Take advantage of the resource at your hands. Get to know a couple of the residents and find out what the program is all about. Get an advisor who can mentor you through the interview process knowing first hand what he or she is looking for in applicants and their paperwork. If you've had an opportunity in your first 3.5 years to do any research or shadowing or have been acquainted to them through the EMIG at your school that will give the PD from your program something more to write about you in his LOR.
Coming from a school with a program you have the advantage of people who know people in what is still the small world of Emergency Medicine and having a "somebody" write your letters can't hurt you if you've worked hard and done well.
For those without EM at their school, you can get some of the same benefits from an advisor from SAEM's virtual advisor program. All of this is only what you make of it though...it takes some effort on your part either way and you can definately match well without a program at your school.
