EM Rotations - When, where, and how?

Updated September 2016

When should you do an EM rotation?

The easy answer is, "as early as possible".  If your school allows electives in the third year it can be really helpful to get a first exposure to help you decide.  In your fourth year, or late in your third year, you will do audition rotations with competing goals of learning about EM and demonstrating your aptitude for potential letter writers. Academic rotations early in the year will help you find the attributes in a residency you are looking for, advise you through this process, and allow you to begin discriminating your needs. 

You should plan to do at least two EM rotations by October of your fourth year.



Where should you do EM rotations?


Most students do one home rotation, at an ED affiliated with their medical school, and at least one away rotation at another ED where they would be interested in matching for residency.  If you do not have an EM residency at your institution, you will need to do two away rotations. Home rotations are usually easier to get earlier in the summer, they often offer personal advising, and you may be more familiar with some aspects of the hospital giving you less to learn.  Away rotations within Emergency Medicine are key to getting to the residency that fits you. Away rotations are not mandatory but are strongly recommended to allow you to see how another ED functions. To get into some geographic areas, an away rotation in that area may be essential to demonstrate interest.

EM rotations should be completed at departments that have a residency program.  While a rotation at a community ED can be a great learning experience, and will give you a window into community practice, the advising and letters you receive at a residency program will be more valuable to your application.  The most useful letters of recommendations you can receive are Standardized Letter's of Recommendation (SLOR's) from an EM Residency Program Director or Medical Student Clerkship Director.


How do I find EM rotations?

Many rotations in EM are available on the VSAS (Visiting Student Application Service) network.

In addition to going on the VSAS network SAEM.org also provides an interactive map of the United States that links to information on most of the EM rotations in the country, including those that do not participate in the VSAS.

Check it out... 

For a lot more on how to navigate the VSAS check out this CDEM EM Stud podcast.


Do I need letters of recommendation for rotations?

Applying to clerkships has become a streamlined process, but many have individual requirements and differing time frames. Some clerkships have begun to require a letter of recommendation as part of their application process. These can be written by an advisor, or clinician you have worked with during third year. Primarily they are looking to ensure you are interested in EM, and in good academic standing. 

Are there hints for success ?


As securing rotations can be difficult, ensure you start early and use your resources and contacts. SAEM keeps a clerkship directory that will help you identify, compare and contrast clerkships. Keep in mind this directory is a great starting off point but may not be entirely up to date, and you will want to look at individual clerkships sites to confirm important information.  

After identifying programs you are interested in strategize to maximize your application both in timing and opportunity. Have back up plans in case your ideal rotation does not have a timely spot for you. If you get  into the summer and you have not secured an away rotation, consider accepting a less perfect slot to ensure you have a timely rotation. 


Often electives in EM (like Ultrasound or Pediatric EM) will be easier to obtain, and can be a great way to make yourself known to a program you are interested in, but didn’t get the chance to complete the clerkship. Just ensure you have your two clerkships early, so your letters will be written in time for the ERAS reviews by the programs. 







18 comments:

  1. Hey, thanks for writing this article! I have a quick question- If I do an away rotation in a hospital that sees a very similar patient population to my home institution, can that hurt my application? I am not sure if it's better to take an away in a setting that I don't think I'll like just to show that I have tried it, or if I am just putting too much thought into it :) Thanks!

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    1. That won't hurt your application, BUT there is some benefit to rotating at different types of hospitals to help you find out what you really prefer.

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  2. Can you get a SLOE from EM Ultrasound rotation?

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    1. That is going to be rotation specific and is a reasonable thing to ask in advance. One way to make that work is to do some clinical shifts during the rotation with their usual letter writers so they can collaborate on a stronger SLOE. Each department handles that differently so the best thing to do is ask up front.

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  3. What if you can't start your second EM rotation until mid-October? Are you sunk?

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  4. Not at all. A small number of really selective programs won't consider an applicant who does not have 2 SLOE's from 2 separate rotations. That is very uncommon. An application with 3 letters, but only 1 EM rotation SLOE that is complete in mid-september should be fine. Should be able to get that later rotations letter to programs that are on the fence as either a late-arriving fourth letter or emailed from the letter writer (if they are willing).

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  5. I'm in a similar situation as the person above, where I have my first EM rotation early on, but then I won't have another one until mid-September. So this means I'll need to get two letters (in addition to my 1 SLOE) by the time I apply, and then send the other SLOE after I apply. Does this hold up my application in the review process? And for the two letters that I need to get, neither of them will be from EM most likely (either SLOE or non-SLOE)...so what do you recommend?

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    1. Having your second SLOE come in late will hold up your application for any program that requires 2 separate SLOE's to get a review (few programs do this). It is more common for programs to hold on reviewing an application until 3 letters are in, that way they have more info to work with. You want programs that are willing to look at 1 SLOE to consider you for interview early so having 3 letters by late september is usually the way to go for most applicants. You can usually get a later SLOE to them one way or another, which can make the difference in coming off the wait list or the indecision pile.

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  6. Can you get a SLOE from a month long Pediatric EM rotation?

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    1. Usually. Some may only write standard LOR's, not feeling like they can adequately complete a SLOE. If you check in advance it is likely there is someone on the rotation who will write you a SLOE. This won't be as helpful if they don't write a lot of letters so you will want it to be the person who runs the clerkship, or to see about doing a shift or two with one of their usual letter writers (CD, PD, APD).

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  7. Hi Adam, I have already completed my home EM Sub-I, am currently on my first away but have a question regarding my next away. I have two possibilities, both of which are well regarded programs. 1) is mid-Aug to mid-Sept but is in a non-desirable location and 2) starts 2nd week in October to Nov. but is in a much more desirable location. The pros of the first option is that the SLOE will surely be with my application but isn't necessarily 'unlocking' a region I want to unlock but then the opposite is true with my second option (i.e. it's late but in a desirable area). Do you have any advice on this decision or about the importance of applying initially with 3 SLOEs on-time vs not?

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    1. The concern I would have with holding your third letter spot for a SLOE that won't arrive until mid-Nov is that some programs may wait until you have 3 letters in to look at your application. If a program lets you sumbit 4 letters then there is no problem saving a spot for that late rotation.
      In general, you would be better off having 2 SLOE's and a 3rd regular letter that are in on 9/15 than an application that could be considered incomplete and not get reviewed.
      Do the rotation that is more helpful for you in deciding where you want to be. Unlocking a region only really matters when you have no other connection to that region AND it is competitive (ex: west coast).

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  8. Any use in doing the late Oct, Nov, Dec electives in places you likely won't match? I have some offers at great programs for these months, but even a good month will be unlikely to match me here. While it would be great for experience and resume building, not the most practical. Would adding another SLOE in early December from one of these places have any weight at all in an application or is it much too late?
    Thanks!

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    1. Only if a late arriving letter will help get access to other programs nearby that will consider you. SLOE's in December are going to be too late to be helpful.

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    2. Thanks for the quick reply! I will already have 2 SLOE's in by this time, was just wondering if a 3rd would help at all. Will not be a new region unlocked so I was unsure of whether to accept it. If it doesn't help with interview invites, could it make a difference when programs sit down to rank at the end of the year?

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    3. Programs are unlikely to change their ranking based on one more letter once they have interviewed you. 2 SLOE's should be plenty.

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  9. I am a late convert to emergency medicine. Currently I only have one rotation set up at my home site. I have above average board scores. I'm willing to go wherever. Do I have a chance with only one EM rotation?

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    1. Absolutely. 2 SLOE's are better but most programs will consider someone for interview with just 1. By early september, when you have to choose which programs to apply to, EMRA Match is supposed to have added data on the number of SLOE's each program requires.

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