Agree with the above. You have to stay proactive and vigilant and hustle about obtaining fourth year rotations, totally up to you. Email the hospitals Nycom has a good relationship with, early (even a year early!) and if you’re rotating there in third year, establish a good rapport and ask if you can schedule a fourth year rotation there. For rotations at “outside” hospitals, it’s really a waiting game based on that VSAS service or emailing hospitals directly and asking them. At the last minute though, if you don’t have a fourth year rotation secured, the school is obligated to place you somewhere at one of it’s hospitals. You can also rotate with a doc in the community of your choice during fourth year and use the majority of the time to study, follow a specialist if they go do rounds or procedures, etc, usually it’s approved by the school. As for third year, yeah the school does it for you so you have nothing to worry about. In the end, honestly it doesn’t matter where you rotate at, just get good grades and score high on boards. Rotating at places with residencies of course helps, but remember you can’t graduate or match if you don’t pass. Also remember the “best” hospitals for rotations may also work you toooooo hard and you may have no time to study, so keep that in mind. But yes, you do need a letter from IM for almost every speciality you apply for in match, so you need to study every day and be a good interested medical student lol. Rotations are honestly overall good, but yeah when you’re a second year, ask the class above you for advice, because things always change.