I started my first rotation (surgery) this week and they have it worked out pretty well for us to balance clinical experiences and sleep.
On weekdays, we get there around 5, have work rounds at 6 and then spend the day in the OR, clinic, or on the floor with the intern (we have a rotation among the med students on the team). We have afternoon rounds usually around 5. If they haven't started by 6, we can just go home unless we're on call. Otherwise, we go home when afternoon rounds are done, as the on-call student and intern are usually responsible for making sure things discussed during afternoon rounds get done unless there is a very long to do list, so we go home at 5-7 p.m., depending on the day.
On weekends, we get there at 7 for work rounds at 8. We finish checking up on patients and unless there are a lot of emergent cases, we generally go home by mid afternoon, again, unless we're on call.
Call for us is q4 (overnight, in house), and we go home by noon the next day (the schedule for call is essentially identical to the surgical interns' schedules). My only call so far, I got about 3 hours of sleep, broken in half by a trauma case.
We get 1/7 or 2/14 days off, worked out with your team, again following the interns' work hour rules.
Overall, it's not terrible. Yes, you're very tired after a 30 hour call day, but you can go home and sleep during the afternoon, be awake and do whatever you need or want to during the evening, and still get enough sleep for the next day. My point is just that the difficulty/sleeplessness of surgery rotations definitely varies by school, so don't take what you read here as gospel for all med schools everywhere.