Unmatched EM- What to do with my application?

[ishryan]

I am an FMG, US citizen, Graduating this year, unmatched to EM or backups, unsuccessful in the SOAP.

Step 1: 241
Step 2: 228
CS: 2nd attempt passed
2 years US clinical Experience
Clean MSPE
3 SLORs from EM physicians I rotated with, 1 high pass, 2 passes
Did 4 EM rotations, 3 adult, 1 peds EM
1 published poster presentation at ACS regarding utility of CT Chest in Trauma Patients

Unfortunately, I only got 2 EM interviews this year. Applied to over 120 programs.

EM fits my personality best. It is my passion. However, now I am really unsure about whether to continue to pursue EM, not because my interest has dropped, but because my confidence in my application is shot.

Are there any program directors out there that can help give me direction? What can I do to strengthen my application at this point? Should I really give up on all my hard work and just try to accept any residency that will take me? I am looking for helpful advice. Please and thank you.

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[Makati2008]

I am an FMG, US citizen, Graduating this year, unmatched to EM or backups, unsuccessful in the SOAP.

Step 1: 241
Step 2: 228
CS: 2nd attempt passed
2 years US clinical Experience
Clean MSPE
3 SLORs from EM physicians I rotated with, 1 high pass, 2 passes
Did 4 EM rotations, 3 adult, 1 peds EM
1 published poster presentation at ACS regarding utility of CT Chest in Trauma Patients

Unfortunately, I only got 2 EM interviews this year. Applied to over 120 programs.

EM fits my personality best. It is my passion. However, now I am really unsure about whether to continue to pursue EM, not because my interest has dropped, but because my confidence in my application is shot.

Are there any program directors out there that can help give me direction? What can I do to strengthen my application at this point? Should I really give up on all my hard work and just try to accept any residency that will take me? I am looking for helpful advice. Please and thank you.

The failed CS and only Passing two EM rotations are red flags....did your slors reflect residency based EM docs or community?

 

[QuackaDO]

The failed CS and only Passing two EM rotations are red flags....did your slors reflect residency based EM docs or community?

This. Failed CS is probably a big factor since it is simply a pass/fail test that something like 90+% of people pass first time. Not bashing you... you clearly aren't "dumb" or something like that, it's just one of the stigmas of FMGs is that they will have a difficult time relating to the US "patient" and often times that comes out in the CS exam. Simply often due to cultural differences, accents, or something stupid like that... not skill. It sucks that it's the way it is but when someone sees that they wonder if it's a functionality thing. Also, as Makati said, the pass grades on the EM rotations are small red flags but might indicate huge red flags in those SLOEs... no way to know without advisement. Honestly, I like to tell most people that anything is possible when it comes to the match but I think your best bet might be FM or IM and then do rural EM afterwards... sorry for your situation.

 

[ishryan]

The failed CS and only Passing two EM rotations are red flags....did your slors reflect residency based EM docs or community?

Residency EM programs. In fact my two interviews were at two of the 3 institutions I did my EM clerkships.

I have a question however, what do you mean by only passing two EM rotations. Is anything less than a high pass considered a no pass? A pass is still a positive mark am I wrong?

 

[ishryan]

This. Failed CS is probably a big factor since it is simply a pass/fail test that something like 90+% of people pass first time. Not bashing you... you clearly aren't "dumb" or something like that, it's just one of the stigmas of FMGs is that they will have a difficult time relating to the US "patient" and often times that comes out in the CS exam. Simply often due to cultural differences, accents, or something stupid like that... not skill. It sucks that it's the way it is but when someone sees that they wonder if it's a functionality thing. Also, as Makati said, the pass grades on the EM rotations are small red flags but might indicate huge red flags in those SLOEs... no way to know without advisement. Honestly, I like to tell most people that anything is possible when it comes to the match but I think your best bet might be FM or IM and then do rural EM afterwards... sorry for your situation.

That is an unfortunate truth. The REAL truth of the matter is that I do not have an accent, I am not a foreigner, and I have excellent social skills. My MSPE and my LOR's should reflect that. Unfortunately I get placed in that stigma, and it is really insinuating a totally wrong picture of who I am. Having an arabic last name really does not help my situation either.

Also, I have to correct your statement about the 90% + passing rate of the CS exam. That is but a thing of the past it seems. The exam has been redesigned for a much larger percentage of students to fail, and I have seen MANY excellent students like myself not pass. The last article I read said that now US students are said to be 90%+ passing, where it used to be something like 97%+, and for IMG, they are hoping for more like 70% pass rate. This is new. I had an equal experience both times taking the exam and two wildly different CIS (patient actor subjective grading portion) scores.

Of course I will be looking into FM and IM. I just wish these stereotypes weren't working to hard against my ability to apply for the field I want.

 

[Killa Beez MD]

Residency EM programs. In fact my two interviews were at two of the 3 institutions I did my EM clerkships.

I have a question however, what do you mean by only passing two EM rotations. Is anything less than a high pass considered a no pass? A pass is still a positive mark am I wrong?

Most competitive EM applicants will have high passes and honors in their EM rotations. Being an FMG already puts you at a huge disadvantage in the application process, so having 2 passes in your EM rotations is going to hurt your chances even more. Also, you mentioned that you only received 2 interviews at 3 of the places you rotated at. Why didn't you get an interview at the 3rd place? Was the place you didn't receive an interview at also one of the places you only received a pass?

 

[ishryan]

Most competitive EM applicants will have high passes and honors in their EM rotations. Being an FMG already puts you at a huge disadvantage in the application process, so having 2 passes in your EM rotations is going to hurt your chances even more. Also, you mentioned that you only received 2 interviews at 3 of the places you rotated at. Why didn't you get an interview at the 3rd place? Was the place you didn't receive an interview at also one of the places you only received a pass?

I had never heard that before speaking recently with a EM PD from a competitive California residency. I was hoping that was only the impression of highly competitive EM programs, and especially california.

I can't comment to the exact reason I did not recieve an interview at said third place, and I do not know which rotations gave me which grades. The program was Kaiser San Diego, a newly accredited EM residency with 6 spots. I'm sure it being a CA residency and having a large influx of highly competitive US applicants coming in played a huge part in the reason.

 

[Killa Beez MD]

I had never heard that before speaking recently with a EM PD from a competitive California residency. I was hoping that was only the impression of highly competitive EM programs, and especially california.

I can't comment to the exact reason I did not recieve an interview at said third place, and I do not know which rotations gave me which grades. The program was Kaiser San Diego, a newly accredited EM residency with 6 spots. I'm sure it being a CA residency and having a large influx of highly competitive US applicants coming in played a huge part in the reason.

Looking back at your original post, a few things jump out to me about your application. First, you had an above average Step 1 score followed by a below average Step 2 score which isn't good. 2nd, you are already at a disadvantage for being an FMG. Third, you passed 2 of your EM rotations which as discussed in my last post doesn't help your case. Fourth, you failed CS on your first attempt. With your application, you probably should have been focusing your EM rotations on much less competitive programs than California and should probably have considered applying to a backup specialty. Even though Kaiser SD is a new program, it will still be a competitive place based on the location and Kaiser name behind it. If you applied to 120 programs and only received 2 interviews, unfortunately, I don't really see things improving for you next cycle.

 

[Makati2008]

That is an unfortunate truth. The REAL truth of the matter is that I do not have an accent, I am not a foreigner, and I have excellent social skills. My MSPE and my LOR's should reflect that. Unfortunately I get placed in that stigma, and it is really insinuating a totally wrong picture of who I am. Having an arabic last name really does not help my situation either.

Also, I have to correct your statement about the 90% + passing rate of the CS exam. That is but a thing of the past it seems. The exam has been redesigned for a much larger percentage of students to fail, and I have seen MANY excellent students like myself not pass. The last article I read said that now US students are said to be 90%+ passing, where it used to be something like 97%+, and for IMG, they are hoping for more like 70% pass rate. This is new. I had an equal experience both times taking the exam and two wildly different CIS (patient actor subjective grading portion) scores.

Of course I will be looking into FM and IM. I just wish these stereotypes weren't working to hard against my ability to apply for the field I want.

I doubt your name being Arabic was an issue. I have classmates that matched EM that are Arabic and at good ACGME programs I might add.

 

[DocEspana]

That is an unfortunate truth. The REAL truth of the matter is that I do not have an accent, I am not a foreigner, and I have excellent social skills. My MSPE and my LOR's should reflect that. Unfortunately I get placed in that stigma, and it is really insinuating a totally wrong picture of who I am. Having an arabic last name really does not help my situation either.

Also, I have to correct your statement about the 90% + passing rate of the CS exam. That is but a thing of the past it seems. The exam has been redesigned for a much larger percentage of students to fail, and I have seen MANY excellent students like myself not pass. The last article I read said that now US students are said to be 90%+ passing, where it used to be something like 97%+, and for IMG, they are hoping for more like 70% pass rate. This is new. I had an equal experience both times taking the exam and two wildly different CIS (patient actor subjective grading portion) scores.

Of course I will be looking into FM and IM. I just wish these stereotypes weren't working to hard against my ability to apply for the field I want.

http://en.wikipedia.org/wiki/United_States_Medical_Licensing_Examination
http://www.ecfmg.org/forms/factcard.pdf

For 2012, the latest data we have, it looks like US grads first-time pass at ~97% and ECFMG students pass at 79%-82%.

 

[DocEspana]

Also, in the east coast at least, we remember why the CS exists. Mostly angrily we remember... Because we accidentally created it. Ive met the student who dreamed up the CS exam (this is obv years ago she did this, she is a peds attending now) because she was afraid that underqualified FMG students were flooding the residency market and wanted a way to make sure that people trained outside of the US knew how to actually interact with US patients. She passed the idea through the AMA student section and full AMA house of delegates. The accreditation people quickly fell in love with this idea. Except they loved it so much that they decided every single MD should have to take it.

NY has always had the wonderful reputation as the state that proudly brought the idea of a test to identify and fail under-trained foreign students.... and ended up putting everyone through an expensive annoying mess. We get a lot of crap for creating the idea for the CS pretty much every time it even tangentially comes up at AMA meetings.

 

[iish]

To the OP, do you have a hook to get PDs interested in you? I myself was a relatively sub-par applicant by numbers and grades though ended up matching at my #1 choice. I can only attribute this to a pretty impressive application that likely turned many heads. Additionally I had H's in 3 aways which made up for past errors. That being said, I think a powerful hook can make an otherwise sub-par application desirable. PM me and we can discuss further.

 

[Venko]

That is an unfortunate truth. The REAL truth of the matter is that I do not have an accent, I am not a foreigner, and I have excellent social skills. My MSPE and my LOR's should reflect that. Unfortunately I get placed in that stigma, and it is really insinuating a totally wrong picture of who I am. Having an arabic last name really does not help my situation either.

Also, I have to correct your statement about the 90% + passing rate of the CS exam. That is but a thing of the past it seems. The exam has been redesigned for a much larger percentage of students to fail, and I have seen MANY excellent students like myself not pass. The last article I read said that now US students are said to be 90%+ passing, where it used to be something like 97%+, and for IMG, they are hoping for more like 70% pass rate. This is new. I had an equal experience both times taking the exam and two wildly different CIS (patient actor subjective grading portion) scores.

Of course I will be looking into FM and IM. I just wish these stereotypes weren't working to hard against my ability to apply for the field I want.

I am sorry that your hopes are not presently working out.

I would suggest that it seems as though you are making the case that you have no communication differences than your US counterparts, and if thats the case then you should expect a pass rate around 97%. The fact that you didn't pass puts you in the bottom 3-5% of test takers going into any specialty let alone one whose competitiveness is on the rise like EM. Although I am sorry that it is working against you, its only fair to the 95-97% of others who passed the first time with comparable communication skills. If you want to be compared yourself to the IMG cohort, then you would still have to credit the 70% of them who passed the first time when you did not. Also, the downward trend to your board scores (excellent step 1, average to below average step 2) doesn't help the situation either, as the field becomes more and more competitive. The passing grades are what we call SABA…so average that they are below average for your EM applicant peers. I'm sorry if I am sounding insensitive, I am sorry things haven't gone as planned.

Moving forward, if you really really want to continue pursuing EM, its a less likely pathway but you could try building a close relationship with an EM residency as a researcher etc and try to see if that relationship can outweigh some of the weaker parts of your application. I don't believe its a high likelihood of success but its a potential avenue.

Best of luck,
Venko