at UNECOM as a 4th year we have to do selectives in internal medicine, surgery, OMM, and ER... they can be at whatever hospital you want, and doing whatever you want within reason (ER has to be a full out ER not just peds, but internal medicine i did a peds cards month and that counted, surgery can be ortho, uro, etc.)... an elective is doing whatever you want and whatever hospital you want to...