Now that you have decided on EM (or are at least treating it as your front-runner), you will need to complete a Home and an Away rotation this summer and early fall. These rotations are where you will get the SLOEs that will be the most important part of your EM application. Take a look at this approach to your myriad of choices, and below is a discussion of the most common questions...
There are no perfect number of clerkship applications. First, self evaluate your competitiveness and the competitiveness of where you are applying to. Your local advisors should be able to help you get a sense of your competitiveness at this point. Keep in mind that this is going to change as you complete rotations. For most students 4 applications will suffice. If you are a weaker applicant or looking at a more competitive market - consider 6.
The Bird in the Hand
Many students get an invitation to one clerkship, but want to wait for their dream spot. In this application your goal is to ensure you have an away rotation during the spring and summer. You have a rotation, take it and smile. If you can manage a third rotation, keep your other applications in. If you cannot do a third rotation and still have applications outstanding call and let them know you appreciate their time but have accepted another opportunity. This is better than waiting and declining the spot. This proactive stance will win you points with the clerkship director and the coordinator (they may remember if you string them along).
Check the Boxes
Read the paperwork from the program carefully, and complete it in a timely manner. There is no second chance for a first impression. You don't want to arrive and not be able to rotate because of paperwork. Health requirements vary at different institutions. Check with the undergraduate medical education office or health services at the hospital you are going to. They should be able to list what you need in detail. This is the time to jump through the hoop and just get it done.
Burn Baby Burn (or Don't!)
Declining an offered spot will be a small annoyance to the clerkship. If you need to, ensure you do it quickly and politely. Waiting weeks to decline hurts your impression with the program. They assume you are stringing them along and not genuinely interested in the program. Never accept a rotation and then back out of it if you want to get an interview there. Getting your perfect rotation is not worth the damage to your credibility elsewhere. If you discover a particular program is not a good fit and expect not to apply to them, go ahead and cancel. Just know that this program interprets withdrawing as disinterest and inconsiderate - not a good impression. The clerkship director and residency coordinator will recognize your name and will be reluctant to interview you.
Lucienne Lutfy-Clayton is an Associate Program Director and former Clerkship Director, she hates when students cancel on her clerkship making her scramble at the last minute.