As far as timing: I did mine in the Oct-Nov timeframe, only b/c this is when I could fit them in with the least amount of difficulty. (My school has an inane amount of required fourth year rotations and requires Step 2 CK & CS to be done before Nov 1.) I did not use these rotations to get LOR, though. I really just used them as a time to see a different system at a place I was very interested in applying to. If you want to use these rotations to secure a LOR, you should do them earlier than that.
As far as where to apply: I'd suggest you sit down and really brainstorm over what you want from your career, both in residency and in the "long run." As Kimberli alluded to, some questions you should answer:
- Do you want to do a fellowship, or do you plan on a career in general surgery?
- Do you want a career in academics or community? Even if you don't know the answer to this question for sure, might you want a career in academics?
- Do you want to do research in residency? (No? you can eliminate all the 'research-mandatory' programs)
- Do you have any other people (spouse, children, family, friends, pets, etc.) whose needs you need to consider?
- Where in the country do you want to live? (This should probably be the first question you answer)
- Do any faculty members at your program have strong ties to other programs (although this should probably be a minor concern)
- (and the obvious question...) How competitive an applicant are you?
First, figure out where you want to live--and be honest with yourself. When I started this game, I said I had no geographic restrictions but as time went on, I realized I wanted to live in a mid to large size city on the same side of the country as my family, and I preferred not to be in the South. Remember--your time is very limited in residency, and if you are close to family/friends, time differences will limit the availability to talk to them and lean on them. I realized I did not want to move to the other side of the country if that meant never seeing or talking to my family. That significantly narrowed the field.
If you want a career in academics, you should really focus your search to academic residency programs. If you are thinking you want to do private/community practice, you may not need to go to a big-time university program (in fact, you'd probably be happier in the long run if you didn't), you just need to go somewhere where the focus is on developing your clinical acumen and operative skills. If you are even considering a fellowship, particularly a competitive one (peds, onc, etc.) you may want to consider looking at programs with these fellowship programs in place, or at least with a good track record matching residents into these fellowships.
I found this website as a good launching pad for making my application list:
http://www.facs.org/residencysearch/search/search.html
It enables you to search for residencies on a state-by-state basis, and gives some basic stats on each program.
