EM PD - Ask Me Anything

[JMOANIAKT]

Third year here. I am at a new school with no advising. As a low USMLE applicant, I want to maximize how many Sub I months I complete starting from July. Do programs consider December a valid time for an applicant to perform a Sub-I? or is that too late? Thank you!

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[gamerEMdoc]

Not too late in that a Dec rotation will likely net you an interview at that rotation site. But too late in the game to net a SLOE from that rotation.

 

[LostinLift]

As always, I can’t speak for other programs. But I suspect most people will have read and decided on the applications one way or another at this point. They may have created a waitlist to go back to, but for the most part, a good chunk of their interviews have been decided upon. Exact number? I’m not sure but I suspect maybe 75% or so. So if you’ve added another sloe that you think might put your application over the top, then it’s reasonable to email the programs that you have genuine interest in to see if it net you an interview there. However, there’s no need to contact programs that you already have interviews that, obviously they’ll be able to see the sloe When they look at your packet when it comes time for the interview.

You might have said this earlier, but at this point should we email the PDs and cc coordinator or just the coordinator?

 

[alphabettebahpla]

Question asked by someone else on the interview spreadsheet I was hoping you could answer:

if you get off the waitlist and interview somewhere, are you at a big disadvantage when it comes to the match? (ie: you are going to likely rank lower on their list since they didn't want you in their first wave).

 

[gutonc]

Question asked by someone else on the interview spreadsheet I was hoping you could answer:

if you get off the waitlist and interview somewhere, are you at a big disadvantage when it comes to the match? (ie: you are going to likely rank lower on their list since they didn't want you in their first wave).

No.

 

[EM2018orBUST]

Third year here. I am at a new school with no advising. As a low USMLE applicant, I want to maximize how many Sub I months I complete starting from July. Do programs consider December a valid time for an applicant to perform a Sub-I? or is that too late? Thank you!

From a logistics point of view though, don't forget that interviews happen from November through January. If you're spending a whole 4 weeks at what is likely a top choice program during the middle of interview season, you don't want to be taking time off to travel.

 

[gamerEMdoc]

You might have said this earlier, but at this point should we email the PDs and cc coordinator or just the coordinator?

I'd generally recommend just emailing the coordinator.

 

[Elevencents]

As always, I can’t speak for other programs. But I suspect most people will have read and decided on the applications one way or another at this point. They may have created a waitlist to go back to, but for the most part, a good chunk of their interviews have been decided upon. Exact number? I’m not sure but I suspect maybe 75% or so. So if you’ve added another sloe that you think might put your application over the top, then it’s reasonable to email the programs that you have genuine interest in to see if it net you an interview there. However, there’s no need to contact programs that you already have interviews that, obviously they’ll be able to see the sloe When they look at your packet when it comes time for the interview.

To piggyback on this - will adding letters now and going forward affect your place on rank lists where you have already secured interviews? I have 2 letters assigned to the places I have interviews and 3 to ones I have not with a 4th forthcoming but am unsure if it will be glowing enough to truly benefit me. Worth adding or will it not even be seen when rank lists are made?

 

[gamerEMdoc]

To piggyback on this - will adding letters now and going forward affect your place on rank lists where you have already secured interviews? I have 2 letters assigned to the places I have interviews and 3 to ones I have not with a 4th forthcoming but am unsure if it will be glowing enough to truly benefit me. Worth adding or will it not even be seen when rank lists are made?

Yes, if they are good letters they can affect your rank list spot positively. I generally like to see two SLOEs on candidates. I realize some people can't get two by the time I interview them, so I usually will ask people if they have a November SLOE coming in to upload it and email me so I know to go back and look at it. Now if you already have 2 or 3 SLOEs already by the time you interview, a fourth one probably isn't going to make a huge difference after the fact.

 

[green lantern]

Hey gamer, I had a question about programs doing both matches. I had two interviews with programs double dipping in both matches. I know the magic number is to be able to rank 9 programs to get a 95% chance of matching (or close to that). So say I have 6 AOA program ranked and 3 ACGME programs ranked with 2 programs overlapping in both matches. Does this mean I have a total of 9 programs ranked or just 7. I figure this is hard to answer questions becasue this is only relevant for the next year or two but was curious about your opinion on this topic.

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[TeddyBoomBoom]

Hey gamer, I had a question about programs doing both matches. I had two interviews with programs double dipping in both matches. I know the magic number is to be able to rank 9 programs to get a 95% chance of matching (or close to that). So say I have 6 AOA program ranked and 3 ACGME programs ranked with 2 programs overlapping in both matches. Does this mean I have a total of 9 programs ranked or just 7. I figure this is hard to answer questions becasue this is only relevant for the next year or two but was curious about your opinion on this topic.

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I would suggest 8 at most. Remember that the “magic number” refers to *contiguous* ranks, which by definition can’t be in different matches.

 

[Wroooong]

Yes, if they are good letters they can affect your rank list spot positively. I generally like to see two SLOEs on candidates. I realize some people can't get two by the time I interview them, so I usually will ask people if they have a November SLOE coming in to upload it and email me so I know to go back and look at it. Now if you already have 2 or 3 SLOEs already by the time you interview, a fourth one probably isn't going to make a huge difference after the fact.

If I currently have 2 SLOEs and a EM LOR that I know are excellent, and I'm happy with my interviews, is it even worth sending out a 3rd SLOE I don't know the quality of?

 

[LostinLift]

If I currently have 2 SLOEs and a EM LOR that I know are excellent, and I'm happy with my interviews, is it even worth sending out a 3rd SLOE I don't know the quality of?

You could always send it to your home program first, see if it's a good letter from someone you trust, and then send it to everyone.

 

[gamerEMdoc]

Hey gamer, I had a question about programs doing both matches. I had two interviews with programs double dipping in both matches. I know the magic number is to be able to rank 9 programs to get a 95% chance of matching (or close to that). So say I have 6 AOA program ranked and 3 ACGME programs ranked with 2 programs overlapping in both matches. Does this mean I have a total of 9 programs ranked or just 7. I figure this is hard to answer questions becasue this is only relevant for the next year or two but was curious about your opinion on this topic.

Sent from my SM-T560NU using SDN mobile

I don't think double counting a program is a wise bet. If you are ranking the same program in both matches, if you don't match there in the AOA match, the likelihood of matching there in the ACGME match seems unlikely.

 

[gamerEMdoc]

If I currently have 2 SLOEs and a EM LOR that I know are excellent, and I'm happy with my interviews, is it even worth sending out a 3rd SLOE I don't know the quality of?

If it's a complete unknown, and you are certain the other two SLOEs are excellent, there is no reason for the 3rd SLOE. Very few programs expect a third SLOE. And if a place wants a 3rd one, you can send it to them then. But until then, I'd just stick with what you have.

 

[surely]

Hey gamer, I had a question about programs doing both matches. I had two interviews with programs double dipping in both matches. I know the magic number is to be able to rank 9 programs to get a 95% chance of matching (or close to that). So say I have 6 AOA program ranked and 3 ACGME programs ranked with 2 programs overlapping in both matches. Does this mean I have a total of 9 programs ranked or just 7. I figure this is hard to answer questions becasue this is only relevant for the next year or two but was curious about your opinion on this topic.

Sent from my SM-T560NU using SDN mobile

The idea of a "magic number" comes from the above chart from Charting Outcomes, which is based on NRMP data on how DO students performed in the ACGME match (in other words, it doesn't count AOA programs at all!). Right now, you only have 3 ACGME programs to rank, putting you at about a 50% chance of success in the ACGME match. However, like gameremdoc says, if you participate in the AOA match and are unsuccessful (i.e. don't match at any AOA programs), the 2 double-dipping programs likely won't rank you to match in the ACGME match, so you'd really only have *1* ACGME program on your list, putting you at a ~30% chance of matching. However, this graph is smoothed out in a way that's pretty misleading, as the below chart shows the actual numbers of matched and unmatched DO students - 50% is more like 40%, and 30% is more like 43%.

The other thing you need to realize is that these data have VERY small sample sizes! Check this out:

Only 23 students ranked just 1 program, 18 ranked 2, and 20 ranked 3. I'm not great at statistics and can't calculate how powered this sample is, but my intuition says that it's hard to draw generalizable conclusions about likelihood of matching with such small sample numbers. It also looks like people who only ranked 1 program had a higher chance of matching (10/23 = 43%) than people who ranked 3 (8/20 = 40%). I wonder if this is because the people who didn't participate in the AOA match and then went on to rank only 1 program in the ACGME match were ranking the program they did an Away at and had some kind of assurance from the PD that they would be ranked to match based on excellent performance. But again, sample size of 10 matched AOA students is tough to draw conclusions from.

I couldn't find a resource that has similar graphs/charts for how DOs performed in the AOA match, so I can't really predict what an AOA match magic number should be. Anyone with more experience in this able to provide a source for an AOA match magic number?

 

[green lantern]

View attachment 224807


The idea of a "magic number" comes from the above chart from Charting Outcomes, which is based on NRMP data on how DO students performed in the ACGME match (in other words, it doesn't count AOA programs at all!). Right now, you only have 3 ACGME programs to rank, putting you at about a 50% chance of success in the ACGME match. However, like gameremdoc says, if you participate in the AOA match and are unsuccessful (i.e. don't match at any AOA programs), the 2 double-dipping programs likely won't rank you to match in the ACGME match, so you'd really only have *1* ACGME program on your list, putting you at a ~30% chance of matching. However, this graph is smoothed out in a way that's pretty misleading, as the below chart shows the actual numbers of matched and unmatched DO students - 50% is more like 40%, and 30% is more like 43%.

The other thing you need to realize is that these data have VERY small sample sizes! Check this out:

View attachment 224809

Only 23 students ranked just 1 program, 18 ranked 2, and 20 ranked 3. I'm not great at statistics and can't calculate how powered this sample is, but my intuition says that it's hard to draw generalizable conclusions about likelihood of matching with such small sample numbers. It also looks like people who only ranked 1 program had a higher chance of matching (10/23 = 43%) than people who ranked 3 (8/20 = 40%). I wonder if this is because the people who didn't participate in the AOA match and then went on to rank only 1 program in the ACGME match were ranking the program they did an Away at and had some kind of assurance from the PD that they would be ranked to match based on excellent performance. But again, sample size of 10 matched AOA students is tough to draw conclusions from.

I couldn't find a resource that has similar graphs/charts for how DOs performed in the AOA match, so I can't really predict what an AOA match magic number should be. Anyone with more experience in this able to provide a source for an AOA match magic number?

My school sent out a chart saying that your goal should be to match 6 programs in AOA. However, I think these stats are school specifics and I don't know where they got there data.

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[green lantern]

I don't think double counting a program is a wise bet. If you are ranking the same program in both matches, if you don't match there in the AOA match, the likelihood of matching there in the ACGME match seems unlikely.

Program told me that they rank 7. 3 will be AOA and 4 ACGME. They rank their top 7 and have nothing to do with MD, DO. They specifically said if you don't match AOA doesn't mean you won't match acgme.

It also sucks if your ranked 4 or 5 at this program because you will match but you might not get your top ranked program due to matching AOA before ACGME match rolls around. But we have to play the game.

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[gamerEMdoc]

Yeah, the split matches is so stupid. I can't wait until everyone is on the same page.

 

[green lantern]

I think everyone would agree

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[BigGAC1]

Yeah, the split matches is so stupid. I can't wait until everyone is on the same page.

Amen. This is the biggest benefit of the merger, fo sho.

 

[Wroooong]

If it's a complete unknown, and you are certain the other two SLOEs are excellent, there is no reason for the 3rd SLOE. Very few programs expect a third SLOE. And if a place wants a 3rd one, you can send it to them then. But until then, I'd just stick with what you have.

Great. So in this case it's not a red flag to be missing a SLOE from a sub-I? That's my only concern.

 

[EM2018orBUST]

Great. So in this case it's not a red flag to be missing a SLOE from a sub-I? That's my only concern.

I suppose it depends on the order. If it's a SLOE from your first one, especially if it's your home program, it's a little weird to not include it. If it's your third subI that you did in October, it's understandable to not go through the effort of uploading it. It's all about narrative.

 

[gamerEMdoc]

Great. So in this case it's not a red flag to be missing a SLOE from a sub-I? That's my only concern.

Yep. Its all about context. First, its unlikely anyone will look that closely and notice one is missing. How would they know you did a third or fourth sub i? Sure, the sloe asks which number of rotation it is, but thats typically innacurate, and many programs just say unknown.

I agree if it was feom your home rotation and it was missing, that would seem off. But other than that, I doubt anyone would notice.

 

[sdhere1234]

M1 at a DO school here interested in EM.

Did research for 2 years after undergrad and absolutely hated it. What are your thoughts on having 0 research experience while in med school and applying to EM? I know EM isn't a research heavy specialty, but I feel that lots of applicants still have at least 1 or 2 projects under their belt.

I was planning on relaxing summer after M1 and traveling with my gf, but I don't want to be shooting myself in the foot down the road either when it comes time for residency applications. Thanks.

 

[gamerEMdoc]

The majority of the applicants I look at have very little research experience in med school. Then again, my applicant pool is skewed, since I’m at a community EM program. People with big research aspirations tend to gravitate towards university based programs. That’s not always true, its a generalization obviously.

 

[Jabbed]

Is the interview broker lock out period an indication of how much notice we should give before cancelling an interview? 7 days seems rather short notice

 

[Elevencents]

Is the interview broker lock out period an indication of how much notice we should give before cancelling an interview? 7 days seems rather short notice

The more time the better I would imagine. Just put yourself in their shoes.

 

[surfguy84]

Will I be at a big disadvantage if I only have 1 SLOE by the time I apply (will have a 2nd SLOE by December)? Will I be costing myself interviews if I submit my app with only 1 SLOE?

 

[gamerEMdoc]

Will I be at a big disadvantage if I only have 1 SLOE by the time I apply (will have a 2nd SLOE by December)? Will I be costing myself interviews if I submit my app with only 1 SLOE?

Just to clarify, you haven't applied yet? Or you aren't a fourth year and you are asking about a future year?

In general, you are putting yourself at a disadvantage if you have only one SLOE for application season. Especially if its not a great one. Not everyone can get two before mid-Sept, but there shouldn't be a reason most students can't get two by Nov.

 

[surfguy84]

Just to clarify, you haven't applied yet? Or you aren't a fourth year and you are asking about a future year?

In general, you are putting yourself at a disadvantage if you have only one SLOE for application season. Especially if its not a great one. Not everyone can get two before mid-Sept, but there shouldn't be a reason most students can't get two by Nov.

That's correct, I'm a third year who has not applied yet. Thinking about 4th year electives and what I'll realistically be able to get and it's a possibility I only have one EM away before I apply. I'd absolutely be able to have 2 SLOEs by November, but it's entirely possible I only have one when applications open up in mid-September.

 

[LostinLift]

That's correct, I'm a third who has not applied yet. Thinking about 4th year electives and what I'll realistically be able to get and it's a possibility I only have one EM away before I apply. I'd absolutely be able to have 2 SLOEs by November, but it's entirely possible I only have one when applications open up in mid-September.

Do everything you can to get 2 in by October 1st, ideally September 15th.

 

[boomshaketheroom]

That's correct, I'm a third year who has not applied yet. Thinking about 4th year electives and what I'll realistically be able to get and it's a possibility I only have one EM away before I apply. I'd absolutely be able to have 2 SLOEs by November, but it's entirely possible I only have one when applications open up in mid-September.

Do you have a home rotation? That would give you 2 SLOEs (1 home + 1 away)

 

[surfguy84]

Do you have a home rotation? That would give you 2 SLOEs (1 home + 1 away)

DO student, no home rotation.

 

[CajunMedic]

What do you feel is the etiquette for a letter of intent? I auditioned at my top choice back in July, and wanted to send them an email now that i'm done with EM auditions. However, they have a new PD and coordinator since then. Who would I need to send it to?

 

[gamerEMdoc]

What do you feel is the etiquette for a letter of intent? I auditioned at my top choice back in July, and wanted to send them an email now that i'm done with EM auditions. However, they have a new PD and coordinator since then. Who would I need to send it to?

PD

 

[OneTwoThreeFour]

What do you feel is the etiquette for a letter of intent? I auditioned at my top choice back in July, and wanted to send them an email now that i'm done with EM auditions. However, they have a new PD and coordinator since then. Who would I need to send it to?

FWIW I've heard to not send in a true letter of intent until after interview season has gone into full swing. Both for you since you'll have seen more places and for them. But YMMV

 

[gamerEMdoc]

FWIW I've heard to not send in a true letter of intent until after interview season has gone into full swing. Both for you since you'll have seen more places and for them. But YMMV

Yeah I wouldnt go shooting a message to your top program about your intent to rank #1 yet. First, you dont need to do this, but if you feel like you want to or that it may help your case, then I would wait until closer to when the match lists are being submitted, maybe like 2 weeks before. No one is going to believe you right now, its still near the beginning of interview season.

 

[DO class of 2018]

In an ideal world there'd be no letter of intent, 2nd looks, or any other such things. After interviews, no communications and programs and candidates rank their preferences, and the algorithm matches everyone...

 

[Elevencents]

In an ideal world there'd be no letter of intent, 2nd looks, or any other such things. After interviews, no communications and programs and candidates rank their preferences, and the algorithm matches everyone...

I like letters of intent. Gives me a chance against the people who interview at 15+ places when they literally have lukewarm interest in a program that I would be over the moon to attend.

 

[gutonc]

I like letters of intent. Gives me a chance against the people who interview at 15+ places when they literally have lukewarm interest in a program that I would be over the moon to attend.

No it doesn't.

But if it makes you feel better to do so, go nuts. Electrons are basically free.

 

[CajunMedic]

Yeah I wouldnt go shooting a message to your top program about your intent to rank #1 yet. First, you dont need to do this, but if you feel like you want to or that it may help your case, then I would wait until closer to when the match lists are being submitted, maybe like 2 weeks before. No one is going to believe you right now, its still near the beginning of interview season.

Whoops, Sent it the other night to one in the AOA match.

 

[GandalfTheWhite]

No it doesn't.

But if it makes you feel better to do so, go nuts. Electrons are basically free.

It does to some people. Got 2 interview invites this way.

 

[green lantern]

I think this would only matter if you were on the wait list and by emailing them would bump you to the top of the list.

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[DO class of 2018]

I like letters of intent. Gives me a chance against the people who interview at 15+ places when they literally have lukewarm interest in a program that I would be over the moon to attend.

Maybe it does, maybe it doesn't. And that's part of the challenge, this whole post-interview game, what works at one place maybe doesn't at the next. And hearing from program directors that students will tell multiple programs they are their #1, is shameful. I plan on telling one program they are #1, but what's frustrating is that I'd probably be more than happy to end up at pretty much any place I interview at.

It does to some people. Got 2 interview invites this way.

Letter of intent is what you send after interviewing, from what I understand to your #1 ranked program. Nothing to do with getting an interview

 

[Apollyon]

Letter of intent right now is in the same neighborhood as suicide matching. Tell one program they're #1 right now? Good luck. That's the "suicide matching" point. Tell more than one program? That's like seeing two people in the same fraternity/sorority. Good luck with THAT!!

 

[Elevencents]

Then I've been lied to.

 

[GandalfTheWhite]

Letter of intent is what you send after interviewing, from what I understand to your #1 ranked program. Nothing to do with getting an interview

My understanding is that if you send them a letter, its meant to say you will interview there if they offer you an invitation, no matter what. I was not referring to post-interview letters. sorry for the confusion.

 

[Jabbed]

My understanding is that if you send them a letter, its meant to say you will interview there if they offer you an invitation, no matter what. I was not referring to post-interview letters. sorry for the confusion.

Letter of *Interest

 

[gamerEMdoc]

Yeah, I think people are mixing up the difference between terms some people use on here such as “letters of interest” and “letters of intent” which is causing some confusion.

The “letter of interest” I think generally refers to an email sent to program saying how interested you are in the program as a way of fishing for an interview. Where as, “a letter of intent” is what some are referring to as post-interview communication with a program where you are telling them you are rank number one.

To complicate matters, people use the abreviation LOI, which makes it more confusing.

My opinion on both forms of “LOIs”:

Sending an email out to fish for interviews is useful in two situations. First, obviously, you haven’t gotten enough emails to be at the point where you are comfortable, so you send out fliers to programs in hopes that it gets them to look at your app for interview consideration. This does work to an extent, and can net a few interviews. Its not gonna net 15 interviews, but it may net you a couple to get you closer to your goal. The second situation this is helpful is, even if you have enough interviews, if you didn’t get one at a place you REALLY want to be at (like your home town, or your spouses hometown, etc) but never received an interview.

As for telling programs that you are ranking them #1. I have mixed feelings. First, I hate being lied to but I accept that its part of the game and some students feel the need to tell a bunch of programs this. So I don’t really 100% believe anyone that says it. Second, it should be unnecessary. Programs should rank candidates in the order of where they want the candidate, not who likes them the most. And the match discourages post-match communication. Asking a program about where they are ranking you is prohibited, same with the program asking you. Either side can freely tell the other party, but its still discouraged, but not against the rules. All that being said, the reason I have mixed feelings about it is, people are human beings and human beings want to be popular. So I wouldn’t be surprised if some programs/candidates rank lists are influenced by their perception on how much the other likes them. Also, programs prefer getting people that actually want to be there, both for potentially faculty retention down the road, but also the happiness of the program. You don’t want a bunch of people that are miserable having matched in your program, obviously. Now, with that said, I don’t think anyone is moving a candidate from spot 45 to spot 6 based on them being told they were #1. But I could absolutely see a situation where all things are equal btw a handful of people, and someone moves up a few spots based on this perception. I just think thats natural. And because there probably is a very small benefit at some places to telling them this, I hesitate to tell people not to do it, because in the end, I want everyone to have their best chance at matching. But, I would discourage you from lying to places.