Prelim Surgery to EM ?

[clinke]

Hey guys,

I will be starting my prelim surgery year this coming summer, and have really been considering the idea of applying to emergency medicine, instead of reapplying to the surgical subspecialty that I failed to match in. I am hoping for some advice from anyone that was in the same situation. I ended up doing my EM core rotation extremely late, and liking it just as much as the surgical specialty that I was trying to match into. After I didn't match, I was toying with the idea of just continuing with gen surg, but EM seems more conducive for me. I have several questions with how to proceed.

Since I am a DO student, our core rotation was at some rural community hospital, so I am not sure to ask the clerkship director for an SLOE? Would this SLOE carry any weight?

I have the option of adding in an elective during my prelim year, so I am going to try and add an EM rotation in early. However, although I will be at a big academic center in the midwest, the EM department doesnt have a dedicated residency (even though they are level 1 trauma and have med students consistently thought there). Is it possible to get more than 1 SLOE from this rotation? I am not sure how the whole SLOE thing works (even though I have been researching it out the wazoo). I figure that even if I can only get one SLOE from this rotation, I may be able to get that SLOE from my community core rotation and that may cover any checklists that the EM residencies have.

Lastly, is it possible for the PD of my surgery prelim program to write a SLOE or would he only be able to write a traditional letter? I imagine even if I am not able to get an SLOE from him, it's probably worthwhile to get a traditional letter since he is my overall boss?

I really appreciate any information that you all may be able to provide.

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[racerwad]

Hey guys,

I will be starting my prelim surgery year this coming summer, and have really been considering the idea of applying to emergency medicine, instead of reapplying to the surgical subspecialty that I failed to match in. I am hoping for some advice from anyone that was in the same situation. I ended up doing my EM core rotation extremely late, and liking it just as much as the surgical specialty that I was trying to match into. After I didn't match, I was toying with the idea of just continuing with gen surg, but EM seems more conducive for me. I have several questions with how to proceed.

Since I am a DO student, our core rotation was at some rural community hospital, so I am not sure to ask the clerkship director for an SLOE? Would this SLOE carry any weight?

I have the option of adding in an elective during my prelim year, so I am going to try and add an EM rotation in early. However, although I will be at a big academic center in the midwest, the EM department doesnt have a dedicated residency (even though they are level 1 trauma and have med students consistently thought there). Is it possible to get more than 1 SLOE from this rotation? I am not sure how the whole SLOE thing works (even though I have been researching it out the wazoo). I figure that even if I can only get one SLOE from this rotation, I may be able to get that SLOE from my community core rotation and that may cover any checklists that the EM residencies have.

Lastly, is it possible for the PD of my surgery prelim program to write a SLOE or would he only be able to write a traditional letter? I imagine even if I am not able to get an SLOE from him, it's probably worthwhile to get a traditional letter since he is my overall boss?

I really appreciate any information that you all may be able to provide.

A SLOE can only be written by EM residency program faculty. It is technically an ACGME thing, but AOA programs can also write them, although they may hold less weight. Without a SLOE you are basically dead in the water so try and schedule your elective between July and August, ideally.

A letter from you current PD will also likely be useful.

Why the change of heart? Someone described a med student rotation in the ED (or any rotation, I suppose) to bring like a tourist there. In my limited experience, this is indeed the case. Just know that your prior ED experience may have had a lot of the good and little of the bad, especially if you were at a small community place.

Good luck!

 

[Angry Birds]

Schedule your elective for the earliest part of the year you can. Do it at a program with an EM residency, especially one you can match into.

1) Get a SLOR out of it. I'm not sure if you can get more than one from the same program but I believe you can. Not sure.

2) Be treated as an intern during your EM away, instead of a Med student. This will make you stand out from the Med students and the other off-service residents. Come early to all your shifts, work super hard seeing patients AS A RESIDENT, and let everyone know you are a surgery intern who wants to switch into EM.

3) Ask if it's possible to rotate in the ER whenever the ER residents are in conference. Now, you're presenting to ER attendings, and if you're any good, they may appreciate having a resident helping them on their least favorite shift of the week.

4) Work during every one of the weekly conferences, if possible.

5) email the residency chief before you come, and let them know your situation. Express how much you want to shine. Even ask if you can pick your shifts to line up with the heavyweight attendings (PD, chair, associate PD, etc). This may or may not go down well, but ask nicely and you never know.

6) if nobody notices, you could potentially pick up a couple extra shifts to line up with the PD or the chair. Keep in mind: you are an intern (an asset), not a student (a burden). Use it to your advantage.

7) before you do any of this, ask the residency chief or someone you are cool with there, who the cool important docs are. Try to rotate with them. Avoid the malignant attendings. Ask "who should I avoid working with?"

8) you can even ask some attendings if it's ok to present to them directly. This is a delicate situation but try to do this, especially with who is going to write your SLOR.

9) be honest of your intentions to match into EM, especially that particular program. Work super hard and SHOW them that you ARE a good resident. The other Med students have to make the attendings PREDICT who WILL be a good resident. Big difference.

10) hang out with the ER residents --as a fellow colleague and not as a lowly student-- and elicit their help and sympathy. Show them you are a good colleague to work with, and would be a good junior resident for them.

11) you can literally become the best off service resident they get the whole year, since none of the other off services will care. Most will actively try to avoid work and to suck.

12) BEG your home program to give you a second away elective and schedule it early as well (before January). Potentially do it at the same EM program you did before. Work super hard and show them how much you've grown. They will see you a second time and treat you as their own intern this time around. The second rotation will help a LOT, especially during ranking time. EDIT: I realize for a surgery prelim getting a second elective is going to be near impossible. If it is, don't bother asking and just ignore this point.

Good luck!

 

[clinke]

Schedule your elective for the earliest part of the year you can. Do it at a program with an EM residency, especially one you can match into.

1) Get a SLOR out of it. I'm not sure if you can get more than one from the same program but I believe you can. Not sure.

2) Be treated as an intern during your EM away, instead of a Med student. This will make you stand out from the Med students and the other off-service residents. Come early to all your shifts, work super hard seeing patients AS A RESIDENT, and let everyone know you are a surgery intern who wants to switch into EM.

3) Ask if it's possible to rotate in the ER whenever the ER residents are in conference. Now, you're presenting to ER attendings, and if you're any good, they may appreciate having a resident helping them on their least favorite shift of the week.

4) Work during every one of the weekly conferences, if possible.

5) email the residency chief before you come, and let them know your situation. Express how much you want to shine. Even ask if you can pick your shifts to line up with the heavyweight attendings (PD, chair, associate PD, etc). This may or may not go down well, but ask nicely and you never know.

6) if nobody notices, you could potentially pick up a couple extra shifts to line up with the PD or the chair. Keep in mind: you are an intern (an asset), not a student (a burden). Use it to your advantage.

7) before you do any of this, ask the residency chief or someone you are cool with there, who the cool important docs are. Try to rotate with them. Avoid the malignant attendings. Ask "who should I avoid working with?"

8) you can even ask some attendings if it's ok to present to them directly. This is a delicate situation but try to do this, especially with who is going to write your SLOR.

9) be honest of your intentions to match into EM, especially that particular program. Work super hard and SHOW them that you ARE a good resident. The other Med students have to make the attendings PREDICT who WILL be a good resident. Big difference.

10) hang out with the ER residents --as a fellow colleague and not as a lowly student-- and elicit their help and sympathy. Show them you are a good colleague to work with, and would be a good junior resident for them.

11) you can literally become the best off service resident they get the whole year, since none of the other off services will care. Most will actively try to avoid work and to suck.

12) BEG your home program to give you a second away elective and schedule it early as well (before January). Potentially do it at the same EM program you did before. Work super hard and show them how much you've grown. They will see you a second time and treat you as their own intern this time around. The second rotation will help a LOT, especially during ranking time. EDIT: I realize for a surgery prelim getting a second elective is going to be near impossible. If it is, don't bother asking and just ignore this point.

Good luck!

You are so awesome for this write up, I appreciate it so much. The only problem that I find myself in is the fact that there is no EM residency at the place I am going. They literally have EVERY other residency BUT EM. Therefore, I believe I will be working directly with the attendings. It's a very well respected department in Chicago, so they know their stuff. Their med school places a ton of students into EM every year, and from what the students tell me, they all use the SLOE that they received there. If it's possible to get two SLOEs from that rotation, I will. If not, I will be relegated to using the one from my home core rotation, which was with the private group. And then, I would add two regular letters from my PD and surgery chair. So assuming I get those letters, what else can I do to help my app? I actually am beginning to think that a surgery year may help me overall, but I could be wrong. The EM chairman is very well known in the Chicagoland area, so maybe I can ask him to look out for open PGY2 positions that I may be able to slide into!

Thanks again guys!


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[Angry Birds]

You are so awesome for this write up, I appreciate it so much. The only problem that I find myself in is the fact that there is no EM residency at the place I am going. They literally have EVERY other residency BUT EM. Therefore, I believe I will be working directly with the attendings. It's a very well respected department in Chicago, so they know their stuff. Their med school places a ton of students into EM every year, and from what the students tell me, they all use the SLOE that they received there. If it's possible to get two SLOEs from that rotation, I will. If not, I will be relegated to using the one from my home core rotation, which was with the private group. And then, I would add two regular letters from my PD and surgery chair. So assuming I get those letters, what else can I do to help my app? I actually am beginning to think that a surgery year may help me overall, but I could be wrong. The EM chairman is very well known in the Chicagoland area, so maybe I can ask him to look out for open PGY2 positions that I may be able to slide into!

Thanks again guys!


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No, you MUST beg your home program to allow you to do an away rotation at a program with an EM residency. If you don't, you will NOT match. I repeat: you will NOT match without a proper SLOR from an EM residency. I cannot stress this enough.

Is your hospital affiliated with any other hospital with an EM residency? Use that affiliation to get an away rotation there.

 

[EMhawkeye]

I'm kind of in a similar situation. I applied to emergency medicine and internal medicine. I am a US IMG. I ended up scrambling into a preliminary IM spot. I will be applying to both EM/ IM pgy2 spots as well as going through the match again for EM. My hospital is a hospital EM residents rotate at. The 2nd and 3rd years spend about 1/2 their EM months here. I'm trying to rotate through the ED as early in the year as possible to make connections and get another SLOR. I know I'm fighting a bit of an uphill battle. I had heavy EM experience before med school as a EMT/ ED tech/ scribe. I passed all my steps on the first attempt however my scores on the step were approx 210/ 230 respectively. I have two other SLOR's from this cycle at a DO residency program. Any advice?

 

[EMhawkeye]

I also noticed 10 former AOA programs will be participating in the ACGME match this fall. I wonder how this will effect things.

 

[TheOther]

I also noticed 10 former AOA programs will be participating in the ACGME match this fall. I wonder how this will effect things.

Can I ask where you got this figure from? I'm only seeing 7 former AOA programs that have successfully received initial accreditation to participate in the ACGME match.

 

[Got Em]

Can I ask where you got this figure from? I'm only seeing 7 former AOA programs that have successfully received initial accreditation to participate in the ACGME match.

Where can we find this information? I'm curious to see which programs are the former AOA programs. Did a quick Google search but came up with nothing.

 

[TheOther]

Where can we find this information? I'm curious to see which programs are the former AOA programs. Did a quick Google search but came up with nothing.

Here you go!
https://apps.acgme.org/ads/public/

 

[Makati2008]

I also noticed 10 former AOA programs will be participating in the ACGME match this fall. I wonder how this will effect things.

A SLOE from the AOA program will be helpful for the AOA programs you apply to not the ACGME ones. I wouldn't place too much hope on getting a spot from the former AOA program.


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[clinke]

Thank you guys so much for your replies thus far. You have really helped.

I am wondering if anyone has heard of anyone gaining a SLOE from shadowing. My prelim program will not give me the time necessary to do any sort of away rotations, but I might be able to shadow a day here and there. I am wondering if anyone has been successful in gaining a good SLOE from something like this.

Thanks

 

[NERDY]

Can you do an EM research project? You have about a month until your prelim year starts--can you jump in on a chart review or something?