Feb 3, 2013
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I am a 3rd year medical always had EM in the back of mind thinking I would do it. Now that I am almost done with my core rotation at a "big name" EM residency and my mind is set. I have been getting really good feedback from the residents and physicians I work with. Many say they don't expect a 3rd year to be at my level, which is not the norm from other rotations I have done (surgery, pads, IM). At this point I would just like some advising from here on out on what to do. I have a great board score, but my grades do not reflect that.

Step 1: 245
Pre-clinical: all passes
3rd year
Surgery: P
Peds: HP
Psych: HP
IM: P

I worked my ass off for the board score, and worked hard for my grades but they seem a little low for someone that can score 245 on step 1. I am not geographically limited at this point (maybe that will change?). I just want to go to a good place to train. What should/can I do from here other then rock my EM rotations I have signed up for? I do not have the background of EMT/Paramedic in college and instead I worked as a nurses aide in nursing homes. I wrote a personal statement for a SLOR from this program and it is a rough draft. WHere should I go to have someone look over that? Any life/career advice from here would be appreciated. I am all in for EM and just want to put the best application out there.

Thanks guys I have been looking at this forum for a long time, but never really contributed to it.
 

winkleweizen

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Apr 10, 2011
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I am a 3rd year medical always had EM in the back of mind thinking I would do it. Now that I am almost done with my core rotation at a "big name" EM residency and my mind is set. I have been getting really good feedback from the residents and physicians I work with. Many say they don't expect a 3rd year to be at my level, which is not the norm from other rotations I have done (surgery, pads, IM). At this point I would just like some advising from here on out on what to do. I have a great board score, but my grades do not reflect that.

Step 1: 245
Pre-clinical: all passes
3rd year
Surgery: P
Peds: HP
Psych: HP
IM: P

I worked my ass off for the board score, and worked hard for my grades but they seem a little low for someone that can score 245 on step 1. I am not geographically limited at this point (maybe that will change?). I just want to go to a good place to train. What should/can I do from here other then rock my EM rotations I have signed up for? I do not have the background of EMT/Paramedic in college and instead I worked as a nurses aide in nursing homes. I wrote a personal statement for a SLOR from this program and it is a rough draft. WHere should I go to have someone look over that? Any life/career advice from here would be appreciated. I am all in for EM and just want to put the best application out there.

Thanks guys I have been looking at this forum for a long time, but never really contributed to it.
Nothing else you can do besides relax and try to H and HP the rest of your rotations. Youll be fine.
 

CommunityED

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Oct 18, 2007
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That was about my situation and I matched at my first choice. That score will open the doors for interviews at least.
 

docB

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It's late in the game but you need a mentor. Usually I'd suggest someone at your home hospital but as you're late in the game you need anyone who is EM faculty at any place you rotated.

SLORs are key. If you did well on your rotation at the "big name" site make sure you can get an excellent SLOR from a faculty member there. Or two. SLORs are huge.

The concern about people with better boards than grades is that they're hard to work and get along with. In EM that's a problem. I'm not trying to be mean. I'm trying to be helpful here, and I'm not saying this is reality. This is just a perception you'll have to manage. The way to fix this is to look at the negative comments made in your evals. Be ready to address those in your interviews. Use your interviews as the opportunity to dispel any misperceptions about you.

Your scores will get you interviews which is good.

Good luck!
 

Dane07MD

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More important than anything else is getting good letters from EM faculty and doing strong in the EM clerkships you complete during your early fourth year. Third year grades are something, but not as important as USMLE scores, EM grade, letters. Trust me.
 
Sep 16, 2012
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More important than anything else is getting good letters from EM faculty and doing strong in the EM clerkships you complete during your early fourth year. Third year grades are something, but not as important as USMLE scores, EM grade, letters. Trust me.
This is 100000% correct. The only other thing which *may* help is to get involved ASAP with something involving EM related (research, etc)...but this won't be anywhere near as important as your EM grades/letters. Don't let anything detract from your ability to destroy your EM rotations.
 

la gringa

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It's late in the game but you need a mentor. Usually I'd suggest someone at your home hospital but as you're late in the game you need anyone who is EM faculty at any place you rotated.

SLORs are key. If you did well on your rotation at the "big name" site make sure you can get an excellent SLOR from a faculty member there. Or two. SLORs are huge.

The concern about people with better boards than grades is that they're hard to work and get along with. In EM that's a problem. I'm not trying to be mean. I'm trying to be helpful here, and I'm not saying this is reality. This is just a perception you'll have to manage. The way to fix this is to look at the negative comments made in your evals. Be ready to address those in your interviews. Use your interviews as the opportunity to dispel any misperceptions about you.

Your scores will get you interviews which is good.

Good luck!
i had a very similar grades vs boards situation. got way more interviews than i needed (30 iirc). didn't match anywhere near the top of my list, but since all of my places were great programs, it wasn't a big deal - just geographically rough for me. i interviewed entirely outside of my "home" geographic area, and in multiple big cities, which probably didn't help.

no one asked me about the negative comments in my evals - there were really only 2, from surg and OB. no shocker there ;) as i'm an assertive non-girly girl female. sighhh... i fit right in w/ EM women, thank goodness!! of all female docs, i liked EM gals the best, which is a lot of why i chose EM. (actually in non-academic life and away from my good ole boy med school, i like a lot of female surgeons too)

docB - what do you mean hard to work with? i don't think you'd get that from anyone with whom i have worked... actually when i rocked the inservice year after year, most people were sort of surprised b/c i'm not arrogant and actually err on the side of being a jokester.
 

docB

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docB - what do you mean hard to work with? i don't think you'd get that from anyone with whom i have worked... actually when i rocked the inservice year after year, most people were sort of surprised b/c i'm not arrogant and actually err on the side of being a jokester.
That's my point about this not being reality, merely a perception. Any application is a disembodied collection of facts without the context of the person. The harsh reality is that everyone who evaluates applications will make assumptions based on those apps. For example, applicants who are are not offered interviews have been assumed to lack something the program wanted. That may or may not be reality but those assumptions result in real decisions.

An assumption that could be made about someone whose board scores surpass their clinical grades could be that they are "book smart" but lack interpersonal skills. Again, not reality, just an assumption to be managed. That's what the interview is for, to show everyone what a great applicant the person is.

My attitude about interviews is to try to anticipate what the interviewer could see as a negative and be ready to manage that.

That was my point. I never intended to say that anyone is hard to work with. Just the opposite.
 
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docB I really appreciate the advice. One thing I should mention is that I don't have negative comments and actually have really good evals. Almost all say the same thing: hard worker, always asked for feedback and tried to improve, good team player ect. Not to make excuses, but it is usually the shelf or exam that holds back my grade. When I have time to really prepare like I did for boards I do very well. I took quite a bit of time off to study for boards and it showed. When I get to my shelf I just don't have the same amount of time to prepare otherwise I would not have any life outside of school. My biggest worry is that programs think I don't work hard on a day to day basis or that the board score is a fluke.
 

NERDY

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Try to study a little bit every night for the shelf (I know it is tough, especially for the 4 week rotations). Also, when you have down time in the hospital, try to do some studying. I used USMLE world all of 3rd year, and would do the questions when I had some down time. 5 minutes here, 10 minutes there, would add up and I was able to get a lot of questions done. Try to keep some study material with you at all time (smart phone, IPAD, book, etc).
 

Anonymous M4

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Oct 16, 2012
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I
The concern about people with better boards than grades is that they're hard to work and get along with. ...

Good luck!
I've never heard this expressed quite so succinctly; it's a very interesting point. The rest of the advice was on point, from a 4th year perspective. :thumbup:
 
May 2, 2010
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I'm a 3rd year in the exact same situation. Did well on Step 1 (238) but have struggled balancing clinical work with studying and my shelf's have suffered. The comments from my clerkships have been very positive but my subpar shelf scores have caused me to get a couple P's. Obviously the best thing to do is finish out my 3rd year strong with some H's. But for you guys in the know, how much do you think the early 3rd year P's (in non-EM clerkships) will hurt me if I'm able to do well in all my EM rotations?
 

winkleweizen

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I'm a 3rd year in the exact same situation. Did well on Step 1 (238) but have struggled balancing clinical work with studying and my shelf's have suffered. The comments from my clerkships have been very positive but my subpar shelf scores have caused me to get a couple P's. Obviously the best thing to do is finish out my 3rd year strong with some H's. But for you guys in the know, how much do you think the early 3rd year P's (in non-EM clerkships) will hurt me if I'm able to do well in all my EM rotations?
Its not an app killer, and probably depends on how your school does Honors and HP (some schools like washU give Hs to half the class so obviously a P there will hurt more than a school that gives Hs to 15% of the class) I would think the number of interviews you are able to get/your competitiveness will really be decided in your early 4th year with your SLORS and EM evals. I have good board scores, but I can say for sure that interviewers have commented way more on my evals from my EM rotations then they have on my board scores.
 
Sep 16, 2012
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Wait until you're in their shoes, giving good feedback is tough. If you want a good response, I would advise self-evaluating and finding one particular area for improvement to work on for that day/week- rapport with patients, H&P, differential diagnosis, plans etc. Let your resident or attending know in the beginning that you're working on that particular aspect and would appreciate any feedback they have. Then ask them about that particular thing when you ask how to improve so they have a direction to go in. There may still be a few instances when you don't get anything useful, but in general it's worked really well for me.

It's kind of like the difference between someone walking up to you and saying "teach me how to be a doctor" vs "teach me how to do an H&P"...
 

Old_Mil

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To be quite honest, had I known that Obamacare was going to become law and be supported by the court, I would have probably gone into family medcine. Although you can open an urgent care as an EM guy, it is probably easier to break free of the system and open a cash concierge practice if you are in one of the chronic care fields. Also, although the ACEP position that we only consume x% of healthcare dollars as a speciality is correct, as acute care physicians we do provide expensive care because we have to make up for a lack of knowledge about a given patient obtained over time with testing. In a cost controlled world this is going to become increasingly unacceptable and will probably increase our malpractice risk as we will be less able to order what we need to order without any changes in the standard of care to which we are held.

Something to consider.

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