A newsletter for medical students pursuing a career in emergency medicine

December 2020
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2020: A Year-in-Review

Al'ai Alvarez MD
There’s no doubt that this time last year, no one would have predicted the #COVID19 pandemic or its impact on #EMBound applicants for the #Match2021. As we look back on how our lives have changed during 2020, we at the ALiEM EMBound team would like to reflect on some of the year's key highlights and share our gratitude for your readership along your journey into emergency medicine.
  • Death toll and the COVID-19 pandemic: The impact of the COVID-19 pandemic cannot be understated. At the time of writing, the Johns Hopkins Coronavirus Resource Center reports over 13 million cases of SARS-CoV-2 infection worldwide, attributing close to 1.5 million deaths globally and close to 270,000 deaths within the US. As a true testament to our specialty and field, the delivery of medical education quickly adapted to the needs to curb the spread of the virus.
  • Innovation in medical education: We saw the rapid adaptation of remote conferences and didactics using various virtual platforms. ALiEM launched a series of #EMconnect events, which are nationwide, remote residency programming in response to COVID-19. ALiEM also launched the largest EM graduation event with #LevelUp, along with supporting medical students during their transition to residency through the Bridge to EM program, as well as this EMBound newsletter.
  • Structural racism is real: 2020 also reminded us of the devastating impact of structural racism, from the murder of George Floyd to the racial disparities and inequity in access to healthcare and the disproportionate rise of death tolls on racial minorities in this country. We saw the impact of #WhiteCoatsforBlacklives in support of #BlackLivesMatter.
  • Your vote matters: The 2020 presidential election also reminded us of physicians’ vital role in social activism and community engagement. The election has a far-reaching impact beyond just the presidency--it impacts our patients and how we can provide the right care for them.
  • We are grateful to you: In all of this, we are grateful for the resilience and fortitude of our medical trainees. In reading your applications, we are grateful for the homegrown #PPE drives, the engagements on virtual meetings and social media, and the continued innovation to advance medical education.
While 2020 may not have been the year we anticipated this time last year, we’ve come to realize how much more connected and stronger we are as a team. We are honored to continue this journey with you for 2021, and we wish you a safe holiday season. Onwards!
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Purposeful Learning

Moises Gallegos MD, MPH

Although the challenges of travel have disappeared during this digital interview season, the process of meeting new people and getting to know a program can be exhausting. While it's important to focus on the task at hand, I would also encourage you to find time to be purposeful with continued learning of Emergency Medicine. It will be useful for your transition to residency a short while from now, but it can also serve as a reminder of why you've chosen this specialty.

To this extent, remember to check out the ALiEM Bridge to EM curriculum which can help guide your way. As you begin the transition from medical student to resident, instead of using general study material which you've probably become very familiar with as you studied for Step 1/2/CK, start to identify the resources that suit your learning needs within the field of Emergency Medicine. The art of learning in health professions is not just about identifying your learning style (in fact, to think in terms of visual, auditory, and kinesthetic learning is not enough), but rather utilizing techniques to maximize knowledge retention and skill mastery.

The book Make it Stick by Brown, Roediger III, and McDaniel discusses the science of successful learning techniques.
Some methods to highlight include:
  • Retrieval practice improves knowledge retention: Use of flashcards or quiz software that encourage active retrieval of information will strengthen long term recall. Try this with doses of common medications, or with the steps of a bedside procedure.
  • Spaced repetition and interleaving improves consolidation of long-term memory: While you may be tempted to spend a long time focusing on a single topic until you get it down, it's better to vary the topics you review and return to topics at different times.
  • Deliberate and effortful practice improves learning: It may be catchy to say that that it takes 10,000 hours to master something, but purposeful mental modeling and focused review can get you far in little time. Thinking about you would address challenges in managing a sick patient or in performing a procedure will strengthen your understanding. Consider the steps of a procedure, envision yourself performing the procedure, then envision yourself running into a roadblock or complication.
Pretty soon you'll be taking your first EM in-training exam (ITE). Then you'll be taking your board exams. Find the approach to studying that works best for you and that you can continue to do amidst the busy time that is residency.

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As 2020 nears the end, none of us could have anticipated what it would bring. This pandemic has turned our world upside down. It has created a physical distance that can leave us with a sense of solitude, especially in this holiday season. Know you aren't alone! We at ALiEM are here with you. We need to press forward despite the resurgence across much of our country. Be mindful of your plans for travel, ensure your compliance with guidelines, and be wary of PPE fatigue. Together we will persevere. Maintain your hope, as vaccinations are around the corner, and help use your medical knowledge and expertise to share with your community how to stay safe during this pandemic.

Here's the link to ARCHIVE newsletters.

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State of the Season

Sameer Desai, MD FACEP
Residency Program Director
University of Kentucky Department of EM
Chair, Advisor Consult Service, CORD Advising Students Committee in EM

Where are we now?
If you are applying to Emergency Medicine this year, you may feel like you are on a wild ride. You are not alone, and programs are on a parallel roller coaster. Together we can look at the ERAS 2021 Residency Preliminary Data to gain insight into the current state of affairs and competitiveness of the season.

Continuing with an average 5 year trend, the number of applicants to emergency medicine has increased, this year by close to 15% compared to last (4,240 applicants as of Nov 9th, up from 3,699 for ERAS 2020). However, from a competitiveness standpoint, the average number of applications received per program has only gone up from 912 to 970 (6% increase) - a slight rise that programs should be able to readily absorb. So despite the potential for paranoia induced by the lack of away rotations and prospect of virtual interviews, I applaud you all for not applying to more programs. It doesn’t help. The average number has stayed about 60 programs which is still way more than needed for most applicants.

Keep in mind, there were 2657 positions available in the EM match in the last cycle. Though I do not have an exact number, there is likely a slight increase in that number. There were 256 programs in last year’s match, but there are now 271 on the current EMRA website. I estimate these 15 additional programs will equate to 100-150 more spots. This is also between 5-6%. Please understand these are estimates.
So what is different this year? Well, obviously with virtually no cost in interviewing nor the time required for travel, it's easier for the students with the most interviews, to take all those interviews. The current word of mouth amongst program directors (PDs) is a lower cancellation rate than usual. So while the number of applications per student hasn't unchanged, the potential exists for a disproportionate number of interviews going to a smaller group of applicants.

What do we recommend?
No hoarding! Students do not need more than 12 interviews with the potential exception for unusual circumstances (couples matching is the only one that comes to mind). If you get more than 12, start canceling/declining ASAP the ones you are least interested in. You are likely to get even MORE offers as cancellations do occur. It’s a team sport, let's start being team players during the draft. One more time, TWELVE, no more. It's EXTREMELY unlikely you will match at the 13th spot on your list. In fact, last I recall you are over 90% likely to match in one of your top 5 choices.

How to cancel?
Many programs are absolutely ok with later cancellations if it means not wasting time on someone who really was never that interested and then getting to offer a spot to the hundreds who really are. PDs struggle to agree on exact timelines, but at least 1 week is ideal. But many, particularly this year, would even accept 48 hours. In the end, you are helping both sides. But please do so kindly, respectfully, and expeditiously. If you are canceling within a week, let someone know in addition to canceling on the scheduling software, such as the program coordinator and/or the PD. That way they have the maximum time to get the next person on their list.

Should I email a program I am interested in but have not heard from?
Debatable. In the past, advisors would often suggest this for students who have fewer interviews or if they are extremely interested in a particular program. Ideally, you would have done this already. Now, I get at a minimum of 5 of these a day, mostly regurgitating my website to me, and giving me a “connection” to our region. If you are going to do this, be real, be honest, be personal. I keep them all in a folder and pull them out when we get a room. But this year feels slightly different as I have gotten so many of these, it may not be as useful. Keep in mind programs have many things they consider: training physicians for their state, improving gender equality, diversity, local pressures, and countless other pulls. We truly try to look at your application holistically.

Plan B?
Well, that’s a personal choice. Talk to someone you trust. There is no downside or shame in having a back-up available. I shudder at giving a hard number, but what I tell my students is if you have less than 10 interviews by the end, plan B is probably a good idea. Local experience may vary, however, so best to seek counsel with an advisor who can speak from past experience at your institution.

What is about to happen?
Hard to guess. But most PD’s suspect we will have a mass cancellation in mid-December as the students who interviewed early realize they do not need to do 20. With that, more offers may start to happen for everyone.

There are a few possible scenarios for the season.
  • Students will get close to the same number of interviews they normally got in previous years as people cancel, just on a slightly delayed timeline.
  • All programs interview the same few hundred students, and in the end, we don’t fill and have a crazy SOAP week.
  • All programs rank the same people near the top and then go further down their list than in past.
The total number of EM interns in July 2021 will still be more than 2657 (2020 #). We will still have some unmatched. But clearly, there are more than enough spots for the top 10%, top 1/3, middle 1/3, and some part of the lower 1/3. The most at risk are the same as they always have been: IMGs, those who did not match last year, those who had red flags on their applications such as very low scores, bad SLOE’s, or repeated years. For those of you in good standing, please be mindful of others in limiting your number of interviews. For those of you in a precarious position for matching, seek guidance from a trusted advisor to discuss options, and develop a strategy for success.
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As we close out the year, we want to continue to encourage you to expand your social media horizons through engagement in the emergency medicine medical student and residency community. Amidst social distancing, we can continue to stay connected through learning and innovation.
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Virtual interviews: Lessons Learned

The beauty of the pandemic is its ability to help us recognize how we can leverage technology to help bridge the distance. While Match 2021 is around the corner and interview season is well underway, we leveraged our #MedTwitter community for lessons learned to help you be successful during your virtual experience.
  • Relax, but don't lose your cool: While programs want you to be relaxed and friendly, they are also expecting you to show up with your A-game. This is a job interview, treat it as such. Your behavior, words, and answers will all be taken into account, so put your best foot forward.
  • Be ready to shine: Come prepared by knowing about the program, what attracted you to apply, and be able to review and answer questions that are on your ERAS application. Remember, if you wrote about it, it's all fair game!
  • Help close the distance: Although virtual interviews may feel artificial, help the interviewers see your enthusiasm, passion, and love for EM and their program. This may not always translate across the screen.
  • Find your fit: There are amazing programs all over the country. What it boils down to is where you fit best. Pay attention to how you "fit in" with faculty and residents.
  • Gain your gestalt by gaining perspective: While you may not be able to travel, use the variety of experiences offered by the institutions you are interviewing at to augment your 'gut feel.' Informal events with residents, the residency websites, social media resources, and reviewing awards and scholarship successes can all help you gain valuable perspectives.
  • Stay united: Try to connect with your colleagues as much as possible. Despite the stress, remember you are interviewing with future EM colleagues. Support and lift each other up during this challenging interview season.
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Editor-in-Chief: Sree Natesan, MD (Duke University)
Top News Section Editor: Al’ai Alvarez, MD (Stanford University)
SpotLight Section Editor: Moises Gallegos, MD MPH (Stanford University)
Clerkship Section Editor: David Gordon MD (Duke University)
Chief Advisor: Michelle Lin, MD (University of California, San Francisco)
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