One of the fun parts of clinical year is getting to choose where you will do electives, but this can be stressful as well. There are a lot of different things to take into consideration when trying to figure out where you want to spend your extra time and various strategies for making those decisions.

Is there an area that you weren't able to rotate in that you think might interest you?

Electives are a great opportunity to explore your options and find out if you would like a job on a daily basis without committing to a contract. For example, my school doesn't require an orthopedics rotation, but it's a very popular area for PA students (and a good chunk of the PANCE) so a lot of my classmates chose to rotate through ortho. Even if you don't love the exact area that you choose to rotate through, it may give you some direction.

Was there a rotation that you loved, but not sure if you would want to do it daily?

Maybe you just need more time to figure it out, and you can use that elective to find out. If you liked a specialty, but spent most of your time in a hospital setting, you could try to find an outpatient office to get some experience in a different setting. There can be a huge difference in working in a private office and working in a hospital. I was on the inpatient wards for my whole psychiatry rotation, and I hated it, but some of my classmates had great experiences in outpatient psych.

Is there an area that you feel like you are not as proficient at or really worried about for boards?

For me, it was cardiology. I still wish I had the opportunity to do a rotation specifically in cardio because it's such an important part of boards and seeing patients in multiple areas. I chose to do a general internal medicine and endocrinology (which I would recommend for sure) instead, but I think cardio or pulmonology would have been really useful. Doing an elective in an area that you don't feel as comfortable in will help you to step outside of your comfort zone, and help you to feel more ready for boards.

Is there a specific area you are interested in working in?

If you already have an area of interest, but have not found a prospective job yet, you may try to do a rotation in that area. It's always a good idea to make your interests known so that potential employers or preceptors who have connections can help you to find a position. By doing electives in an area you want to work in, it will give you extra experience, which is a plus when applying for jobs in that area.

Do you have a prospective job opportunity?

If someone has made you an offer of employment or is possibly considering that, you may want to do one or all of your electives with that group. It gives you a chance to see if you would fit in and feel comfortable, and it gives them a few months of free training, which means you'll be working on your own sooner potentially. Personally, I knew I wanted to work in dermatology if possible, and I was able to use my 2 months of electives as a benefit during my interview. I was hired before my electives and that time was great for training, and I was able to start seeing patients on my own about 1 month after I was officially licensed because I had 3 full months of training done already.

If you already know what area you will be working in, is there a different specialty that would make you a better provider in your field?

Many fields have a lot of overlap, or you may end up sending patients out to a specific specialty, so it wouldn't hurt if you are able to spend some time in an area that is complementary to your field. In derm, we send patients to Rheumatology a lot for example, and Mohs surgeons as well since we don't do that at the practice I'm at. If you're going to be working in primary care, I think extra time in any specialty is helpful, but consider derm, endocrine, or ER. If you're planning on working in an ER, I think a derm or surgery rotation where you'll be able to really work on suturing is a good idea.

Do you feel like you need more study time for PANCE, but still want to take it early?

Some rotations are more laid back and less time consuming than others, which would give you more time to study. ER is one that typically you have to do a set number of shifts so if you have flexibility to do them all at the beginning, you would potentially finish a rotation early and have extra study time.

Is there a different city or state you are possibly interested in working there?

Elective rotations are a great opportunity to explore other areas of your state or maybe another part of the country. A classmate of mine did rotations in Texas, Tennessee, Wisconsin, Washington, and Alaska, where she is now currently working. If you have the financial means and the flexibility to travel, then go for it. Doing rotations in other geographic areas will also help expose you to how healthcare is different among regions.