Don't forget the crowd you're talking to on this site. Whereas many just do one home and one away (myself included), you'll hear about people doing their home rotation +3 aways. Some will argue that you should do more aways to get more interviews if you are not as competitive on paper...

My personal opinion about other senior rotations is that unless you plan on getting a sweet letter out of it, no one will care that you learned how to float a Swan-Ganz in the ICU. Just do what you would have done anyway. An elective in Rads is always a safe bet if not required at your school.

Jn, You will get more ICU and CCU immersion that you ever cared to have as an intern even in ORTHO. AND if you take it as a fourth year in the fall you will likely forget it (much less how many milligrams are in one tablet of tylenol) or if you take it in the spring you will be ready to strangle yourself, because you realize that you have hardcore senioritis, wish you were taking that "medical art" elective and don't learn the CCU/ICU stuff anyway because you have already matched. Just my two cents. Radiology (especially musculoskeletal if you can work it, not mammography) is beneficial, ER is very handy, Rheum is probably a good one, Physical medicine, Pathology is also good if you are looking for electives that might help and don't kick your butt too bad.

It seems like this question gets asked a lot. What do the residents at your school say? I'm telling my students the same advice I got--too many aways and you look desperate. Do what you need to do to make your program happy then rotate at a program that you're interested in. You don't have to rotate to match at a great program; however, with that said, there are programs that heavily favor rotators. If you choose to rotate at the latter, I would make sure you are not wasting a month and consider your competitiveness before going there. I think the true value of an away is to see another program so you have a better idea of what you want when you are trying to choose between programs in March.

As for fourth year electives, I don't think they matter too much and I wouldn't kill yourself. Have fun. Do some private plastic surgery if you can--it's a lot of fun and you'll never see anything quite as nice again as an ortho res at a university program. I did a MICU rotation and think it was a waste of time. Next July you'll be so busy changing lines and writing for TPN as intern that any fourth year experience won't matter after about two days. I also did a month of rheum. It was easy and I got to work on my physical exam, but man, you'll pay the price when you're taking a history for an hour and trying to sort out a rash with intermittent fevers. Just wait until you get pimped on the serologies. Good luck. Down with the big ten!

My advice as to medical school electives is as follows:

do away rotations at as many places you care to. with so many applications, programs like knowns

As far as ICU vs Rheum vs geriatrics...do nothing that requires call. You will work your rear-end off as an intern and for the rest of your life. Dermatology is a good rotation for this reason. Nothing can prepare you for doing the ATLS trauma survey your first night on call except for a clear head with a motivated heart and callused, sunburned hands from golfing/fishing/beer tipping. Knowing how to do a central line or float a...swan (duck?) might make you 1-2 weeks ahead of your fellow interns, but who cares. These are things that your attendings malpractice insurance will not allow you to do as a second year resident. Anyway, shooting a 110 and getting the beer girl's number is a much more memorable 4th year experience than duck floating.

Do as little as possible after Feb 1.

Musculoskeletal radiology might be helpful if you can retain what you learn amidst mountains of practical knowledge you will gain learning to take care of surgical patients as an intern.

Sorry for the cynicism, but pragmatic me is.