Strider_91

2+ Year Member
Feb 20, 2016
242
210
Status
Medical Student
I have just started school and am really pretty sure I want to do EM. It is a lot harder than I thought it would be and I am always scoring right around the average. I don't really care about being the best at this point, I want everyone to do well and am happy if there is a high average in my class. What I do care about is matching into the specialty I want, in the place I want to live (somewhere with good outdoor activities).

I am trying to revamp my study methods and learn from kids scoring high on exams, but worst case scenario if I stay average what can I do to still match em?


Also, my school is pass fail right now and doesn't have rank but I'm thinking if I'm scoring around the average on exams it would be delusional to think I would miraculously be in the 90th percentile of step 1 even though I'm going to try my hardest.
 

surely

MD Class of 2018
7+ Year Member
May 9, 2010
1,173
814
Status
Medical Student
What I do care about is matching into the specialty I want, in the place I want to live (somewhere with good outdoor activities).

...

Also, my school is pass fail right now and doesn't have rank but I'm thinking if I'm scoring around the average on exams it would be delusional to think I would miraculously be in the 90th percentile of step 1 even though I'm going to try my hardest.

You'll be FINE! 1) People who do average in preclinical classes can and do go on to rock Step 1. 2) You don't really need to absolutely rock Step 1 to match EM, even in areas with good outdoor activities. Yes, some programs are more selective, but there are plenty of opportunities even for average applicants.

Some things to look at:
Step 1 percentiles by score, page 3: www.usmle.org/pdfs/transcripts/USMLE_Step_Examination_Score_Interpretation_Guidelines.pdf
Match rates by Step 1 score, EM on Page 58: www.nrmp.org/wp-content/uploads/2016/09/Charting-Outcomes-US-Allopathic-Seniors-2016.pdf

While I don't have data for this, my gut says you don't need a 90th percentile Step 1 score to match somewhere with good outdoor activities. Plus, residency is only 3 years - You can hunker down and spend 3 years away from good outdoor activities if it means you get to work your dream career for the rest of your life.
 
Last edited:
OP
Strider_91

Strider_91

2+ Year Member
Feb 20, 2016
242
210
Status
Medical Student
You'll be FINE! 1) People who do average in preclinical classes can and do go on to to rock Step 1. 2) You don't really need to absolutely rock Step 1 to match EM, even in areas with good outdoor activities. Yes, some programs are more selective, but there are plenty of opportunities even for average applicants.

Some things to look at:
Step 1 percentiles by score, page 3: www.usmle.org/pdfs/transcripts/USMLE_Step_Examination_Score_Interpretation_Guidelines.pdf
Match rates by Step 1 score, EM on Page 58: www.nrmp.org/wp-content/uploads/2016/09/Charting-Outcomes-US-Allopathic-Seniors-2016.pdf

While I don't have data for this, my gut says you don't need a 90th percentile Step 1 score to match somewhere with good outdoor activities. Plus, residency is only 3 years - You can hunker down and spend 3 years away from good outdoor activities if it means you get to work your dream career for the rest of your life.
Thanks for the encouragement, I needed it. I'm going to continue to try my hardest academically, I am becoming more efficient every day.

If it comes down to matching somewhere I don't want to live for the rest of my life, for 3 years, I will gladly make that sacrifice for my dream career. Except for maybe manhattan (please don't make me go to the big Apple).

Thank you for the resources.

Is it true that LOR are weighed more heavily in EM than other specialties? I am usually able to form tight mentor/ mentee relationships with people and have had strong letters for things in the past.
 
About the Ads

surely

MD Class of 2018
7+ Year Member
May 9, 2010
1,173
814
Status
Medical Student
Is it true that LOR are weighed more heavily in EM than other specialties? I am usually able to form tight mentor/ mentee relationships with people and have had strong letters for things in the past.
The letters in EM are unique - They're called SLOES, or Standardized Letters of Evaluation. Generally speaking, the way it works is that you do your EM clerkship, the people you work with fill out evaluation cards for you every shift, and then the clerkship leadership and/or program leadership convene after the clerkship ends to discuss your performance and compose a group SLOE using this form to compare you to your peers: https://www.cordem.org/files/DOCUMENTLIBRARY/SLOR/SLOE Standard Letter of Evaluation 2015.pdf Note how all of the questions on Page 2 ask them to rank you above peers, at the level of peers, or below peers.

Forming tight mentor/mentee relationships won't help you in this regard, since the SLOE is effectively an evaluation or a narrative grade for your performance on an EM clerkship. You can still submit "individual letters of recommendation" (i.e. traditional, non-SLOE letters), but they aren't weighted nearly as strongly as the SLOEs.
 
  • Like
Reactions: Strider_91

Perfect Hair Day

Grapes of Wrath, Chocolate Ice Cream, Johnny Cash.
2+ Year Member
Aug 16, 2016
375
273
The Pit
Status
Medical Student
If it comes down to matching somewhere I don't want to live for the rest of my life, for 3 years, I will gladly make that sacrifice for my dream career.
Same. I'm above average in competitiveness but I'm dealing with a "red flag" on my application which makes things challenging (though not impossible from the advisement I've received on SDN and elsewhere). I used to be very narrowly focused on living in a big city like Los Angeles or New York but those were during my Internal Medicine days. Emergency Medicine is unique in that "prestige" and "name" is not as much of a factor as volume, setting, and quality of teaching. Someone who has suffered significant trauma to their hand from a chainsaw is going to go to the closest place that can help them - they don't have time to "seek out" the expert like someone with a rare genetic neurologic condition or metabolic disorder might. I think it's the "I need help, now" nature of injury and acute illness, and that it can happen to anyone, which makes a location for EM training a non-issue. You'll see frost-bite in NYC and Madison Wisconsin, you'll see heat stroke in Erie, PA and Miami Beach, FL, you'll see trauma in Los Angeles and in Hattiesburg, you'll see poisonings in Chicago and Morgantown, WV, you'll see compound fractures in Baltimore, MD and in Elmira, NY. Accidents happen, emergencies happen - hopefully, we'll be fortunate enough to match into EM and be the ones to help when these things happen, wherever they happen.

Keep that eye on the prize - ABEM eligibility :)
 
  • Like
Reactions: surely

carbonizedeyesockets

5+ Year Member
Oct 27, 2013
210
203
East Coast
Status
Attending Physician
The number of EM positions make it hard for the specialty to be as competitive as many other specialties (4th largest in terms of PGY1 spot, beat by FM, IM, and peds). Certain programs are certainly very competitive. But the field itself? Not as much as some make it out to be. I had done an anonymous survey of classmates and even those who did poorly on step I or step II (e.g. <210) matched in their top 3.
 

surely

MD Class of 2018
7+ Year Member
May 9, 2010
1,173
814
Status
Medical Student
The number of EM positions make it hard for the specialty to be as competitive as many other specialties (4th largest in terms of PGY1 spot, beat by FM, IM, and peds). Certain programs are certainly very competitive. But the field itself? Not as much as some make it out to be. I had done an anonymous survey of classmates and even those who did poorly on step I or step II (e.g. <210) matched in their top 3.
Worth pointing out that "their top 3" means "their top 3 among the programs they got interviews from," not among all the programs they initially applied to on ERAS. But I agree with your post overall!
 
  • Like
Reactions: Strider_91

Mad Jack

Critically Caring
5+ Year Member
Jul 27, 2013
35,680
65,473
4th Dimension
You'll be FINE! 1) People who do average in preclinical classes can and do go on to to rock Step 1. 2) You don't really need to absolutely rock Step 1 to match EM, even in areas with good outdoor activities. Yes, some programs are more selective, but there are plenty of opportunities even for average applicants.

Some things to look at:
Step 1 percentiles by score, page 3: www.usmle.org/pdfs/transcripts/USMLE_Step_Examination_Score_Interpretation_Guidelines.pdf
Match rates by Step 1 score, EM on Page 58: www.nrmp.org/wp-content/uploads/2016/09/Charting-Outcomes-US-Allopathic-Seniors-2016.pdf

While I don't have data for this, my gut says you don't need a 90th percentile Step 1 score to match somewhere with good outdoor activities. Plus, residency is only 3 years - You can hunker down and spend 3 years away from good outdoor activities if it means you get to work your dream career for the rest of your life.
Places with good outdoor activities tend to be less competitive, so that interest helps if anything.
 
  • Like
Reactions: Strider_91

alpinism

Give Em' the Jet Fuel
7+ Year Member
Nov 6, 2011
3,132
2,793
Port Au Prince
As long as you apply broadly to less desirable locations you should have no trouble matching provided you pass your classes and get above 220 steps.

Almost everyone I know who didn't match EM had a problem with one of the three factors above.
 
  • Like
Reactions: Strider_91

surely

MD Class of 2018
7+ Year Member
May 9, 2010
1,173
814
Status
Medical Student
Places with good outdoor activities tend to be less competitive, so that interest helps if anything.
Is that true? I thought that Utah and Denver were competitive/desirable due to their mountain proximity. One of my friends applied to a lot of west coast programs on the basis of mountain proximity, too.

"Outdoor activities" is pretty broad, to be fair.
 

Mad Jack

Critically Caring
5+ Year Member
Jul 27, 2013
35,680
65,473
4th Dimension
Is that true? I thought that Utah and Denver were competitive/desirable due to their mountain proximity. One of my friends applied to a lot of west coast programs on the basis of mountain proximity, too.

"Outdoor activities" is pretty broad, to be fair.
I guess it depends on what you mean. If you like hiking, plenty to do in rural America. If you like the water, it's almost everywhere.
 
  • Like
Reactions: surely
OP
Strider_91

Strider_91

2+ Year Member
Feb 20, 2016
242
210
Status
Medical Student
Is that true? I thought that Utah and Denver were competitive/desirable due to their mountain proximity. One of my friends applied to a lot of west coast programs on the basis of mountain proximity, too.

"Outdoor activities" is pretty broad, to be fair.
Thanks for all the responses.

What I mean by outdoor activities is access to public land for camping, backpacking, hiking, kayaking/ canoeing mountaineering.

Being near big mountains like Colorado or Washington or Utah would be great but I don't actually ski so I can get my weekend fix with a trip to 5-6k ft. Mountains which opens up a lot more options than just Utah or Colorado. It's easy to get on a plane and go somewhere with real mountains to get in the mountaineering fix. I know I won't have much time during residency to pursue these things but I feel there is a chance you end up practicing near the area you train.
 

carbonizedeyesockets

5+ Year Member
Oct 27, 2013
210
203
East Coast
Status
Attending Physician
Looking back at the data I have, one classmate (MD school) had <205 and another had <215. They applied to 50 and 70, and received 14 and 21 invites, respectively. There was a class mate that went from >230 on step 1 to <210 on step 2. That person applied to 11 programs and received 7 invites and they matched at their number 2.

Again, I give these examples to show that yes you CAN match with poor scores. Will you get in to In&Out BurgER? Probably not, but you can match. And, lets face it, there are many great programs that are not considered "top" programs or "competitive". Again, remember that some of the competitive programs are only such because of where they are located, and NOT because they offer superior training.

Worth pointing out that "their top 3" means "their top 3 among the programs they got interviews from," not among all the programs they initially applied to on ERAS. But I agree with your post overall!
Thank you for your insight, Captain Obvious.
 

takeurmeds02

5+ Year Member
Dec 9, 2014
1,513
2,103
Status
Medical Student
@surely @Mad Jack

What goes into a good SLOE other than "gel'ing" with that particular department?

Like what can I do at least cover my ass in terms of, "he may not be the most social, but damn, he was a good student."

To be honest, not socially awkward or anything but I'm hit or miss. Sometimes I'm the life of the party and other times, not so much. Wouldn't want that to impact me too much.
 

Mad Jack

Critically Caring
5+ Year Member
Jul 27, 2013
35,680
65,473
4th Dimension
@surely @Mad Jack

What goes into a good SLOE other than "gel'ing" with that particular department?

Like what can I do at least cover my ass in terms of, "he may not be the most social, but damn, he was a good student."

To be honest, not socially awkward or anything but I'm hit or miss. Sometimes I'm the life of the party and other times, not so much. Wouldn't want that to impact me too much.
Not going into EM, wouldn't know.
 
  • Like
Reactions: takeurmeds02

surely

MD Class of 2018
7+ Year Member
May 9, 2010
1,173
814
Status
Medical Student
@surely @Mad Jack

What goes into a good SLOE other than "gel'ing" with that particular department?

Like what can I do at least cover my ass in terms of, "he may not be the most social, but damn, he was a good student."

To be honest, not socially awkward or anything but I'm hit or miss. Sometimes I'm the life of the party and other times, not so much. Wouldn't want that to impact me too much.
I want to help, but it's such a broad question that I'm not sure I could do it justice without committing a ton of time to it. Rather than reinventing the wheel, I hope you won't mind that I'm pointing you to some other resources:

1) The SLOE form itself has the actual criteria/qualifications you're supposed to be evaluated on, see Page 2 and the examples on Page 3: https://www.cordem.org/files/DOCUMENTLIBRARY/SLOR/SLOE Standard Letter of Evaluation 2015.pdf
2) 8 Tips on How to Succeed in Your EM Sub-Internship
3) How to Excel in Your 4th Year Clerkship
4) http://www.saem.org/docs/default-source/saem-documents/students/maximize-your-slor.pdf?sfvrsn=5570ef07_4
5) EM Stud Podcast – Dominate the Clerkship

If your flair is correct and you're an MS2, some of the "how to be an engaged and relatively helpful med student on the wards with solid presentations/differentials/plans" stuff you just pick up as you go along during your third year.
 

takeurmeds02

5+ Year Member
Dec 9, 2014
1,513
2,103
Status
Medical Student
I want to help, but it's such a broad question that I'm not sure I could do it justice without committing a ton of time to it. Rather than reinventing the wheel, I hope you won't mind that I'm pointing you to some other resources:

1) The SLOE form itself has the actual criteria/qualifications you're supposed to be evaluated on, see Page 2 and the examples on Page 3: https://www.cordem.org/files/DOCUMENTLIBRARY/SLOR/SLOE Standard Letter of Evaluation 2015.pdf
2) 8 Tips on How to Succeed in Your EM Sub-Internship
3) How to Excel in Your 4th Year Clerkship
4) http://www.saem.org/docs/default-source/saem-documents/students/maximize-your-slor.pdf?sfvrsn=5570ef07_4
5) EM Stud Podcast – Dominate the Clerkship

If your flair is correct and you're an MS2, some of the "how to be an engaged and relatively helpful med student on the wards with solid presentations/differentials/plans" stuff you just pick up as you go along during your third year.
Really good stuff. Thanks.
 
  • Like
Reactions: surely
About the Ads