, Yosemite, etc.

Cons: very expensive place to live, not a walk in the park to find housing for your subI month.

Rotation consists of two primary services for students, cranial and trauma for two weeks each. You have the option to take a few days to a week at Childrens. I highly recommend it, it is a major gem. Tons of operations, 2 to 3 rooms a day.

You dont have any clinic responsibilities during the rotation (though I elected to spend a couple days to get some more face time with a couple attendings that I had research interests in). Basically you just operate every day and attend teaching conferences (highly recommend the 3D skull base conference). No overnight call, but they want you to do a few nights with the moonlighter, who is a senior resident that they pay 500 bucks to take consults from 5 to 10. Awesome experience and chance to get to know your future chief. Basically you see the consults, present, write the notes, learn any procedures that pop up. Since the moonlighter has no service responsibilities, down time is chock full of teaching and socializing. Weekends they let you kind of work out your own schedule. My co subis and I alternated days. 

In terms of ORs theres tons to choose from, usually 9 to 10 rooms going with a few less on Fridays. You arent expected to operate on the service you are on, and I highly recommend doing at least one scoli correction because its such a big case and the chief resident let me dissect as much of my side as I could before he finished his, the helped me through the rest. Great practice for closing too. Definitely see an aneurysm or two with the vascular guys as well as some cases with Friedlander (AVMs, Aneurysms) and Lunsford (tumors and GK). Take a day with Lunsford in clinic, he is a human encyclopedia of teaching goodness. Skull base cases are a sight to see, but you wont get to do much since they are endoscopic. 

Morning responsibilities include collecting labs on trauma and presenting icu patients on cranial service. 

Ask the coordinator about housing, a couple of the residents had spare rooms that they will rent you on the cheap near the hospital. A car isnt an absolute must since there is only one hospital and you can always bus it to Childrens or hitch a ride with a resident. That being said, you have substantial down time to explore Pittsburgh, and the areas of interest are scattered enough to make it convenient to drive.

UCSD.

4 weeks total.  2 weeks spent at the main university Hillcrest hospital.  1 week spent at the private Thornton hospital.  1 week spent at the pediatric hospital.

Hillcrest:  the trauma and stroke center of San Diego.  Busy service with lots of operative autonomy and unpredictability.  Neuro Critical Care manages all the sick patients, which lets the residents operate.  The intern runs the services and does the discharges, consults, bedside procedures (including EVD).  There is a PGY 2 and 3, who operate.  A PGY 7 is the chief resident.  

Thornton:  the private hospital with mostly elective cases.  Lots of tumor, MIS spine, MVD, and peripheral nerve.  Not a very busy service, and a lot more "tame" of a hospital.  The PGY 2 and 3 operate, and alternate who does the floor and ICU work, and a PGY 7 is the chief.

Childrens:  A fellow and a PGY4 staffs this hospital, and are run by two very busy pediatric neurosurgeons.  A lot of interesting pathology and lots of autonomy.

VA:  subinterns do not rotate here, but a PGY 4 runs the service here.

Research/Elective:  The resident will take very little in-house call and are mostly protected.  These will be the PGY 5's and 6's.  Two were doing stem cell research, one was doing something with monkeys.  Current chiefs did infolded elective clinical rotations in Mexico, and UC-Irvine (Delashaw).  One of the residents will be going to Sydney.  

Residents:  All get along well.  They are spread out across 4 different hospitals, so they don't see each other often.  They definitely make up for it on friday conferences or during interview dinners.  They are sort of like the "in" crowd and all enjoy each other.  Many are married, some have children.  If you are single, San Diego has some very young and attractive people (the nurses!).  

Attendings:  All very nice. Bob Carter was especially nice.  He seemed like a father figure that looked out for your success.  Attending involvement was variable in the OR.  Most attendings were uninvolved and let the residents operate.  Many of the residents were quite good. 

Role of the subintern:  There were 5 of us, but we were split up across 3 hospitals.  All ICU patients were covered by a subintern, which was presented every morning.  All OR cases had a subintern, and we did many of the tying, knot-cutting, assisting with positioning, and drilling a burr hole or two.  A presentation of our research or another interesting topic was presented at the end of our subinternship.  Clinic was covered by us, which gave us time to get face time with the attendings.  There are weekly meetings with the educational director to discuss the cases we saw, which was very educational.  There was no student-abuse or scutwork here.

All in all, I did 3 subinternships, and UCSD was the best and most educational of them all.  There was harmony between residents, between residents and attendings, between residents and students, and even the attendings and the students.  No place else can say that.  I was extremely tired at the end of the rotation, but it was due to working and learning hard, and not doing stupid things that other programs force students to do.  Check this place out for yourself and form your own opinion.  

Disclaimer: Seems to be chief-dependent and may change with new incoming chiefs.

Structure: 1 week and Children's, 1 week at Denver Health (Level 1 Trauma), 2 weeks at University. You'll be busiest at University. The had a lot of rotators, and they split us up into groups of 1-2 per location.

Children's: Call q2 with one resident and two fellows (this year). A ton of students from other specialties rotate here, and there are only a few call rooms available, so secure one early in the day when you're expecting to stay the night. Operative experience was great with many very complex procedures, with them allowing a great degree of participation. You'll of course do much of the suturing, though something I personally was unprepared for was the lack of clipping hair. Show up at 5-5:30 and prepare a list, gather labs, etc. and preround on your post-op patients. They have 4 surgeons that work there, and the chair is a very colorful character. You can best impress him by following his suture instructions to keep the needle driver open (no palming) and by following generally efficient practices (push, push, pull with the needle already set up for another bite, etc.). The other guys didn't seem to care about that so much. Plenty of opportunities to participate more if you show you know what you're doing. No clinic time really here, and it'd be good to read up on the conferences you'll attend during the week. You see consults and are strongly encouraged to call the attending after working with the resident to report, so get your presentations down.

Denver Health: Call q2 with the night float intern. The chief and another resident (could be research or VA) will take home call, and you'll directly report to him/her after going over your presentation with the intern. Paper charts are used here, so you'll be able to contribute a bit more work, though it will take some digging when you preround in the morning. Operative experience is pretty normal here, where you work with the trauma cases, doing opening and closing.

University Hospital: Call q2-3 with the on-call resident. Chiefs were taking in-facility call here, which was unusual, and they said they want to get rid of that on the interview...but we'll see. You rarely get to sleep here (main competition being Swedish for a multi-state catchment area), which sounds bad initially if you hear about services where you only shadow, but it's truly fantastic experience because of the degree to which you actually get to participate. If you feel like you're only shadowing, something's wrong. You can actively participate in many of the regular ICU procedures, which are plentiful because of the massive NS-ICU. The philosophy here was that you're learning to be a full-fledged physician, and they regularly take over care from other services when they feel things would be better optimized with them as the primary. You, similarly, will be expected to be able to know what to do in a critical care environment for basic problems, and you are expected to pick up the number of patients you can handle and present during morning table rounds with independently-thought-out plans. There is a boatload of attendings here, so you see a very wide variety of approaches (with a similarly varying degree of participation in the OR). This rotation is the money rotation, where you get to know Lilihei (pronounced lilly-high...something I was thankfully corrected on before meeting him) and Breeze. You might not see the PD, Brega, much because she works out of the VA pretty often. You also get some quality time in the endovascular suite, if that's something you enjoy. Finally, at the beginning of your second week, you'll do a presentation here for the residents and attendings without any real "gotcha" questions.

Residents: Generally pretty friendly bunch of folks that will gladly allow you to show your skills with consults, in the OR, and in the ICU. You'll get written off if you don't actively participate, though, of course. Most are married with many having kids. They actively teach you and ensure you're picking up good things to know wherever you end up in residency.

Misc: Cellphone reception was a huge issue for me, mainly in Children's where your call room is separated by multiple floors from the resident call room. Find a spot where you can set it to avoid missing anything. Try to make sure you're around someone with a pager in the other hospitals. I didn't get any time to ski, hike, mountain bike, or anything, but if you wanted to make this your last rotation so you can spend some vacation time in the mountains, that might be something fun to end your sub-I season!

Sub-I at Vanderbilt. The hospital is a nice facility and is a private hospital, and the children's hospital is beautiful. Nashville is a fun town to be in, but you had better have an appreciation for country music if you want to rotate there (seriously, it was played in virtually every OR). 

During the rotation, there were way too many medical students - 4 away rotators and 4 Vanderbilt students (although the Vanderbilt students were third and second years, due to their new curriculum). It made the rotation challenging in terms of having enough work to do and deciding who got to scrub in to cases, etc., which really took away the ability of sub-i's to shine. There also wasn't a lot of direction for what was expected of you as a sub-I, and there were very mixed signals from the residents about what they wanted you to do or not do in terms of patient care. As a student rotator, you get to do very little in the OR. In fact, most of the time, sub-i's served as pseudo-scrub techs, and even then, some attendings asked that you not touch the instruments. On one or two occasions, you might get to suture or put on a Raney clip, if you were lucky.

The attendings were friendly for the most part but generally didn't interact much with students. There generally wasn't much of an emphasis on teaching, as compared to my other rotations, from the attendings and from the residents. You only go to clinic once, and it's with Dr. Thompson. Dr. Lola Chambless was great though and met with students to provide guidance on ERAS, which was extremely helpful. The residents were okay - other than the current group of third year residents who were great, there were some that were just hard to get along with as a medical student and didn't seem to get along with the rest of the residents either. 

Also, to comment on a couple other topics brought up in this forum... First, regarding locations that favor sub-i's, Vanderbilt is certainly not one of them. In fact, they don't interview many, if not most, of the sub-i's. Second, the letter from Dr. Thompson took over a month to receive and was only a few sentences long.