EM PD - Ask Me Anything

[gamerEMdoc]

I am trying to secure away rotations but haven't heard back from any yet. One program did get back to me but offered me an EM U/S rotation instead because their spots were full for the dates I requested. I've read that you should try to get two "true" EM SLOEs. I was planning on getting one from my home institution, and then hopefully two aways. Would it be a bad idea to schedule the U/S rotation as one of my aways? I'm just worried about turning down an offer when I haven't secured any aways yet. Thank you.

Still probably too early to freak out. The US rotation with a modified SLOE eval is fine for a 3rd SLOE, but I wouldn't go that route as your only away. I think if you can get a 2nd away (and 2nd SLOE then) then the EM US rotation is fine.

---

Members don't see this ad.

 

[Status Sciaticus]

At risk candidates, meaning people with a red flag, lower boards, previous match failures, etc... those are candidates that I think are best served going above and beyond. I've mentioned networking, and while I think its overkill for many candidates, I think going to ACEPs residency fair and hitting up less competitive programs is a great strategy for people who are more at risk. Obviously doing well on step 3 helps. If you have anyone who can give you any advice on your SLOEs, and possibly replace any lower SLOE with a new one or a LOR from your PD that will help.

I may be wrong but my understanding was that STEP 3 is reported as Pass/Fail. How would programs be able to see your score?

 

[surely]

I may be wrong but my understanding was that STEP 3 is reported as Pass/Fail. How would programs be able to see your score?

According to this website, United States Medical Licensing Examination | Scores & Transcripts, "With the exception of Step 2 CS (which is reported as Pass/Fail), USMLE results are reported on a 3-digit scale." I could be wrong and hope I am, but I've never heard it called Pass/Fail...

 

[gamerEMdoc]

Yeah you can see the score for Step 3 in people that have taken it.

 

[gamerEMdoc]

What score should I aim for on Step 3? Above a 225?

You should aim for a perfect score. The higher you get the better. You should never set aim for a low or average target. But in reality, you'd at least score higher than step 1/2, most people do. Step 3 is a much more clinical test, its like a combination of all the shelf exams from 3rd year.

 

[Birdstrike]

EM APD - Ask me anything?

Why aren't you director, yet?

 

[gamerEMdoc]

Why aren't you director, yet?

Hahaha... well, I guess this one is on me, because I’m too stubborn to move unless it’d be to the perfect location (ie no winter ever) and PD jobs in perfect locations aren’t exactly easy to get. PD jobs in general are tough to get TBH, mainly because most places either look to hire someone who was a previous PD, or they look to promote from within internally. An APD at a random program isn’t likely to get a PD job ahead of the hiring programs APD if a PD is leaving. It just seems tough as an APD to move up, unless its internal, or you are hired to start a new program. And that would be cool, starting a new program, but again, I would never want to move just to move, it would have to be a great location.

 

[Anxietyfreak]

Hey! So what's your take on sloes from all 4 year programs? Unfortunately my July, potentially August and Sept rotations are all 4 year programs and my October one is a 3 year one. I'm still waiting on my home institution to get back to me (but that's a 3 year). I don't want programs to think I'm only interested in 4 year programs but it just happened to turn out that way based on scheduling/hearing back from some institutions earlier. I have the option to not accept the current 4 year one I have but I feel like it's a place i'd potentially want to be at.

 

[gamerEMdoc]

Hey! So what's your take on sloes from all 4 year programs? Unfortunately my July, potentially August and Sept rotations are all 4 year programs and my October one is a 3 year one. I'm still waiting on my home institution to get back to me (but that's a 3 year). I don't want programs to think I'm only interested in 4 year programs but it just happened to turn out that way based on scheduling/hearing back from some institutions earlier. I have the option to not accept the current 4 year one I have but I feel like it's a place i'd potentially want to be at.

Shouldn't matter at all.

 

[The Knife & Gun Club]

Thanks so much for your continued activity in this thread, I think everyone really appreciates it.

Quick question - I managed to get EM at home for my 1st rotation of 4th year, which I thought was great. But looking at the student roster it’s basically every student in my class who’s serious about doing EM taking it that same block.

How bad is this for my SLOE?

Should I push my EM rotation back so that I’m not taking it with such a competitive group (but have less time for always?)

 

[surely]

Thanks so much for your continued activity in this thread, I think everyone really appreciates it.

Quick question - I managed to get EM at home for my 1st rotation of 4th year, which I thought was great. But looking at the student roster it’s basically every student in my class who’s serious about doing EM taking it that same block.

How bad is this for my SLOE?

Should I push my EM rotation back so that I’m not taking it with such a competitive group (but have less time for always?)

I wouldn't worry about this at all, since your SLOE is going to end up comparing you against your peers regardless of when you do your rotation. Google the SLOE PDF to see what it looks like - it explicitly says "above peers" "below peers" "same as peers" etc.

 

[The Knife & Gun Club]

I wouldn't worry about this at all, since your SLOE is going to end up comparing you against your peers regardless of when you do your rotation. Google the SLOE PDF to see what it looks like - it explicitly says "above peers" "below peers" "same as peers" etc.

Thanks so much - This makes much more sense.

 

[DubbiDoctor]

@gamerEMdoc Do you think that since EM residencies exclusively use SLOEs, subjective evaluations, even if standardized, are more important to matching than with other residencies? Are board scores relatively less important? Are EM rotations mandated to give 1/3rd of their students the below peers ranking? Would there be any repercussions if they gave, say, only the bottom 20% the below peers ranking? How detrimental is the below peers ranking to an applicant's chance of matching?

 

[gamerEMdoc]

I wouldn't worry about this at all, since your SLOE is going to end up comparing you against your peers regardless of when you do your rotation. Google the SLOE PDF to see what it looks like - it explicitly says "above peers" "below peers" "same as peers" etc.

What she said. Totally agree.

 

[surely]

What he said. Totally agree.

She!!! ♀️ Brb, redoubling my efforts to write effusively and use gratuitous exclamation marks to better perform my gender through text.

 

[gamerEMdoc]

Do you think that since EM residencies exclusively use SLOEs, subjective evaluations, even if standardized, are more important to matching than with other residencies? Are board scores relatively less important?

Yes and yes. The SLOE is subjective and objective. Sure, its based on someones opinion of performance, but it forces the program to objectively rank the students. And many places don’t use just basic opinion but factor in things like boards/test scores along with clinical performance to make their decision as to how competitive they think a candidate is. The SLOE system absolutely devalues board scores to an extent. And honestly that is a good thing, because I can tell you that board scores don’t predict, at all, who will be a good EM doc. There are tons of all star EM residents who were on the lower end and some people with astronomical scores who rotate through the ED and are terrible. Deciding who to rank solely on board scores would be a terrible system.

Are EM rotations mandated to give 1/3rd of their students the below peers ranking? Would there be any repercussions if they gave, say, only the bottom 20% the below peers ranking?

No, no one mandates anything. CORD definitely encourages people to keep to the spirit of the SLOE and try to have a real distribution of people, but it usually doesn’t work out that way and things do lean a little top heavy. The SLOE is useful because it makes the programs list the percentages they have listed in each category, so you know if a “top 1/3” at one place is truly meaningful or if 90% of people got a “top 1/3” there.

How detrimental is the below peers ranking to an applicant's chance of matching?

It hurts, but it also depends on the other SLOEs. A bottom 1/3 with great comments from a super compettive place may still be fine, and that student may be a top 1/3 at a less compettive community EM program. So depending on where else they rotate, they may get higher SLOEs from places that are closer to where they will realistically match. The true kiss of death is a “Do Not Rank” with negative comments, or a low 1/3 that has really negative comments.

 

[gamerEMdoc]

She!!! ♀️ Brb, redoubling my efforts to write effusively and use gratuitous exclamation marks to better perform my gender through text.

Changed. My apologies. I actually thought when I wrote that I may have assumed incorrectly. Oops...

 

[Above&Beyond]

MS2 here with some questions about letters. Apologies if this has already been discussed on here.

My understanding has been that you need at least 2 SLOEs. After looking around online, I saw some programs require 3 letters, and some even say 2 of them should be SLOEs. So based on that, are they trying to say the 3rd letter should NOT be a SLOE? If it doesn't matter, would it look bad if you choose to get a 3rd SLOE over a regular letter or vice versa? Is trying for a 3rd SLOE too risky if you think your 2 SLOEs are already good? Should a regular letter be from an EM physician or do programs typically want to see a recommendation from another department?

Sorry for the question barrage, but thanks in advance!

 

[gamerEMdoc]

MS2 here with some questions about letters. Apologies if this has already been discussed on here.

My understanding has been that you need at least 2 SLOEs. After looking around online, I saw some programs require 3 letters, and some even say 2 of them should be SLOEs. So based on that, are they trying to say the 3rd letter should NOT be a SLOE? If it doesn't matter, would it look bad if you choose to get a 3rd SLOE over a regular letter or vice versa? Is trying for a 3rd SLOE too risky if you think your 2 SLOEs are already good? Should a regular letter be from an EM physician or do programs typically want to see a recommendation from another department?

Sorry for the question barrage, but thanks in advance!

ERAS allows you to submit four letters of rec. at least two should be SLOEs. Letters 3 and 4 can be anything, although I dont find em letters that arent sloes real helpful unless someone has significant work experience with the author. Typical other letters come from other services, or are extra sloes, or modified sloes (us, ems), are from a research mentor, etc. 2 sloes should be the minimal goal. Many get a 3rd. I dont think anywhere expects students to have 4, and nearly every program is cool with 2.

 

[Apollyon]

She!!! ♀️ Brb, redoubling my efforts to write effusively and use gratuitous exclamation marks to better perform my gender through text.

Wait, you're a chick? Dude!!

 

[surely]

Wait, you're a chick? Dude!!

TELL ME ABOUT IT

No but really, first clue should have been the IUD avatar, right? Or maybe that my name is a homonym for Shirley?

 

[InternistDO]

TBH I had always assumed that was a bicycle pump

 

[Apollyon]

TELL ME ABOUT IT

No but really, first clue should have been the IUD avatar, right? Or maybe that my name is a homonym for Shirley?

People have all sorts of images. I've learned on SDN that you can't conclude ANYTHING, at ALL. Likewise, I thought the username meant "certainly". Hell, half the world thinks I'm Jewish from my username. (I'm not, but, boy howdy, a kosher meal is a good one!)

Or, the IUD is "surely" a good way to do its job!

 

[Elevencents]

What sort of resources do you recommend for newly minted interns? Have some free cash to burn so garnering opinions! Rosh and Hippo already on my list.

 

[Bill Brasky]

TBH I had always assumed that was a bicycle pump

I thought it was the top part of a razor scooter.

 

[surely]

I thought it was the top part of a razor scooter.

I own zero bicycles but 3 adult-sized kick scooters, so that actually fits haha

 

[gamerEMdoc]

TELL ME ABOUT IT

No but really, first clue should have been the IUD avatar, right? Or maybe that my name is a homonym for Shirley?

Yeah, I noticed that was an IUD immediately after you pointed out your second X chromosome. I'm not sure what the hell I thought that was. LOL.

 

[gamerEMdoc]

What sort of resources do you recommend for newly minted interns? Have some free cash to burn so garnering opinions! Rosh and Hippo already on my list.

Depends what type of a learner you are. If you like textbooks, I'd say a textbook source like Tintinali or Rosens as well as a procedure book like Roberts and Hedges. But honestly, I'm not a textbook learner, and also many hospitals will have something like this available electronically through their electronic library. I definitely think Rosh is a must. I personally like video lectures for board review, Hippo is good, I personally like NEMBR better its just more no nonsense cut to the chase facts. But I don't think you can go wrong with either.

 

[Apollyon]

Yeah, I noticed that was an IUD immediately after you pointed out your second X chromosome. I'm not sure what the hell I thought that was. LOL.

I knew it was an IUD right away, but I wasn't motivated enough to look it up (I recall the Cu-7, and that one in @surely 's image is the copper T or some such). That dates back, now, 18 years for me.

Ah, the TCu-220C!

 

[Birdstrike]

Depends what type of a learner you are. If you like textbooks, I'd say a textbook source like Tintinali or Rosens as well as a procedure book like Roberts and Hedges. But honestly, I'm not a textbook learner, and also many hospitals will have something like this available electronically through their electronic library. I definitely think Rosh is a must. I personally like video lectures for board review, Hippo is good, I personally like NEMBR better its just more no nonsense cut to the chase facts. But I don't think you can go wrong with either.

Before you buy the book by Rosen, be aware Dr. Peter Rosen (yes, that Rosen) testifies against fellow Emergency Physicians for pay, helping lawyers sue doctors like you and I. Worse yet, he was censured by ACEP for giving testimony against emergency physicians, that is “false, misleading," "without medical foundation” and biased.

Here's a great write up on the specifics of the case by Dr. William Sullivan who is an Emergency Physician, and also happens to be an attorney.

 

[gamerEMdoc]

Good point on Rosen. Still crazy that it got to the point where ACEP censured him.

 

[surely]

We just had a very handwavy, vague lecture on leadership styles and becoming a leader. Do you have any advice on this topic, or resources you've found useful?

I've got some innate motivation to be involved in starting initiatives to change things for the better, and being a leader is part of that, but I've already been burned by the "all of the responsibility, none of the power" nature of that kind of position. That kind of setback makes it tempting to just put my nose down and do my work and not put myself out there, be vulnerable, and add things to my plate. I get the impression that that's a common theme in EM. What are your thoughts?

 

[gamerEMdoc]

We just had a very handwavy, vague lecture on leadership styles and becoming a leader. Do you have any advice on this topic, or resources you've found useful?

I've got some innate motivation to be involved in starting initiatives to change things for the better, and being a leader is part of that, but I've already been burned by the "all of the responsibility, none of the power" nature of that kind of position. That kind of setback makes it tempting to just put my nose down and do my work and not put myself out there, be vulnerable, and add things to my plate. I get the impression that that's a common theme in EM. What are your thoughts?

Great great question. I don't have any specific resources, but I will say that my personal experience has been that leadership is something that is wrought with its ups and downs. There will be times where it will feel great to be in that position, and times like you said where you'll feel powerless and just taken advantage of. But having good mentors, leaders you look up to, and watching how they handle their roles is very helpful. I'm not sure leadership can be taught as much as it can be modeled. I definitely thing many people choose EM, like you said, specifically to avoid administrative leadership. Its a field that lends itself to basically just do your job and go home and that's it. To many, that's what attracts them to the field in the first place.

 

[Steve_Zissou]

TELL ME ABOUT IT

No but really, first clue should have been the IUD avatar, right? Or maybe that my name is a homonym for Shirley?

Am I the only one who just glanced at it and thought it was a pickaxe?

 

[PianoMedic]

Am I the only one who just glanced at it and thought it was an pickaxe?

Nope, that’s what I thought it was too...

 

[surely]

I'm not sure leadership can be taught as much as it can be modeled.

That's a really interesting point. It's easier to grok what's being modeled in front of you if you have some idea of what you're looking at, of course, so maybe I can hunt down resources that'll help me build a common language or framework for all of this. I want to at least get familiar with the basics so I'm not bumbling around blindly or, worse, living on the proximal end of the Dunning-Kruger curve, but so much of what's out there seems to be snake oil "top 10 jobhacks to improve team synergy" garbage. If only everything could be as straightforward as personal finance...

But yeah! Appreciate your input about the ups and downs - That's definitely consistent with what I've experienced so far. I'll always believe in the whole "be the change" thing, but sometimes it's nice to be able to say "not my circus, not my monkeys," y'know?

 

[surely]

Am I the only one who just glanced at it and thought it was a pickaxe?

Nope, that’s what I thought it was too...

Chiseling away at undesired fertility I guess?

 

[theSmurfette]

Suggestions for the re-applicant? If you’ve already graduated, didn’t SOAP but need something clinical to show your continued interest in the field? I really don’t know what they’re looking for? Scribe? But that seems way below your level of training. I can’t get a true clinical job because I can’t get a license.

I mean the vast majority of your application is already set: Step, SLOE’s, class rank. And then you have the stigma of an independent applicant on top of all that?

I can’t find any statistics for a USMD who went unmatched and their success rate.


Sent from my iPhone using Tapatalk

 

[Status Sciaticus]

Suggestions for the re-applicant? If you’ve already graduated, didn’t SOAP but need something clinical to show your continued interest in the field? I really don’t know what they’re looking for? Scribe? But that seems way below your level of training. I can’t get a true clinical job because I can’t get a license.

I mean the vast majority of your application is already set: Step, SLOE’s, class rank. And then you have the stigma of an independent applicant on top of all that?

I can’t find any statistics for a USMD who went unmatched and their success rate.


Sent from my iPhone using Tapatalk

@Smurfette
Today is your lucky day.
Lincoln EM just opened up 2 new spots for PGY-1s this morning as part of an expansion.
Residency Vacancy Services

Dont delay! Best of luck!

 

[theSmurfette]

@Smurfette
Today is your lucky day.
Lincoln EM just opened up 2 new spots for PGY-1s
Residency Vacancy Services

Dont delay! Best of luck!

Already applied. Thanks!


Sent from my iPhone using Tapatalk

 

[gamerEMdoc]

I think the re-applicant thing is tough. It's easier if the person has something where they are working clinically (scramble into FP, IM, transitional, etc) because they at least have a backup and are working clinically and getting paid. Graduating and then not working is tough to deal with. I have heard of people scribing. Obviously, the money isn't great and the job is way below skill level, but still, at least it is something clinically. Some I'm sure try and do research. Some schools let students delay graduation. Overall, its a tough spot to be in no doubt, and I don't have any easy answers.

 

[ethiopiancoffee]

Given that an applicant has 1-2 SLOEs uploaded by September 15, will programs overlook/postpone reviewing your application if your Step 2 score is not available (yet)? (But step 1 score is available on ERAS.

My school doesn’t upload the deans letter until October 1, so I’m rationalizing that my application will be “incomplete” until that date regardless of whether my Step 2 score is available.

Just trying to figure out the latest date that I can take Step 2 to have my score back in time! EM is so SLOE heavy that I’m wondering if Step 2 scores play a significant role when deciding whether to interview an applicant or not.

Thank you!

 

[medstudnt14]

Is it at all possible to go from a surgical prelim year to a PGY-2 EM position that opens up?

 

[TeddyBoomBoom]

Is it at all possible to go from a surgical prelim year to a PGY-2 EM position that opens up?

To the best of my knowledge, no.

How could a surgical pre-lim replace an EM PGY-1?

Maaaaaaybe if EM did Prelims/transitional years/TRIs, but as far as I see your situation would be like me doing my first year as an EM resident, and then trying to switch into a second-year resident in surgery/gas/wtvr. It’s just doesn’t work like that unless you’re going into a specialty that routinely matches directly into PGY-2.

disclaimer: I’m an incoming emergency medicine resident, so if I am incorrrct, please comment.

 

[TheOther]

@gamerEMdoc whats your opinion on DO students who take a year off between 3rd and 4th year to do research at a top academic institution? Would the connections that could be made and research published help (and be worth it) to match at a strong academic program?

 

[Status Sciaticus]

Is it at all possible to go from a surgical prelim year to a PGY-2 EM position that opens up?

To the best of my knowledge, no.

How could a surgical pre-lim replace an EM PGY-1?

Maaaaaaybe if EM did Prelims/transitional years/TRIs, but as far as I see your situation would be like me doing my first year as an EM resident, and then trying to switch into a second-year resident in surgery/gas/wtvr. It’s just doesn’t work like that unless you’re going into a specialty that routinely matches directly into PGY-2.

disclaimer: I’m an incoming emergency medicine resident, so if I am incorrrct, please comment.

From what I recall, the SAEM website that posts vacancies usually says that you need to have completed PGY-1 in an ACGME-accredited program. This can vary. For example, looking at the website, Lincoln EM and Johns Hopkins want a completed PGY-1 year in EM, but the UNM PGY-2 spot requires only the completion of PGY-1 year in an accredited program. So, I guess the answer is that it is program dependent.

 

[EM2018orBUST]

To the best of my knowledge, no.

How could a surgical pre-lim replace an EM PGY-1?

Maaaaaaybe if EM did Prelims/transitional years/TRIs, but as far as I see your situation would be like me doing my first year as an EM resident, and then trying to switch into a second-year resident in surgery/gas/wtvr. It’s just doesn’t work like that unless you’re going into a specialty that routinely matches directly into PGY-2.

disclaimer: I’m an incoming emergency medicine resident, so if I am incorrrct, please comment.

Seeing as how previous years' unmatched people doing a surgery prelim were applying for PGY1 EM spots, I'm pretty sure you can't skip a year.

To my understanding, the reason that EM residencies are either 3 or 4 years is because it used to require a prelim year with a 2,3,4 EM residency. That was later removed which either reduced the residency to 3 years or they integrated the intern year into the EM curriculum to create an expanded 4 year. So at least for a 3 year residency, it wouldn't make any sense that the intern prelim year that was removed would then be allowed to substitute for what would be the PGY2 EM-dedicated year.

 

[gamerEMdoc]

Is it at all possible to go from a surgical prelim year to a PGY-2 EM position that opens up?

Generally not. Most of the time when an EM2 spot opens up, they look to fill it with someone with a year of EM gme experience.

 

[gamerEMdoc]

@gamerEMdoc whats your opinion on DO students who take a year off between 3rd and 4th year to do research at a top academic institution? Would the connections that could be made and research published help (and be worth it) to match at a strong academic program?

I think it should depend on what you want out of your career. If you want to do a bunch of research at a big academic place, then sure, do a research year. But if you are doing the research strictly as a means of trying to get into a residency with a bigger name, then I’d question the logic of spending a year of your life doing research just at the chance of maybe getting into a more prestigious program. Doesn’t seem worth it to me, unless research is truly your interest.

 

[PianoMedic]

@gamerEMdoc whats your opinion on DO students who take a year off between 3rd and 4th year to do research at a top academic institution? Would the connections that could be made and research published help (and be worth it) to match at a strong academic program?

I know this wasn’t directed at me, but thought I should give my input. I interviewed at the EM program that reportedly receives the most NIH research dollars of any EM program in the country. I’m a DO. I did two aways in that state, but otherwise have no ties there: not from there, medical school isn’t there, no family there. Those SLOEs were apparently quite strong (lots of comments on my SLOEs’ strength) and I had a total of four aways. All Honors, i believe at least one was a top 10%. I had a summer research program with a poster presentation and one other research project on my application and got the interview. I did above average on Step 1 and did very well on Step 2.

As gamerEMdoc said, unless you want to be a big name researcher, I don’t think an entire year is necessary. If it is at a place with a good EM program that is known to take DOs on occasion, then it could be worthwhile. Otherwise, I’d focus on rocking your aways for strong SLOEs (this is how I got interviews) and rocking Step 1 and 2 (this is how you get past their filters). Doing a little bit of research somewhere along the way will be needed, but a month or two should be fine. Of note: I got rejected at several DO unfriendly programs, so scores and SLOEs alone will not open those up to you as a DO. If they’re biased against DOs, they will never look at you no matter your scores.