The tougher the challenge....the greater the reward. This is the rest of your life and you don't want to have remorse.

In terms of the specifics, you need to speak to program directors of programs in your city, or others that are readily accessible and you have a good chance of getting interviews at, etc....

Have you fulfilled the requirments (you will need letters)? My recommendation is to be honest with your curent program. This serves 2 purposes 1) they will write you a letter of support which will be important, 2) you give them the common courtesy of filling the spot with as much advance notice as possible.

Write back with questions.

I agree with the above post. I was an ER resident who switched into ortho (just started my ortho residency). You need to be honest with your program. It is the right thing to do, plus it may help you keep your job in case you don't match. Get a letter from the head honcho of your ortho rotation. Also, you have many free days during ER, so go and volunteer in ortho clinic/cases. Make sure there are faculty members as well as residents when you do this. It shows that you're interested. Go to journal club, grand rounds, etc. Offer to do a presentation at grand rounds/weekly lecture. Feel free to PM me with any questions. I've never been happier.