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Emergency Medicine�Is it for you?

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Welcome to EM!

A career in Emergency Medicine
How to plan ahead
Maximizing your application

Let’s Talk About...

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What We Do

Experts in undifferentiated patient presentations
See anyone who comes through the door
Make critical decisions in real time with little information
WE ARE THE SAFETY NET

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What We Do

Administration
Critical Care
EMS
International Medicine
Ultrasound

Pediatric EM
Research
Simulation
Sports Medicine
Toxicology
Wilderness Medicine

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Find a Mentor!

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Plan Ahead - MS1

Join EMIG and EM resident organizations

Get involved

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Plan Ahead - MS2

Take on leadership roles with EMIG/volunteering

Study for and take USMLE Step 1

Get involved

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Plan Ahead - MS3

Strong performance across all clerkships

Winter: Meet with EM advisor to plan 4th year schedule

Spring: Apply to away rotations

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Start applying to

away rotations during spring of MS3 year….

as early as March

One away rotation is enough for most students.

Pro Tip #1

Pro Tip #2

Where to Rotate?

Academic programs: It’s almost assumed you will do 1 rotation at your home school. There are always unique scenarios where this may not be what you choose to do, but be prepared to explain during interviews if you have not rotated at home. Academic programs will prepare a Standardized Letter of Evaluation (SLOE) which is written by the residency leadership/Clerkship Director based on your rotation performance. �

•Community Emergency Departments without EM residents may offer more opportunities for hands on procedures and may be a great rotation to learn what exactly a lifelong career in EM entails. However, a letter from this rotation is not as helpful as the one written by EM educators. �

•Most programs use VSAS/VSLO for applications. A few programs have individual applications. These are more cumbersome, but the non-VSAS schools tend to have fewer applicants. Newer programs may also get fewer applicants, and can be a great opportunity. �

•Location is the most common reason to be interested in a program and rotation. Application reviewers like to see a connection between applicants and their program. A rotation in the region can supply this connection. �

• Based on ASC-EM Committee adviser experience, we recommend applying to three places for each block/month you are trying to fill. �

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Plan Ahead - MS4

Summer

Fall

Complete home and away EM rotations

+

Take USMLE Step 2CK and Step 2CS

Apply and interview

Winter

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Plan Ahead - MS4

Transition from data gatherer to clinician
Focused presentations
EM differentials (Pro tip: Use your EMRA Basics of EM Guide!)
Have a plan & own your patients
Practice calling consults

Rock Your Rotations!

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Plan Ahead - MS4

Complete 2 academic EM rotations
One HOME
One AWAY

If your school does not have a home rotation, complete 2 AWAYS

We recommend applying to 3-6 rotations for every block/month you are trying to fill

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Maximize your Application

ERAS application
MSPE (Dean’s Letter) and transcript
USMLE scores
Letters of recommendation
Personal Statement and SVI

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Maximize your Application

USMLE Step 1 and Step 2CK are both important

If you fail Step 1, take Step 2 CK early

(early means score available before 9/15)

Programs all treat the exams slightly differently when deciding who to interview and rank. Some data suggest that programs view Step 1 and Step 2CK equally, while other data indicates that either Step 1 or 2CK scores are given more importance by programs when deciding who to interview and rank. However, it is true that Step 2CK covers more clinically relevant material, thus a really good Step 2CK score can make a Program Director forget about a mediocre Step 1 score.�

Some programs require Step 2CK in order to grant an interview and most programs will want to see a Step 2CK score prior to ranking you. Try to do Step 2CK as early as you can and ensure you take it by December so it is available by the time rank lists are submitted.�

Remember to release these scores to ERAS so programs can actually see the results of all of your work.

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Maximize your Application

The Personal Statement is not highly weighted

Address any areas of concern in your application

Most important: less than a page, spell checked, and grammatically correct!

Surveys of EM Program Directors show that they consider the Personal Statement (PS) to be one of the least important factors in deciding who to offers interviews to and in determining the match list.¹Generally speaking, this means for most people -play it safe.

DO:

Address the following questions:�

1) What drew you to Emergency Medicine?

2) What experiences have you had that prepared you for EM?

3) What qualities do you possess that will make you an asset to a program?

4) What are your goals for your EM training?

Run spell check.
Have someone else read over it for grammar and flow.

DON’T:

Spend too much time on this!
Make it longer than one page (Program Directors get tired of reading these things).
Be too weird or clever. For many readers the Personal Statement will not help and can only hurt you.
Don't use a Personal Statement writing service. Just don’t.�

Special consideration:

Use the Personal Statement to address any area of concern or deficit in your application. Most people screening your application will look to the Personal Statement to explain anything concerning they find in the transcript, Dean’s Letter (MSPE), or CV. Use this as an opportunity to explain what happened and how you learned and grew from the experience. It’s better to get in front of something and offer your explanation than to vainly hope no one finds the red flag.

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Maximize your Application

Programs require 3 letters (4th is optional)
Obtain two Standardized Letters of Evaluation
For your third letter:

People who know you well
Non-SLOE EM letter
Trauma or ICU letters

All EM is okay and sometimes preferable

Ask during your rotation, don’t wait

Leave them an out: “Would you feel comfortable writing me a Letter of Recommendation?”

Most letters other than SLOEs have very little weight. Program reviewers know how to interpret each other’s letters much better than the letters written from non-academic EM faculty. Letters from EM physicians who are not on faculty are ok, but not as useful. They usually cannot be done on the SLOE form as they do not have a comparison group for many of the questions.

Most academic departments are now creating a “departmental SLOE,” a combined letter with the signatures of the Clerkship Director, Program Director, Associate Program Directors, and occasional other key faculty. A second letter from the same institution is less useful. At best, it will duplicate the departmental opinion; at worst it will differ, becoming confusing for those reading your file.

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The eSLOE

Standardized Letter of Evaluation from EM

Establishes credentials of the writer
Allows comparison of student to peers
Provides global assessment of student
Allows for narrative comments

Matching in EM is ALL about the rotations and your letters of recommendation. In fact, our specialty puts an enormous emphasis on letters from within the specialty. We even created our own standard letter, the Standardized Letter of Evaluation (SLOE), which is often cited by EM program directors as the most important factor in deciding who to interview for an EM residency position.�

We recommend 2 SLOEs. According to a recent CORD ASC-EM survey, the majority of residency programs (79.2% (95% CI 71.3-87.1%) require at least one SLOE to interview the “average” applicant (defined as high pass/honors grades, first-pass United States Medical Licensing Exam (USMLE) Step 1 score of 230, 1-2 scholarly projects and no red flags). When ranking an average applicant, 47.5% (CI 37.8-57.2%) require 2 SLOEs and only 1% (CI 0-2.9%) require 3 or more.² Three SLOEs is generally unnecessary except for certain applicant groups.
A home institution SLOE is expected by most programs. The occasional exception is if your home institution does not have an EM residency or a robust clerkship. It is also anticipated that you would have a letter from each site you rotate at, unless it is a particularly late rotation. Not having those letters will require explanation. The most unbiased opinion is the one from the visiting rotation leadership.

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Timeline

March/April: Schedule home/away rotations
May-Sept: Complete rotations, secure your eSLOEs
Mid-Sept: ERAS opens
Oct 1: MSPE released
Oct-Feb: Interviews
Feb: Rank lists due
Mid-March: Match!

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Maximize your Application

Talk to your advisor

Most students will only need to apply to 20-30 programs to match!

You should apply to enough residencies to obtain a reasonable number of interviews and programs to rank. The 2018 NRMP Charting Outcomes in the Match showed that those who matched in EM ranked 13 programs, on average (versus 4 for unmatched applicants).³ In a recent CORD survey, the majority of faculty involved in advising EM bound medical students recommended that the “average” student (described as a combination of high pass/honors grades, first-pass USMLE Step 1 score of ~230, 1-2 scholarly projects & no red flags) apply to between 21-30 programs.² Less competitive applicants will likely need to apply to more but AAMC data suggests that even for students with a USMLE Step 1 score of </=218, the rate of diminishing returns is 27-31 applications, making it not beneficial to apply to more than this number. Ultimately, the number to which you should apply will depend on the strength of your application and competitiveness of programs you are applying to.

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Maximize your Application

Aim for 10-12 interviews
Go to pre-interview social events
Prepare some well-researched questions
Be yourself

Most programs will send out their first wave of offers (via email) in October and early November. Rolling admissions continue with applicants continually being taken off the waitlist.�

•How many interviews: It depends. The factors involved include your competitiveness (medical school, grades, step scores, SLOEs), as well as factors like being part of a couples match and the region or type of programs you are targeting.�

•Generally speaking, data has shown that interviewing at 12 programs will give you a 99% match rate.³�

•There is generally no benefit to “hoarding” more than 12 interviews. Other applicants (your future colleagues) are hoping for those spots. Cancel your “extra” interviews early and focus your energy on the 10-12 you are most interested in. This will save you time and money.�

•Because the majority of interviews take place in November, December, and early January, plan to take those months off or take elective rotations that would allow you to be away during that time.�

•Stay on top of your emails. Offers are sent in batches and if you want a certain date, the earlier you respond the more likely you will get it. If you will be off-line for awhile, designate a proxy to check your emails. Have them respond if invites come in, as these can fill up amazingly quickly.�

•There is an etiquette with canceling interviews. If you have decided not to go on an interview, you should cancel as soon as you make this decision (or at the very minimum, at least 2 weeks before your interview date). This is in deference to those still on the waiting list who can take your spot and you would want this reciprocated for you. Canceling an interview less than 2 weeks of the date reflects poorly on your professionalism. The world of EM Program Directors is a small one and they often know each other. Many Program Directors will contact your home program leadership if you no show for an interview or cancel at the last minute. �

Pre-interview

• Most programs have a social event with residents either the night before the interview or afterwards, usually at a restaurant, bar or lounge. Dress is typically casual. Significant others are usually welcome. �

•It is highly encouraged, if you can make it, for you to attend these socials. The events are for you to interact with the residents, get to know them, and obtain a resident perspective on the program. There are attributes of the program that you may not learn during the formal interview day.�

•Although these are informal settings, you do not want to raise any red flags by making inappropriate comments or end up being carried out for excessive drinking.�

The Interview

•Besides the obvious (dressing professionally, being on time, etc), make sure you show up with a positive attitude. Be courteous to everyone you meet, from the program director to the coordinator to the residents to the research assistants.�

•Review the program website and have questions of your own, showing your interests.�

•Anything on your application is fair game: be prepared to answer any questions.�

• Ken Iserson’s “Getting into a Residency--a Guide for Medical Students” is an excellent read to prepare for interviews. It is written by an emergency medicine program director.

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February: Certify Rank List!

Rank at least 9 for 90% chance of matching!
>12 ranked 95-99% of matching!

Mid-March: Match Day!

Which program should I rank 1^st?

Your number one program should be the program that you expect to be happiest at. While many aspects contribute to your decision, it is your gut feeling that matters most. Here are some general suggestions for picking out your top 3 programs:

Ask your local EM program directors for advice – Program Directors consider it part of their job to help and guide you through the application process. Their knowledge base is formidable and they read thousands of applications annually.
You will make new friends – This may sound silly, but many applicants are reluctant to leave their medical school institution, fearing they will lose touch with their friends due to the increased distance. Rest assured, however, you WILL make new friends, either intra- or extra-departmental (or even outside the hospital).
Location, Location, Location – This is true with the housing market, and it is equally pertinent in residency selection. If a particular EM Residency is your dream program, but it’s located in a region that you are unfamiliar with, or have limited access to your hobbies (i.e. an outdoorsman in NYC or a Californian surfer in Colorado), then you should strongly reconsider.
Don’t be distracted by gizmos and gadgets – What differentiates a strong EM Residency program is the cohesive nature of the residents, the supportive faculty, and the willingness to respond to feedback. Fancy technologies such as EMR, ready access to MRI scanners, and even scribes can be enticing, but they are only as functional as the organization that utilizes them.
Are the residents happy? – This is one of the most important things to assess during your pre-interview dinners. Training at an accredited residency program ensures that you will learn to be an effective and efficient healer. As a result, why not have a good time? If the residents at the dinner seem miserable and depressed, that is a big RED FLAG.

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