Prestige of away rotations

[TopGun]

Hey guys, few more questions about aways. 

First of all--how many have a first come first serve, versus meritocratic selection process? I'm still early in the process, but it seems like most require scores, grades and CV. Does that mean that those programs have a meritocratic selection process? 

Another somewhat related question. If there is in fact a meritocratic process, does it look good to do aways at more "classically prestigious" programs? Conversely, if the process isn't very meritocratic and most people can get into most away programs: might it look bad to gravitate only towards the most "classically prestigious" programs? One neurosurgeon heavily involved with resident selection told me: "It says more about how good you think you are than how good you are." The point being that those who only do aways at top programs may look ostentatious and look like they have an inflated self-worth. 

Where does the truth lie? Or am I overthinking all of this? Thanks

[Guest]

Most are first come first serve as long as you meet some sort of bare minimum credentials.

If you’re a stellar applicant - only prestigious since that’s where you’ll likely end up and networking is important for the “boys club” that is top tier academic neurosurgery

If you’re an above average candidate you’ll want to go to mostly prestigious programs with maybe 1 middle / upper middle for flavor. You’ll likely end up at a middle to upper middle tier program and showing you can hack it at a prestigious program makes you look good and more competitive for all residencies.

If you’re an average applicant - at least one prestigious paired with middle / upper middle aways. Prestigious one shows you the gap in training is not so clear cut depending on your goals. The others to increase your chances at matching at a solid program that’s familiar with you.

If you’re a below average applicant - as many subi’s at middle to low tier programs as possible. Since this guarantees you an interview at MOST of these programs, your best chance of matching is at a SubI. Most programs prefer to take people they know they can tolerate and won’t cause waves on their program if they can.

Make sense? If you’re average to above average I’d do -> 1 prestigious / academic, 1 solid rep clinical rogeams, 1 clinical / acadmemic with solid rep. This gives you good flavor for choosing your top picks and also gives you a lot to talk about / bond over during interviews. I did 3 aways so I’m bias though...

[Guest]

Doesn't matter. Just make sure your Step 1 is over 250.

[Guest]

Generally strength of rec letters based on overall sub-I performance> where you do your aways assuming you have a decent home program and scores/research. You don't have to do Sub-Is at MGH and Mayo to match well. Performing well at a place like Florida/UTSW/Oregon can open lots of doors. That being said, if you do impress someone like the Brems or the Lawtons of the world then a glowing rec letter from a big name chair can get you anywhere.