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. 


  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!

    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.

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

    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.

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

  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).

  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?

    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.