Are you wondering how to ace the hardest rotations in medical school? You're not alone. Medical school rotations are a balancing act. You need to find a way to prioritize patient care, while finding time to study, and help your team, while also standing out. They also occur when you're trying to figure out how to prepare for your residency application. In other words, it's a lot to handle, but don't worry – we've got you! In this post, we will give you tips and strategies to help you perform well and secure the best references and MSPE from your medical school rotations. 

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9 min read

What are medical school rotations? Tips to ace the hardest medical school rotations References Conclusion FAQs

What are medical school rotations?

Medical school rotations or clinical rotations are an integral part of most medical school curriculums in the USA and Canada. It is medical students’ opportunity to apply what they have learned in the classroom and develop their clinical skills by treating real patients under the supervision of experienced physicians and residents. The students are assigned shifts at an approved healthcare facility where they are expected to carry out various tasks, including patient interviews and examinations, monitoring vitals, lab data interviews, team discussions, and much more. 

There are two types of medical school rotations: core and elective. The core clinical rotations focus on the more general disciplines, while the elective rotations allow students to explore specific specializations. With the latter, not only do you have to perform well, but you must also consider how to choose medical school electives to increase your Match chances for residency. However, the core rotations come first, and the Association of American Medical Colleges requires every student to spend significant time on core rotations. These include:

Typically, these rotations occur during the last two years of medical school, each lasting several weeks. The aim is to give students a chance to see what is involved in each rotation’s discipline. At the end of it all, the students are evaluated on performance, and they also need to successfully pass the shelf exams – a standardized test— to advance.

Rotations are also extremely important in helping you figure out how to choose a medical specialty. How can you really know which residency to apply to if you cannot imagine what type of work it involves? This means that not only do you gain important clinical skills, but you are also learning which potential medical field you may be pursuing.

Not sure where to start with choosing a medical specialty? This infographic should help:

What makes medical rotations challenging?

There is no sugarcoating it; clinical rotations are challenging. Students are expected to manage their academics, patient responsibilities, all of the emotions that come along with taking care of patients for the first time. They need to balance all those things while also thinking about residency applications. During rotations, you have limited time to soak up an incredible amount of knowledge and apply concepts that you may have learned about a few semesters ago. 

Medical school rotations can also be hard on the body and mental health. During rotations, many students report getting little to no sleep. Between 12-hour shifts and studying for shelf exams, it can be hard to find the time to get rest. Students have to adjust to this new way of doing things, while their sleeping schedule changes every few weeks depending on the discipline that they are on rotation for. Additionally, keep in mind that patient interaction and clinical work are exhausting, especially as you learn to adjust to your new responsibilities.

Furthermore, the important nature of medical school rotations also makes them a challenge. In addition to studying for shelf, students also have to start securing references from their attendings or residents. They also need to remember that Medical Student Performance Evaluations (MSPE) are largely subjective, so they need to make a good impression.  

Tips to ace the hardest medical school rotations

As you’ve probably figured out, a lot goes into successfully completing your medical school rotations. Acing this medical school chapter means to come out of it with better practical knowledge, having secured the writers of your ERAS recommendation letters or CaRMS reference letters, and the best MSPE Noteworthy Characteristics. We’ve put together some tips and strategies to help you do just that:

Commit to every rotation

Some medical students get to this point of the journey, and they already know what field they are interested in. Others simply don’t care for specific specialties. This is very normal, but it doesn’t mean that you shouldn’t give your all to every single rotation that you are on. In other words, just because you’re focused on how to become a plastic surgeon doesn’t mean that you should act disinterested during your psychiatry rotation. You need to remember that your actions and attitude are being evaluated by the physicians supervising you. They may not see your every move, but if you suddenly stop asking questions or start spending more time on your phone instead of helping during a particular rotation, they will notice it, and it will show on your evaluations.

Additionally, students are often surprised by what they find out during medical school rotations. The experiences you have may make you curious about different specialties, or you might find that you enjoy working on a particular rotation more than you thought you would. The best way to thrive during medical school rotation is to completely immerse yourself in every rotation as though you planned to specialize in that rotation's discipline. 

Develop good habits early

To do well on your medical school rotations and come out with good references and MSPE comments that will stand out, you need to put your best foot forward from the very beginning. Starting strong means that you are more likely to finish strong, and it will make things easier for you during the process. It would help if you focused on:

Keep up with your studying

During medical school rotations, your responsibilities at the hospital are very important but so are your duties as a student. The most important of which is to learn! You have to learn by learning practical skills, of course, but you also need to study to prepare for the shelf exams, USMLE and MCCQE tests, the final year of medical school, and the rotations themselves. We recommend having a study schedule that involves at least one form of high yield study techniques for medical school every day, whether reading, note-taking, flashcards, or answering practice questions. It would be best to try to incorporate the different active study methods and use them to your advantage. For example, you can take notes during the day on your rotations as you learn new things, review flashcards on your commute, and spend some time reading in the evenings.

A common mistake students make is planning to study during downtime at the hospital. In theory, this is not a bad thing. The issue with this plan is that it is not reliable. There will be weeks where you have an hour of downtime every day and others where you don’t have any at all. This then leads to days where a student might not get the chance to study, and before they know it, the amount of reading required has piled up, and they don’t have the time to catch up. A set schedule for studying that is not dependent on how busy the hospital is would allow you to use the downtime for other beneficial things. You can spend the time getting to know your supervisors or your patients, building relationships with other medical students, taking care of yourself, or maybe getting some rest. 

You may want to consider getting some expert help or registering for a prep course as well. A big part of creating a study schedule is finding the right resources to study with and identifying high-yield study techniques. If you feel that you might have trouble doing this or simply don’t have the time to do it well, you should consider getting some help from qualified professionals. 

Go the extra mile

Remember how we talked about putting your best foot forward? What no one tells you is that doing what you are told is not enough. You need to take the initiative and go the extra mile to stand out and get the best MSPE. Here are a few ways that you can do that:

Get Feedback

The best way to find out how you are doing is to ask. When you start your rotations, it’s always a good idea to determine the expectations. Ask for feedback from your residents, fellows, and attendings about your performance and contributions to the team. This feedback will help you improve your skills in preparation for upcoming rotations and, ultimately, residency. Furthermore, if you find yourself struggling with a particular aspect of things, go and ask for guidance. The supervising physician will most likely have some tips that will help you do better, and they will appreciate the fact that you sought out help when you needed it. 

This is also a great way to build relationships and maybe even get a mentor. You should consider the physicians you are learning from and who could make good referees. For instance, if you plan on applying to family medicine residency, it would be a good idea to talk to doctors in that field and get feedback from them. Tell them about your plans and gauge their reaction. If they respond with enthusiasm, you can put them down as a potential referee. Which bring us to the next topic that we need to discuss...

Interested in 15 tips to help you with your residency applicatons? Check out this video:


We've given you tips that will help you do well during your medical school rotations and get the best MSPE. Still, you should keep your letters of recommendation in mind during rotations because they are an essential part of your residency application. The latest NRMP Program Director Survey showed that 70% of programs consider the letters of recommendation on par with USMLE/COMLEX scores when ranking applicants. This means that you need to secure the strongest referees possible. 

Strong letters of recommendation come from physicians who have worked with you and know you well enough professionally to speak regarding your character, work ethic, and aptitude. Most importantly, they should be able to comment on your suitability for your chosen medical specialty. You should aim to have a diverse list of referees, including research advisors, pre-clinical professors, department heads, and at least one clinical clerkship attending. Medical rotations are such a big part of medical school, and they involve a lot of students. It's therefore very impressive when one student, in particular, can stand out and impress an attending enough that they write a letter on their behalf. 

If you follow the guidelines and tips provided above, you will be well on your way to securing excellent references. That said, in addition to standing out and building a relationship with your chosen referee, you need to be tactful when asking them to write a letter on your behalf. A recommendation letter is essentially an endorsement of your candidacy for residency and your chosen specialty, so you want to be mindful of who you ask for one and how you ask for it.  

Whenever possible, you should ask early and in person. As mentioned earlier, you should make your intention to apply for residency known from the very beginning. As your relationship with your chosen writer grows, you can bring it up again. We suggest asking to speak with them for a few moments after you've completed your daily tasks and politely inquire if they would be willing to write a letter of recommendation on your behalf when the time comes.  


Medical school rotations are challenging, but it is possible to do well on them. The key is to commit to every rotation as though you plan to specialize in that rotation's discipline, develop and stick to good habits, keep up with your studying, and go the extra mile when you can. It's a tall order, but if you follow the tips and guidelines that we've outlined above, you will ace even the hardest medical school rotation and secure excellent references and MSPE. 


1. What are medical school rotations?

Medical school rotations refer to the few months in the last two years of medical school when students get to practice medicine under the supervision of physicians. The students are required to rotate through different medical specialties in order to get practical experience.

2. Why are medical school rotations difficult?

Medical school rotations are quite challenging because they require managing patient care and academic demands. They are also physically exhausting because most shifts are 12-14 hours long.

3. When do students have medical school rotations?

Medical school rotations occur during the last two years of medical school (year 3 and 4).

4. What fields are considered the core medical school rotations?

The core rotations are internal medicine, family medicine, obstetrics & gynecology, pediatrics, neurology, surgery, and psychiatry.

5. What is MSPE and how can I improve my MSPE via rotations?

MSPE stands for Medical Student Performance Evaluations. These are essentially a snapshot of your quantitative performance (test scores, grades, class standing, etc.) and some of the more nuanced aspects of how you've executed your rotations, clerkships, and extracurricular activities. It was previously referred to as the Dean's list. Your MSPE will include the evaluations from rotations so if you do an outstanding job during your rotation, you will improve your MSPE greatly.

6. Should I ask a rotation’s attending to be my referee?

You definitely can ask an attending to be your referee, especially if it is one in chosen specialty. This will depend on a few factors, though. You should only ask an attending to be a referee if they worked with you directly and have openly supported your candidacy to residency and your chosen faculty. You should be tactful when asking them to be your referee.

7. When is the best time to study during medical school rotations?

That depends on you! There is no one-size-fits-all answer, but we recommend a study schedule that allows you to study using different study methods at different points of the day, instead of simply relying on reading when things are slow at the hospital.

8. How can I make sure I stand out during medical school rotations?

You should find out what is expected of you and exceed those expectations by going the extra mile. You should also talk to other residents, fellows, and attendings. Ask them for help and/or feedback. It will help you improve, and it will also make them notice you.

To your success,

Your friends at BeMo

BeMo Academic Consulting

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