EM Match Advice 44: Approaching your EM sub-internship clerkship – “Just gotta roll with it”

EM match advice approaching your sub-internship clerksihp

Dr. Sara Krzyzaniak (podcast host and Stanford University PD) and Dr. Michelle Lin (ALiEM Founder/UCSF) are joined by Dr. Jessica Bod (Yale University Clerkship Director and 2024 CDEM Clerkship Director of the Year award winner) in this episode to discuss how one might approach their emergency medicine sub-internship. Dr. Bod shares her her wealth of experience and wisdom to provide not only general advice but also answers more detailed questions like:

  • What are some things NOT to do on a rotation?
  • How do I judge my own competitiveness in the residency application process?
  • What if I have decided late in the process that emergency medicine is the career fit for me?
  • What should I expect AFTER the rotation?

Podcast: Approaching your EM Sub-Internship Clerkship

 

Mentioned Links

Read and Listen to the Other EM Match Advice Episodes

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

 

 

 

 

Hot off the press: Bridge to EM curriculum (2nd edition) released

bridge to em emergency medicine 2nd edition

It has been 3 years since the 8-week, self-guided Bridge to Emergency Medicine (EM) curriculum was launched to help graduating medical students prepare for EM residency. The curriculum has been viewed over 43,000 times and we have awarded over 5,000 ALiEMU course certificates. It is now a part of many residency programs’ intern boot camp.

Launching the 2nd edition of Bridge to EM (2024)

We are thrilled to announce that we launching the second edition of the curriculum.

This was made possible thanks to our new co-editor, Dr. Andres Lopez, who revamped and updated the entire curriculum with Dr. Christina Shenvi to include more current articles, updated links, and new quiz questions. We also include a broader representation of foundational learning content such as the interpretation of diagnostic imaging as well as professional competency skills (e.g., communication, efficiency).

Check out the Bridge to EM home page and then head over to take the 9 free ALiEMU weekly quizzes.

By |2024-05-05T21:16:13-07:00May 6, 2024|ALiEMU, Medical Student|

EM Match Advice 43: EM Program Directors Reflect on the 2024 Match

em program directors reflect on 2024 matchDr. Sara Krzyzaniak (podcast host and Stanford University PD) and Dr. Michelle Lin (ALiEM Founder/UCSF) are joined by Dr. Abra Fant (Northwestern PD) in this discussion reflecting on the 2024 Match results, after last year’s shocking number of 500+ unfilled positions. Here are the 2024 relevant numbers for Emergency Medicine, as compared to prior years. In the following podcast, we run down the numbers and what they might mean for the future.

em 2024 match from nrmp competitive table

Match Fill Rates Across Specialties in 2024

 In 2023 Match, the number of unfilled positions was 554 for EM. This has been dramatically reduced to 135 in only one year, although still above previous counts of ≤30 before 2022. 

em 2024 match competitive numbers for other specialties

Episode 43: Reflecting on the 2024 Match

 

Mentioned Link

NRMP Main Residency Match and Reports 

Read and Listen to the Other EM Match Advice Episodes

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


 

EM Match Advice 42: Mid Interview Season Check-In

EM Match Advice featuring Dr Aaron KrautDr. Sara Krzyzaniak (podcast host and Stanford University PD) and Dr. Michelle Lin (ALiEM Founder/UCSF) are joined by Dr. Aaron Kraut (University of Wisconsin PD) in this insightful, rapid-fire, practical episode through the lens of experienced residency program directors.

  • What does the Electronic Residency Application Service (ERAS) preliminary data show just far for the 2024 residency application season?
  • Has the program signaling option been working? 
  • Have there been any surprises or changes during interview season?
  • What should students think about in the post-interview stage? 

Episode 42: Mid Interview Season Check-In

 

Preliminary ERAS Data for Emergency Medicine Residency

Number of Applicants for EM Residency

Graduate TypeERAS 2023ERAS 2024
DO9441,340
IMG7631,437
MD1,4841,568
Overall3,1914,345

 

Average Number of Applications per Person*

Graduate TypeERAS 2023ERAS 2024
DO5950
IMG6348
MD4942
Overall5647

 

Average Number of Applicants per EM Residency Program*

Graduate TypeERAS 2023ERAS 2024
DO202239
IMG175245
MD265238
Overall642722

 

* Values were rounded to whole numbers

 

Mentioned Links

  1. Preiksaitis C, Krzyzaniak S, Bowers K, et al. Characteristics of Emergency Medicine Residency Programs With Unfilled Positions in the 2023 Match. Ann Emerg Med. 2023;82(5):598-607. doi:10.1016/j.annemergmed.2023.06.002. PMID 37436344
  2. Jewell C, David T, Kraut A, Hess J, Westergaard M, Schnapp BH. Post-interview Thank-you Communications Influence Both Applicant and Residency Program Rank Lists in Emergency Medicine. West J Emerg Med. 2019 Dec 9;21(1):96-101. doi: 10.5811/westjem.2019.10.44031. PMID: 31913827; PMCID: PMC6948692.

Read and Listen to the Other EM Match Advice Episodes

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

 

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

Read and Listen to the Other EM Match Advice Episodes

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


 

By |2024-01-04T16:11:31-08:00Jul 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]

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