Emergency Medicine 2014-2015 Residency Cycle

[Siggy]

1) no, but it does make it more likely
2) ACGME primarily

For ACGME, then it can impact things. AOA... the letter wouldn't be quite as useful since it's not going to get you any more interviews.

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[carbonizedeyesockets]

As long as you have 3 letters in by Oct 1st you're fine. Most EM programs don't look at people until then anyway because they don't have your dean's letter till then. If you only have 2 letters in at that point, a lot of programs won't look at your application until the 3rd letter is in.

My experience in the last cycle was that many more programs (not a majority, for sure) were sending invites out before the dean's letter was sent (Carolinas is the one that comes to mind). I'm curious if more and more programs are going to do that every year.

 

[carbonizedeyesockets]

Though, I'm sure these will probably be cleared up, but two EM programs are on probationary status with the ACGME. USC+LAC and LSU Shreveport.

 

[Gaclavve]

Will have two SLOEs in by Sep 15th. How important is a third letter (don't really have a particular person I would feel comfortable about getting one from at this point). Will have an additional "regular" LOR come the end of October from an away rotation. Would this even be helpful? thx.

 

[OR4life]

can we ask an attending to write us a letter in addition to the SLOE we are getting?

 

[scummie]

Two quick questions about the personal statement:

Are you guys just writing EM for short instead of "emergency medicine" throughout the personal statement? Would save space.

Should we capitalize Emergency Medicine?

 

[swamprat]

can we ask an attending to write us a letter in addition to the SLOE we are getting?

yeah, i did

 

[BoardingDoc]

Will have two SLOEs in by Sep 15th. How important is a third letter (don't really have a particular person I would feel comfortable about getting one from at this point). Will have an additional "regular" LOR come the end of October from an away rotation. Would this even be helpful? thx.

Unless something has changed since last year, you need a 3rd letter. Unless you're hurting to find people that will write you good letters, I don't know why you wouldn't submit 4.

 

[deleted547339]

Though, I'm sure these will probably be cleared up, but two EM programs are on probationary status with the ACGME. USC+LAC and LSU Shreveport.

USC?? Really? Not enough attending coverage? Work hours?

 

[DocEspana]

USC?? Really? Not enough attending coverage? Work hours?

It's usually something totally random. My program('s hospital) was on probationary status with the joint commission (slightly different) recently. Lasted a whole week. We had no written protocol on when to use what kind of restraints in the EDs, and were using an "escalate restraints prn clinical judgement" type deal. A week later we had written protocols and we're back to normal joint commission status.

Lesson here: check into it, but it's nearly always something very easy to fix, like the program director doing too many shifts a week, rather than some big problem.

 

[deleted547339]

It's usually something totally random. My program('s hospital) was on probationary status with the joint commission (slightly different) recently. Lasted a whole week. We had no written protocol on when to use what kind of restraints in the EDs, and were using an "escalate restraints prn clinical judgement" type deal. A week later we had written protocols and we're back to normal joint commission status.

Lesson here: check into it, but it's nearly always something very easy to fix, like the program director doing too many shifts a week, rather than some big problem.

Gotta be careful with that. Without written protocols we'd never know that the combative 6'4, 250 lb schizophrenic patient who is coked up needs to to be restrained. WHAT WOULD WE DO WITHOUT PROTOCOLS!?!?!?! lol

 

[DocEspana]

Gotta be careful with that. Without written protocols we'd never know that the combative 6'4, 250 lb schizophrenic patient who is coked up needs to to be restrained. WHAT WOULD WE DO WITHOUT PROTOCOLS!?!?!?! lol

On paper we are (per joint commission) to offer oral ativan and benadryl +/- haldol. Even the PCPers need documented offer for oral pills before we tackle them, hog tie them, and put the B52 in them.

But we codified that threats let us skip all that. So that's a plus.

 

[GTP]

Unless something has changed since last year, you need a 3rd letter. Unless you're hurting to find people that will write you good letters, I don't know why you wouldn't submit 4.

Hey. I have a question for you regarding this. I am getting two early sloes (met with PD today who said he will make sure I get it fairly quickly), and I've heard Kzoo is pretty fast too, and that's my next rotation. However, nobody knows me better than the psyc doc and the IM docs I worked with in third year. Are people actually going to read those letters or do they only care about sloes? I was hoping to use those 2 sloes then 2 regular letters from the two said docs. Thanks!!

 

[BoardingDoc]

Hey. I have a question for you regarding this. I am getting two early sloes (met with PD today who said he will make sure I get it fairly quickly), and I've heard Kzoo is pretty fast too, and that's my next rotation. However, nobody knows me better than the psyc doc and the IM docs I worked with in third year. Are people actually going to read those letters or do they only care about sloes? I was hoping to use those 2 sloes then 2 regular letters from the two said docs. Thanks!!

They'll read them. My letters were (in order): SLOR from home, LOR from an EM doc at home, LOR from a surgery doc at home, SLOR from an away. The away SLOR didn't get in until mid/late October. Everything else was in by Oct 1st. So my thought is that they did look at my surgery letter since it was my 3rd letter by the time interview offers started coming in.

 

[red10]

Hey. I have a question for you regarding this. I am getting two early sloes (met with PD today who said he will make sure I get it fairly quickly), and I've heard Kzoo is pretty fast too, and that's my next rotation. However, nobody knows me better than the psyc doc and the IM docs I worked with in third year. Are people actually going to read those letters or do they only care about sloes? I was hoping to use those 2 sloes then 2 regular letters from the two said docs. Thanks!!

I was going to get a letter from a psych attending but was told no one would really care about it because it's psych. One of my peds attendings wrote a very nice letter and multiple programs commented on it. The SLORs matter more for sure. A nice letter from IM isnt going to make up for a mediocre SLOR, but they do get read.

 

[red10]

can we ask an attending to write us a letter in addition to the SLOE we are getting?

An attending who has a say in the SLOR? It's kinda redundant if the person's comments about you were already part of the SLOR. I'd get someone else. Surely you can find one more person who has nice things to say about you.

 

[Gaclavve]

I am planning to submit my two SLOEs by Sep 15th, and am getting a 3rd LOR by the end of October. I was told by my home program that this was fine. The only attending who even knows my name from all of third year was the family doc I worked directly with for 6 weeks, but he is in private practice...should i ask him for one just to be safe?

 

[GTP]

I was going to get a letter from a psych attending but was told no one would really care about it because it's psych. One of my peds attendings wrote a very nice letter and multiple programs commented on it. The SLORs matter more for sure. A nice letter from IM isnt going to make up for a mediocre SLOR, but they do get read.

Well I don't really have a choice about that psyc letter. It was an intense rotation with lots of long papers (which he actually read) and a lot of talk about feelings. In 4 weeks he knew me better than anyone else I interacted with on a professional level. Hopefully someone will care enough to read it. I got a letter from surgery that's not well written so I don't want to use that. Another attending asked me to write my own letter and then he would sign it. I can barely spell, so I'm not doing that either. Maybe I'll meet someone cool in later rotations who understands me well, but I'll keep the psyc letter on deck just in case.

 

[Modafinil]

An attending who has a say in the SLOR? It's kinda redundant if the person's comments about you were already part of the SLOR. I'd get someone else. Surely you can find one more person who has nice things to say about you.

The associate PD at a place I rotated, subsequently ranked #1, and matched at wrote me a letter in addition to the SLOE. His personal letter was talked about more than any others on my interviews. If it is going to be a good letter - GET IT.

 

[GTP]

The associate PD at a place I rotated, subsequently ranked #1, and matched at wrote me a letter in addition to the SLOE. His personal letter was talked about more than any others on my interviews. If it is going to be a good letter - GET IT.

How do you get a PD to write you a letter? The PD where I am right now is very personable and super chill. We have interacted on several occasions but he doesn't do shifts in the ED. I made an appointment with him once to have him look over my application and express my interest in the program. I don't want to seem desperate and keep dropping by. What else can one do?

 

[gutonc]

How do you get a PD to write you a letter? The PD where I am right now is very personable and super chill. We have interacted on several occasions but he doesn't do shifts in the ED. I made an appointment with him once to have him look over my application and express my interest in the program. I don't want to seem desperate and keep dropping by. What else can one do?

I have no idea about the inner workings of the EM RRC but is that even possible? Not actually practicing the specialty you're supposedly in charge of training people to do?

If this is really the case, that the EM PD doesn't actually practice Emergency Medicine, I would suggest thats not really a letter you want.

 

[GTP]

I have no idea about the inner workings of the EM RRC but is that even possible? Not actually practicing the specialty you're supposedly in charge of training people to do?

If this is really the case, that the EM PD doesn't actually practice Emergency Medicine, I would suggest thats not really a letter you want.

Okay oops. Maybe he has been doing shifts, but none of them have overlapped with mine. I'm only here for a month too, so maybe he had vacation for a while. Nonetheless, I've only seen him pass by to say hello. He teaches simulations but it's usually 4 residents and maybe 2 med students. It seems douchey volunteering myself as team leader or answering questions without giving residents a chance to answer them first.

 

[OptimusPrimal]

4th year DO student in East Coast looking for some advice. COMLEX at 580, USMLE Step 1 at 212. Step 2 is pending. I have 4 rotations (2 ACGME, 2 AOA) lined up and am currently on my first one (my home program, with an AOA residency). Depending on step 2, would it be worth doing the other 2 ACGME auditions? Or should I try to squeeze in one more AOA audition?

 

[alpinism]

How are your clinical grades, ECs, LORs?

Your chances are better at AOA programs due to your step 1 score but it also depends on where you're applying/how many programs.

 

[MSmentor018]

4th year DO student in East Coast looking for some advice. COMLEX at 580, USMLE Step 1 at 212. Step 2 is pending. I have 4 rotations (2 ACGME, 2 AOA) lined up and am currently on my first one (my home program, with an AOA residency). Depending on step 2, would it be worth doing the other 2 ACGME auditions? Or should I try to squeeze in one more AOA audition?

depends on which route you want to take and the location

 

[Hair Police]

depends on which route you want to take and the location

I'm not a DO, so I don't have experience applying to both pathways, but I have met very few applicants who did more than three rotations. Most do two. If you were applying MD and DO, I would guess your two MD and two DO would be enough. You should spend some of your MSIV year on something else - ICU, anesthesiology, etc.

 

[Hair Police]

Okay oops. Maybe he has been doing shifts, but none of them have overlapped with mine. I'm only here for a month too, so maybe he had vacation for a while. Nonetheless, I've only seen him pass by to say hello. He teaches simulations but it's usually 4 residents and maybe 2 med students. It seems douchey volunteering myself as team leader or answering questions without giving residents a chance to answer them first.

At most programs, the PD or Asst PD will write a gestalt SLOR based on comments gathered from everyone you worked with. That way they don't have to work with you to write your letter. That being said, you should try to spend some clinical time with them if you're at all interested in the program (likely given you're rotating there). Doing well in front of the PD is a big deal when they're making up the program's ROL.

 

[MRSAful Fate]

I'm not a DO, so I don't have experience applying to both pathways, but I have met very few applicants who did more than three rotations. Most do two. If you were applying MD and DO, I would guess your two MD and two DO would be enough. You should spend some of your MSIV year on something else - ICU, anesthesiology, etc.

I'm doing 5, several of my classmates are doing the same. I know it's overkill but I'm stoked to be spending so much time in the ED (no rounding until 2015, woohoo!). A few of my rotations are going to be too late for letters but I'd like to go somewhere that I've spent a month and gotten a feel for the program. The idea of putting a place high on my rank list that I've only spent a day at during interviews freaks me out.

 

[scummie]

I'm doing 5, several of my classmates are doing the same. I know it's overkill but I'm stoked to be spending so much time in the ED (no rounding until 2015, woohoo!). A few of my rotations are going to be too late for letters but I'd like to go somewhere that I've spent a month and gotten a feel for the program. The idea of putting a place high on my rank list that I've only spent a day at during interviews freaks me out.

Holy crap, that's insane. Might be a record. How are you guys getting away with doing that many rotations? I'm guessing your school doesn't limit # of rotations in a certain field.

ERAS opening soon on the DO side!

 

[Modafinil]

I'm doing 5, several of my classmates are doing the same. I know it's overkill but I'm stoked to be spending so much time in the ED (no rounding until 2015, woohoo!). A few of my rotations are going to be too late for letters but I'd like to go somewhere that I've spent a month and gotten a feel for the program. The idea of putting a place high on my rank list that I've only spent a day at during interviews freaks me out.

WOW. I only did one

 

[MSmentor018]

Holy crap, that's insane. Might be a record. How are you guys getting away with doing that many rotations? I'm guessing your school doesn't limit # of rotations in a certain field.

ERAS opening soon on the DO side!

I did 9 or so. you have to be creative. radiology is emergency medicine ultrasound. peds is peds ER. critical care find a place where the ICU is ran by EM or combined program, research is whatever your topic is and EM based....etc. by making it EM based or hospital w EM residency will increase your face time. I don't know how the upcoming combined match will change but being a DO crossing into MD programs, you gotta pull out all the stops

 

[deleted547339]

whoa....i did 0 aways...wouldn't recommend it, but it was fine.

 

[res1cue]

Any other DO students thinking of applying ACGME only?

 

[ewokka]

Any other DO students thinking of applying ACGME only?

I plan on it... Really hope it works out.

 

[GTP]

I'm doing 5, several of my classmates are doing the same. I know it's overkill but I'm stoked to be spending so much time in the ED (no rounding until 2015, woohoo!). A few of my rotations are going to be too late for letters but I'd like to go somewhere that I've spent a month and gotten a feel for the program. The idea of putting a place high on my rank list that I've only spent a day at during interviews freaks me out.

At most programs, the PD or Asst PD will write a gestalt SLOR based on comments gathered from everyone you worked with. That way they don't have to work with you to write your letter. That being said, you should try to spend some clinical time with them if you're at all interested in the program (likely given you're rotating there). Doing well in front of the PD is a big deal when they're making up the program's ROL.

lol right after my comment I ended up having a shift with the PD. He didn't give me upper 5% cuz he says he doesn't give that to anybody. But I learned a lot and we took some jabs at each other. Good times were had.

 

[wonderbread12]

How did you guys know based on your step scores/rotation scores/etc which programs you would be competitive for?

 

[msbbc833]

.

 

[deleted547339]

So you had 1 SLOE? How many programs did you apply to and how many interviews did u get?

I actually went to a school without a residency program.....so I kinda had no SLORs. Applied 31, got 27.

 

[BoardingDoc]

How did you guys know based on your step scores/rotation scores/etc which programs you would be competitive for?

You don't. You can do very well on everything and subsequently be competitive most places. You can do crappy on everything and know that you're reaching everywhere. You can be an IMG and just start praying if you didn't break 250 on step 1. Everyone else is somewhere in between.

 

[Handinhand]

As an MD student at a US Med school, is a 250 step 1 score good enough for any program in the country?

 

[DocEspana]

As an MD student at a US Med school, is a 250 step 1 score good enough for any program in the country?

Every

 

[BoardingDoc]

As an MD student at a US Med school, is a 250 step 1 score good enough for any program in the country?

Yep. It certainly isn't as though a 250 will get you any spot you want, but with that score, it's all about the rest of your application and whether or not they like you if you interview.

 

[swamprat]

As an MD student at a US Med school, is a 250 step 1 score good enough for any program in the country?

I would say don't put all your eggs in one basket. EM application is def more than just step 1 scores. I had a higher score and got rejections from places I thought I was a shoo-in for an interview invite. It def doesn't hurt though.

 

[AvocadoLover]

Any other DO students thinking of applying ACGME only?

Yes, I am applying ACGME only. Have good board scores, EM research, and 3 ACGME rotations lined up (one SLOE so far and feedback was very positive). Nothing is guaranteed but I am making the best choice that I can for myself. I think it all depends on your particular situation, application, region, etc. whether or not it is a good idea to forgo the AOA match. Did you have any particular questions about making this choice?

Hopefully this will be a wonderful match year for all of us!

 

[red10]

As an MD student at a US Med school, is a 250 step 1 score good enough for any program in the country?

It won't close any doors, but EM cares about more than numbers. SLORs, leadership, being someone they think they'd wanna work with at 3am are all just as important.

 

[Handinhand]

Thanks for all the replies. I know that EM takes a wide-eye view of applicants and doesn't focus as much on numbers as other fields do, but I've also read on other threads that step 1 scores are on the rise in EM so I just wanted to ask.

I got my boards scores back a few days ago and got a 250 flat. I'm from the midwest but am going to be applying to many programs on both coasts, so I need all the help I can get. Also have a global health research project dealing with injury prevention in Vietnam & China (PI is in EM faculty at my school), 5 years of EMT experience prior to med schools, and was president of my school's wilderness medicine group. Besides that... slightly above average grades (probably 85% High passes, a few honors and a pass or two). Just started M3 year a few weeks ago so I don't have any grades yet for that. Just trying to get a feel of how good of an applicant I'm shaping up to be, and if there's anything I can do over the next 1.5 years, besides rocking out on rotations, that will make a difference.

 

[BoardingDoc]

Thanks for all the replies. I know that EM takes a wide-eye view of applicants and doesn't focus as much on numbers as other fields do, but I've also read on other threads that step 1 scores are on the rise in EM so I just wanted to ask.

I got my boards scores back a few days ago and got a 250 flat. I'm from the midwest but am going to be applying to many programs on both coasts, so I need all the help I can get. Also have a global health research project dealing with injury prevention in Vietnam & China (PI is in EM faculty at my school), 5 years of EMT experience prior to med schools, and was president of my school's wilderness medicine group. Besides that... slightly above average grades (probably 85% High passes, a few honors and a pass or two). Just started M3 year a few weeks ago so I don't have any grades yet for that. Just trying to get a feel of how good of an applicant I'm shaping up to be, and if there's anything I can do over the next 1.5 years, besides rocking out on rotations, that will make a difference.

Your MS1/MS2 grades don't matter at all unless they're helping you get AOA or you failed something. Doing well in the first 2 years is really only important because it's effectively forcing you to study for (and subsequently do well on) step 1. EMS experience will help somewhat, but you need to remember that former EMS/paramedic/first responder etc etc etc applicants are dime a dozen in EM. You sound like you're already doing very well so you're fine, I just always remind students not to hang their hat on it because it doesn't really make them special.

Most important thing is to do well on your clinical rotations, rock your EM rotations, and go on an away or two at places that you think you might be interested in going. If you do an away somewhere and they love you, they're going to take you over the guy with the 260 and more honors than you simply because you're a known entity.

 

[Handinhand]

I've read that if I want to go to the west coast, coming from the midwest, I'm going to have to do an away rotation out west. Is the same true for the east coast? I was planning on doing one home and one or two away rotations.

 

[DocEspana]

I've read that if I want to go to the west coast, coming from the midwest, I'm going to have to do an away rotation out west. Is the same true for the east coast? I was planning on doing one home and one or two away rotations.

Yea. That's generally the case with west coast places, so the word on the street goes. But for the east coast it's not really that way. You want to be on the east coast, just be someone good enough to be wanted.

Some areas of the east coast will want some evidence that you're not big city-adverse. Namely NY and Boston. But it's pretty easy. Have spent some time living or training in a big city and say you loved it. the end.

 

[Handinhand]

I'm trying to get out of the midwest and closer to the mountains -- if I end up in NYC something will have gone terribly wrong haha.

Thanks for all of the advice though guys. I know it might be a little early to worry about this stuff, but I don't like being in the dark about this stuff.