What do you think about this application? Where do I go from here? AOA EM

[JediZero]

I'm trying to gauge where my application for EM stands. I am applying only to AOA residency programs, and not ACGME. Applying for college and medical school, I had a pretty good handle on what my options were, but right now I'm not sure if I ought to be looking for another specialty, if I'm in good shape to match at a smaller, less competitive residency, or if I've got an outside shot at some of the better programs.

Preclinical: 4th quartile GPA. Failed one system, successfully remediated.
COMLEX I: 518
Rotation Grades: Mostly HP or P. LP's in Surgery (which I deserved) and FP (which I felt was excessively harsh)
COMLEX II: Took 8/26, expecting substantial improvement from Step I (knock on wood).
Letters: 2 from IM preceptors and 1 from Peds preceptor. Have waived my right to view them, but they all liked me (both in person and on eval). Currently on my home EM rotation and feel that I'm doing well, should provide a solid SLOE, though from a rural West Coast L3 trauma center without a residency program. Will solicit more as I start auditions.
Auditions: one set up at Kent (RI) in Sep/Oct, others in the works through December.
EC: Numerous social, service and medically-related activities with leadership in preclinical years, none years 3/4 (I'm assuming that's not unusual). No research (unless you count a study on MCAT scores I did with my Pre-Med advisor). Minor 'awards' (Certificate for OMM TA and scholarship awarded to attend AAO Convocation).
Red flags: 2 month LOA between 2nd/3rd year (1 month for aforementioned remediation, extended after a death in the family a week before boards), but will complete all 4th year rotations in time to start residency.

Overall, I know that this is a below-average application, but I do think I can overcome that. My difficulties the first two years stemmed from health and personal difficulties (not sure if I should discuss that with programs), but I think my Level I score better reflects my true ability, and again, I'm hoping Level II will show that I've grown as I've moved further past all that.

If I can get that far, I do think I'm well-suited to interviews and auditions. What I've consistently heard from every single preceptor (well, not surgery) is that I'm good with patients, establish rapport quickly and put people at ease. I can talk about myself, my life and my experiences thoughtfully. I can take responsibility for what hasn't worked, and point to things that show I'm growing and learning to overcome my weaknesses.

So:
1) Am I likely to match in EM?
2) Should I bother applying to top programs (Lehigh Valley, etc.)?
3) Should I address my struggles in my PS, or only focus on my strengths? (There's a box to explain the LOA, and I'm sure I'll be discussing them in my interviews)
4) How can I tailor my strategy (application, interviews, rotations, shadowing etc.) to play to my strengths? I know that's a little vague, but I want to do the best I can with what I've got.

One final note, I've got a significant other who will be matching in 2015, most likely AOA Peds only, so I'm only planning to apply to areas with a reasonable number of DO programs (Florida, Ohio, Tri-State) so that she can try to end up relatively close by. Neither of us wants to go anywhere near Detroit.

Thank you all in advance for taking the time to sift through all that.

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[dotcb]

1. Possibly. You might have a hard time matching into an MD program. I'm not as familiar w/ DO programs and their level of competitiveness. If you are at all interested in MD programs, you have to take USMLE (and do well on it). I'd suggest you have a backup plan - at least a transitional year lined up.

2. It probably won't hurt, except your wallet.

3. Explain you LOA somewhere in the application process. Talk to your med school or EM advisor on where best to disclose this, possibly just in the interview. This will likely NOT be held against you.

4. The one thing you're not doing that I'd recommend is rotate at a top or big-name EM residency (preferably MD) and blow the rotation out of the water w/ sheer hard work and positive attitude.

With respect to your significant other, best bet general strategy is to shoot for a major metro area, such as NYC, Boston, LA, with lots of programs of all types

So:
1) Am I likely to match in EM?
2) Should I bother applying to top programs (Lehigh Valley, etc.)?
3) Should I address my struggles in my PS, or only focus on my strengths? (I'm sure I'll be discussing them in my interviews)
4) How can I tailor my strategy (application, interviews, rotations, shadowing etc.) to play to my strengths? I know that's a little vague, but I want to do the best I can with what I've got.

One final note, I've got a significant other who will be matching in 2015, most likely AOA Peds only, so I'm only planning to apply to areas with a reasonable number of DO programs (Florida, Ohio, Tri-State) so that she can try to end up relatively close by. Neither of us wants to go anywhere near Detroit.

Thank you all in advance for taking the time to sift through all that.

 

[JediZero]

1. Possibly. You might have a hard time matching into an MD program. I'm not as familiar w/ DO programs and their level of competitiveness. If you are at all interested in MD programs, you have to take USMLE (and do well on it). I'd suggest you have a backup plan - at least a transitional year lined up.

2. It probably won't hurt, except your wallet.

3. Explain you LOA somewhere in the application process. Talk to your med school or EM advisor on where best to disclose this, possibly just in the interview. This will likely NOT be held against you.

4. The one thing you're not doing that I'd recommend is rotate at a top or big-name EM residency (preferably MD) and blow the rotation out of the water w/ sheer hard work and positive attitude.

With respect to your significant other, best bet general strategy is to shoot for a major metro area, such as NYC, Boston, LA, with lots of programs of all types

Thanks for your reply.

1. My apologies for the lack of clarity- I am applying AOA only. I alluded to that in the title, but neglected to mention it in the post. Will edit that...

2. Heh. That's going to be a whole different can of worms. Expecting to apply to about 25 programs.

3. I remembered that there was a box to explain any gaps in medical school, under the 'Misc' section of ERAS... Does that sound like it would be sufficient?

4. That's my goal. Working on adding another 1-3 audition rotations, hopefully in high-end programs.

Thank you again for your help. Just trying to muddle through all of this...

 

[TeamZissou]

Thanks for your reply.

1. My apologies for the lack of clarity- I am applying AOA only. I alluded to that in the title, but neglected to mention it in the post. Will edit that...

2. Heh. That's going to be a whole different can of worms. Expecting to apply to about 25 programs.

3. I remembered that there was a box to explain any gaps in medical school, under the 'Misc' section of ERAS... Does that sound like it would be sufficient?

4. That's my goal. Working on adding another 1-3 audition rotations, hopefully in high-end programs.

From a OMSIV in very similar shoes FWIW
1/2- Personally I would apply to the programs you're interested in (like top programs) and areas you could see yourself Iiving (not MI). I don't know if there is as much value in applying high numbers as there would be on the MD side. Seems like 25 would be alright for you. With the DO world being all about FaceTime you don't want to spread yourself too thin and end up with many poor showings and not enough stellar interviews. At least that's the impression I got from some friends having difficulty in last years AOA EM. Not being an avg or excellent candidate probably means it's more important for you to get quality face time (vs quantity) at a few programs of your choice. Sounds like you already have that arranged.
3- That's what I did, literally "Yes, Medical LOA." As far as discussing it in detail elsewhere; I will if it comes up but otherwise will leave it be. This is difficult to do since there were some big lessons taken away from it. But at the advice of a few mentors I'll leave that stone unturned and instead of having an explaining/negative feel to the app go with the positive/upside.

Good luck

 

[Siggy]

One quick note, SLORs are supposed to only be written for rotations at facilities with a EM residency program.

 

[JediZero]

One quick note, SLORs are supposed to only be written for rotations at facilities with a EM residency program.

Hmm... Their website says "only Emergency Medicine faculty". Not clear if that applies to residency faculty only or could include medical school faculty. Do you see clarification elsewhere?

 

[JediZero]

From a OMSIV in very similar shoes FWIW
1/2- Personally I would apply to the programs you're interested in (like top programs) and areas you could see yourself Iiving (not MI). I don't know if there is as much value in applying high numbers as there would be on the MD side. Seems like 25 would be alright for you. With the DO world being all about FaceTime you don't want to spread yourself too thin and end up with many poor showings and not enough stellar interviews. At least that's the impression I got from some friends having difficulty in last years AOA EM. Not being an avg or excellent candidate probably means it's more important for you to get quality face time (vs quantity) at a few programs of your choice. Sounds like you already have that arranged.
3- That's what I did, literally "Yes, Medical LOA." As far as discussing it in detail elsewhere; I will if it comes up but otherwise will leave it be. This is difficult to do since there were some big lessons taken away from it. But at the advice of a few mentors I'll leave that stone unturned and instead of having an explaining/negative feel to the app go with the positive/upside.

Good luck

Glad to hear from others in the same place. By 'spreadingmyself too thin', do you mean applying to more programs (like 40+), scheduling too many auditions, or...?

And yeah, that seems to be the best course of action. I'm sure if they care, they'll ask. Just need to be prepared.

And thanks. Good luck to you too!

 

[TeamZissou]

Glad to hear from others in the same place. By 'spreadingmyself too thin', do you mean applying to more programs (like 40+), scheduling too many auditions, or...?

And yeah, that seems to be the best course of action. I'm sure if they care, they'll ask. Just need to be prepared.

And thanks. Good luck to you too!

This is a vague description but I hope you take away the idea bc that's all that matters. It's a fine line between
- putting in just enough facetime at a place to get your face/name recognized
vs
- assure them you're mediocre
vs
- putting in extended time with select places to ensure the prog they are your "#1".

My friends who had difficulty varied in app strength but it seemed like something they had in common was not targeting one prog and really convincing them they wanted to go there. Granted n= 5-7sh but that's what I got right now.

 

[NYEMMED]

Hmm... Their website says "only Emergency Medicine faculty". Not clear if that applies to residency faculty only or could include medical school faculty. Do you see clarification elsewhere?

The SLOE is meant for programs to be able to communicate how you did while rotating at another program (program meaning EM residency).

There are questions such as "where do you intend to rank this person on your match list?" Now if you dont have a residency this becomes invalid.

The SLOE wont really help if not from an EM residency program. They will look at it and think it really has no value because they are not comparing to other EM applicants, nor do they have interest in selecting residents.

Best bet for any SLOE to help, is to have a good one from a respected EM residency program, or at least any EM residency program.

 

[JediZero]

The SLOE is meant for programs to be able to communicate how you did while rotating at another program (program meaning EM residency).

There are questions such as "where do you intend to rank this person on your match list?" Now if you dont have a residency this becomes invalid.

The SLOE wont really help if not from an EM residency program. They will look at it and think it really has no value because they are not comparing to other EM applicants, nor do they have interest in selecting residents.

Best bet for any SLOE to help, is to have a good one from a respected EM residency program, or at least any EM residency program.

Yeah, I asked an advisor at my school about it, and he contacted CORDEM directly. Response from them:

The SLOE is intended to be completed by Faculty of an emergency medicine residency program. Anyone else would write a letter of recommendation.

Thank you all for the heads-up. Hopefully a regular letter will at least be enough to consider my application, as it looks like I will not be adding a SLOE until late October in the best-case scenario.

 

[Makati2008]

From a OMSIV in very similar shoes FWIW
1/2- Personally I would apply to the programs you're interested in (like top programs) and areas you could see yourself Iiving (not MI). I don't know if there is as much value in applying high numbers as there would be on the MD side. Seems like 25 would be alright for you. With the DO world being all about FaceTime you don't want to spread yourself too thin and end up with many poor showings and not enough stellar interviews. At least that's the impression I got from some friends having difficulty in last years AOA EM. Not being an avg or excellent candidate probably means it's more important for you to get quality face time (vs quantity) at a few programs of your choice. Sounds like you already have that arranged.
3- That's what I did, literally "Yes, Medical LOA." As far as discussing it in detail elsewhere; I will if it comes up but otherwise will leave it be. This is difficult to do since there were some big lessons taken away from it. But at the advice of a few mentors I'll leave that stone unturned and instead of having an explaining/negative feel to the app go with the positive/upside.

Good luck

Op. I agree with this TeamZissou except a few things:
1.) I would apply to more than 25 programs( probably 40)
2.) I would truly think about adding Michigan sites to the mix with you being an applicant with a few red flags.
3.)I would apply to newer programs as well.

I hope I don't sound harsh but before I got my level two score I had to be honest with myself that I was an applicant with a Lower level 1(520ish)from a newer DO school and honestly wanted to be an EP.
Also remember residency is like med school-temporary so think about that before you totally write off a state and risk not matching at all especially with EM getting more and more competitive.

Gl

 

[QuackaDO]

Just FYI, unless something has changed I wouldn't be too concerned about a SLOR/SLOE... Osteopathic programs don't need them or require them. The SLOE/SLOR is an allopathic thing and required for allopathic programs, not osteopathic so don't even make the mistake of asking for a SLOE from an osteopathic program or from a non-EM person.

 

[TeamZissou]

How many programs are there? That actually fit OPs description?

Anyhow I agree with adding the MI programs, not because you have red flags (that too), but because those are some of the best ones with the most resources.

We should start a DO EM application thread. I'm curious as to which and how many programs have started sending invited.

 

[Makati2008]

Just FYI, unless something has changed I wouldn't be too concerned about a SLOR/SLOE... Osteopathic programs don't need them or require them. The SLOE/SLOR is an allopathic thing and required for allopathic programs, not osteopathic so don't even make the mistake of asking for a SLOE from an osteopathic program or from a non-EM person.

Actually I was asked to turn in my sloe if I had any to a NJ program. Also I know of one of the OK programs going to the sloe format.

 

[Makati2008]

How many programs are there? That actually fit OPs description?

Anyhow I agree with adding the MI programs, not because you have red flags (that too), but because those are some of the best ones with the most resources.

We should start a DO EM application thread. I'm curious as to which and how many programs have started sending invited.

As of now I have seven invites. Eight counting my audition.

 

[codegrey]

You need to apply to every program that you can afford. If you can afford to apply to every program in the US, do that. Only take interviews at places that you have a reasonable chance at matching.

EM is getting hard, I experienced that first hand last year. For "weaker" applicants, I think the advice this year is to apply to 60 programs. You should be on the safe side and apply to more.

 

[JediZero]

Op. I agree with this TeamZissou except a few things:
1.) I would apply to more than 25 programs( probably 40)
2.) I would truly think about adding Michigan sites to the mix with you being an applicant with a few red flags.
3.)I would apply to newer programs as well.

I hope I don't sound harsh but before I got my level two score I had to be honest with myself that I was an applicant with a Lower level 1(520ish)from a newer DO school and honestly wanted to be an EP.
Also remember residency is like med school-temporary so think about that before you totally write off a state and risk not matching at all especially with EM getting more and more competitive.

Gl

Not harsh at all. If people didn't share advice unless it was sunshine and daisies, it wouldn't be worth much, now would it?

The problem for us is finding programs with at least some modicum of geographic overlap. There are 20 total AOA peds programs, and 50 AOA EM programs. Of those 50, 5 don't have a Peds program in the same state, and about another 10 are still too isolated or only have one or two programs nearby, making it a risky proposition. So probably my absolute max for programs to apply to is ~35.

Unfortunately, it does look like Michigan is one of the richest opportunities for us to end up near each other, even if we know it's not going to be good for us. I don't know. Maybe that's a tough decision we're just going to have to make. On the plus side, if I don't match and wind up scrambling into a TRI, that allows us to enter the couples match next year, which would at least make the geographic proximity easier, even if a) we're not in our top-choice programs and b) I don't get credit for my internship and start over as a PGY-1 again. Which is a compromise I'd be happy with, I think.

And I don't have a problem with newer programs. I do think that my school will be a positive- it's an older school at this point and (I think) pretty well-respected, and while Western is far away from the East coast programs, given the dearth of residencies out here I'm sure we export plenty of students in that direction.

 

[Warbler]

Hi all-

LATE applicant to the EM pool here, with some questions:

I just recently did my ER rotation and LOVED it...got 2 LOR from 2 doctors pending, and 2 more good LOR.

COMLEX Step 1: 626
COMLEX Step 2: Pending, 9/15

Otherwise good app, tons of extra curricular stuff and leadership.

Is it too late to apply EM?
Is my step 2 being so late going to hurt me?

I'd almost certainly want to be at Barnabas, PCOM, or Mt. Sinai...some big urban program like that (not sure if anyone can recommend any others?).

 

[TeamZissou]

Makati- mind me asking when you were complete? At least with your PS, transcript, COMLEX and ~2 LORS?


I have a couple red flags so I applied multiple specialties and broadly. Everyone said it was overboard, but it's not looking like it anymore. Ya I know it's still early.

 

[QuackaDO]

Actually I was asked to turn in my sloe if I had any to a NJ program. Also I know of one of the OK programs going to the sloe format.

That's definitely a new thing then for AOA programs. Most (I guess not all) don't use it but I think there is a push to move in that direction so having one doesn't hurt you. Problem you get into is that if you get a SLOR (I just refuse to say SLOE yet, lol... sounds so derogatory) from an allopathic program that's used to the format and filling out SLORs how will it be perceived by an osteopathic program? Will they look at it and say "Hmm... he did a rotation at an allopathic program and did well... I bet he's trying to go allopathic instead of osteopathic" and bump you down the list? Sounds crazy, but I've actually talked to an osteopathic APD who said this is a HUGE factor in their rank list (whether they think you will go allopathic or not). They don't want to rank people they have no chance at so you may not want to send off the wrong signal with an allopathic SLOR.

On the flipside, if you ask an osteopathic program for a SLOR it may be a foreign concept to them because they are just getting oriented to seeing/writing them and the letter may not come out as good as you want it to. You'd have to feel confident your letter is well written which is hard to do since most write with the premise that you are going to waive your right to see it. On top of that, if you were going to entertain the option of allopathic programs (not that you are, just saying this as a general for whoever reads that might be) then a SLOR from an osteopathic program is nearly pointless because I've had NUMEROUS (and I mean like >10) PDs tell me that the biggest thing they look for is who the letter writer is or where it's from to see if they know them and then read what's there. They claim to almost talk in code, lol. One in MI said "If I see a letter written by Dr. X I've likely seen 100 letters from him over the years and know by the way he writes if this candidate is good or if he's just doing lip service on the letter and the candidate is nothing special". It's that crazy, lol! Sooo... if you get a letter from an osteopathic program that most letter readers (aka, PDs and APDs) are not familiar with they will put a LOT less stock in what the letter says than they would if it was someone who they could call up and ask about you.

Difficult bind here with osteopathics starting to ask for SLORs... I think in 4-5 years it won't be a problem but with this year being what appears to be an early transition time I would be a little uneasy about how my SLOR would be taken by a program. Best advice to the OP would be to contact the programs you are interested in (just contact the program coordinator listed on the residency listing on the AOA search page) and ask if they require "a certain type of letter of recommendation or if any type letter that accurately describes your skills is sufficient". Specific wording there... you don't throw out the word SLOR/SLOE but you give them the opportunity to say that's what they want. Many will say the second option is fine but if you specifically ask about a SLOR they may say "Oh yes, a SLOR would be fine" which leaves you in a dilemma... is a SLOR "fine" or is a SLOR "necessary". Let them fill in the blanks for you and if the majority (or all) of the programs that you're applying to don't need a SLOR then don't worry too much about it...

 

[123165]

How many programs are there? That actually fit OPs description?

Anyhow I agree with adding the MI programs, not because you have red flags (that too), but because those are some of the best ones with the most resources.

We should start a DO EM application thread. I'm curious as to which and how many programs have started sending invited.

I have heard from
Doctors
Conemaugh
Kent
Sparrow
St joseph (nj)
SOMC
Lehigh emailed me and said they need my MSPE

 

[Makati2008]

Makati- mind me asking when you were complete? At least with your PS, transcript, COMLEX and ~2 LORS?


I have a couple red flags so I applied multiple specialties and broadly. Everyone said it was overboard, but it's not looking like it anymore. Ya I know it's still early.

A month ago I think with level two uploaded. I already have all my lor loaded as well.

I had my initial stuff all turned in literally the first week we could.

 

[NYEMMED]

That's definitely a new thing then for AOA programs. Most (I guess not all) don't use it but I think there is a push to move in that direction so having one doesn't hurt you. Problem you get into is that if you get a SLOR (I just refuse to say SLOE yet, lol... sounds so derogatory) from an allopathic program that's used to the format and filling out SLORs how will it be perceived by an osteopathic program? Will they look at it and say "Hmm... he did a rotation at an allopathic program and did well... I bet he's trying to go allopathic instead of osteopathic" and bump you down the list? Sounds crazy, but I've actually talked to an osteopathic APD who said this is a HUGE factor in their rank list (whether they think you will go allopathic or not). They don't want to rank people they have no chance at so you may not want to send off the wrong signal with an allopathic SLOR.

On the flipside, if you ask an osteopathic program for a SLOR it may be a foreign concept to them because they are just getting oriented to seeing/writing them and the letter may not come out as good as you want it to. You'd have to feel confident your letter is well written which is hard to do since most write with the premise that you are going to waive your right to see it. On top of that, if you were going to entertain the option of allopathic programs (not that you are, just saying this as a general for whoever reads that might be) then a SLOR from an osteopathic program is nearly pointless because I've had NUMEROUS (and I mean like >10) PDs tell me that the biggest thing they look for is who the letter writer is or where it's from to see if they know them and then read what's there. They claim to almost talk in code, lol. One in MI said "If I see a letter written by Dr. X I've likely seen 100 letters from him over the years and know by the way he writes if this candidate is good or if he's just doing lip service on the letter and the candidate is nothing special". It's that crazy, lol! Sooo... if you get a letter from an osteopathic program that most letter readers (aka, PDs and APDs) are not familiar with they will put a LOT less stock in what the letter says than they would if it was someone who they could call up and ask about you.

Difficult bind here with osteopathics starting to ask for SLORs... I think in 4-5 years it won't be a problem but with this year being what appears to be an early transition time I would be a little uneasy about how my SLOR would be taken by a program. Best advice to the OP would be to contact the programs you are interested in (just contact the program coordinator listed on the residency listing on the AOA search page) and ask if they require "a certain type of letter of recommendation or if any type letter that accurately describes your skills is sufficient". Specific wording there... you don't throw out the word SLOR/SLOE but you give them the opportunity to say that's what they want. Many will say the second option is fine but if you specifically ask about a SLOR they may say "Oh yes, a SLOR would be fine" which leaves you in a dilemma... is a SLOR "fine" or is a SLOR "necessary". Let them fill in the blanks for you and if the majority (or all) of the programs that you're applying to don't need a SLOR then don't worry too much about it...

I have had quite a different experience. Most of the better/more competitive AOA programs actually do require a SLOE/SLOR. They will consider your application incomplete until they receive one and for some programs 2 SLOEs. I also rotated through 4 programs and all knew about SLOEs and wrote them. Students coming through my program are given SLOEs and our program has used them for at least the last 4 years.

 

[QuackaDO]

I have had quite a different experience. Most of the better/more competitive AOA programs actually do require a SLOE/SLOR. They will consider your application incomplete until they receive one and for some programs 2 SLOEs. I also rotated through 4 programs and all knew about SLOEs and wrote them. Students coming through my program are given SLOEs and our program has used them for at least the last 4 years.

Are you talking about the more "competitive" programs such as Lehigh, St Lukes, and all the other dually accredited programs? If so then no big surprise on that... they are essentially ACGME programs that also are AOA so their familiarity with SLOR/SLOEs is understandable. Honestly, not even sure what other AOA residencies are considered "competitive" outside of the dually accredited and maybe Arrowhead.

 

[jkmph]

Are you talking about the more "competitive" programs such as Lehigh, St Lukes, and all the other dually accredited programs? If so then no big surprise on that... they are essentially ACGME programs that also are AOA so their familiarity with SLOR/SLOEs is understandable. Honestly, not even sure what other AOA residencies are considered "competitive" outside of the dually accredited and maybe Arrowhead.

I have two ERAS emails sitting in my inbox from AOA (not combined) programs essentially saying "make sure to upload your SLOR".

 

[scummie]

sorry to dig up an old thread, but did you end up matching? either way, best of luck to you.