10+ Year Member
Jan 26, 2005
I am an MS3 and recently met with my advisor, who is EM faculty at our school. I asked him how to approach planning the fourth year. He asked about my board scores, clinical grades, etc.

Step 1 is 211. Clinical grades this year are two HP, one H, and rest are P. Then he looks over the comments that the attendings write at the end of the rotation, the same comments that will go into my dean's letter. In three roations, the faculty talked about how I was "cautious", "reticent", or "hesitant" and needed some improvement. Or they talked about how I was that way initially, but eventually came around and did good work. The advisor thought these comments might pose a problem for me. This is news to me.

Does anyone know whether comments like these can hurt an application for EM residencies? I have four months of very good comments. I just wanted another opinion before getting too freaked out. I haven't even taken my EM rotation yet.



Senior Member
7+ Year Member
15+ Year Member
Sep 23, 2003
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From my experience (I've sat in on residency selection committees but am not faculty)

Comments such as "cautious" "reticent" "hesitant" may be a disadvantage when applying to ER since EM programs tend to look for residents who can be decisive in critical situations. EM physicians tend to be calm (or at least calmer than others) even in the midst of chaos or crashing patients. The ER can be hectic and thus students and/or residents who are quiet can become lost or easily ignored. However, don't be discouraged. You haven't done your ER rotation yet. If you get good grades in EM, then it will be seen as an improvement from 3rd year. Comments from your EM rotation are more important than the Fam Med/Peds, etc rotations from 3rd year.

Pointers to help you succeed as a fourth year (you can do a search to get more comprehensive suggestions) but briefly

Work Hard

Be Interested

Don't decline cases when offered (ie -- even if you've done a thousand laceration repairs (which you won't have), don't turn down procedures (and lacs count) when offered)

It's not how many patients you see but how well you manage them (nothing is worse than a med student picking up multiple charts, presenting them, and then never looking up a single lab result, xray, etc)

Be on time (ER is shift work -- no one wants to leave even 5 minutes late after working for 12 or even 8 hours)

Don't stand in a corner (in busy ER's, attendings will be swamped. don't wait to be asked if you have a patient to present, be proactive for yourself and for your patient)