EM Match Advice 41: The 2024 ERAS Application – New and Improved

em match advice podcast new eras applicationDr. Sara Krzyzaniak (EM program director at Stanford) hosts this episode with Dr. Michelle Lin (ALiEM/UCSF) featuring all-star guests Dr. Alexis Pelletier-Bui (EM associate program director at Cooper University Hospital) and Dr. Elizabeth Werley (Chair of CORD Application Process Improvement Committee, Penn State Hershey). Both our guests serve as key representatives on behalf of the EM specialty on the AAMC ERAS Supplemental Application Working Group and provide you with a sneak peek behind what is coming for the totally revamped ERAS application for the new 2024 application season.

It will be helpful to download and view the advanced copy of the entire ERAS application while listening to this episode, as we dive into the nuts and bolts of completing the application. 

Episode 41: New ERAS Application

 

Useful Links

Twitter: @Pelletier-Bui, @ebwerley

Read and Listen to the Other EM Match Advice Episodes

Blog posts: https://www.aliem.com/em-match-advice-series/


 

By |2023-08-16T14:57:41-07:00Jul 24, 2023|EM Match Advice, Medical Student, Podcasts|

Mismatch: Why were there so many unfilled emergency medicine residency positions in 2023?

The Study

In an Annals of Emergency Medicine paper, Preiksaitis et al. sought to identify program factors associated with unfilled post-graduate year 1 (PGY-1) emergency medicine (EM) positions in the 2023 Match [1]. The authors completed a cross-sectional, observational study using National Residency Matching Program (NRMP) data and examined 9 variables as potential predictors of unfilled PGY1 positions using regression analyses [2].

The Findings

The authors identified 6 program characteristics associated with unfilled EM PGY-1 positions in the 2023 Match:, smaller program size (< 8 residents), Mid-Atlantic or East North Central location in the United States, prior accreditation by the American Osteopathic Association, unfilled positions in the 2022 Match, and corporate ownership structure. Program type, length, proximity to other programs, and first accreditation year were not predictive characteristics. Many of these findings were similar to a study of the 2022 EM Match results by Murano et al., as well as an analysis of the 2023 Match by Pupazan and Cook in Emergency Medicine News [3,4].

Match 2023, mismatch, emergency medicine residency programs unfilled positions

Match Data

The unprecedented numbers of unfilled PGY-1 EM residency training positions in the NRMP Match results shocked the specialty these last two years. In 2022, unfilled PGY-1 positions totaled 219 (7.9%), and 554 (18.4%) positions were unfilled in 2023 [2,5]. In contrast, the greatest number of unfilled PGY-1 positions in the last decade was 30 (1.2%) in 2019 [6]. A staggering 131 (47%) EM residency programs had unfilled PGY-1 positions among in 2023 [7].

What does this mean for the future of EM?

Who knows? We can’t make such predictions based on data from only 1 Match cycle. We need to closely follow these numbers in the coming years to fully understand trends in student behavior and program expansion. EM was once considered a competitive specialty, but the current supply/demand mismatch of positions to applicants now suggests otherwise. Without a significant influx of additional applicants, the high unfilled rate for EM is likely to continue for the next several years. This has implications for the composition of the EM physician workforce and its adequacy to meet the rising demand for emergency services.

Is student disinterest the problem?

Many have focused on changes to specialty preferences by students as the major driver in these dramatic Match results. However, the decrease in applicants to EM programs may not be the whole story. 2021 was an unusual outlier in the EM Match, likely fueled by the unique circumstances surrounding the COVID pandemic. Comparison of today’s applicant numbers to data from 2021 gives a false impression of applicant numbers. In fact, the average number of applicants between 2015-2020 and 2022-2023 were relatively similar, with the latter demonstrating 122 more applicants (2,801 vs 2,923). However, between 2015 and 2023, the number of available EM positions grew, with an annual addition of 149 PGY1 positions. Although the establishment of new EM programs is often cited as the source of this growth, anywhere from 25-50% of these new positions were due to the expansion of existing residency programs over several different years. With these data in mind, it makes sense to consider the program factors associated with unfilled residency positions and ensure that we don’t exclusively focus on improving recruitment.

What can residency programs do in this upcoming Match cycle?

Programs that have one or more of the characteristics identified in this study are at risk of being unfilled in the Match once again in the next cycle. Many of these characteristics are immutable. Deliberate actions are required to mitigate the risk:

    • Interview more candidates
    • Submit a longer Rank Order List
    • Optimize program website and digital presence
    • Broaden online recruitment efforts to target students in other regions of the country
    • Enhance marketing efforts for medical students at nearby schools
    • Improve the ‘brand experience’ for visiting students and applicants on interview day

What can we do to help recruitment for our specialty?

Excerpted from the paper, “The most impactful elements of student recruitment to our specialty remain unchanged: student mentorship and exposure to the elements of emergency medicine that make for a rewarding career.”

  • Mentor pre-clinical medical students to build early interest in the field
  • Describe your love for the specialty during ED shifts with students
  • Remain positive when interacting with students
  • Don’t role model burnout on shift
  • Explain the limitations of recent EM workforce projections

Conclusion

In conclusion, the landscape of the EM Match is shifting, evidenced by the startling numbers of unfilled PGY-1 positions in recent years. Our deep dive into the factors contributing to these outcomes shed light on several program characteristics associated with unfilled positions. It’s important, however, not to let these figures contribute to a panic regarding the future of EM.

Sure, the increase in vacant spots seems unnerving at first glance, but there’s context to be considered. The surge in EM positions and the relatively steady number of applicants speaks volumes about the supply-demand dynamics at play, something that will require a detailed exploration in its own right. Data points like these do not exist in a vacuum. They’re part of a larger, interconnected system influenced by myriad factors — from medical school experiences to external forces like the pandemic, the changes in the employment structure of many emergency departments, and the current landscape of the healthcare system in general.

Absolutely, the key mission of EM – providing quality care to everyone, at any time – stays constant even as we face these challenges. Remember, even though there were 554 unfilled positions from the 2023 Match, an impressive 90.4% (501 positions) were filled during the Supplemental Offer Acceptance Program (SOAP) [5].  For now, the current workforce and pipeline of new emergency physicians appears stable.

While it’s important to understand and address the dynamics of recruitment, our main goal should always be the training of new doctors. Right now, there are 2,957 interns just starting out who need our guidance and support. They’re the future of our specialty, and our priority should be to help them become the best emergency physicians they can be. Despite the ups and downs of the Match process, let’s not lose sight of our most important job: training the next generation of EM physicians.

References:

  1. Preiksaitis C, Krzyzaniak S, Bowers K, Little A, Gottlieb M, Mannix A, Gisondi MA, Chan TM, Lin M. Characteristics of Emergency Medicine Residency Programs With Unfilled Positions in the 2023 Match. Ann Emerg Med. 2023 Jul 11:S0196-0644(23)00429-8. PMID: 37436344.
  2. National Resident Matching Program. 2023 Main Residency Match: Advanced-Data Tables. Published March 17, 2023.
  3. Murano T, Weizberg M, Burns B, Hopson LR. Deciphering a Changing Match Environment in Emergency Medicine and Identifying Residency Program Needs. West J Emerg Med. 2023;24(1):1-7. PMID: 36735008.
  4. Pupazan, Ionut MD; Cook, Thomas P. MD. Unfilled Residencies were Newer, Rural. Emergency Medicine News 45(7):p 1,22, July 2023.
  5. National Resident Matching Program. 2022 Main Residency Match: Results and Data. Published May 2022.
  6. National Resident Matching Program. 2023 Main Residency Match By the Numbers. Published March 2023.
  7. National Resident Matching Program. NRMP Program Results 2019-2023 Main Residency Match. Published March 2023.

52 Articles in 52 Weeks, 3rd edition (2022)

How can I keep up with so many landmark articles in Emergency Medicine (EM)? This is an often asked question we hear from interns and residents. Published in 2013 (1st edition) and 2016 (2nd edition), the “52 Articles in 52 Weeks” compendium is a compilation of 52 journal articles provided interns a list to read over a 52-week period, at an average pace of 1 journal article per week. We present the updated 2022 compilation.

Methodology for Article Selection

We primarily build off of the original list from 2016. These 52 articles were refreshed such that newer landmark articles replaced those on the same topic.  Additional publications were considered if they were cited on MDCalc’s site or reviewed on clinical EM websites like REBEL EM, Wiki Journal Club, and The Bottom Line during 2016-2022. A panel of 7 EM faculty with a niche in graduate medical education could also add publications for consideration. A total of 71 articles were scored by these 7 faculty using the Best Evidence in Emergency Medicine (BEEM) score with an EM intern audience in mind.

Best Evidence in Emergency Medicine (BEEM) Scoring [1]

Question for reviewer: Assuming that the results of this article are valid, how much does this article impact on EM clinical practice?

BEEM ScoreDescription (revised for EM intern audience)
1Useless information
2Not really interest, not really new, changes nothing
3Interesting and new, but doesn’t change practice
4Interesting and new, has the potential to change practice
5New and important: this would probably change practice for some EM interns
6New and important: this would change practice for most EM interns
7This is a “must know for EM interns

Results

The final list of the top 52 articles, based on the mean BEEM scores, are presented below in descending rank order. A bonus 53rd article is also listed because there was a 4-way tie for articles #50-53. Feel free to copy-paste this list into your own Google Sheets or Excel spreadsheet for list sortability.

Project Lead

  • Nicholas Dulin, MD (EM Resident, Department of Emergency Medicine, Einstein Medical Center; Captain, Medical Corps, United States Air Force)

Faculty Raters

  1. Claire Abramoff, MD (Assistant Residency Program Director, Department of Emergency Medicine, Einstein Medical Center)
  2. Layla Abubshait, MD (Associate Residency Program Director, Department of Emergency Medicine, Einstein Medical Center Montgomery)
  3. Jacqueline Dash, MS, DO (Core Faculty, Department of Emergency Medicine, Einstein Medical Center)
  4. Joseph Herres, DO (Research Director, Department of Emergency Medicine, Einstein Medical Center)
  5. Jessica Parsons, MD (Associate Program Director, Department of Emergency Medicine, Einstein Medical Center)
  6. Anthony Sielicki, MD (Assistant Program Director, Department of Emergency Medicine, Einstein Medical Center)
  7. Steven J. Walsh, MD (Medical Toxicology Faculty, Einstein Medical Center)

Reference

  1. Worster A, Kulasegaram K, Carpenter C, et al. Consensus conference follow-up: inter-rater reliability assessment of the Best Evidence in Emergency Medicine (BEEM) rater scale, a medical literature rating tool for emergency physicians. Acad Emerg Med. 2011;18(11):1193-1200. [PubMed]

Improving Your ED Efficiency: Upgrade This Elusive Skill

Improving Your ED Efficiency ALiEMU emergency department

No specialty in medicine requires “efficiency” more than Emergency Medicine (EM). Being able to seamlessly and quickly move between tasks is a necessary skill to function in the Emergency Department (ED). The controlled chaos and many moving parts can be overwhelming to new learners in the department and takes dedicated time and experience to overcome. Along with learning the necessary medical knowledge, efficiency expertise is crucial to becoming a high-performing emergency physician. Unfortunately, there is minimal formal training on how to maximize efficiency skills, leading many new EM learners (e.g. medical students and junior residents) having to troubleshoot and create these skills for themselves. 

ED Efficiency Themes

Research and anecdotal tips on being an efficient healthcare provider are sprinkled throughout the literature, but there are no established efficiency guidelines or consensus recommendations. Parsing through all available smattering of information in the literature, we identified 3 distinct “themes”: 

  1. Efficiency in workflow practices: This means learning skills that maximize a practitioner’s ability to see more patients throughout the shift. These skills work to help providers navigate patients quickly through the department, maintaining constant flow and maximizing resource utilization. By improving one’s workflow practices, tasks can be completed quickly and more patient’s can be seen overall.
  1. Anticipating roadblocks: Situational awareness of potential hurdles allows providers to more easily find workarounds to keep patients on a forward path. Understanding the intricacies of the health system and the functionality of a hospital allows for better anticipation and planning for future impedances to patient care and progress toward disposition.
  1. Effective team communication: Communication is an integral part of being an EM physician. By improving communication and learning to effectively work in a team, a provider can improve their overall efficiency in the department and can decrease provider mental burden. 

The ALiEMU 3-Course Series

As educators, we believe all skills can be taught. This includes efficiency skills. After distilling the available efficiency literature, we designed 3 courses, based on the above themes to best teach efficiency to new EM learners.

ED Efficiency ALiEMU badges emergency department

Our FREE curriculum uses the ALiEMU platform to simulate real-world scenarios, integrating the lessons in an interactive and fun way. Learners will discover strategies to optimize their time in the ED and begin their journey toward optimal efficiency. 

Examine how your ideas of efficiency fit with the strategies. These concepts may be new, or may already be a part of your EM practice. While operations vary for hospitals and EDs, the content taken as a whole represents the best practices found in the literature. These 3 themes should begin and guide your journey toward efficiency mastery. 

What are some of YOUR best tips for efficiency on shift? Contact us on Twitter (Dr. Guy Carmelli @GuyCarmelli) with any suggestions or feedback.

By |2021-12-16T14:34:48-08:00Dec 17, 2021|Academic, Life, Medical Education, Medical Student|

GroundED in EM: A new ALiEMU course series for third-year medical students

GroundED in EM curriculum medical student

During the pandemic, similar to how a work-from-home mentality has become more accepted, a learn-on-own mentality has arisen for medical students. The success of the 9-part Bridge to Emergency Medicine (EM) self-guided curriculum for senior medical students interested in EM has confirmed this. This was evidenced by over 130,000 page views about the Bridge curriculum since March 2020 and 609 awarded ALiEMU certificates since April 2021 (launched only 2 months ago!).

GroundED in EM: A new curriculum for third-year medical students

We are thrilled to announce a 4-week, self-guided reading/listening curriculum along with choose-your-own-adventure cases paired now with ALiEMU quizzes, certificates, and badges for third-year medical students interested in EM. It’s called GroundED in EM, and created by an all-star team led by GroundED Editor-in-Chief, Dr. Andy Little. Here’s the rest of the team:

Editors:

  • Brian Barbas, MD, FACEP (Associate Professor of Emergency Medicine, Loyola University Chicago – Stritch School of Medicine)
  • Carmen J. Martinez, MD MSMEd (Assistant Professor of Emergency Medicine, University of South Alabama)
  • Guy Carmelli, MD, MSEd (Assistant Professor of Emergency Medicine, University of Massachusetts)
  • Laryssa A. Patti, MD (Assistant Professor of Emergency Medicine, Rutgers Robert Wood Johnson Medical School)

Adventure Co-Creators:

  • Kaitlin Bowers, DO (Vice Chair of Emergency Medicine, Campbell University College of Osteopathic Medicine)
  • Meenal Sharkey, MD FACEP (Assistant Program Director & Clerkship Director; Department of Emergency Medicine, Doctors Hospital)

GroundED on ALiEMU

Similar to Bridge to EM, reading and listening materials have been identified and curated from external sites. Then come on back to ALiEMU to take self-assessment quizzes to get your certificates and badges.

By |2021-06-22T13:20:35-07:00Jun 22, 2021|ALiEMU, Medical Student|

IDEA Series: Virtual “Faux-tation” Rotation for 4th Year Medical Students Interested in Emergency Medicine

Visiting clerkships have traditionally offered the opportunity for extended contact among medical student applicants and residency program representatives, allowing for enhanced assessment of mutual compatibility. Accordingly, visiting clerkships are consistently rated as an essential consideration among residency program leadership when reviewing applications, and among medical students, as they determine “fit” [1,2]. The COVID-19 pandemic has resulted in institutional restrictions on visiting clerkships. Despite the now limited opportunities for medical students to see residency programs of interest in-person, demand for these experiences remains high. Opportunities that allow for increased interaction among medical student applicants and residency programs that maintain compliance with COVID-19 restrictions are needed to fill this gap. Virtual rotations have previously been described in the literature in multiple other specialties [5]. Several emergency medicine programs have advertised a formal virtual rotation experience via the Council of Residency Directors’ (CORD) listserv that offers course credit to student rotators.

(more…)

Introducing: GroundED in EM a 4 week asynchronous curriculum for 3rd year students

A group of educators from our ALiEM Faculty Incubator 2020 class has created a 4-week virtual introduction to Emergency Medicine curriculum for 3rd-year medical students called Grounded in EM!

Think back, back to March 2020: you were a medical student, happily rotating through core specialties, considering Emergency Medicine, and then WHAM! The coronavirus pandemic pulled the rug out of your regularly scheduled 3rd year. Or, you were a program looking forward to a “business as usual” approach to your 3rd-year EM clerkship. Now, you’ll have limited face to face time, and are wondering “How do we provide the same general em content?”

Are you still considering emergency medicine? Are you worried that your fragmented clinical experience is leaving you unprepared for your rotations in an Emergency Department near you? Are you a program looking for an answer to provide a great EM learning experience? This is the curriculum for you!

Target Audience: Third-year medical students who haven’t committed to Emergency Medicine, but are interested in being introduced to the field AND programs looking to have a comprehensive and ready-made EM related content for MS3’s rotating this academic year.

What: A 4-week completely asynchronous and virtual curriculum containing FOAM resources, including blog posts, podcasts, webpages, and interactive modules, based on the ACGME core competencies. Each module includes a short quiz to test immediate knowledge retention, and the end of the week choose your own adventure case.

Where: Hosted on ALiEM.com

When: Curriculum release on July 1st

Benefits: Walk into your EM rotations feeling confident that you will know how to approach the undifferentiated patient, make a differential, talk to people about it, and write it down, in a compassionate and patient-centered way! Programs can have their students do this curriculum in parallel with their clinical shifts during their 4-week rotation.

Over four weeks, we will cover:

  1. How to approach undifferentiated and acutely ill adult and pediatric patients (Patient Care and Clinical Reasoning)
  2. An introduction to the flow and system of the Emergency Department (System Based Practice)
  3. Communication strategies in Emergency Medicine, both with written and verbal and with EM physicians, consultants, and patients (Interpersonal and Communication Skills)
  4. Professionalism, medical ethics, and patient-centered issues that arise in the Emergency Department (Professionalism)
  5. Creating a differential diagnosis for both common and life-threatening patient presentations (Medical Knowledge)
  6. Exposure to key Emergency Medicine content areas such as resuscitation, evaluation, diagnostics interpretation, and management of common ED presentations (Medical Knowledge, Practice-Based Learning and Improvement)
  7. Development of procedural skills, including suturing, vascular access, as well as EM tricks of the trade. (Medical Knowledge, Practice-Based Learning and Improvement)

We can’t wait to have you join us on GroundED In EM!

By |2020-06-30T14:48:03-07:00Jul 4, 2020|Academic, Medical Student|
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