Dear EM Program Directors

[Wolf02]

On paper i'm not the greatest applicant. US-IMG, below 220 on steps 1 and 2. but I'm not a good test taker, I'm a good doctor. my clinical grades are all Honors with a few high passes. and I have great LORs. The dream is to do Emergency Medicine. Since I didn't match this year I need some help figuring out, from a PD point of view, what would you like to see on my application for next year??

obviously getting a prelim or transitional spot would be the best, and I'll be trying to get one as hard as I can. But, say I don't get one...

here's what I've been considering:
Research? (I never really got the feeling that EM cared too much about research.)
ED scribe? (I've done this before. and on the plus side I'll be spending a year IN the ED, working with ED docs, involved in medical decision making.)
Teaching? (I saw some positions for things like anatomy and physiology at a MA/RN program. I also think teaching ACLS/BLS could be benificial because I can meet people and obvously this is something I want to be an expert at.)
Observerships/Externships.
Step 3


So for anyone who wants to, (PDs especially appreciated) please rank the above based on what would help me most for applying next year.
any/all advice would be appreciated.

yes, I know it's a long shot.

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[deleted480308]

(thinking outside the box here...did you also apply for joint residency programs that had an EM component?)

 

[Wolf02]

no, I did not. At the time I didn't really consider those since there were so few. are those easier or harder to get do you think?

 

[deleted480308]

no, I did not. At the time I didn't really consider those since there were so few. are those easier or harder to get do you think?

I would assume (completely anecdotal here with no evidence) that they are easier. Who wants to deal with 2 certifications and a longer residency when you could just get yourself out there and making money or into a fellowship faster? My bet is less people than those that just want a basic slot

 

[BoardingDoc]

On paper i'm not the greatest applicant. US-IMG, below 220 on steps 1 and 2. but I'm not a good test taker, I'm a good doctor. my clinical grades are all Honors with a few high passes. and I have great LORs. The dream is to do Emergency Medicine. Since I didn't match this year I need some help figuring out, from a PD point of view, what would you like to see on my application for next year??

obviously getting a prelim or transitional spot would be the best, and I'll be trying to get one as hard as I can. But, say I don't get one...

here's what I've been considering:
Research? (I never really got the feeling that EM cared too much about research.)
ED scribe? (I've done this before. and on the plus side I'll be spending a year IN the ED, working with ED docs, involved in medical decision making.)
Teaching? (I saw some positions for things like anatomy and physiology at a MA/RN program. I also think teaching ACLS/BLS could be benificial because I can meet people and obvously this is something I want to be an expert at.)
Observerships/Externships.
Step 3


So for anyone who wants to, (PDs especially appreciated) please rank the above based on what would help me most for applying next year.
any/all advice would be appreciated.

yes, I know it's a long shot.

I'm confused by this thread. You said you would try to get a prelim or transitional spot having not matched this year... shouldn't you have already SOAPed into one of those spots? Are you a 3rd year and this is a hypothetical question?

Also...

I would assume (completely anecdotal here with no evidence) that they are easier. Who wants to deal with 2 certifications and a longer residency when you could just get yourself out there and making money or into a fellowship faster? My bet is less people than those that just want a basic slot

I wouldn't put a lot of stock into this. There were zero unfilled spots for EM/IM, EM/FM and EM/Peds this year.
EM/IM had 28 spots, filled 28
EM/FM 4 spots, 4 filled
EM/Peds 9 spots, 9 filled.

 

[Wolf02]

I'm confused by this thread. You said you would try to get a prelim or transitional spot having not matched this year... shouldn't you have already SOAPed into one of those spots? Are you a 3rd year and this is a hypothetical question?

I'm a real person!! no, sadly, this isn't hypothetical. I didn't get any spot in SOAP, which is usually not too kind to the IMG anyway. I just meant that I'll be scouring any position that may come up in the next few months due to visa or drop out or whatever.

 

[sylvanthus]

I would assume (completely anecdotal here with no evidence) that they are easier. Who wants to deal with 2 certifications and a longer residency when you could just get yourself out there and making money or into a fellowship faster? My bet is less people than those that just want a basic slot

The combined programs are more competitive than either individual residency program at that same hospital.

 

[gman33]

I don't like to shoot down dreams, but your best shot at getting into EM has passed.
Your first goal should be to get a spot in any field.
I'd try for something less competitive and really put your all into it.
Below average board scores are likely not going to get you a spot anywhere.

 

[witzelsucht]

Your best bet is going to be FM -> rural EM or FM/EM fellowship

 

[Tiger26]

Have to echo the above--you're very unlikely to get a shot at EM, given that you're an IMG, have low board scores, and failed to match this year.

I'd concentrate on just getting a spot in any residency training program that you have the least bit of desire to do.

Perhaps later, you might be able to match into a fellowship that more closely matches your interests after you have (hopefully) re-established your academic credentials in residency.

 

[K31]

Did you do EM rotations? SLOEs?

Probably your best chance at this is get into a prelim year that allows you to do a rotation at an EM residency program early and impress the right people.

 

[deuist]

Ditch the ideas of teaching RN's or scribing. Both of those are huge steps backward. The best bet is to take a PGY-1 in any ACGME accredited residency, whether its surgery, peds, or anything else that's willing to accept you. If clinical work is out of the question, you can try for a research position doing either EM or trauma. You would make some contacts and get a letter that way. Definitely take Step 3 since you want to show PD's that you can get a medical license.

 

[Wolf02]

Yes, I do know it's a long shot. People over the past year have been more than generous with that information. However I'm just not ready to give up on my dream yet. Of course I'll also apply to family.

Can I ask why you say scribing is a huge step backwards? Any of those other options won't keep up my practical clinical knowledge and I'll be involved in all the medical decision making.

And yes, step 3 in August/September

 

[deleted480308]

Yes, I do know it's a long shot. People over the past year have been more than generous with that information. However I'm just not ready to give up on my dream yet. Of course I'll also apply to family.

Can I ask why you say scribing is a huge step backwards? Any of those other options won't keep up my practical clinical knowledge and I'll be involved in all the medical decision making.

And yes, step 3 in August/September

if you can get in an fm residency (maybe after working bureau of prisons for a few years) and would just rather work in an em setting, you can often get into rural em....or even take the (doesn't let you be BC) 1yr em fellowship that fm offers to help beef up your credentials to get a rural em job

 

[Wolf02]

if you can get in an fm residency (maybe after working bureau of prisons for a few years) and would just rather work in an em setting, you can often get into rural em....or even take the (doesn't let you be BC) 1yr em fellowship that fm offers to help beef up your credentials to get a rural em job

Yes I totally agree with everything you guys are saying and I'm sure that's what will end up happening but no one except one person briefly, has really said anything about what would be best to do in my next year from the ones i mentioned. (Short of residency)

 

[mybubbles14]

Yes I totally agree with everything you guys are saying and I'm sure that's what will end up happening but no one except one person briefly, has really said anything about what would be best to do in my next year from the ones i mentioned. (Short of residency)

How many places did you apply to/interviews did you get this year? Did you only apply EM?

 

[theSmurfette]

Can I ask why you say scribing is a huge step backwards? Any of those other options won't keep up my practical clinical knowledge and I'll be involved in all the medical decision making.

Scribing is a premed, unskilled labor job. Many of these positions do not require much/if any prior medical knowledge.

 

[gutonc]

Scribing is a premed, unskilled labor job. Many of these positions do not require much/if any prior medical knowledge.

This.

Scribing is what you do when you're dicking around taking the MCAT for the 13th time in search of that elusive 42T that you just know is going to make up for your 2.9 sGPA. Not what you do when you're trying to resurrect a failed residency app.

If you're doing it for the money, that's fine. We all need to eat and it beats working at Home Depot. But don't kid yourself that it's somehow going to improve your application down the road.

 

[foxtrot24]

On paper i'm not the greatest applicant. US-IMG, below 220 on steps 1 and 2. but I'm not a good test taker, I'm a good doctor. my clinical grades are all Honors with a few high passes. and I have great LORs. The dream is to do Emergency Medicine. Since I didn't match this year I need some help figuring out, from a PD point of view, what would you like to see on my application for next year??

obviously getting a prelim or transitional spot would be the best, and I'll be trying to get one as hard as I can. But, say I don't get one...

here's what I've been considering:
Research? (I never really got the feeling that EM cared too much about research.)
ED scribe? (I've done this before. and on the plus side I'll be spending a year IN the ED, working with ED docs, involved in medical decision making.)
Teaching? (I saw some positions for things like anatomy and physiology at a MA/RN program. I also think teaching ACLS/BLS could be benificial because I can meet people and obvously this is something I want to be an expert at.)
Observerships/Externships.
Step 3


So for anyone who wants to, (PDs especially appreciated) please rank the above based on what would help me most for applying next year.
any/all advice would be appreciated.

yes, I know it's a long shot.

FWIW, here's my story: US-MD with just below average Step 1 and just above average Step 2, mostly all honors on clinical rotations, with a few HP (dang those shelf exams). Applied for EM last year, didn't match, didn't get anything in the SOAP. Over the past 9 months, I did:

- research: I was fortunate to have a strong EM research dept. at my home institution and took on a "research fellowship" for the year... I was able to help develop and start a research project that was truly all mine (not just my name signed on to an already-ongoing project). I was asked about it on every interview I went on this cycle, although for the most part, I don't think EM residencies care that much about whether or not you have research.
- masters program: ok, I'll admit it... 90% of the reason I did this was because student loans suck and I didn't have the cash flow to start paying down on them. Although I was asked about this at every interview as well, and it really seemed to make an impression on several of my interviewers.
- observerships: of a sort, at least. I used the connections I had with faculty in the ED to get in and "shadow"... basically, I acted like a 4th year medical student, except that I wasn't allowed to do procedures or actually document anything because I wasn't malpractice covered. I also managed to work in some time as an assistant in the med school's sim lab, which let me keep my hand in procedures (art lines, central lines, LPs, intubations)... sim lab isn't as good as practice in the real world, but it's a good way to keep your mind and your skills sharp.
- work: I worked as a pharmacy technician, and spun it in my interviews to explain how my job related to work in the hospital/what I learned from my job. Your idea of scribing could work like this too. The most important thing is to take whatever you do and always put it into the context of "this is how it would help me as an intern in your program".

I understand that EM is the dream. Believe me, I do. I felt the same way. But the truth is, it's hard and it's scary to face the possibility of not matching twice. Find a backup plan you could be happy with (mine ended up being FM) and apply for that too. I applied to a ton of programs, ended up with 10 EM interviews plus some for FM, and matched EM at my #4 program. There's no guarantee that what worked for me would work for you, but you asked for advice. From someone who's been there, take it for what it's worth. Good luck.