It depends on the school. AT OSU (oklahoma state) we get 8 electives, which I used 7 of in fourth year, thus spending almost all (7 out of 10) of 4th year rotations in chicago. Additionally, 4 of those elective must be "primary care" thank God ER and ICU/Medicine count as primary care. (I did ER at community hopital, ER at level one trauma center, ICU at LEVEL I, medicine at County, Ortho trauma at level I, anesthesia at community, Pulmonology/critical care at level I) It was a good experience, and a chance to see more trauma and pathology than in oklahoma. (which is helping me some now, with our knife and gun club).
It just Depends on the school - remember it is hard coordinating all that paperwork form outside hospitals to your home school, and as elelctives at OSU were pass/fail and many of my rotations required a end of rotation test, my motivation laid purely in getting a good SLOR (and of course my own education.)
Hope that helps
The Mish