Aspiring EM

[anthony78001]

I'm a OMS II interested in EM, which is all I have ever wanted to be. I was recently informed that students who fail a course and successfully re-mediate at my school go to the back of the line as far as class rank goes and their rank doesnt improve much b/c they are always behind the students who managed to pass all courses even if they did with all C's.

I was disheartened by this realization b/c I've wanted to do well second year in the hopes I would do better on boards but also to improve my rank and show an upward trend throughout med school. I failed histo my first semester and successfully re-mediated. My grades in the first year spring semester improved (mostly B's) compared to my first semester (mostly C's) and I've earned mostly high B's to A's during second year.

It is my hope moving forward that I can do well second year to raise my GPA to show that although I made a mistake first semester, I performed well after that mistake. I thought if I did well on boards and rotations particularly EM it would be enough to obtain an EM residency (at least mid tier program) since these are the heaviest weighted criteria. I have research, presentations, volunteer hours, international medical mission experience, class officer positions and I've been shadowing during second year.

If anyone has any input based on their experience with residency programs or was in a similar situation while in med school I would appreciate the advice and support. I assume most of the feedback will say to do well on boards (COMLEX/USMLE) and do well on rotations. Thanks for any support.

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[Rekt]

I'm a OMS II interested in EM, which is all I have ever wanted to be. I was recently informed that students who fail a course and successfully re-mediate at my school go to the back of the line as far as class rank goes and their rank doesnt improve much b/c they are always behind the students who managed to pass all courses even if they did with all C's.

I was disheartened by this realization b/c I've wanted to do well second year in the hopes I would do better on boards but also to improve my rank and show an upward trend throughout med school. I failed histo my first semester and successfully re-mediated. My grades in the first year spring semester improved (mostly B's) compared to my first semester (mostly C's) and I've earned mostly high B's to A's during second year.

It is my hope moving forward that I can do well second year to raise my GPA to show that although I made a mistake first semester, I performed well after that mistake. I thought if I did well on boards and rotations particularly EM it would be enough to obtain an EM residency (at least mid tier program) since these are the heaviest weighted criteria. I have research, presentations, volunteer hours, international medical mission experience, class officer positions and I've been shadowing during second year.

If anyone has any input based on their experience with residency programs or was in a similar situation while in med school I would appreciate the advice and support. I assume most of the feedback will say to do well on boards (COMLEX/USMLE) and do well on rotations. Thanks for any support.

You're not out of the running. GPA barely matters, but there is correlation to how you perform for classes and how well you'll do on boards. You're not going to be getting Cs and then magically crush boards and land a 285. Dump all your volunteering and useless class officer positions and work on understanding the material. With how competitive EM is becoming (Only ~75% of DO applicants matched to an ACGME program last year), you need to shoot for >235/550-575+.

 

[anthony78001]

that was my plan, thank you for the advice.

 

[anthony78001]

Thanks for the advice, I've been told rank is just dependent on GPA at my school and I was misinformed initially.

 

[anthony78001]

You're not out of the running. GPA barely matters, but there is correlation to how you perform for classes and how well you'll do on boards. You're not going to be getting Cs and then magically crush boards and land a 285. Dump all your volunteering and useless class officer positions and work on understanding the material. With how competitive EM is becoming (Only ~75% of DO applicants matched to an ACGME program last year), you need to shoot for >235/550-575+.

do you think gettting a board score in that range will help to PD and residents look passed my histo fail.

 

[HooliganSnail]

do you think gettting a board score in that range will help to PD and residents look passed my histo fail.

Yeah no one cares if you were the treasurer or something stupid. You are at the point in your career where people are going to be actually looking for REAL qualities they can work with, not if you are a goody two shoes who joined X-club and went to X-meetings, no one cares. At all

PD's want two main things

1. They want to know you are smart, or at least will pass the ABEM exam on the first try, so their program doesn't look bad come ACGME visit time ( They have to show an 80% first time pass rate). The best indicator that you will pass the exam is how you do on the USMLE. Failing one class in your first semester of med school, then showing consistent improvement is the best course of action. Doing well on the USMLE will increase the likelihood that they will look past the failed class (at least academically).

2. They want to know if you have common sense, can communicate effectively, and get the job done. EM is a sandbox specialty, you have to be able to get along with others. You have to be able to coordinate a lot of different things, departments, consultants, therapies. The best way to show this is to actually go and rotate at the EM program you want to match at. Your EM rotation grade is NOT a good substitute. A SLOE is NOT a good substitute. It is amazing how many med students we see who look great on paper, but are complete idiots. Some are lazy. Some are stupid and have no common sense. Some piss off the nurses. If you show up, do hard work, read up on your cases, show everyone you would be a great addition to their program, you will be better than 75% of our "auditioning" students. You need to pick out 3-4 programs you think you can match at, and go there and do rotations. That is your best shot at EM.

Good Luck.

 

[anthony78001]

Thank you for the advice, I really appreciate it.

Yeah no one cares if you were the treasurer or something stupid. You are at the point in your career where people are going to be actually looking for REAL qualities they can work with, not if you are a goody two shoes who joined X-club and went to X-meetings, no one cares. At all

PD's want two main things

1. They want to know you are smart, or at least will pass the ABEM exam on the first try, so their program doesn't look bad come ACGME visit time ( They have to show an 80% first time pass rate). The best indicator that you will pass the exam is how you do on the USMLE. Failing one class in your first semester of med school, then showing consistent improvement is the best course of action. Doing well on the USMLE will increase the likelihood that they will look past the failed class (at least academically).

2. They want to know if you have common sense, can communicate effectively, and get the job done. EM is a sandbox specialty, you have to be able to get along with others. You have to be able to coordinate a lot of different things, departments, consultants, therapies. The best way to show this is to actually go and rotate at the EM program you want to match at. Your EM rotation grade is NOT a good substitute. A SLOE is NOT a good substitute. It is amazing how many med students we see who look great on paper, but are complete idiots. Some are lazy. Some are stupid and have no common sense. Some piss off the nurses. If you show up, do hard work, read up on your cases, show everyone you would be a great addition to their program, you will be better than 75% of our "auditioning" students. You need to pick out 3-4 programs you think you can match at, and go there and do rotations. That is your best shot at EM.

Good Luck.

 

[zero0]

I'm gonna level with you. Fact is, failing a class is going to be a big stumbling block come match time. EM is increasing in competitiveness every year and there will be plenty of people without any blemishes on their record to choose from. I'd say get over 650 and 230 on boards, then bust your butt on your EM rotation; a good SLOE can go a long way. Try not to get anything below a B in your classes from here on out too and you should have a good chance.

 

[gamerEMdoc]

Grades matter very little in the first two years. If there are faculty out there who actually look at histology grades when looking at an interview packet for EM, then well, you probably are doing it wrong.

Fact of the matter is, clinical performance trumps all. In order of importance to me when scoring an application:
1. EM SLOEs (sloe rank, quality of program it came from, comments)
2. Personal experience. I'll take someone I rank as a top 1/3 students in my SLOE over someone ranked as top 1/3 elsewhere any day, strictly based on personal experience. Its a good tiebreaker.
3. Interview
4. Clinical grades on other rotations (if your school actually grades and doesn't just give everyone an A or "pass")
5. Board Scores
6. Leadership/Research
7. Class rank
7. Preclinical grades

Obviously just one persons opinion, but I think that's a realistic way people weigh the parts of the application. Some of these could go up or down one (like clinical grades and board scores if your school doesn't have a good grade distribution, which happens WAY TOO OFTEN unfortunately).

 

[68PGunner]

Yeah no one cares if you were the treasurer or something stupid. You are at the point in your career where people are going to be actually looking for REAL qualities they can work with, not if you are a goody two shoes who joined X-club and went to X-meetings, no one cares. At all

PD's want two main things

1. They want to know you are smart, or at least will pass the ABEM exam on the first try, so their program doesn't look bad come ACGME visit time ( They have to show an 80% first time pass rate). The best indicator that you will pass the exam is how you do on the USMLE. Failing one class in your first semester of med school, then showing consistent improvement is the best course of action. Doing well on the USMLE will increase the likelihood that they will look past the failed class (at least academically).

2. They want to know if you have common sense, can communicate effectively, and get the job done. EM is a sandbox specialty, you have to be able to get along with others. You have to be able to coordinate a lot of different things, departments, consultants, therapies. The best way to show this is to actually go and rotate at the EM program you want to match at. Your EM rotation grade is NOT a good substitute. A SLOE is NOT a good substitute. It is amazing how many med students we see who look great on paper, but are complete idiots. Some are lazy. Some are stupid and have no common sense. Some piss off the nurses. If you show up, do hard work, read up on your cases, show everyone you would be a great addition to their program, you will be better than 75% of our "auditioning" students. You need to pick out 3-4 programs you think you can match at, and go there and do rotations. That is your best shot at EM.

Good Luck.

EM is one of the fields that I'm interested in. What is the chances for a EM match at a decent program with 228-235 Step 1, 60-70% percentile in term of class rank, and 2-3 published research? Just curious. Let's assume that the person is a team player who's flexible and hardworking during rotations.

 

[68PGunner]

Grades matter very little in the first two years. If there are faculty out there who actually look at histology grades when looking at an interview packet for EM, then well, you probably are doing it wrong.

Fact of the matter is, clinical performance trumps all. In order of importance to me when scoring an application:
1. EM SLOEs (sloe rank, quality of program it came from, comments)
2. Personal experience. I'll take someone I rank as a top 1/3 students in my SLOE over someone ranked as top 1/3 elsewhere any day, strictly based on personal experience. Its a good tiebreaker.
3. Interview
4. Clinical grades on other rotations (if your school actually grades and doesn't just give everyone an A or "pass")
5. Board Scores
6. Leadership/Research
7. Class rank
7. Preclinical grades

Obviously just one persons opinion, but I think that's a realistic way people weigh the parts of the application. Some of these could go up or down one (like clinical grades and board scores if your school doesn't have a good grade distribution, which happens WAY TOO OFTEN unfortunately).

What does a medical student have to do to do well in an EM rotation? Just curious.

 

[Rekt]

I'm gonna level with you. Fact is, failing a class is going to be a big stumbling block come match time. EM is increasing in competitiveness every year and there will be plenty of people without any blemishes on their record to choose from. I'd say get over 650 and 230 on boards, then bust your butt on your EM rotation; a good SLOE can go a long way. Try not to get anything below a B in your classes from here on out too and you should have a good chance.

Quite the spread there. 94th percentile for COMLEX for a below average step 1?

 

[gamerEMdoc]

What does a medical student have to do to do well in an EM rotation? Just curious.

I get asked this alot in private messages. I'll copy and paste what I told another student lately. Here's what I came up with off the top of my head the other day when asked this.

Here's my best advice to get a good SLOE:
1. Show up 10 min early to every shift. If you are late, even once, and someone writes about that on your SLOE (I see this several times a year reading applications), it looks AWEFUL!
2. Don't be hard to schedule. If the chief residents make the students schedule, and you have a ton of requests and are a headache, I guarantee you that chief resident will tell EVERYONE about it
3. At the beginning of the shift, find out who you are working with. Are you assigned to a resident or attending. Introduce yourself, and ask them how they'd like you to approach the shift. Some might want you picking up charts anytime. Others may prefer to hand you charts. Everyone has a different workflow.
4. If you work with a resident, do anything you can to help them. I can't stress this enough. Residents probably have more say in boosting people up, and dropping people down, the rank list than some attendings. PD's don't want drama. They don't want to deal with residents who don't get along. And residency is tough. So if you can do little things that help the residents, I promise you, they will lobby for you.
5. Don't ever lie. If someone asks you a question like "does the patient have any vomiting" and you didn't ask, say you didn't ask. Don't say "no" and hope you are right. Because if you get caught in one lie, noone will forget it.
6. Be courteous and nice to the nurses and ancillary staff at all times.
7. There is too much focus for students on seeing more patients. Its great if you can see 10-12 patients a shift, but if all you are doing is an H+P and never following up on anything, never rechecking anyone, and never updating the person you are working with, then you are basically creating more work.
8. Understand that sometimes, you may get pushed aside. The ED can be busy and chaotic. Sometimes, an attending/resident may just not have time for you to pick up another case with them. They are often carrying a huge patient load. Don't be offended or take it personal. Offer to help out in anyway you can.
9. Read and follow up on your cases. If you see something interesting, it would be crazy impressive to see the attending a week later and tell them "remember that patient with delirium the other night? I looked him up, and it turns out they found..."
10. Don't just followup labs/xrays. Anyone can do that. Students shine when they followup on the patient's themselves. I promise you, if you go back and see a patient and catch something that wasn't caught before (patients do change over time), they will be VERY impressed
11. Lastly, time yourself in the room. Strive to eventually be able to get out of the room in 10 min or less. Thats not going to be feasible when you start, but it eventually needs to happen. You'll learn what is essential to ask and what isn't. You're job isn't to do a medicine H+P. It's to do an ED note. Focus on high yield questions about the chief complaint, don't get tied down in the ROS and not flesh out why the patient is actually here. There will be patient's that make this hard to do, but getting out of the room faster is essential for you to impress residents and staff.

Hope that helps!

 

[zero0]

Quite the spread there. 94th percentile for COMLEX for a below average step 1?

I probably give too much credit to the recent osteo match data published by the NRMP. From the looks of it, I wouldn't feel safe with anything under 600 if I had other red flags.

230 because that's the highest cutoff to apply to any EM program I've seen, but the higher the better.

 

[Yadster101]

I probably give too much credit to the recent osteo match data published by the NRMP. From the looks of it, I wouldn't feel safe with anything under 600 if I had other red flags.

230 because that's the highest cutoff to apply to any EM program I've seen, but the higher the better.

Are these hard cutoffs or are they "recommendations"? For example, could someone get into one of these programs with a 225?

 

[zero0]

Are these hard cutoffs or are they "recommendations"? For example, could someone get into one of these programs with a 225?

Pretty sure they're just hard cutoffs, as in a computer just sifts out anything below that