Choosing an elective clinical rotation is your golden opportunity to narrow your career goals, strengthen your clinical skills, and explore something new. If you’re unsure where to begin or worried about making the wrong choice, check out these tips from Marisa, a board-certified primary care PA who used UWorld to study. A passionate community health advocate, Marisa shares thoughtful insights to help you select electives that align with your interests, aspirations, and growth as a future PA.
Your Guide to Elective Rotations in PA School
You’re almost there. The end of your didactic year is in sight, meaning clinical rotations are just around the corner. This next chapter is brimming with exciting changes, hands-on learning, and the opportunity to apply everything you've studied. From hospital and clinic settings to the operating room and rural medicine, you’ll experience a wide range of environments and specialties during your clinical year.
But here’s the big question: What rotations will you take?
Your program will initially assign many of them. As a PA student, you'll complete a series of required core rotations and take end-of-rotation (EOR) exams to assess your proficiency in key areas such as family medicine, internal medicine, psychiatry, general surgery, pediatrics, women’s health, and emergency medicine. Some programs may require additional rotations, such as rural medicine or cardiology.
Most programs also offer elective rotations — typically between 1 and 5 rotations you can select based on your interests. These electives are what truly personalize your clinical year experience. You can use them to gain exposure to a potential future specialty, deepen your skills in the OR, or explore areas of medicine that genuinely excite you. Elective rotations give you the chance to tailor your education in a meaningful way — and that makes them valuable and rewarding.
Start by taking a deep breath and enjoy the process of picking and trying new things. No stress allowed here."
Some PA programs offer just 1 or 2 elective rotations, while others offer more. If you’re in a program that allows 4 or more electives, you can explore a broader range of specialties. The more exposure you get, the better prepared you’ll be to make informed decisions about your future career path.
So how should you choose? Elective clinical rotations can be incredibly valuable and may even help you land your first job after graduation. But there’s no one-size-fits-all answer. The truth is: You can pursue electives in 1 area of medicine and work in a vastly different field — and that’s perfectly acceptable. Some programs don’t offer electives, and their students still go on to have successful, fulfilling careers.
Here’s the key takeaway: Don’t stress. Enjoy the process. You’re shaping your clinical experience to reflect your interests, goals, and curiosity.
Here are 4 smart approaches to selecting elective rotations:
#1 Based on General Interests
This is where many students start, and it’s a great place to be. You might not know the exact specialty you want to pursue, but you likely have a sense of what excites you. Maybe you’re drawn to general medicine, enjoy procedures, or feel energized in hospital settings. Wherever your curiosity lies, there are ways to align your electives with your interests. The following suggestions may nudge you in the right direction:
- Primary care or general medicine: Consider electives in areas you’re likely to encounter frequently in practice, such as cardiology, dermatology, or sports medicine. Rotations where you “see it all,” including urgent care, geriatrics, or outpatient internal medicine, can also be extremely valuable. You might also benefit from palliative care or hematology/oncology, where you can develop strong communication and patient-support skills.
- Surgery or the OR: Choose electives that put you in the operating room as much as possible. You might also consider procedural specialties such as ENT, dermatology, gastroenterology, or plastic surgery, which allow you to sharpen technical skills in various settings.
- A combination of medicine, surgery, and procedures: It can be difficult to choose when you enjoy so many areas of medicine. Look for electives offering clinical and procedural exposure, such as urgent care, dermatology, orthopedics, gastroenterology, or OB-GYN. These areas give you a well-rounded experience that taps into multiple aspects of patient care.
These elective rotations, in my opinion, are what truly differentiates everyone’s clinical year experience."
#2 Based on Future Job Aspirations
You may already know what area of medicine you want to pursue. In that case, you’re ahead of the game. When your goals are clear, your electives become a means of gaining early experience and making valuable connections in your intended field.
For example, if you're set on working in infectious disease or addiction medicine, seek out an elective in that specialty. Don’t hesitate to lean into what interests you most. This is your chance to turn interest into experience.
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."
#3 Based on Once-in-a-Lifetime Opportunities
You could approach your electives by choosing an area you’re almost sure you wouldn’t pursue as a long-term career but are still curious about. These rotations give you a rare glimpse into a highly specialized field you may never work in again. It’s a bold, fun approach — one that many students fondly remember. If there’s a “bucket list” rotation you’ve always wanted to try, this is your chance.
You may decide to take this opportunity to try something you may never have the opportunity to do again!"
#4 Based on the PANCE
Choosing electives based on the PANCE Blueprint is not typically encouraged, but it can be helpful. Here’s the reality: PA school is demanding. If extra clinical exposure in a challenging area gives you a confidence boost, using an elective to sharpen your focus is a smart strategy. You can also look at high-priority topics on the PANCE and pick electives that give you the most value, including cardiology, pulmonology, gastroenterology, or musculoskeletal medicine.
If you would feel better picking your elective based on how you think it will help you for the boards, go for it!"
Ultimately, your electives are a chance to explore, grow, and gain the experience you need. That could mean deepening your knowledge of tough subjects or following your curiosity into something completely new. No matter your choice, you will learn so much from each rotation. Embrace the journey and trust yourself. Before you know it, you’ll be a practicing PA-C.
