EM PD - Ask Me Anything

[EM2018orBUST]

I think programs appreciate some certainty. We're always excited to hear someone we have ranked highly is ranking us #1. But we also take it with a grain of salt because people lie to you every year. Smart programs should never ever change their rank list in order to stack people that tell them they are ranking them #1. Just like candidates shouldn't rank their list in order of the feedback they get from programs. Don't get me wrong, programs want residents who want to be there and residents I'm sure want to be at a program that valued them as a candidate. But from a programs standpoint, I think its the logical choice to rank candidates in the order you want them, no matter if you hear from a candidate or not after the interviews.

Has there been any talk about these love letters on listservs on the PD side? Dunno how it's been in past years, but it seems like it's starting to get out of hand and it makes more sense to collectively ban receiving them from applicants. Or is this year no different in terms of how post-interview communications have gone?

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[gamerEMdoc]

I doubt its any difference than the past. I've been out of residency almost 10 years and I don't think its any different now than when I was applying over a decade ago. I haven't really seen it brought up on the CORD listserv. I went and did a quick search and couldn't find any threads about it.

In the end post-interview communication is totally allowable via the NRMP rules, as long as its not coercive. A program/candidate can freely contact the other party and let them know where they are ranking them, however, neither party can do so as a matter of trying to coerce the other party into telling them where they stand. A program can contact 20 students, tell them they are in their top 20 for instance. They can't however, ask students where they are ranking them, or even worse, suggest that their rank will improve if the student ranks them highly.

 

[Aquab1ll]

Hello @gamerEMdoc,
So I recognize this question is a bit odd, but my significant other is applying for phD programs and we are trying to match up locations with my ROL. The only problem is that she doesn't hear back for most until just before rank submission. Is there any value on the program's end to getting a message from me that says something like "I really enjoyed your program for x,y, and z reasons and really felt like it was a great fit. Your program is at the top of my personal list and I'm hoping my significant other gets an acceptance in the area at q university so I can cement your program as my #1". Is this helpful at all or does it look like a copout? I want to let the program know I am very interested, but also don't want to come off as if I'm trying to mislead them.

 

[gamerEMdoc]

Hello @gamerEMdoc,
So I recognize this question is a bit odd, but my significant other is applying for phD programs and we are trying to match up locations with my ROL. The only problem is that she doesn't hear back for most until just before rank submission. Is there any value on the program's end to getting a message from me that says something like "I really enjoyed your program for x,y, and z reasons and really felt like it was a great fit. Your program is at the top of my personal list and I'm hoping my significant other gets an acceptance in the area at q university so I can cement your program as my #1". Is this helpful at all or does it look like a copout? I want to let the program know I am very interested, but also don't want to come off as if I'm trying to mislead them.

Seems reasonable

 

[enalli]

@gamerEMdoc, have you regretted matching residents before? If so, what made those residents not work out well? Were there any red flags in hindsight, or was it a complete surprise?

 

[gamerEMdoc]

Dissapointments in the match usually more so come from candidates that match elsewhere that you really wanted more than being dissapointed in the ones you did match. Does everyone work out as expected? No, I mean there’s always surprises both good and bad. Its an imperfect science, trying to guess who will be better than who.

 

[njbio]

Hi Gamer,

Another question about LOI. I planned to send my LOI to one of the interviewers that I clicked with and who has been in contact with me post-interview. Do you think this is ok, or better than sending it to the PD whom I have had no contact with since the interview?

Thanks

 

[gamerEMdoc]

Send it to whoever you feel like you clicked with and stayed in contact with IMO.

 

[green lantern]

Hey gamer, I wanted to get your opinion on what you think of programs contacting applicants after the interviews about were they fall on their rank list? Do you thinks this is a way for programs to get less interested applicants more interested in their program in hopes that the applicant will rank their program higher? Or is this just a nice thing to do to help give applicants an ease of mind with the upcoming match?

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[gamerEMdoc]

Hey gamer, I wanted to get your opinion on what you think of programs contacting applicants after the interviews about were they fall on their rank list? Do you thinks this is a way for programs to get less interested applicants more interested in their program in hopes that the applicant will rank their program higher? Or is this just a nice thing to do to help give applicants an ease of mind with the upcoming match?

Sent from my SM-T560NU using SDN mobile

I don’t think its generally anything nefarious, trying to manipulate a candidates rank list by showing interest. Rather, I think both candidates and programs see it as the same thing. Both look at post-interview communication as almost a necessary evil; if they don’t do it, then the other party will take that as disinterest and may rank them lower than they otherwise would. Overall, I think both parties involved are out their communicating with the other party just to let them know there is legit genuine interest. I’m sure there are excpections on both sides, but I suspect for most candidates and for most programs, when they contact someone about their interest in the other party, its likely genuine.

 

[mymembernames]

What's the difference between getting a regular SLOE and a EM Subspecialty SLOE? Does the subspecialty one carry the same weight? Are there any pros or cons or both seen as equal?

 

[gamerEMdoc]

Regular EM sloe > Subspecialty sloe.

It’s hard to extrapolate how someone will do in the ED based on how they did on an US rotation. ED rotations are going to be the best way to predict how good of an ED resident you’ll be.

 

[mymembernames]

With residents covering about 16-18 shifts a month, does that mean they get at least 2 days off per week? Am I missing something here?

 

[gamerEMdoc]

All depends on the length of the shifts, but yeah, for the most part, you get off about 2 days a week or more on average. Programs can work you a maximum of five 12 hour shifts a week (20 12's a month). Many programs don't do 12's though, so the shift numbers can be more than 20 technically. For my program, we work 9's. Our residents work:

ACGME allowable hours/month: 240

PGY1: 20 9's (180 hrs)
PGY2: 19 9's (171 hrs)
PGY3: 18 9's (162 hrs)

Our goal is to go nowhere near the max number of hours per month. I personally am opposed to 12's because they lead to very little personal time off when you are in a stretch of shifts. You basically work, go home, sleep, and get up for work. It leads to a grueling lack of work/life balance with little time to do anything else. Because our curriculum has a decent amount of self study intertwined into our conference, we've always wanted to be far under the max work hours to allow residents to have ample time to actually read and study EM.

 

[PatchAdams25]

@gamerEMdoc Thanks for this thread!

What are the advantages of deciding EM early in med school vs 3rd year... Is there a sig. disadvantage to not deciding EM until the end of 3rd year?

Anything students can be doing preclinical years that would help support an EM app?

 

[deleted109597]

@gamerEMdoc What are the advantages of deciding EM early in med school vs 3rd year... Is there a sig. disadvantage to not deciding EM until the end of 3rd year?

Not arranging your aways early is one

Anything students can be doing preclinical years that would help support an EM app?

Get a good Step 1 and keep your grades up. Avoid red flags. Beyond that, publishing/EMS work/etc isn't as important.

 

[PatchAdams25]

Not arranging your aways early is one


Get a good Step 1 and keep your grades up. Avoid red flags. Beyond that, publishing/EMS work/etc isn't as important.

Awesome thanks for your reply.

Do things like preclinical grades/class rank matter a lot for EM residency or is the focus more on Step 1/Clinical Grades/SLOEs?

 

[gamerEMdoc]

The focus is on SLOEs. The next focus is on personality and fit and your interview. Then probably boards and clinical grades. Then probably all the rest.

 

[gamerEMdoc]

Interview season is FINALLY over on our end. What a long and grueling process for everyone involved. I'm sure from a students standpoint, everyone feels the same. It was a pleasure meeting all of you that came through. Now to tackle the rank list....

 

[Perfect Hair Day]

Hi - VSLO (formerly VSAS) opened up about a week ago following a platform overhaul and was out of commish for some weeks to maybe a month IIRC - are programs in general (but of course I'm most interest in the EM clerkships) running behind with publishing their rotation catalogs/dates offered because of this? Many programs I am interested in doing an EM rotation at aren't on VSAS but they were the previous academic year I know this for sure.

 

[gamerEMdoc]

Hi - VSLO (formerly VSAS) opened up about a week ago following a platform overhaul and was out of commish for some weeks to maybe a month IIRC - are programs in general (but of course I'm most interest in the EM clerkships) running behind with publishing their rotation catalogs/dates offered because of this? Many programs I am interested in doing an EM rotation at aren't on VSAS but they were the previous academic year I know this for sure.

I dont know too be honest. We dont use VSAS, so its hard for me to answer questions about it. Id imagine if programs arent updated yet, its a combo of it being updated to VSLO and the fact that many programs arent even close to starting to schedule for next year until they get their match list squared away in mid February. But thats all speculation on my part.

 

[rexabanit]

What is the deadline for programs to submit their rank list of applicants? (I'd like to know in case I decide to submit a LOI that I do it before then!)

And on a similar note, I'm leaning against doing a LOI (since I don't have an OBVIOUS #1), but is that a dumb move since everyone says that there is no downside and only a possible upside?

 

[gamerEMdoc]

Feb 21 is the deadline to certify the rank list, though most will do so before then. Id say if you are going to send a LOI, you should do so by the first week of February. Re: should you? IDK. I'm not a big believer in the LOI effect. But I don't think there is a downside to doing it either, and theoretically it could help at the place you send it to, depending on if they value such things.

 

[unoso]

Apologies if these questions have already been asked. Appreciate you taking the time to answer!

1. If I had a SLOE from my home program and a non-EM letter (IM or surgery) ready to go when ERAS can first be downloaded by programs, would this be enough to get interview invites? I'm concerned because I won't be able to do an EM elective at my home institution until August then I was planning two aways for September and October. I plan on getting SLOEs from the aways but I'm worried they wouldn't be in my application in time for the first wave of interview invites.

2. I'm from the Midwest, but ideally I'd like to end up in the Northeast (NYC specifically). Is doing an away or two in the region enough to break through the regional bias?

 

[kittykattat]

Apologies if these questions have already been asked. Appreciate you taking the time to answer!

1. If I had a SLOE from my home program and a non-EM letter (IM or surgery) ready to go when ERAS can first be downloaded by programs, would this be enough to get interview invites? I'm concerned because I won't be able to do an EM elective at my home institution until August then I was planning two aways for September and October. I plan on getting SLOEs from the aways but I'm worried they wouldn't be in my application in time for the first wave of interview invites.

2. I'm from the Midwest, but ideally I'd like to end up in the Northeast (NYC specifically). Is doing an away or two in the region enough to break through the regional bias?

Im not gamerEMDoc, but do have experience with both of these scenarios this year during my app cycle, so my two pennies:

1. Yes, many places only need one SLOE to offer interview (some programs specify on the EMRA MATCH website, not sure how up to date it is), just make sure to rock your home Sub-I, and try to schedule your first away at a place with a good track record of putting in SLOEs in a timely manner (for those places you may apply to that may want to see 2 to compare them). You can look at the "where did you have a great away rotation" thread to see folks' reviews and SLOE timeliness.

2. I am from Wisconsin, lived here my entire life, did one of my two aways in NYC and got 6 interviews there including half of the "top" programs despite pretty average scores and grades. Away rotation in NYC is the best possible way to open up that area for interviews in my experience. If you did both aways there it would probably increase your odds even further. Good luck!

 

[notmyrealone]

I just found out I failed Step 2 CS (CIS). I’m going to retake it next week but scores won’t be back until after match. How do I know which programs need it to rank?

 

[gamerEMdoc]

I just found out I failed Step 2 CS (CIS). I’m going to retake it next week but scores won’t be back until after match. How do I know which programs need it to rank?

You aren’t going to know to be honest.

 

[gamerEMdoc]

1. If I had a SLOE from my home program and a non-EM letter (IM or surgery) ready to go when ERAS can first be downloaded by programs, would this be enough to get interview invites? I'm concerned because I won't be able to do an EM elective at my home institution until August then I was planning two aways for September and October. I plan on getting SLOEs from the aways but I'm worried they wouldn't be in my application in time for the first wave of interview invites.

It’s enough to secure interviews at most places, but not enough to get ranked at most places. Most places want to see 2 SLOEs, but recognize that getting two by mid-September is not reasonable. So the majority of places want to see one to decide on whether or not to interview you, and a second one to help them figure out where to put you on their rank list. General goal should be one SLOE by mid-Sept when ERAS opens, and a second SLOE by the end of October at the latest.

All of this assumes that the “one SLOE” is at least decent. If you have one SLOE, and its a “low 1/3”, you aren’t going to see interviews pouring in because people then want to see another SLOE just to see if that one was an anomaly before they extend an interview.

2. I'm from the Midwest, but ideally I'd like to end up in the Northeast (NYC specifically). Is doing an away or two in the region enough to break through the regional bias?

That’s about the only thing you can do initially. If you dont initially get many interview invites in NYC and that’s where you want to be, I’d consider emailing programs earlier on to let them know of your intention to want to train in NYC and point out that you rotated there. That way, if you are filtered out based on the geography of your home address and school, they are more likely to give your app consideration.

 

[sfwtboy]

You aren’t going to know to be honest.

Do you think programs would email and ask for him for it if required or just silently take you off the rank? I know some people have posted that programs have specifically requested it because they require it. You could always email the program coordinators and just ask when it's due by

 

[gamerEMdoc]

Do you think programs would email and ask for him for it if required or just silently take you off the rank? I know some people have posted that programs have specifically requested it because they require it. You could always email the program coordinators and just ask when it's due by

I’d imagine different places handle it differently. Some would require to rank, some wouldnt. Some may followup and ask for the result, some would just not rank. If there’s a piece of data missing on a candidate I want to see, I email the candidate typically around Thanksgiving and again around Christmas. Usually its a 2nd sloe I’m waiting on.

 

[Wroooong]

I’d imagine different places handle it differently. Some would require to rank, some wouldnt. Some may followup and ask for the result, some would just not rank. If there’s a piece of data missing on a candidate I want to see, I email the candidate typically around Thanksgiving and again around Christmas. Usually its a 2nd sloe I’m waiting on.

Is it worth it to send out updates on a passing CS score if we haven’t been asked for it? Or should I just resend my scores? Several of my top programs state on their website they require it for rank, but haven’t asked me about it.

 

[gamerEMdoc]

Is it worth it to send out updates on a passing CS score if we haven’t been asked for it? Or should I just resend my scores? Several of my top programs state on their website they require it for rank, but haven’t asked me about it.

I dont think it would hurt to email the program coordinator, but I doubt you have to. If a program requires Step 2CS to rank, they’d have to have some process of going back and looking at ERAS at everyones Step 2CS status. Because many candidates haven’t done 2CS at the time of their interview. I’d imagine that as long as your score is submitted to ERAS, then you should be fine.

 

[GC-DR]

IMG from Australia here 232 step 1. 3 first author ortho papers.
Would An awesome Australian LOR be helpful at all.
Do PDs consider the country of origin when looking at IMGs.

 

[emergency22]

I sent my #1 program email to a PD and my interviewers and made a spelling error in the name of the program in the title of the email that more likely reflects missing a key on the keyboard than not knowing the name itself (the body of the email had the correct name several times, as well as the same misspelling one time). I didn’t realize I did this and it really was missing a key while I was typing - I read the email dozens of times and just think I missed it and read it as correct because I looked at it for so long. Thoughts on whether this would be viewed as extreme carelessness affecting the programs ranking of me rather than simply as an accidental typo?

 

[gamerEMdoc]

I sent my #1 program email to a PD and my interviewers and made a spelling error in the name of the program in the title of the email that more likely reflects missing a key on the keyboard than not knowing the name itself (the body of the email had the correct name several times, as well as the same misspelling one time). I didn’t realize I did this and it really was missing a key while I was typing - I read the email dozens of times and just think I missed it and read it as correct because I looked at it for so long. Thoughts on whether this would be viewed as extreme carelessness affecting the programs ranking of me rather than simply as an accidental typo?

Man I would hope not, especially with you spelling it correctly multiple times. You never know. I can imagine some people taking offense, but really, most people are pretty laid back in em and probably arent going to ruin you over a typo.

 

[gamerEMdoc]

Congrats to all that matched on the AOA side today!

 

[Willzyk]

Thanks for doing this thread. This had been great. I was wondering about how concerning it is when a program has accreditation with warning status. Is it common for programs to receive these warnings?

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[gamerEMdoc]

Thanks for doing this thread. This had been great. I was wondering about how concerning it is when a program has accreditation with warning status. Is it common for programs to receive these warnings?

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Accredidation with warning means there was some violations that need closely watched, but dont yet warrant loss of accredidation or probation. I think the program has a year to fix whatever led to the warning before having to undergo another site visit. In terms of what to make of it? Well, generally I guess it depends on what they got the warning for and how easily fixable the whole thing is.

 

[Willzyk]

Accredidation with warning means there was some violations that need closely watched, but dont yet warrant loss of accredidation or probation. I think the program has a year to fix whatever led to the warning before having to undergo another site visit. In terms of what to make of it? Well, generally I guess it depends on what they got the warning for and how easily fixable the whole thing is.

From what I heard there was a class that lowered the board pass rate

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[gamerEMdoc]

From what I heard there was a class that lowered the board pass rate

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Yeah thats a tough one for a program. You dont want to rank candidates based on boards, bc it doesnt really correlate with clinical performance well, but on the otherhand you dont want to take any risks. a few failures and your accredidation is at risk. And no matter how good your education is, the number one thing that predicts how people will do on their boards is past performance on standardized tests. Which is why boards matter to a large number of programs. They dont want to take any risk.

 

[Apollyon]

that need closely watched

You know how I know you're from Pennsylvania?

 

[wjk12]

Hey thanks for hosting this thread!

I have a general question about timing for aways. I’m a 3rd year student at one of those shortened preclinical year programs, so I’ll be starting my fourth year in March. I’m trying to set my schedule for next year and I’m thinking of doing my home rotation in April and my away in May. This will be my only away.

Is that too early to do an away? I think I might be being a bit neurotic, but I was scared that they might forget about me by the time the away program needs to submit my SLOE when I’m applying for residency in aug/September. Are there any other downsides to doing an away in May, opposed to the more popular months of July - September?

 

[gamerEMdoc]

You know how I know you're from Pennsylvania?

Is that a PA grammer mistake? Yinz jagoffs in other states dont know how to speak correctly.

 

[gamerEMdoc]

Hey thanks for hosting this thread!

I have a general question about timing for aways. I’m a 3rd year student at one of those shortened preclinical year programs, so I’ll be starting my fourth year in March. I’m trying to set my schedule for next year and I’m thinking of doing my home rotation in April and my away in May. This will be my only away.

Is that too early to do an away? I think I might be being a bit neurotic, but I was scared that they might forget about me by the time the away program needs to submit my SLOE when I’m applying for residency in aug/September. Are there any other downsides to doing an away in May, opposed to the more popular months of July - September?

I dont see any downside.

 

[sdhere1234]

From a PD perspective, how does it look if you don't really have any leadership positions/involvement during pre-clinical years? Everyone in my class is scrambling to run for positions just so they have titles to put on their CV, but I could really care less about joining clubs that host events 2x (if even) per semester.

 

[gamerEMdoc]

From a PD perspective, how does it look if you don't really have any leadership positions/involvement during pre-clinical years? Everyone in my class is scrambling to run for positions just so they have titles to put on their CV, but I could really care less about joining clubs that host events 2x (if even) per semester.

Well if I ever get a PD job, I'll let you know. But as an Associate PD, I'll give you my perspective. I don't care. Like, at all. I care about real leadership. All the filler activities are meaningless to me. Being treasurer of the yoga in medicine club isn't leadership. I'm not saying all school activities aren't real leadership, but many of these club positions are pretty meaningless.

 

[EctopicFetus]

As a faculty member having a resident who is a t1DM isn’t an issue as long as you have your snacks around if your BS gets low. I dont think anyone thinks or expects that level of detail. If it impacts your ability to work then thats different. To me just work hard, dont bring it up any which way and move on with your life.

 

[Apollyon]

One of my fellow residents was type 1 and on a pump. He did fine.

 

[EctopicFetus]

Also, as with any other health issue it would be inappropriate to ask unless it affected your ability to do your job. T1DM doesn’t..

 

[gamerEMdoc]

I'm curious what you'd think of an applicant who is a type 1 diabetic looking to match into EM. Before medical school I worked as an ER tech in a department with an attending who was a type 1 and he seemed to manage well with an insulin pump. I'd assume if your SLOE's were good and it was never brought up in them then it wouldn't be a major concern. My thought would be from more of a full transparency standpoint. I don't know how the faculty would react when they found out, maybe something along the vein of "what else are they keeping from everyone" and "are they a liability now."

One of my favorite senior residents and later attending in residency was a type 1 dm. She was a great ED doc. I wouldnt care at all.