This is a topic for which the “how to” seems to be passed down from senior to junior medical students and never written down. I remember being pretty clueless about this process when I went through it. I was a relative late-comer to the Royal College EM sweepstakes, having decided to pursue that program only during the summer before fourth year. This was compounded by my inability to plan anything in advance, ever. I started planning my electives a month or two before my first elective block. As a result, my emergency medicine elective schedule was quite deficient compared to the other EM applicants. It included only two emergency medicine electives – one at my school (which did not have a Royal College EM program at the time) and one in Edmonton. I wouldn’t want to try applying to CaRMS with that lack of preparation these days. If you’re reading this, hopefully you will not make the same mistakes!
In this post, I’ll go through some FAQ’s about medical student electives. If you’re interested in this topic, I imagine my posts on How to Rock EM Clerkship, the Reference Letter Triple Crown, Interview Inducing Elective Behavior, and the overall CaRMS Guide will be of interest. As always, I’ll be focusing on the EM perspective (it’s what I know!), but this information is likely applicable to electives in multiple other specialties.
Where should I do electives?
Think of electives as your opportunity to take a program for a swing around the dance floor. Who should you dance with? Probably the programs that you could see yourself most likely to have a future with. In addition to a great opportunity to get reference letters, electives give you an opportunity to check out a program, learn about it, meet the residents, and consider if you could see yourself involved with it long-term.
If you would consider matching far from your current school, some geographic considerations may come into play. If you’re from Ontario and plan on applying to schools in Western Canada, for example, I’d recommend that you head West for at least one elective. It may not count for much, but I think doing this implies that you’re more willing to consider moving far away from your current school. Additionally, taking the Reference Letter Triple Crown into account, it’s nice to have at least one or two letters from physicians that are in the same region as the school you are submitting it to, if not in the same province. The same advice would apply to students from Western Canada that are planning to apply to schools out East.
Do I need to do an elective with a program to get an interview? Does doing an elective at a program guarantee me an interview?
No and no! I’d like to say that these are simply myths that the senior medical students came up with to scare the junior medical students, but they seem to persist no matter how often they are disproven.
You do not need to do an elective to get an interview. Of course, for many reasons you are more likely to get interviewed by programs you have done electives with:
- Your elective will be noted on your application, so they will know that you were interested enough to check out the program yourself.
- If you did a good job, there will be attendings and residents that remember that they liked you.
- You should be able to include a reference letter from one of the program’s own faculty.
- You will be able to write a more pertinent personal letter because you know more about the program.
However, other schools will want the opportunity to meet and assess the best applicants regardless of whether or not they came for an elective.
Conversely, doing an elective with a program does not guarantee you an interview. From the program’s perspective, if they do not see you fitting in, they do not punish you by asking you to attend an interview that will not result in a match. To state this succinctly: programs want to match the best applicants so that is who they interview. They’ll interview a solid applicant that didn’t do an elective. They won’t interview a weak applicant that did an elective.
Do I need to do all of my medical student electives in EM?
No. But you do need enough time in EM to acquire strong reference letters. I think the right amount of time in EM will vary for individual applicants based on a lot of things:
- How much time you have for electives (some schools have ~10 weeks, others have more than double that)
- How much EM prep work you’ve done (if everyone in your school’s emergency room knows your first name because you’ve been doing research/shadowing there since you started med school then you may not need as many EM electives as someone that made a late switch to get good letters)
- How much EM time you get at your school (some have 2 weeks of core, others have more)
I’d recommend doing EM electives at ~3 or more other schools if possible. If you’re from one of the lucky schools that gets a lot of elective time, consider spending some of it in related disciplines. Pretty much every discipline will teach you things that will help in the ED. While you’re with them, make sure that they know EM is your area of interest so that they can focus on it in your teaching.
As a side-note, letters from off-service attendings that rave about how much they wished you would apply to IM/surgery/etc. are very nice additions to your application. We like having residents that excel both on and off service. That said, I’d only submit one of this kind of letter so you have room for EM letters as well.
If I have the opportunity to do a cool elective should I take it?
By “cool” elective I mean stuff like:
- NASA elective
- Wilderness Medical Elective
- International Electives
- Toxicology
- Etc.
This is a silly question. Of course you should! These are things that will stick out on your application. I have always found that doing what you love leads you to where you want to be. In addition to the potential opportunities that could result out of doing cool electives like this, they will give you awesome experiences that you will be able to talk about on your interviews.
How can I get the electives I want?
Unfortunately, the elective-granting policies are a black box. Applying can be one of the most frustrating experiences of medical school. The rise in popularity of EM means that electives are not the easiest to obtain. As of 2017, applications for visiting electives at all English-speaking Canadian faculties of medicine have been standardized through the creation of the AFMC Student Portal. Any visiting electives must be applied for through the portal, with no exceptions. Many schools will outline their general procedures on the website but, even at my own institution, I do not know exactly how it works. There’s definitely no foolproof way to get the ones you want. Follow these tips, and hopefully you’ll end up with a schedule that you can work with.
Each school has a catalog that details their EM elective and school policies on the AFMC website. This table below is current up to Feb. 11, 2017 and provides a good overview of application policies for EM electives, but you should always check the AFMC website for the most up-to-date information. Not included are the available EM electives at rural sites.
| School | Elective Length (weeks) | When To Apply (weeks in advance) | Application Cost | Prerequisites |
| Dalhousie | 2 – 4 | 16 – 28 | 150 | – |
| McGill | 3, 4, 8 | 16 – 28 | 175 – 475 + 75 application fee | – |
| McMaster | 2 | 16 – 28 | 150 | Core ER complete |
| Memorial | 2 – 4 | 16 – 28 | 100 | Core ER or Family complete |
| NOSM | 2 – 8 | 16 – 28 | 200 | – |
| Queen’s | 1 – 2 | 17 – 28 | 100 | – |
| Alberta | 2 – 4 | 16 – 28 | 100 | – |
| UBC | 4 | 12 – 28 | 200 | – |
| Calgary | 2 | Dependent on academic year | 100 | – |
| Manitoba | 2 | 16 – 30 | 100 | – |
| Ottawa | 2 – 4 | 17 – 26 | 100 | 6 months of core clerkship or 3 months + 4 weeks ER electives |
| Saskatchewan | 2 | 15 – 28 | 100 | – |
| Toronto | 2 – 4 | 16 – 28 | 220 – 290 | – |
| Western | 2 | 16 – 28 | 100 | Core ER |
Application Elective Tips
- APPLY EARLY. I cannot stress this enough. The majority of schools allow you to apply 28 weeks in advance and you might as well apply the day that the portal opens. You should have all your forms uploaded, draft ready to go, etc. It’s likely a first-come, first-served process at many schools once local students have their electives taken care of.
- In order for tip 1 to work, you should also have your immunization forms completed. The serology and immunization form is generally valid for 1 year, so I would suggest timing it so that you only have to get tested once or twice during your entire clerkship. You should also get tested for HIV and Hep C, and obtain the flu shot to fulfill extra requirements (for Toronto, Queen’s, etc.)
- Use the comments section on the application form well! Many schools will allow you to elaborate on your elective date choices. For example, if you have a 4 week elective block and are applying for a 2 week elective, be flexible, and comment that you can start at either 2 week period.
- Regarding double booking electives (e.g. applying for two electives for the same dates with the intention of cancelling one). The advantages are obvious: you are more likely to get an elective for those dates and will not have to scramble if the other is rejected. Disadvantages include cost, as most applications are non-refundable. Further, I understand that schools discourage their students from this practice or even consider it unprofessional. However, I have seen students wait patiently for a reply to their application for months, only to learn that there is no space for them at the single school they applied for a given set of weeks. This may inhibit their ability to apply to get an elective at another school. Regardless of how you decide to work within this reality, I think it’s fair to say that holding an elective spot that you have been offered is uncool, as it may inhibit your colleagues from around the country to get this elective.
- Be patient! This is likely the most frustrating part of the entire elective experience. You’ve sent in your applications early. You checked and double checked that you included everything that the school requested. Why haven’t you heard back? What’s taking them so long!? Some schools get back to you in days, others in months. Give it at least a few weeks. Review the school’s website to see if they have guidelines posted for how long it will take, and don’t be afraid to send a pleasant email to an appropriate person if the wait is getting unreasonably long.
Conclusion on electives
Electives can be a stressful time for medical students. A lot rides on them, and getting them set up can be a frustrating process. Hopefully this post sheds a bit of light on how to approach them. As always, remember that the content of this blog contains only my opinions, and others may disagree. Be sure to ask around, get multiple opinions, and make up your own mind.
If you have any other elective questions ask them in the comments, and I’ll do my best to respond to them there. If you found this helpful, please e-mail it to your classmates, post it on Facebook, tweet/retweet it, follow CanadiEM and I on Twitter, or follow our RSS feed. Social media/e-mail links are at the top of the right sidebar.
Note: This post was originally published on BoringEM on March 24, 2013. It has been updated by Kelly Lien & Brent Thoma and republished on March 1, 2017.
Brent Thoma
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