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Thanks! Do you get to choose/list your preferences for your sites?
If you aren't signed up for a whole year at a single site, you take part in the lottery. It can be a simple or a complex process depending on how much you care about specific sites and how anal-retentive you are.
The lottery system lets you plan out when you want to do your rotations, and where you want to do them (except for Family Medicine. The time is assigned in the normal lottery, but since there are so many little sites for it the location is its own separate FM lottery). You can assign different priorities, and leave sites blank if all your care about is the timing like doing Medicine first to give you a good foundation, or leave time blank if all you care about is doing Surgery at Easton.
Or you can leave everything blank if you give 0 craps, and the system will just chuck a random schedule at you.
In general, depending on how specific your requests are, you may get one or two. I got psych, surgery, and medicine when and where I wanted them. Psych at Friends, where I did it, was a pretty hot commodity but I aimed for the lowest hanging fruit with surg/medicine, asking for Philadelphia area stuff which has a lot of slots since I didn't want to move away for them.
Ultimately, if you are truly dissatisfied with your schedule, you can engage in horsetrading with your classmates. "I'll give you peds at St. Chris if you'll swap surgery with me so I don't have to do it first."
As long as everyone comes out of the process with a functional schedule, the school gives you a thumbs up.