EM-Bound Medical Students: Residency Application Process
David Gordon, MD
Associate Program Director
Duke University
Originally published in Jan 2024 EM Bound newsletter
One of the challenges in the residency application process has been the ability of applicants to communicate their genuine interest to programs through ERAS. Historically, programs have been left to guess whether they are just one box among many being checked by an anxious applicant. To remedy this, Emergency Medicine (EM) joined other specialties in 2023 in using Program Signaling to incorporate an applicant’s level of interest in the interview selection process. In 2024, Program Signaling will be joined by Geographic Preferences as additional means for applicants to express their interest to programs.
What did last year’s experience teach us about how to utilize these tools as part of one’s application strategy?
Signaling Matters
Across specialties, the AAMC’s analysis of the ERAS 2023 showed that sending a program signal increased the interview invitation rate. For EM, the median applicant interview invitation rate at a program was 63% for applicants who sent a signal compared to 33% for those who did not. There was variability in the degree to which a program weighted signaling, but the averages indicate that signaling is a valuable tool that could improve – but not guarantee – an applicant’s chances of an interview offer. There is no reason for an applicant to skip this section as programs won’t be able to differentiate whether they didn’t receive a signal because the applicant didn’t send a signal to them or because they didn’t send any signals at all.
Geographic Preference May Help
Emergency Medicine did not participate in geographic preferencing last year, so there is no specialty-specific data yet to provide guidance. But extrapolating from other specialties, geographic preference will likely further help an emergency medicine applicant’s probability of being offered an interview. The AAMC’s analysis revealed that the highest interview invitation rates occurred with the combination of a program receiving a signal and being located in the applicant’s geographic preference. Independent of signaling, geographic preference aligning with a program’s location increased invitation rates in some specialties. Geographic preference differs from signaling in offering an applicant the option of selecting “no preference” to demonstrate flexibility, but the potential impact of this option in EM has not been studied. Advisors in EM have outlined potential pros and cons for the different selection options for geographic preferences. Similar to signaling, it’s important for applicants to understand that programs will not be able to distinguish an applicant from skipping the question from an applicant selecting a different geography.
Home and Away Signaling
Last year, the recommendation from EM advising was not to signal one’s home or away rotation. This year, however, the AAMC has made the suggestion that applicants signal the programs they are most interested in even if they are a home or away rotation. Of note, EM increased the number of signals each applicant has at their disposal from 5 to 7 for this year. It is possible that some home and away rotations may tell their students not to send them a signal, but unless this is very clearly stated by a program, one should follow the AAMC’s guidance.
Strategy is Personal
Which programs an applicant should signal and whether or not to select a geographic preference vs no preference will be a personal decision, primarily determined by one’s interest (e.g., strong geographic preference) and sense of competitiveness. The general advice remains that applicants should only signal programs they are genuinely interested in, but it is important to recognize data from last year showing signals were not evenly distributed across programs. Signals may vary in their potential to increase the probability of an interview offer depending on the total number of signals a program receives, so having some spread across programs of different competitiveness is worth considering.
Program Signals and Geographic Preferences offer new tools for applicants to communicate their interest to programs in the pre-interview phase of the application process. These are not sections that should be skipped as programs will assume you just signaled other programs or preferred other geographic regions. How to best incorporate them into a strategy that reflects your interests and competitiveness will be optimized by open communication with your EM advisor.
Resources
- MyERASⓇ Application Updates and Program Signaling: Guide for Applicants
- AAMC: Exploring the Relationship between Program Signaling, Geographic Preference, and Interview Invitations across Specialties
- 2023-2024 MyERAS Applicant and Advisor Guide for Emergency Medicine
David Gordon, MD
Associate Program Director
Duke University
Originally published in Nov 2023 EM Bound newsletter
November has strolled in and you still haven’t heard from your favorite program. Or maybe you are worried you have fewer interviews than you are comfortable with. Is it okay to reach out to programs at this point to let them know you are still out there and genuinely interested? With over a month having passed since ERAS opened to programs, November marks an appropriate time for applicants to begin individually emailing programs of high interest. That being said, there are a few ground rules and suggestions to keep this form of communication effective for everyone:
- Limited Number: This is not round two of ERAS where applicants should blast 20 plus programs and see what sticks. If everyone did that, it would only make for a bunch of disgruntled program directors and render this form of communication useless. So begin with a limited number of programs to reach out to – with around two being an approximate guide. You should only be reaching out to programs you have yet to hear back from.
- Limited Size: This is also not the time to resend another personal statement. A lengthy email can create a negative first impression visually from the time it’s opened. Try to keep the main text of your email to 1 paragraph. Your goal here is simple:
- Reaffirm your interest in the program.
- Briefly explain the reasons for your genuine interest.
- Express appreciation for being considered for an interview.
- Be Specific: It can be helpful to reinforce any professional or personal reasons why the program is of particular interest. Professional reasons could include an EM subspecialty (e.g., ultrasound, toxicology) or an area of research that is strongly supported at a program. One can also make reference to desirable aspects of a curriculum or institutional strength, but try to avoid the use of generic statements that are cut-and-paste in nature. Personal reasons for wanting to be in an area – such as being near family – can be impactful and should be shared. If you are couples matching and your partner received an interview at the institution, mentioning this information can also add credibility to your expression of sincere interest.
These emails will not guarantee an interview, but they should at least help ensure your application has been carefully considered. As always, if you have any concerns over your interview numbers or overall situation, be sure to engage with your advisor for tailored guidance. Best of luck and happy interviewing!
Resources
David Gordon, MD
Associate Program Director
Duke University
Originally published in Oct 2023 EM Bound newsletter
Along with cooler temperatures and the changing colors of leaves, the arrival of October marks the next phase of the residency application season. Programs will review the ERAS applications that you spent countless hours – and perhaps sleepless nights – to complete. They will be looking for applicants estimated to be a great fit for their program and offer them the opportunity to interview. Once you are at this stage, a successful interview is one of the most important factors that can lead to a favorable position on a program’s rank list. So what can you do to optimize your interview?
Here are 3 big things you can bring to the table:
- Bring Energy: Maya Angelou’s famed quote of “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel” are words to live by. They also apply to residency interviews. Programs may not remember your exact words, but they will remember how they felt talking to you. At the end of the day, programs will be asking a simple question: “Is this someone I would be excited to work with?” Even in a virtual setting, bringing positivity and enthusiasm to the interview will help ensure the answer is “Yes!” Pay attention to how you are feeling on the inside because if you are feeling tired and uninterested, so is the other person. Channel the feelings you want to be a lasting impression of your interview.
- Bring Substance: In addition to bringing good energy, you can also create a good impression by making your interview “easy.” In this context, easy means supporting an effortless flow and exchange of information. So when asked about your hobbies, research, or experiences, be prepared to speak about them not only with enthusiasm but also in detail. Entertain your listener with intrigue and specifics about what the activity was like, why it was important to you, what challenges you faced, and what you learned from them. Once again, the interview with you as an applicant is being used as a rough proxy for what you may be like as a resident. If the interviewer has to work hard to draw out answers and keep the conversation going, the assumption will be that it will also be hard to work with you in the ED. But we know that is not true, so do not give that impression!
- Bring Curiosity: Anticipate being questioned with “Do you have any questions?” It is genuinely a way to give you space to ask anything you want to know, but it is also a good opportunity for you to demonstrate sincere interest. Be careful of asking generic questions about the curriculum that can easily be gleaned off a program’s website – as that may just reveal you didn’t take time to do your homework. If you have heard any negatives about a program, it is fair to ask for clarification but do so tactfully. Don’t make a program director feel like they are on a witness stand as you may then come under more scrutiny as well. In general, some of the best questions to ask are those that are personal and positive such as what someone enjoys about their program and its location or, if you have a specific area of interest (e.g., ultrasound), how might a resident with that interest be supported?
At the end of the day, interviews for Emergency Medicine are just conversations. In fact, if the final impression left by your interview is “That was a great conversation,” then congratulations, you have just won the game…and left a memorable feeling. Check out this infographic by our very own Section Editor: Dr. Moises Gallegos for a quick infographic of additional ways to be successful in your interview.
Resources
David Gordon, MD
Associate Program Director
Duke University
Originally published in Sept 2023 EM Bound newsletter
September marks the next phase of the residency application season, during which applicants may begin applying, and towards the end of the month, programs may begin reviewing. In this stage, the perennial questions of “How many programs?” and “Which programs should I apply to?” come full steam ahead. Like many things, the answers to these questions are individualized based on personal goals and one’s level of competitiveness. And like most things pertaining to application strategies, the best sources of information are local advisors who know their students best and are informed by the experience of previous students from their institution. There are, however, some general principles and resources that are good for all applicants to know:
Begin with you
Before asking where to apply, make sure you have taken a self-inventory on what matters to you. Residency will be the most formative and rewarding time in your medical training, but it is no walk in the park. Be honest with yourself about whether you need a specific geography or living environment to support your well-being. Ask yourself: Is it important for you to be near family for support, or are you out for adventure and want to try something different? Do you thrive in the big city or prefer quieter living? Do you learn best by doing, or do you need time to think and process? There is no right or wrong here. Knowing yourself upfront will help make sure you put yourself in a good position to find that right fit and help others in guiding you accurately.
Where should I apply?
After completing your self-inventory, you can use directories to develop and refine your list. EMRA Match and the SAEM Directories both allow you to filter by geography, practice setting, and length of training. If you are an International Medical Graduate (IMG), EMRA Match, as well as the AAMC’s Residency Explorer ™ Tool, can provide you with information on the percentage of IMGs and visa sponsorship at a program. While making sure you identify programs that meet your personal needs, it is also good to be open to different possibilities and not limit yourself at this stage. Explore programs with different practice environments and lengths of training as this may either reaffirm your priorities or pleasantly surprise you with new possibilities.
How many programs should I apply to?
The number of programs an applicant should apply to is a combination of an applicant’s competitiveness and that of the programs being considered. Several factors have changed over the last couple years with Step 1 moving to pass/fail, programs moving towards holistic review, the implementation of program signaling, and, honestly, emergency medicine not filling in the match the last two years. Historic data suggested that there was a point of diminishing returns in which there was no advantage for an applicant to apply to more programs. For US MD applicants, that point was between 20-30 programs and for US DO applicants it was more in the 30-40 range. These numbers are probably still helpful as a rough approximation, but In addition to being based on old data, the predictive ability of this information is limited by the importance of the SLOE, which is often the most important factor when programs review applicants. Do not expect to be told what your SLOE rankings are, but you should be able to gain a sense of your performance from the grade and feedback you received on your 4th year EM rotation.
Talk to people
Lots and lots of people. The common saying goes that all EM programs will give you great training, but there are programs that, because of geography and visibility, may be more difficult to match into because of applicant numbers and selectivity. In addition to your advisor, talk to other faculty and residents to get feedback on your list or at least some of the programs you are considering. Listen for comments like “I know lots of people who are happy there” or “that’s a great place for …” You also may potentially want to adjust if the response to every program you mention is “that’s a hard place to get into.” Just like you did for college and medical school, it is good to have some range of competitiveness as it is not just the number but also the spread that determines the adequacy of your list.
Special circumstances
If you are worried that you have “red flags” in your application that will challenge your ability to match in EM, the Emergency Medicine Application Tool for Common Hangups (EMATCH) can help you identify those situations and direct you to advising resources. For applicants with special circumstances such as couples matching, international medical applicants, or re-applying, multiple advising guides (CORD) have been created.
Resources
David Gordon, MD
Associate Program Director
Duke University
Originally published in Aug 2023 EM Bound newsletter
One of the challenges in the residency application process has been the ability of applicants to communicate their genuine interest to programs through ERAS. Historically, programs have been left to guess whether they are just one box among many being checked by an anxious applicant. To remedy this, Emergency Medicine (EM) joined other specialties last year in using Program Signaling to incorporate an applicant’s level of interest in the interview selection process. This year, Program Signaling will be joined by Geographic Preferences as additional means for applicants to express their interest to programs. What did last year’s experience teach us about how to utilize these tools as part of one’s application strategy?
Signaling Matters
Across specialties, the AAMC’s analysis of the ERAS 2023 showed that sending a program signal increased the interview invitation rate. For EM, the median applicant interview invitation rate at a program was 63% for applicants who sent a signal compared to 33% for those who did not. There was variability in the degree to which a program weighted signaling, but the averages indicate that signaling is a valuable tool that could improve – but not guarantee – an applicant’s chances of an interview offer. There is no reason for an applicant to skip this section as programs won’t be able to differentiate whether they didn’t receive a signal because the applicant didn’t send a signal to them or because they didn’t send any signals at all.
Geographic Preference May Help
Emergency Medicine did not participate in geographic preferencing last year, so there is no specialty-specific data yet to provide guidance. But extrapolating from other specialties, geographic preference will likely further help an emergency medicine applicant’s probability of being offered an interview. The AAMC’s analysis revealed that the highest interview invitation rates occurred with the combination of a program receiving a signal and being located in the applicant’s geographic preference. Independent of signaling, geographic preference aligning with a program’s location increased invitation rates in some specialties. Geographic preference differs from signaling in offering an applicant the option of selecting “no preference” to demonstrate flexibility, but the potential impact of this option in EM has not been studied. Advisors in EM have outlined potential pros and cons for the different selection options for geographic preferences. Similar to signaling, it’s important for applicants to understand that programs will not be able to distinguish an applicant from skipping the question from an applicant selecting a different geography.
Home and Away Signaling
Last year, the recommendation from EM advising was not to signal one’s home or away rotation. This year, however, the AAMC has made the suggestion that applicants signal the programs they are most interested in even if they are a home or away rotation. Of note, EM increased the number of signals each applicant has at their disposal from 5 to 7 for this year. It is possible that some home and away rotations may tell their students not to send them a signal, but unless this is very clearly stated by a program, one should follow the AAMC’s guidance.
Strategy is Personal
Which programs an applicant should signal and whether or not to select a geographic preference vs no preference will be a personal decision, primarily determined by one’s interest (e.g., strong geographic preference) and sense of competitiveness. The general advice remains that applicants should only signal programs they are genuinely interested in, but it is important to recognize data from last year showing signals were not evenly distributed across programs. Signals may vary in their potential to increase the probability of an interview offer depending on the total number of signals a program receives, so having some spread across programs of different competitiveness is worth considering.
Program Signals and Geographic Preferences offer new tools for applicants to communicate their interest to programs in the pre-interview phase of the application process. These are not sections that should be skipped as programs will assume you just signaled other programs or preferred other geographic regions. How to best incorporate them into a strategy that reflects your interests and competitiveness will be optimized by open communication with your EM advisor.
Resources
- MyERAS Application Updates and Program Signaling: Guide for Applicants
- AAMC: Exploring the Relationship between Program Signaling, Geographic Preference, and Interview Invitations across Specialties
- 2023-2024 MyERAS Applicant and Advisor Guide for Emergency Medicine
David Gordon, MD
Associate Program Director
Duke University
Originally published in July 2023 EM Bound newsletter
The personal statement arguably wins the award for the worst ratio of time spent relative to the importance of matching. The Standardized Letter of Evaluation (SLOE), away rotations, and performance on interview day rank supreme in this domain. But that doesn’t mean the personal statement isn’t important or can’t help you end up at the program of your choice. The act of writing the personal statement can help you crystalize your vision and goals, a well-crafted personal statement may enable a program to see a good fit, and personal statements can provide an easy conversation starter on interview day. Here are some broad and basic recommendations to consider as you take on your personal statement.
First do no harm
As the personal statement is typically of limited importance to programs when it comes to interview offers and rank lists, a safe rule to go by is to first and foremost make sure it will not hurt your application. There is the potential of scaring away a program with a statement that comes across as bizarre, egocentric, or full of typographical errors. By all means, feel free to be creative and expressive, but it is always a good idea to have an experienced faculty reviewer confirm “this will not hurt you.”
Address reg flags
As Dr. Benjamin Schnapp has previously advised, the personal statement is the perfect space to address red flags (e.g., USMLE failures) worthy of additional explanation. It is important to demonstrate self-ownership, self-reflection, and resilience – not come up with a bunch of excuses or lay blame on others.
Times to take a risk
There are situations where taking creative risk is worth considering to either further counterbalance a red flag – beyond just providing an explanation – or when you are a less competitive applicant (e.g,, poor rotation performance) who is trying to stand out. Writing a personal statement that utilizes creative writing or a theme to add emotional texture could potentially evoke interest. If taking this approach, it is definitely worthwhile having your statement reviewed to be sure you found the right balance of creating intrigue without crossing over into the outlandish.
Keep to one page
This is a debatable recommendation. I have heard varying comments from program directors about how they respond when they see a personal statement more than one page in length. Some are not bothered by it and are happy to read everything you have to share. I have heard others say that a personal statement that goes beyond one page is an automatic rejection. That might sound extreme, but when you are reviewing a 1000+ applications, little things can take on big meanings. So the best I can say – and how I advise my students – is that there are at least some programs out there that respond negatively if the personal statement exceeds one page, so barring exceptional circumstances, play it safe. Keep it to one. First, do no harm!
Now is a good time to start writing or at least brainstorming for ideas. Use your emergency medicine rotations as inspiration. Best of luck writing and we look forward to hearing what you have to say!
Sharon Bord, MD
Clerkship and Sub-Internship Director
The Johns Hopkins School of Medicine Department of Emergency Medicine
Chair of the CORD/CDEM SLOE Committee
Cullen B. Hegarty, MD
Program Director
HealthPartners Institute/Regions Hospital Emergency Medicine Residency Program
Originally published in June 2023 EM Bound newsletter
Hey Emergency Medicine Applicants—it’s June 2023, and student rotations and letters of recommendation will be returning to a more standard application season this year (YEAH!). Here are some helpful things to know about EM letters heading into the September ERAS application opening.
Background
Emergency Medicine was the first specialty to create our own EM-specific letter, and now many other specialties such as internal medicine, OB/GYN, orthopedics, and dermatology have jumped on board with this concept! Our letter was originally called the SLOR: Standardized Letter of Recommendation. In the past 10 years we’ve changed the name to be the SLOE: Standardized Letter of Evaluation, as the letter is partly a recommendation and partly an evaluation of your performance on a rotation. Recently we created an electronic portal for the letters to be created and saved in, so the letter is now called the eSLOE for electronic Standardized Letter of Evaluation. The eSLOE is written by faculty at academic EM residency programs. Oftentimes, these letters are authored by a group of faculty, rather than an individual faculty member.
- Why is the eSLOE so important? Over the years of the SLOR, then the SLOE, and now the eSLOE, has been consistently rated as one of the most valuable parts of a student’s application to EM by program directors.
- Have there been any recent changes to the eSLOE? This past application cycle we launched an updated SLOE. There is an increase in criterion-based references (does a student meet a certain standard or goal), whereas in the past it was more norm-referenced (how does a student compare to other students). It now includes assessments on:
- Performing a focused history and physical
- Ability to generate a differential diagnosis
- Ability to formulate a plan
- Ability to perform common ED procedures (if your rotation allows students to do procedures)
- Ability to recognize and manage basic emergent situations
- As well as assessments in areas such as:
- Compassion, sensitivity, and respect toward patients and team members
- Receptivity to feedback and ability to incorporate feedback
- Dependability, responsibility, initiative, and work ethic
- Punctuality, attendance, and preparation for duty
- Timeliness and responsiveness in completing administrative tasks
- Interpersonal and communication skills with patients and family members
- Interpersonal and communication skills with faculty, residents, and healthcare professionals.
SLOE Variations
Given the success of the SLOE, over the past 5 years, we have created a few variants of the letter (all versions).
- SLOE for non-academic EM faculty: This is a letter designed to be written by an Emergency Physician that works at a hospital not affiliated with an EM residency program. Examples of this letter from the Midwest would include the University of North Dakota and the University of South Dakota—both schools have EM rotations, but neither has their own EM residency.
- SLOE from an EM sub-specialty rotation: This is a letter designed to be written by an Emergency Physician that you worked with during an Ultrasound, EMS, Peds EM, toxicology, or other EM sub-specialty rotation.
- O-SLOE: Off-service Standardized Letter of Evaluation: This letter can be used for all your non-EM letter writers to use (ex: Surgery, Medicine, Pediatrics, etc.). For this letter, we recommend having someone write the letter that knows you well, more than someone that is well known, and we are truly open to reading this letter from any clinical rotation that you have done. This letter format has been used with less frequency now that away rotations have returned to pre-COVID baseline, but still provides valuable information to letter readers and may be preferred over a standard narrative letter.
Now that you know a little bit about the letter options in EM, let’s talk about letters specific to the 2023 application cycle. Here are some basic recommendations on how to approach getting 3-4 letters for your ERAS application:
- 2 eSLOEs: This should ideally be a group or departmental letter from your home rotation and one letter from your away rotation. If you don’t have a home rotation at your medical school, these both may be from away rotations.
- 1-3 other letters: This should include some combination of a SLOE from a non-academic rotation, SLOEs from EM subspecialty rotations and/or O-SLOEs from your off-service rotation. Instead of an O-SLOE, a standard narrative letter of recommendation could be used as well. What combination you will have of these letters will depend on what clinical rotations you have done so far and where you think you can get your strongest letters from.
- Mentor letter: 1 possible letter from a research mentor or someone who knows you well outside of the clinical area. These individuals should write a regular narrative letter of recommendation for you.
FAQs
What should I do if I have already asked my non-EM letter writers to write a letter for me?
- Don’t worry about it—if they can use the O-SLOE format, great, but if they have already written the letter they can use whatever format they prefer!
What should I do if I am re-applying to EM and only have 1 eSLOEs from last year I can use again?
- If you are re-applying to EM, feel free to use your eSLOE from last year. You may want to add a new letter if you are currently in a preliminary program (from the Program Director). That will be a valuable addition to your application.
For any other questions you may have for this application season, we recommend you find an EM advisor at your school to connect with. If your school doesn’t have an EM advisor, reach out to any EM residency program and we’d be happy to help you out! Feel free to reach out directly to Sharon as well with LOR questions.
Best of luck with applications in the 2023-24 cycle!
David Gordon, MD
Associate Program Director
Duke University
Originally published in March 2023 EM Bound newsletter
There is a lot going on in March! Match Day will be here soon, more programs will begin accepting applications for away rotations, and NCAA brackets will be made only to be broken (if your annual luck tends to be as good as mine). With respect to applying to away rotations, there are some key items surrounding the process that are worth highlighting:
Letters
Depending on the institution, you may be asked to provide 1 of 3 different types of letters. It is good for you to be familiar with how they differ. Letters of Good Standing are typically generic letters that can be provided by your medical school’s Office of the Registrar and simply attest that you are an actively enrolled medical student. Letters of recommendation will require you to identify a faculty member to write on your behalf in support of your application. This type of recommendation is different from the Standardized Letter of Evaluation (SLOE) that will be used for residency applications based on your 4th-year rotations. For away rotations, recommendation letters are primarily designed to affirm your interest in emergency medicine while they may provide general comments on your medical school performance to date and your extracurricular activities. Letters of interest come from you and are your chance to elaborate on any specific areas of interest within emergency medicine but particularly why you are interested in that program (e.g., clinical training environment, areas of expertise, or geography). Follow the program’s instructions carefully. These are not typically the lengthy personal statements you will write for residency applications but more likely a couple of brief paragraphs. Take these letters of intent seriously, as they may be the main determinant of whether a program sees you as a good fit and offers you a rotation.
Communications
Communicating with a program outside their application process is not required. If there is a program you are particularly interested in such that you would accept their offer, then it is reasonable to contact the course director in advance or simultaneously with submitting your application to emphasize your high level of interest. But this type of communication should be limited to the program that is your top choice, both from a professionalism standpoint and also because you could be remembered as disingenuous come residency application season if you write to express interest but do not follow through on it. If you have not previously communicated with a program and are wondering when it would be okay to find out the status of your application, waiting about 2-4 weeks from the time of submission is appropriate before reaching out.
Cancellations
Inevitably you will hear from some programs before others. It can be stressful knowing what to do if you have yet to hear from your top choice. It is understandable if you end up canceling an initial offer if a more preferable one comes later. But timing is important! Canceling at least 2 months in advance should not be a problem, however, canceling less than 4 weeks could be. If you cancel less than 4 weeks before your start date, the vacancy you left may become a wasted spot as a program will not have enough time to onboard a new student. It is best to avoid canceling this late.
Best of luck to those who will soon find out where you will be training to become an emergency physician. To those beginning the process of deciding and applying, we look forward to getting to know you in the months to come.
Resources
David Gordon, MD
Associate Program Director
Duke University
Originally published in Feb 2023 EM Bound newsletter
As a medical student, you have either already heard much about the concept of the “fit” or will undoubtedly come across it in due time. While I may have forgotten most of my high school French, one expression I have remembered is “je ne sais quoi” which translates to “a quality that cannot be described nor easily named”. And so it is in explaining how you should choose your specialty and then ultimately your residency program that you will similarly be presented with the illustrious yet amorphous “fit”. How is one exactly supposed to know when something is present when it cannot be easily defined? I have accumulated 3 methods:
Wake-up Call
I did not come into medical school with any notion that I would be an emergency physician. We found each other in my third year. Like many students, I enjoyed most rotations, but what stood out about emergency medicine was how I felt in the morning, noticing a different level of excitement and anticipation of what was to come. You might say there was an extra kick in my step on the way to the hospital, but whatever it was, that initial reaction to the start of the day – or evening if it was a night shift – served as my guide that I had found the right specialty for me.
Try on Different Hats
It’s hard knowing whether you found that perfect jacket or dress until you try it on. Even then, taking off the first item and trying on others can be helpful in realizing what you are really looking for. In choosing a residency program, I similarly had to try things “on”, pretending to be at a different program at different times, paying close attention to how I felt about the “fit”.
Talk It Out
Sometimes the answer does lie within, but it requires getting it out of our minds and into the air to let it take shape and reveal itself. If you are feeling unsure about your choice of specialty or program, talk about it with a trusted confidant. As you are talking, the answer may declare itself or you can at least pay attention to the feelings that come with discussing the different options.
Medical education is full of choices. Some are easy; some are hard. Some come quickly; others take time. Our feelings can be a helpful guide when the decision is unclear. Paying attention to them, testing them out, and talking through them may ultimately bring clarity and reveal what you are looking for.
David Gordon, MD
Associate Program Director
Duke University
Originally published in Jan 2023 EM Bound newsletter
The arrival of the New Year marks several important events. There is the affirmation – or often reaffirmation – of promises made to promote one’s better self, typically through improved diet, exercise, or personal values. There is also the intersection in the application process where current applicants start to wind their season down while future applicants begin to wind theirs up. For those beginning the process, planning for an away rotation is one of the first orders of business. The national recommendation for doing an away rotation in Emergency Medicine has been balanced each year against the status of COVID-19 infections, but given the high likelihood that an away rotation will remain recommended, preparing now can help ease the process.
One Away
The longstanding recommendation for Emergency Medicine has been that an applicant only needs 2 Standardized Letter of Evaluations (SLOEs) to be competitive, meaning one SLOE from two different programs. Students that have an emergency medicine clerkship but not a residency program at their institution should seek the advice of their advisor on whether more than one away rotation is necessary based on local experience and the strength of their personal application. There may be rare and special circumstances where a student that has a home residency program will be advised to do more than one away, but as a general rule, no student should feel it is necessary to do more than one for the sake of gaining competitive advantage. (In fact, the opposite may occur). An applicant who is unable to do an away rotation may still successfully match, but having two SLOEs is the norm and puts the applicant in the best position.
Plan Now
There is a lot of preparation behind obtaining an away rotation. In addition to deciding where you want to visit, you will need to have your vaccination record ready – noting different institutions may use different forms – secure a criminal background check, and update your CV. While most programs use the AAMC Visiting Student Learning Opportunities (VSLO) program for applications, be aware that there are some programs that use a different service or direct mailing. This information should be available on directories or, most reliably, on a program’s website.
Know Your Resources
Emergency Medicine has a lot of dedicated educators who have put together some excellent resources to guide you through application season. There are 2 main directories to help you pick out an away rotation: SAEM Clerkship Directory and EMRA MATCH. In addition, Clerkship Directors in Emergency Medicine (CDEM), the Council of Residency Directors in Emergency Medicine (CORD), and the Emergency Medicine Residents’ Association (EMRA) all have sections on their websites dedicated to medical students. Definitely check them out. And if you haven’t already, be sure to engage your local advisor who can best tailor a strategy that aligns with your candidacy and goals.
You may come across different schools of thought about where to do an away rotation and, in particular, whether to do one at a top-choice program where the concern is that you might hurt your chances rather than prove your worth. I would encourage you to stay positive and choose a place you are strongly considering for residency or that offers a different training environment than your home school to broaden your experience. When done for the right reasons, an away rotation can be of great educational value and help shed light on where you will ultimately be happy. Welcome to the New Year!
Resources
- CORD – Advising Students Committee in EM: How to Get an Away Rotation Guide
- EMRA and CORD: Student Advising Guide
- Clerkship Directors in Emergency Medicine: For Students
David Gordon, MD
Associate Program Director
Duke University
Originally published in Dec 2022 EM Bound newsletter
It’s December which means it’s list-making time. There is your holiday shopping list, your New Year’s resolutions list – which may look remarkably similar to last year’s if you are like me – and then, of course, your evolving program list for the residency match. As interviews continue, what are some ways you can catalog your impressions so that come February you have some aids and reminders to guide your final decision? Here are some considerations and suggestions:
Facts vs Feelings
The most important indicator from an interview day for whether a program may be a good fit for you will not be its statistics and policies (e.g., patient volume or how traumas are run), but rather how you felt. Did you feel connected with your interviewers? Could you relate to the residents? Did you sense people were happy? Were you inspired? In the past, you have made choices over colleges and medical schools, so you already have experience making big decisions for what best suits your learning style and well-being. I wager it was your feelings that provided the most insight back then, so here, too, prioritize capturing and recording what your “gut” tells you about the program rather than the facts acquired by your mind.
Audio vs Visual
Consider your learning style in what medium you want to adopt in capturing your impression. Different learning styles exist with some of us being visual, others auditory, and then those that process through reading and writing. Visual learners may be aided by the use of colors or pictorial representations. Conversely, auditory learners could consider recording their impressions to later hear both their thoughts and tone. Reading-writing learners may be best served by taking notes to process both at the moment and then reflect upon in the future.
Electronic vs Paper
If a visual medium is used, spreadsheets can be useful for displaying a broad overview, adding accents, and making continual adjustments. On the other hand, notecards provide a tactile feel that can help engage memory, are conducive to adding visuals, and are easy to rearrange. Look at how you already prefer taking notes in other settings and consider adopting the same approach for this task.
At the end of the day, there may be one program that clearly stands out to you above the rest, but commonly it will come down to two or three. Keeping an active record of your impressions and feelings now may help you make that final decision in the months ahead. A new year with new beginnings awaits!
Resource
Alexis Pelletier-Bui, MD
Associate Program Director
Cooper University Hospital
Originally published in Sept 2022 EM Bound newsletter
Stressed out about where to send your 5 signals through the ERAS Supplemental Application? Don’t be! Remember – program signaling (PS) is designed to help YOU, the applicant, garner the attention of your most desired residency programs at the time of application submission. The PS experience from otolaryngology, internal medicine, general surgery, and dermatology over the past 1-2 years has proven to do just that – programs report interviewing applicants they would have previously overlooked, and ENT applicants across all levels of competitiveness experienced increased interview yield at signaled programs. Hopefully, that eases some of the anxiety a bit – but if not, let’s discuss some ways to maximize those signals.
Do not signal your home or away rotation programs
Your friends in other specialties may be told otherwise because their specialties have decided to allow applicants to signal their home and away rotation programs. However, for the 2022-2023 residency application season, the emergency medicine community has decided to allow your home & away rotation programs to be two “freebie” signals – so do NOT waste your signals on them!
It is only to your advantage to use all 5 signals
While you do not have to participate in PS and can choose to use anywhere from 0-5 signals, there is no downside to participating. It is in your best interest to utilize all 5 signals to maximize your choices of obtaining residency interviews.
Understand your competitiveness
Your signal does not guarantee an interview at the signaled residency program. If a residency program filters out applicants by the requirement of a USMLE Step 1 or 2 score, USMLE score cutoffs, or need for visa sponsorship, it is unlikely that a signal will overcome these hurdles. You are most likely to garner an interview at a program if your stats and applicant characteristics closely match those of current residents in the program. Do your homework and look closely at program information available to you via EMRA Match, Texas Star, the AAMC Residency Explorer tool, and program websites, etc., to compare your application information with information of current/past residents.
Understand the competitiveness of the programs you are signaling
Current ENT and ERAS SuppApp data suggest that about a quarter of programs in each specialty received about half of all signals. As the number of signals received by these competitive programs increases, the signal value at those programs decreases. Therefore, if you are trying to decide between two programs that you like equally, you’ll likely get the most bang for your buck by utilizing a signal on the one that is less competitive.
The golden rule
Only signal programs you are TRULY interested in! This is the first year emergency medicine is participating in program signaling and it has only been in existence in GME for 2 years, therefore there is a paucity of data available to advise best practices for signal allocation. However, one recommendation remains true: Only signal programs you are genuinely interested in! Do not try to game the system just to pad your interview numbers – you’re only hurting yourself.
Still stressed out?
Discuss your signal choices with an experienced emergency medicine advisor. If you do not have access to one at your institution, you can email [email protected] to be connected with an advisor from an EM residency program.
Resources
CORD: Preference/Program Signaling
AAMC: Supplemental ERAS Application
David Gordon, MD
Associate Program Director
Duke University
Originally published in Aug 2022 EM Bound newsletter
Applying to emergency medicine should be done thoughtfully and strategically. Your advisor will play a key role in helping you understand the process, estimate your competitiveness, and identify programs that might provide the right fit, but it’s also good for you to be aware of the resources out there to conduct your own analysis. The National Resident Matching Program (NRMP) and the Council of Residency Directors in Emergency Medicine (CORD) publish key resources to guide you along the way.
Charting Outcomes
This NRMP report provides insightful statistics based on the actual outcome of the match. Here you can view by specialty tables and graphs comparing different measures for matched and unmatched applicants (e.g., number of contiguous ranks, USMLE scores). You can also see the probability of matching based on the number of programs an applicant ranks. This data can help you estimate your initial competitiveness as well as your final probability of matching based on the number of interviews you completed.
Program Director Survey
Typically every other year, the NRMP administers this survey to program directors to learn more about what factors they rely on when making interview and rank list decisions. While the response rate runs low (29% for Emergency Medicine in 2021), the data provides a story consistent with a common understanding of what matters in applying to emergency medicine. The big ticket items are that your letters of recommendation carry the most weight in interview decisions, away rotations can be impactful, and a USMLE failure can make matching difficult (although certainly not impossible!). After interviewing, your interpersonal skills and interaction with both faculty and residents play a major role in final ranking decisions. The previous 2020 Program Director Survey contains additional information about USMLE targets used by programs and the implications of a USMLE failure on the probability of matching.
CORD
Through its Advising Students Committee in EM (ASC-EM), CORD provides applicants with a helpful series of guides to address the needs of applicants facing specific circumstances. This includes applicants who do not have an EM residency program at their medical school, applicants who are re-applying, applicants who are couples matching, and more. These guides are informed by data and the collective wisdom of highly experienced advisors in EM.
These resources and more can provide you with a general sense of important factors in the application process. Your advisor will be key in translating this data to your school and specific situation. And remember, these are just rough guides to inform you. Everyone is unique and brings something different to the table.
Resources
- NRMP Match Data & Report Archives
- EMRA and CORD Student Advising Guide
David Gordon, MD
Associate Program Director
Duke University
Originally published in April 2022 EM Bound newsletter
As one application season has concluded with the completion of The Match and another season begins with away rotations, I wanted to reflect on the question “why choose Emergency Medicine (EM)?” Some of you may be firmly committed to EM as a career choice whereas for others EM is one of several specialties being considered. The reasons to choose EM which I share below are not just my own, but also those expressed by the talented applicants I got to meet this year. While the reasons are numerous, I have grouped them into 3 main themes:
Intellectual
Emergency Medicine offers the excitement of the unexpected and unknown. Each shift is unique with a variety of patient presentations that span different medical specialties and diverse patient demographics. In the ED, emergency physicians are the first ones to lay eyes and hands on undifferentiated patients and have to think both critically and creatively about their diagnosis and treatment. In critical care situations, emergency physicians must quiet the mind to act methodically and decisively in life and death scenarios. EM offers great reward for those who enjoy being intellectually challenged as we must utilize the arsenal of medicine to figure out the best way to serve every patient that enters the ED.
Relational
When it comes to interprofessional relationships, emergency medicine functions as a team sport. It is a specialty with a horizontal hierarchy reflected in close working relationships among attendings, residents, and students. Emergency physicians enjoy and depend on their collaboration with other health professionals including nursing, mid-level providers, paramedics, social workers, respiratory therapists, and more. With respect to patient care, emergency physicians are privileged with supporting patients and their families through moments of fear, hardship, and sometimes loss. The immediacy and significance of these moments bring great value and meaning to one’s career.
Spiritual
Medicine is a profession rooted in service to humanity. No where is that mission more strongly manifested than in Emergency Medicine, and each year I see this increasingly recognized by and resonating with EM applicants. No matter the issue, the time of day, or one’s ability to pay, the doors of the ED are always open. There is a dignity and nobility in the role that ED’s play in the healthcare system which provides a big draw to EM and a reason one can feel good after every shift. The global pandemic recognized this during their #healthcareheros campaign. In that national shut-down, it was our field that showed up to do what we have done long before the pandemic, and will continue to do long after: to serve our community.
No matter where you are on the spectrum: whether you have no idea what specialty you want to do or you are about to embark on your training in an EM residency, it can be helpful to reflect and connect with what brings you enjoyment and sense of purpose. Not every day may be your best, but when your profession aligns with your core values, you know you have made the right choice.
Resource
David Gordon, MD
Associate Program Director
Duke University