I would suggest doing your home and away ortho rotations as early as possible. Sometimes it can be like pulling teeth to get LORs prepared. If you do a late fall rotation that you want a letter from, it will stress you out trying to get it in time.

I would suggest that you do your home ortho first since you are familiar with your hospital and hopefully have already been exposed to ortho during your third year. Most likely you are looking to leave your school anyway, so you can use the knowledge you gained from your home rotation to assist you on your aways.

As for research, you may be behind the eightball there. It's hard to get anything accomplished between now and the time you submit your application next fall. Good luck in that endeavor, but maybe there is a simple project out there that someone needs a helping hand on.

I'm not sure if programs are really looking at your fourth year electives all that close. We didn't discuss it all when I assisted in the process. I would choose those electives that will assist you in your career. Things like radiology, rheumatology, advanced gross anatomy, etc.. I think mine were rads, rheum, anesthesia, SICU, VA subI in medicine (painful, but helpful), and advanced gross anatomy plus two ortho rotations.

Good Luck.

This is true. Noone really cares what you do 4th year as long as you kick a$$ on your ortho electives. Set up fourth year to be relaxing but at the same time take some electives that you find interesting and will help you later in life.

As far as aways. DEFINATELY do you home rotation first. Then do perhpaps two aways. I would highly suggest you take a week off between all your ortho months or at least a week off between your two aways. Aways are tough.....you have to be on your A game all month.....and most places get so many applicants that if you do anything less than stellar you wont really be considered at that prigram. They are a double edged sword. you get to learn about a program but you have to mind your p's and q's for a month. It gets tiring...and to top that off you are in a strange cityand have no friends.

SO be careful as you select aways so you get to see different types of programs....

Also aways define your geographic perference so if you want to match in a certain state you should rotate there. This especially applies to Cali, Chicago, and the northeast.

Your away rotations are the most important thing you do your MS4 year. Plan them very carefully. Only go to places you would like to train. I would also probably pick two places: (1) a dream place that is bit of a stretch, (2) somewhere you think you are pretty safe with, but would not mind training there.

Oh, and think twice about going to Vanderbilt. I had two friends who were both very competitive (20+ interview offers), and even received excellent LOR?s from there, but did NOT get invited for an interview.

Thanks to all of you who took time to respond. There is a lot of conflicting advice out there regarding how to best approach fourth year, it always helps to hear more opinions.

Even though I'm a west-coaster, NYC is one of my top destinations. Obviously HSS is the program that is always brought up because it is the mecca. But I haven't heard as much about HJD and Columbia.

Does anyone out there have firsthand experience with either of these programs as a fourth year sub-I?