Advice for an applicant who didn't match

[Clintamycin]

Hi everybody! Firstly, congrats to those who Matched! Unfortunately, I won't be joining you this year, but next year I hope to come back even stronger! I am an IMG who was only able to get one SLOE, are there programs for unmatched docs to do additional rotations to obtain more SLOEs or do research? I have been looking everywhere!

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[gamerEMdoc]

SLOEs are meant to be written on 4th year students, comparing them to other 4th year students. I think you are out of the SLOE window.

As for what to do now, you have to decide between doing a prelim/transitional year (if there are many of these spots even open after the SOAP), taking an FP/IM spot and going in a different career direction, or taking a year off. If you take a year off, I would consider getting a job as an ED scribe rather than research. Research is more important in the application at research heavy university based places, and my guess is, you probably aren't going to have success getting interviews at those places anyways as an unmatched IMG.

 

[bravotwozero]

See if you can land a prelim IM or transitional year spot, where they have an EM residency, do an EM rotation and get another SLOE. Also, apply to FM and IM as backups.

If you can't score a transitional or prelim year, just go with whatever specialty or program is willing to take you and accept it as fate. That will likely be a FM program, but if that's what it comes down to, so be it.


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[Clintamycin]

I will be looking into these programs today. Is there a way to filter the programs and see the new programs you are speaking of?

 

[dadaddadaBATMAN]

SLOEs are meant to be written on 4th year students, comparing them to other 4th year students. I think you are out of the SLOE window.

As for what to do now, you have to decide between doing a prelim/transitional year (if there are many of these spots even open after the SOAP), taking an FP/IM spot and going in a different career direction, or taking a year off. If you take a year off, I would consider getting a job as an ED scribe rather than research. Research is more important in the application at research heavy university based places, and my guess is, you probably aren't going to have success getting interviews at those places anyways as an unmatched IMG.

So a few questions from the applicant side of the match (not trying to be a jerk, just curious about pd perspective )

1. I get that you guys are trying to compare apples to apples, but isn't the end goal to evaluate someone's ability to start an EM internship within that peer group?

2. If someone were to fail third year and repeat it, would you consider them ineligible for a SLOE?
If not, how does failing 4th year or "failing" the match make someone different?

3. Some people have completed 0 sub is, some people have completed 4 at the beginning of a rotation. If you can compensate for that in your grading scale, why can't the extra year be factored in?

 

[CliveStaples]

Maybe I'm confused but hasn't this person passed 4th year and is set to graduate? Not matching isn't failing 4th year. And the difference between an prelim med/surg intern and somebody who had to repeat 3rd year probably doesn't need to be explained very hard.

 

[dadaddadaBATMAN]

Maybe I'm confused but hasn't this person passed 4th year and is set to graduate? Not matching isn't failing 4th year. And the difference between an prelim med/surg intern and somebody who had to repeat 3rd year probably doesn't need to be explained very hard.

It does to me, but perhaps I need to clarify my question.

If you failed third year, you have same number of clinical years experience as someone who delays graduation to re-apply, and you are in the exact same role (senior medical student). If you are an intern with a couple months experience I can see why that's different due to the difference in roles and capabilities (notes, orders), but even so the amount of clinical experience remains constant.

I don't get why the person who failed third year is fine for a sloe, but a person who delays graduation is not. I also don't understand why an intern can't receive a letter. Which is why I asked: it doesn't matter much for me anymore, but I think it might matter for OP or for others who need to re-apply.

 

[gamerEMdoc]

So a few questions from the applicant side of the match (not trying to be a jerk, just curious about pd perspective )

1. I get that you guys are trying to compare apples to apples, but isn't the end goal to evaluate someone's ability to start an EM internship within that peer group?

2. If someone were to fail third year and repeat it, would you consider them ineligible for a SLOE?
If not, how does failing 4th year or "failing" the match make someone different?

3. Some people have completed 0 sub is, some people have completed 4 at the beginning of a rotation. If you can compensate for that in your grading scale, why can't the extra year be factored in?

I get your point, and understand, its not an "eligibility" thing. The SLOE doesn't require proof that you are a fourth year for someone to download the form and have someone fill it out. The hospital janitor could download a SLOE and fill it out for a nurse. There's no magic key in obtaining the form. The bigger point is the "spirit" of the SLOE, who it is meant for (fourth years) and who it is meant to be filled out by (faculty at EM residencies). I've seen tons of SLOEs from people who aren't faculty at residencies. I've seen SLOEs on many 3rd years, sometimes interns, I've seen SLOEs from research rotations (I have NO IDEA why that is valid, since its a clinical evaluation), US rotations, etc. I've seen SLOEs from people who didn't even rotate at a place, but just showed up at conference... Again, there's a difference between "can you get a SLOE" and "should you get a SLOE". Some are going to be far more valid and informative than others, that is for sure.

My point wasn't to say that you CAN'T get a SLOE, because you absolutely may be able to get someone to write you one. It's more what places will consider a valid evaluation. Because once you graduate, you aren't a student anymore, you are a physician. Which means, you can't just set up "rotations" anymore. You aren't a student, you are a doctor, a doctor without malpractice insurance. At best you'd be able to shadow, and some places won't even let physicians shadow. You are VERY unlikely to be able to secure a rotation as a physician who isn't a resident. And without being able to actually rotate somewhere, I'm not sure how you can get a valid evaluation of your performance.

 

[dadaddadaBATMAN]

I get your point, and understand, its not an "eligibility" thing. The SLOE doesn't require proof that you are a fourth year for someone to download the form and have someone fill it out. The hospital janitor could download a SLOE and fill it out for a nurse. There's no magic key in obtaining the form. The bigger point is the "spirit" of the SLOE, who it is meant for (fourth years) and who it is meant to be filled out by (faculty at EM residencies). I've seen tons of SLOEs from people who aren't faculty at residencies. I've seen SLOEs on many 3rd years, sometimes interns, I've seen SLOEs from research rotations (I have NO IDEA why that is valid, since its a clinical evaluation), US rotations, etc. I've seen SLOEs from people who didn't even rotate at a place, but just showed up at conference... Again, there's a difference between "can you get a SLOE" and "should you get a SLOE". Some are going to be far more valid and informative than others, that is for sure.

My point wasn't to say that you CAN'T get a SLOE, because you absolutely may be able to get someone to write you one. It's more what places will consider a valid evaluation. Because once you graduate, you aren't a student anymore, you are a physician. Which means, you can't just set up "rotations" anymore. You aren't a student, you are a doctor, a doctor without malpractice insurance. At best you'd be able to shadow, and some places won't even let physicians shadow. You are VERY unlikely to be able to secure a rotation as a physician who isn't a resident. And without being able to actually rotate somewhere, I'm not sure how you can get a valid evaluation of your performance.

Fair enough, thanks for taking the time to write that out

 

[The White Coat Investor]

An intern can have a SLOE done on them. A practicing doc can have one done too. This stuff happens all the time in the military match even if it isn't very common in the civilian one. Just like anyone else- you get the best SLOEs you can get.

 

[Red Husky]

I get your point, and understand, its not an "eligibility" thing. The SLOE doesn't require proof that you are a fourth year for someone to download the form and have someone fill it out. The hospital janitor could download a SLOE and fill it out for a nurse. There's no magic key in obtaining the form. The bigger point is the "spirit" of the SLOE, who it is meant for (fourth years) and who it is meant to be filled out by (faculty at EM residencies). I've seen tons of SLOEs from people who aren't faculty at residencies. I've seen SLOEs on many 3rd years, sometimes interns, I've seen SLOEs from research rotations (I have NO IDEA why that is valid, since its a clinical evaluation), US rotations, etc. I've seen SLOEs from people who didn't even rotate at a place, but just showed up at conference... Again, there's a difference between "can you get a SLOE" and "should you get a SLOE". Some are going to be far more valid and informative than others, that is for sure.

My point wasn't to say that you CAN'T get a SLOE, because you absolutely may be able to get someone to write you one. It's more what places will consider a valid evaluation. Because once you graduate, you aren't a student anymore, you are a physician. Which means, you can't just set up "rotations" anymore. You aren't a student, you are a doctor, a doctor without malpractice insurance. At best you'd be able to shadow, and some places won't even let physicians shadow. You are VERY unlikely to be able to secure a rotation as a physician who isn't a resident. And without being able to actually rotate somewhere, I'm not sure how you can get a valid evaluation of your performance.

Thanks for the informative post. I have a few question that I'd appreciate it if you could help with. If a physician or graduate can land a hands-on clinical experience where you don't just shadow but you actually take history, perform physical exam, write notes (not in patient's chart of course but for the attending to check) and almost do whatever a medical student would do, is it appropriate to get a SLOE?
Also, if you just observe somewhere or if you do research (which by your post I'd assume one won't be eligible for a SLOE) can you get a normal letter of recommendation instead? Do EM programs accept normal recommendation letters?

 

[gamerEMdoc]

Thanks for the informative post. I have a few question that I'd appreciate it if you could help with. If a physician or graduate can land a hands-on clinical experience where you don't just shadow but you actually take history, perform physical exam, write notes (not in patient's chart of course but for the attending to check) and almost do whatever a medical student would do, is it appropriate to get a SLOE?
Also, if you just observe somewhere or if you do research (which by your post I'd assume one won't be eligible for a SLOE) can you get a normal letter of recommendation instead? Do EM programs accept normal recommendation letters?

Obviously, ED programs prefer SLOEs, but there are time where regular LORs make more sense. For instance, WCI brought up military folks up above. Lets say a flight surgeon, who has a year of internship and 4 years of practice as a physician as a flight surgeon is exiting the military. That person is 5 years removed from med school. What is more valuable? A SLOE from when they were a 4th year student? Or a letter from their commanding officer? Sometimes a LOR does make more sense than a SLOE. Not often, but sometimes in uncommon situations like this. Also, that flight surgeon could go and volunteer and work some shifts in a military ED and get a new SLOE, but its obviously not comparing apples (doc 5 years out of med school) to apples (4th years), but its still better than nothing.

To answer your question, if someone who's graduated can still somehow land a rotation (I'm not sure how easy that would be to make happen), then by all means, I'd say try and get a SLOE. Its always better than not having one. The author will likely note that your in a different status than other rotators (4th years) for context, but the question regarding where they likely will be ranking you remains valid in my opinion.