What PA Elective Rotations Should I Take?

Written by Marisa, PA-C

It’s one of the biggest questions PA students have as they approach their didactic year: What rotations should I choose for my elective rotations? If you are asking yourself that same question, read what Marisa, a recently graduated PA-C, has to say about her experience and advice choosing elective rotations . . . 

You can see the light at the end of the tunnel—your didactic year is wrapping up, which means your clinical rotations start soon.  A year full of excitement, change, hands-on learning, and putting everything you’ve learned from your didactic year into practice on actual patients! Hospital settings, clinic settings, the OR, rural medicine—there are SO many different types of medicine and practice environments that you will encounter in your clinical year. But, what rotations should you take?

Let me backup just a few steps. Because you might be thinking, But, Marisa, our program picks our rotations for us. Duh. Yes, this is true! We, as PAs, have to take a set of core rotations and EOR exams to test proficiency: family medicine, internal medicine, psychiatry, surgery, pediatrics, women’s health, and emergency medicine. While most programs have all of these rotations, some have other mandatory rotations as well such as rural medicine or cardiology. Either way, all programs will pick some if not all of your rotations for you. However . . .

The vast majority of programs give their students what they call “elective” rotations. These are 1–5 rotations that you get to choose based on what area of medicine most excites you or the area you want to dig into a bit more. These elective rotations, in my opinion, are what truly differentiates everyone’s clinical year experience. These are the rotations that can help you gain experience in a future job area that you want, can give you additional OR exposure, or can be the beginning of a career in a specialty area.  Elective rotations are so much fun because, well, they are picked by you, and therefore, you are able to tailor your medical education to your needs and interests.

I personally chose a PA program that offered 4 elective rotations. I wanted to expose myself to as much medicine as I possibly could, so it was important for me to be at a program that offered a lot of electives. Additionally, I am a (very) indecisive person! So, the more medical exposure, the better. To note, my electives were heme/onc, cardiology, urgent care, and nephrology. While all of my electives were carefully thought out, I wish I had done a few things differently. But I digress…

So, how do you choose? These elective rotations seem to be crucial rotations that can really “set you up” for success. So, what do you take? There are a few approaches to this question, so I’m going to break it down for you in hopes that at the end of this post, you will be confident when choosing your precious elective rotations.  Might I start out by saying that you can pick whatever you want and still go into a vastly different area of medicine for a job.  You can go to a program that doesn’t even offer elective rotations and be totally fine. So, start by taking a deep breath and ENJOY the process of picking and trying new things. No stress allowed here. Ok, let’s get started. Here are 4 approaches you can take when deciding on elective rotations:

BASED ON GENERAL INTERESTS

This is where a lot of students find themselves (myself included) and is a great mindset to have when picking electives. You may not know the exact area of medicine you want to go into, but you may know that you like general medicine, you may like procedures, you may like hospital medicine, etc. You get the point. Here are some tips based on the area that you feel pulled to:

• Primary Care: If you like primary care or general medicine, I highly recommend the following electives, as they are areas of medicine you see a LOT in the general public: cardiology, dermatology, and sports medicine. Furthermore, a rotation where you “see it all” will be helpful too, such as urgent care, geriatrics, or outpatient IM. Finally, I feel that palliative care or heme/onc- areas, where you need to learn how to talk to and comfort patients, are extremely helpful.
• Surgery: If you like the OR, then I highly recommend rotations in the OR, but also in procedural electives: OR specialty elective, ENT, dermatology, GI, or plastics.
• Medical/Surgical Mix: If you love the OR, but also love medicine, and procedures, and clinic, and #allthethings it can be hard to pick! However, I would recommend something with a mix of medicine and procedures such as urgent care, dermatology, orthopedics, GI, and OB/GYN.

BASED ON FUTURE JOB ASPIRATIONS

You lucky duck! If you know exactly what area of medicine you want to go into, more power to you! Try to get your elective in that exact thing. If you know you want to work in infectious disease, get your elective in that. If you know you want to do addiction medicine, get your elective in that! There is no reason to shy away from the exact area of medicine you love. Why not get a head start and some hands-on experience.

NICHE/ “WILL NEVER HAVE THIS OPPORTUNITY AGAIN”

Some people take this approach when picking electives. Basically, they know what they will never do as a career! You may decide to take this opportunity to try something you may never have the opportunity to do again! Neurosurgery, ICU, pediatric cardiothoracic surgery, rheumatology, infertility medicine, etc. Whatever you want to see, but think you likely will never go into that specialty, have at it! I think this is a super fun approach to your elective rotation, and honestly, I’m kind of jealous of my classmates who did this. I totally wish I did!

BASED ON THE PANCE

While I don’t recommend you use the PANCE blueprint to decide what electives you should take, some people do really struggle in an area on the PANCE, and therefore, want a dedicated rotation to expose themselves to that area. While it is easy for me to look back on rotations and say, “Use this time to try something fun, new, or exciting,” I also understand the immediate and acute stress PA school induces; therefore, if you would feel better picking your elective based on how you think it will help you for the boards, go for it!

• Take the specific elective that you struggle with (for me, that was nephrology!)
• Take the specific elective that will give you the most “bang for your buck” on the PANCE: cardiology, pulmonology, GI, or MSK.

Good luck, have fun, and let me know what rotations you decide to take!  Whatever happens, I am confident you will make the most out of each rotation you are on. Enjoy the ride, friends. Soon enough, you will be a PA-C!