EM PD - Ask Me Anything

[TheOther]

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.

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.

Thank you both for your responses. While I'm not sure what I want out of my career long-term, I had a career in research prior to med school so it's something I'm open to.

Does your advice change at all with these other caveats? I'm at the end of my 3rd year and I have multiple away/audition rotations set up in a surgical subspecialty. I'm realizing that it may not be for me. I also have a family so I'd like to maximize my chances of matching/staying in California. So with away season (and Step 2) just around the corner, I feel like I'm going to have a tough time securing aways in California. I also haven't done an EM rotation yet so along with doing research, I'd spend time shadowing in the ED.

Any thoughts are appreciated. Thanks for your time!

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[miacomet]

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.

Presumably someone who left a different EM program? Then what happens to the program they left? Presumably there is a remaining deficit from the resident(s) that transferred. Who fills that spot(s)?

 

[gamerEMdoc]

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.

Excellet advice/insight.

 

[gamerEMdoc]

Presumably someone who left a different EM program? Then what happens to the program they left? Presumably there is a remaining deficit from the resident(s) that transferred. Who fills that spot(s)?

They often go unfilled.

 

[gamerEMdoc]

Thank you both for your responses. While I'm not sure what I want out of my career long-term, I had a career in research prior to med school so it's something I'm open to.

Does your advice change at all with these other caveats? I'm at the end of my 3rd year and I have multiple away/audition rotations set up in a surgical subspecialty. I'm realizing that it may not be for me. I also have a family so I'd like to maximize my chances of matching/staying in California. So with away season (and Step 2) just around the corner, I feel like I'm going to have a tough time securing aways in California. I also haven't done an EM rotation yet so along with doing research, I'd spend time shadowing in the ED.

Any thoughts are appreciated. Thanks for your time!

No I don't think anything changes. Do the research if your goal is to do research. But if you are looking at it as a magic key to opening up spots at traditionally DO unfriendly places, I wouldn't bank on that, and taking an entire year of future earning potential (and another year of student loans) to gamble on that is a bad gamble IMO. Matching in CA is very difficult, and its crazy hard as a DO. Doing a year of research isn't going to change that. I realize you may want to stay in CA, but unfortunately, that's not always possible, especially with EM. Eventually you'll have to decide if you want to do EM and only gun for CA but run the risk of not matching, or expand your geographic horizons. But something will likely have to give. Either accept leaving CA to go do EM elsewhere or staying in CA to do a less competitive specialty. That being said, I'm not saying its impossible to match in EM in California as a DO. I'm just saying the odds are stacked against you and I wouldn't put all my eggs in that basket.

 

[TheOther]

No I don't think anything changes. Do the research if your goal is to do research. But if you are looking at it as a magic key to opening up spots at traditionally DO unfriendly places, I wouldn't bank on that, and taking an entire year of future earning potential (and another year of student loans) to gamble on that is a bad gamble IMO. Matching in CA is very difficult, and its crazy hard as a DO. Doing a year of research isn't going to change that. I realize you may want to stay in CA, but unfortunately, that's not always possible, especially with EM. Eventually you'll have to decide if you want to do EM and only gun for CA but run the risk of not matching, or expand your geographic horizons. But something will likely have to give. Either accept leaving CA to go do EM elsewhere or staying in CA to do a less competitive specialty. That being said, I'm not saying its impossible to match in EM in California as a DO. I'm just saying the odds are stacked against you and I wouldn't put all my eggs in that basket.

Noted, thank you so much for the thoughtful and thorough response. I appreciate it!

 

[gamerEMdoc]

I thought this file might be useful for people trying to gameplan where to rotate and apply. It gives a state by state look at what type of candidates matched where. The categories are basically:

US SR - MD student graduating
US MD - MD student, already graduated (reapplying residents who did a prelim for instance)
US DO - DO students
US IMG - US citicizens who are IMGs
IMG - noncitizen IMGs

I compared two states I've lived in before, CA and PA just as an example.

CA: 202 spots, 176 (87%) went to US Sr grads. 6 spots went to US MD reeaplicants, 18 to DOs, and 2 to US IMGs, 0 to other IMGs

PA: 176 spots, 100 (56%) went to US Sr grads, 7 spots to MD reapplicants, 62 to DOs, 3 to US IMGs, 2 to other IMGs

Looking at the data, CA remains extremely tough to match into for anyone who isn't a US MD Senior. Reeapplicants and DOs had a much harder time compared to PA. IMGs struggled in both states.

These are just two examples. Depending on the type of candidate you are, it would be really useful at looking geographically at where you intend to apply and see how competitive its going to be for you based on the type of candidate you are. If a State is 90% US MD Senior grads, and you are a DO, scheduling all your rotations in that state could really kill your chances.

I've been preaching for a long time that so much of the success of the match is knowing your competitive window and targeting programs where you'll have success. I think the info in this file can really be helpful to many to try to figure out where they will be competitive geographically. Best of luck all! Hope everyone is securing rotations out there.

 

[CajunMedic]

One that will apply to the medics that are interviewing EM...

How can I address teachability? That was a common thread in my interviews last year. "You've been a Paramedic for a long time, are you teachable?". I also have gotten post-match feedback from a PD I interviewed with that said that was their only concern about me (I for sure had an episode where an EMS bad habit popped up in front of the aPD). Does the letter from my TRI PD need to address it?

 

[gamerEMdoc]

Definitely would help if your TRI PD letter mentions something about how teachable or responsive to feedback you are I'd imagine. That's a common question medics get on the interview trail. I think a good answer is acknowledge that while you do have some experience in prehospital medicine, you certainly realize that while that gives you some clinical experience, it isn't a substitute for everything you have to learn to be a successful EM doc and you are eager to learn and be mentored.

 

[bom602]

Just wanted to throw this out there in regards to securing aways for any DO students. I highly, highly recommend contacting programs that are not on VSAS as early as possible and securing aways that way. If there are programs only on VSAS that you want to attend then by all means leave a month or two for them. However, I had more rotations than I could fit prior to March but saved two months for programs on VSAS and could not secure a single VSAS program. Thankfully I scrambled back into a program not on VSAS.

Where do we find programs not on VSAS? Is there a list of available programs somewhere?

 

[bom602]

Already had someone who is just finishing 2nd year request an EM sub-I at the end of 3rd year or beginning of 4th year. Damn, you all are starting earlier and earlier...

When is the right time to send out those requests? I've been told to wait till when VSAS opens, but that's not till January/February

 

[gamerEMdoc]

Where do we find programs not on VSAS? Is there a list of available programs somewhere?

EMRA and SAEM both have residency catalogues online where you can search for residency programs by state. Would take a little cross referencing with VSAS to find the ones that don't use VSAS. There is no resource that I'm aware of that lists all the places that take students outside of VSAS.

 

[gamerEMdoc]

V

When is the right time to send out those requests? I've been told to wait till when VSAS opens, but that's not till January/February

Programs on VSAS usually don't start taking student requests for rotation until after the match, so typically March sometime. I'd imagine there are some non-VSAS places that may accept applications earlier. We don't use VSAS, and let students send us their applications, but don't make any decisions regarding who can rotate until after the Match.

 

[Elevencents]

Where do we find programs not on VSAS? Is there a list of available programs somewhere?

EMRA and SAEM both have residency catalogues online where you can search for residency programs by state. Would take a little cross referencing with VSAS to find the ones that don't use VSAS. There is no resource that I'm aware of that lists all the places that take students outside of VSAS.

This. That’s how I did it. Just have to take the time to cross reference but time WELL spent. I looked at a LOT of webpages and they’ll generally have the whole application process on one page if they are not on VSAS. Sometimes it’s as simple as emailing someone and asking for certain dates. Good luck!

 

[Brorthopedic]

What is your opinion on a SLOE from a program that is ran by a CMG like HCA? How would the PDs at well-respected academic programs view the letter?

 

[RustedFox]

What is your opinion on a SLOE from a program that is ran by a CMG like HCA? How would the PDs at well-respected academic programs view the letter?

Psst. HCA is not a CMG; but I can see how it's an easy mistake to make with HCA and EmCare now being "Envision".

 

[gamerEMdoc]

What is your opinion on a SLOE from a program that is ran by a CMG like HCA? How would the PDs at well-respected academic programs view the letter?

As long as its a SLOE from a residency program, I doubt anyone will make a big deal about it.

 

[FallingFromSpace]

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

It is, but only if you’ve done two years in another specialty and only at certain programs, (even then, you would be considered after someone with a year of EM experience looking to switch locations) and likely only in 4 year programs. You just don’t have enough experience to replace someone with a year of EM under their belt, as the skills you’ve learned from a surgical prelim year don’t translate well.

 

[mymembernames]

Is it ok to take Step 2 CS around November 16th?

 

[gamerEMdoc]

Is it ok to take Step 2 CS around November 16th?

I personally don't even look at the Step 2 CS result, other than if its in the application, I look to see if there was a failure. But if its not in a students application by the time they interview, I never make a note to go back and check like I do if there is missing SLOEs or a step 2 CK score that's missing. So to me, it wouldn't matter at all when you took it. Though I'm not exactly sure how universal that opinion is. I'd say as long as you take it and pass sometime before rank lists are submitted, its probably fine.

 

[Nedsson]

Is it harder to match EM as an older nontraditional? I'm matriculating to a US allopathic program this fall. Its a career change for me after a decade as an EMT then ICU RN. I'm really interested in EM (I started in the ER, and the things I learned there have helped me throughout my career), take good care of myself, and am both a very teachable learner and a hard worker. But, I'll be at least a decade older than most applicants when interviewing. I've heard conflicting reports on this here on SDN...some people say its not an issue, others say it definitely is. What's your take?

 

[gamerEMdoc]

Is it harder to match EM as an older nontraditional? I'm matriculating to a US allopathic program this fall. Its a career change for me after a decade as an EMT then ICU RN. I'm really interested in EM (I started in the ER, and the things I learned there have helped me throughout my career), take good care of myself, and am both a very teachable learner and a hard worker. But, I'll be at least a decade older than most applicants when interviewing. I've heard conflicting reports on this here on SDN...some people say its not an issue, others say it definitely is. What's your take?

I don't think it's a big deal at all. But you will notice that some places may seem to be more friendly towards nontraditional applicants like yourself. It's not a bias. I think it has more to do with the fact that people who are in a different place in their life (married with kids for instance) are usually looking for a place that's cheaper to live with decent schools. So you'll see some smaller town community programs with a higher % of nontraditional candidates than places in cities I'd imagine, at least that's been my experience. After all, geography and where you want to live is almost always one of the biggest, if not the biggest, determiner in how people rank their list.

 

[gamerEMdoc]

First group of 2019 match class students started today. Let the games begin!

 

[Brorthopedic]

Couple of questions for you big guy.

1) What's your opinion on well-groomed beards? During both auditions and interviews

2) How is it viewed if you are in the middle of an away but have to leave for an interview at another program?

 

[gamerEMdoc]

I'm finding conflicting information regarding the number of SLOE's you should get. Is 2 just as good as 3 SLOE's assuming you have a competitive application? Thanks.

2 is great if they are both good sloes. A third can come in handy if you need a tie breaker SLOE, for instance you get a middle 1/3 at one place and a top 1/3 at another. A third strong sloe will make your app more competitive in that case. But if your first two are competitive SLOEs, a third doesn't add anything, and could potentially hurt I guess if it turned out to be a bad one.

 

[Bea5T]

How important is it where a SLOE is from?

 

[gamerEMdoc]

Couple of questions for you big guy.

1) What's your opinion on well-groomed beards? During both auditions and interviews

2) How is it viewed if you are in the middle of an away but have to leave for an interview at another program?

1. I doubt anyone is going to care about a beard. Hell, half my residency has beards and we have a no shave November competition. Hahaha. I think you'll be fine.

2. Leaving during auditions is common, programs aren't surprised from Oct to Jan when you need to go interview. It's part of the system and understood.

 

[gamerEMdoc]

How important is it where a SLOE is from?

Important, to an extent. First of all, SLOEs from EM residencies are valued way over a non-residency sloe. After that, programs are probably going to weigh SLOEs from programs they see as in or above their tier more heavily than a program that is less competitive than theirs. That being said, a good SLOE is a good SLOE, and for the most part, its better to have a top SLOE from a lesser known place than a bad SLOE from a big name place.

 

[bom602]

Important, to an extent. First of all, SLOEs from EM residencies are valued way over a non-residency sloe. After that, programs are probably going to weigh SLOEs from programs they see as in or above their tier more heavily than a program that is less competitive than theirs. That being said, a good SLOE is a good SLOE, and for the most part, its better to have a top SLOE from a lesser known place than a bad SLOE from a big name place.

I have a few questions about the quality of SLOEs. Here is my situation:

My school has an EM residency program. I have no desire to be a resident at my home program. During our MS-3 year, we have a required EM core clerkship. I can start scheduling aways in July of my 4th year since my 3rd year clerkships end at the of June (not this year, I'm not an MS-3 yet). I'm interested in how to schedule my aways and how many I will need from home/away institutions.

1. Do I have to do a 4th-year EM rotation at my home institution? (People tell me this is expected since my school has an EM residency program here. But I would prefer not to since I could use that time to set up an away rotation at another program I actually want to go to)

2. I heard it's recommended to do the 4th-year rotation at my home program because they tend to always give out positive SLOEs to their own students. Is this true?

3. When people recommend 2-3 SLOEs total for a complete application, do they mean:

- 2-3 total SLOEs (including one from your home program if you have one)? i.e. 1 SLOE from my home program + 1 SLOE from a different program = 2 = done!
or
- at least 2-3 SLOEs from programs that are not your home institution? i.e. if I do a 4th year EM rotation at my home program and they write me a SLOE, I still need to do at least 2 more rotations at different programs and get SLOEs from them?

4. If it is absolutely required to do a 4th-year rotation at my home program, can I just schedule it for like October so I can complete aways at my desired programs first? How would that look from the residency program's perspective?

 

[gamerEMdoc]

Will we get to know how competitive our SLOEs were in case we try to scramble for a third SLOE upon knowing they weren't as good?

Depends on the program, but for the most part you won't know. I mean, if a place flat out tells you they love you as a student and would be thrilled if you'd match there, then sure, that SLOE will be a good one. But most places keep things closer to the vest, and because the SLOEs are blinded, you are basically going to have to guess how competitive they are until you get on the interview trail. Usually by then people figure out whether or not they have a bad sloe or red flag in one that is holding them back because they either aren't getting interviews, or it gets brought up on their interviews.

 

[gamerEMdoc]

1. Do I have to do a 4th-year EM rotation at my home institution? (People tell me this is expected since my school has an EM residency program here. But I would prefer not to since I could use that time to set up an away rotation at another program I actually want to go to)

You don't have to, though obviously if you were considering your home program as a possible safety match, they may be ticked if you didn't rotate there. Then again, if you aren't going to apply there, then I'd say you'd be fine to skip it. With the exception of the next response in the question below.

2. I heard it's recommended to do the 4th-year rotation at my home program because they tend to always give out positive SLOEs to their own students. Is this true?

That's going to be institution dependent. But if that's true about your school, then you may want to not give up rotating there. You could do your first EM AI rotation (June maybe) and get an early good SLOE and some EM experience under your belt before going on the away trail. That would give you the opportunity to do two aways between July and October, giving you some scheduling flexibility.

. When people recommend 2-3 SLOEs total for a complete application, do they mean:

- 2-3 total SLOEs (including one from your home program if you have one)? i.e. 1 SLOE from my home program + 1 SLOE from a different program = 2 = done!
or
- at least 2-3 SLOEs from programs that are not your home institution? i.e. if I do a 4th year EM rotation at my home program and they write me a SLOE, I still need to do at least 2 more rotations at different programs and get SLOEs from them?

2-3 SLOEs total. Home SLOE counts in that total. If you get one home, and one away, that's usually enough assuming they are both good SLOEs.

4. If it is absolutely required to do a 4th-year rotation at my home program, can I just schedule it for like October so I can complete aways at my desired programs first? How would that look from the residency program's perspective?

As above, I think it would be better to do the home one first, and do it early as possible, if you don't have interest there. Because it can be used as a warmup rotation, especially if its true that it's an easier way to get a good SLOE. If you go somewhere foreign to you, where you dont know the system, who doesn't know you, and thats your first AI, and you struggle a bit, and you were counting on that to get a strong SLOE, then you may be scrambling a bit. So if you can get a home rotation in June, I think that's the best time to do it.

 

[surely]

I have a few questions about the quality of SLOEs. Here is my situation:

My school has an EM residency program. I have no desire to be a resident at my home program. During our MS-3 year, we have a required EM core clerkship. I can start scheduling aways in July of my 4th year since my 3rd year clerkships end at the of June (not this year, I'm not an MS-3 yet). I'm interested in how to schedule my aways and how many I will need from home/away institutions.

1. Do I have to do a 4th-year EM rotation at my home institution? (People tell me this is expected since my school has an EM residency program here. But I would prefer not to since I could use that time to set up an away rotation at another program I actually want to go to)

2. I heard it's recommended to do the 4th-year rotation at my home program because they tend to always give out positive SLOEs to their own students. Is this true?

3. When people recommend 2-3 SLOEs total for a complete application, do they mean:

- 2-3 total SLOEs (including one from your home program if you have one)? i.e. 1 SLOE from my home program + 1 SLOE from a different program = 2 = done!
or
- at least 2-3 SLOEs from programs that are not your home institution? i.e. if I do a 4th year EM rotation at my home program and they write me a SLOE, I still need to do at least 2 more rotations at different programs and get SLOEs from them?

4. If it is absolutely required to do a 4th-year rotation at my home program, can I just schedule it for like October so I can complete aways at my desired programs first? How would that look from the residency program's perspective?

It's expected that you do a 4th year rotation at your home institution. If your home institution has a program, it'll be pretty unusual for you to not have a SLOE from them prior to ERAS opening or shortly afterward. Programs might wonder why, and may even be concerned that you rotated at your program but did so poorly that you wanted to hide the SLOE. October would be a strange time to do a home rotation, but would be a totally normal time to do an Away.

Your position isn't unusual, btw - Many people don't want to stay at their medical school for residency, but all of them still do that rotation and get a SLOE.

When people say 2-3 total SLOEs, that's including your home program. Some students don't have a home program, but they still need at least 2 SLOEs, so they end up doing more Aways.

 

[surely]

But won't it be kind of too late to get another away scheduled and done by the time you figure out if a bad SLOE was holding you back?

That's right. It's a raw deal for the applicant.

 

[mymembernames]

What are your thoughts about doing an away rotation during Nov-Dec? This will not be for a SLOE, but at a program I would love to match at and they interview rotators during that time. I will already have done 3 other EM rotations for SLOEs by then.

 

[gamerEMdoc]

But won't it be kind of too late to get another away scheduled and done by the time you figure out if a bad SLOE was holding you back?

Yep. Though, sometimes you do get an idea of what you're SLOEs will be based on your grade or feedback you get on rotation. Maybe not exactly, but you can possibly guess at least whether its a top 10 or top 1/3 SLOE. But for the most part, its a pretty blinded system.

 

[gamerEMdoc]

What are your thoughts about doing an away rotation during Nov-Dec? This will not be for a SLOE, but at a program I would love to match at and they interview rotators during that time. I will already have done 3 other EM rotations for SLOEs by then.

We are always full in November with potential candidates on rotation. Many people take this strategy and I don't think its a bad idea. If there's a place you want to end up, but they were booked during the peak SLOE months, then this is a great time to rotate with them. By then you'll have a ton of practice, and you'll usually be able to knock out your interview while you are there.

 

[whatisthisstuff]

We are always full in November with potential candidates on rotation. Many people take this strategy and I don't think its a bad idea. If there's a place you want to end up, but they were booked during the peak SLOE months, then this is a great time to rotate with them. By then you'll have a ton of practice, and you'll usually be able to knock out your interview while you are there.

How difficult does this make in regards to scheduling interviews? Interested in a specific place out of my geographic zone and looks like November would be my only opportunity. I've heard things might be a little later this year due to ACEP being in October, any truth to this you think? Just don't want to make scheduling interviews a major difficulty or have to ask off time from an AI. That said there is 18 shifts + didactics so that doesn't leave a ton of time for scheduling around. Will have already done home rotation in July, away in August.

 

[gamerEMdoc]

How difficult does this make in regards to scheduling interviews? Interested in a specific place out of my geographic zone and looks like November would be my only opportunity. I've heard things might be a little later this year due to ACEP being in October, any truth to this you think? Just don't want to make scheduling interviews a major difficulty or have to ask off time from an AI. That said there is 18 shifts + didactics so that doesn't leave a ton of time for scheduling around. Will have already done home rotation in July, away in August.

We always try to be as accommodating as possible to students rotating during interview season. I'd imagine other places are as well, but I can't speak for any other program but the one I work at. It's not a surprise to programs that students have interviews during interview season, and most programs want to see students find success and match. I can't imagine you wouldn't have a problem squeezing 2-3 interviews in during that month.

 

[bom602]

You don't have to, though obviously if you were considering your home program as a possible safety match, they may be ticked if you didn't rotate there. Then again, if you aren't going to apply there, then I'd say you'd be fine to skip it. With the exception of the next response in the question below.



That's going to be institution dependent. But if that's true about your school, then you may want to not give up rotating there. You could do your first EM AI rotation (June maybe) and get an early good SLOE and some EM experience under your belt before going on the away trail. That would give you the opportunity to do two aways between July and October, giving you some scheduling flexibility.



2-3 SLOEs total. Home SLOE counts in that total. If you get one home, and one away, that's usually enough assuming they are both good SLOEs.



As above, I think it would be better to do the home one first, and do it early as possible, if you don't have interest there. Because it can be used as a warmup rotation, especially if its true that it's an easier way to get a good SLOE. If you go somewhere foreign to you, where you dont know the system, who doesn't know you, and thats your first AI, and you struggle a bit, and you were counting on that to get a strong SLOE, then you may be scrambling a bit. So if you can get a home rotation in June, I think that's the best time to do it.

Thanks for the feedback. The earliest I can schedule my home rotation to get a SLOE is July, so it looks like I'll need to expect to schedule my away rotations in August/September/October. Ideally I'll be able to get some in both August and September! Regardless, thanks for the input. It was really helpful, as always.

 

[bom602]

That's right. It's a raw deal for the applicant.

Is it common for the home programs to give their students high evals on the SLOEs they write for the initial home rotation? I was curious how that would look because it seems to me that programs would take those high marks on SLOEs with a grain of salt if a program always list their own students as top 1/3.

 

[surely]

Is it common for the home programs to give their students high evals on the SLOEs they write for the initial home rotation? I was curious how that would look because it seems to me that programs would take those high marks on SLOEs with a grain of salt if a program always list their own students as top 1/3.

Great question, and one that our friendly neighborhood super-aPD is more qualified to answer than I am. However, I'll say this: The SLOE tracks and displays how many students were reported to be in each category in the previous year for transparency's sake. That should cut down on grade inflation to some extent.

 

[gamerEMdoc]

Is it common for the home programs to give their students high evals on the SLOEs they write for the initial home rotation? I was curious how that would look because it seems to me that programs would take those high marks on SLOEs with a grain of salt if a program always list their own students as top 1/3.

Great question, and one that our friendly neighborhood super-aPD is more qualified to answer than I am. However, I'll say this: The SLOE tracks and displays how many students were reported to be in each category in the previous year for transparency's sake. That should cut down on grade inflation to some extent.

Surely is once again on the money. I'm starting to think she could take my job.

The SLOE includes a grading and ranking breakdown in terms of how many students were in each category in the previous year. So you know how many the previous years got honors, HP, pass, fail... and how many got Top 10, top 1/3, mid 1/3, low 1/3, and DNR. So basically, you know if a place is inflating its grades and giving everyone a high grade. That's the thing I think programs are going to pay attention to, the distribution, rather than there being some type of hometown bias from a home vs away rotation.

 

[GLIPGLOP]

would you rather have a brilliant trouble maker or an average lazy resident?

 

[gamerEMdoc]

would you rather have a brilliant trouble maker or an average lazy resident?

Well, being lazy is a a form of trouble maker in EM, so I'm not sure its a fair question. I don't mind (at all) brilliant residents who are cocky about it, but I don't know if that's what you mean by trouble maker. If its someone who starts trouble with other residents in the program, I don't want them around no matter what. You don't sacrifice upsetting the tight knit dynamic of the residency just to get better test scores. I'd much rather take a resident who scores below average on the in service than a resident that gets a top 5% score who is constantly starting trouble with other residents.

 

[miacomet]

would you rather have a brilliant trouble maker or an average lazy resident?

This doesn't answer your question exactly, but I can tell you that in community EM a doc can be pretty short on brains (barely competent IMHO), but as long as someone is pleasant and patients, nurses, and admin love them, they will do very well. Brilliance is certainly not rewarded in clinical EM, and is perhaps a liability.

 

[gamerEMdoc]

This doesn't answer your question exactly, but I can tell you that in community EM a doc can be pretty short on brains (barely competent IMHO), but as long as someone is pleasant and patients, nurses, and admin love them, they will do very well. Brilliance is certainly not rewarded in clinical EM, and is perhaps a liability.

I don't know that its a liability. All other things being equal, I'd take the brilliant doc over the not so brilliant one. But smarts are overrated, typically by people who aren't in the position to hire people. Students think that board scores are a ticket into a residency and I can tell you, they are not. People want to hire people who work hard, are personable, and who aren't going to be an administrative headache. If they score high on tests, that's a bonus.

Trust me, I'm pretty proud about my board scores and academic achievement in medical school. And they weren't brought up much on the residency interview trail, and in the last 10 years after residency, I've never had one boss or administrator ever ask me, not once, how I scored on a standardized exam. But you better believe they want to know about patients/hr, patient satisfaction issues, committee involvement, any previous lawsuits, etc. It's great if you are a great test taker or brilliant, but its not going to unlock many doors for you unless you are good clinically.

 

[miacomet]

I don't know that its a liability. All other things being equal, I'd take the brilliant doc over the not so brilliant one. But smarts are overrated, typically by people who aren't in the position to hire people. Students think that board scores are a ticket into a residency and I can tell you, they are not. People want to hire people who work hard, are personable, and who aren't going to be an administrative headache. If they score high on tests, that's a bonus.

Trust me, I'm pretty proud about my board scores and academic achievement in medical school. And they weren't brought up much on the residency interview trail, and in the last 10 years after residency, I've never had one boss or administrator ever ask me, not once, how I scored on a standardized exam. But you better believe they want to know about patients/hr, patient satisfaction issues, committee involvement, any previous lawsuits, etc. It's great if you are a great test taker or brilliant, but its not going to unlock many doors for you unless you are good clinically.

Agreed 100%. And good clinically means being a team player, not being brilliant. Medicine is often recommended to bright young people, but it's not necessarily a great field for people who really need an intellectual challenge, and EM is not as welcoming to, nor in need of, geniuses who aren't happy to be team players. It really is all personality.

 

[GLIPGLOP]

Seems to be the prevailing thought. We have blackballed/matched a good amount of applicants based on personality alone.

 

[Vandalia]

As for brilliance being a liability in the community, it depends a bit on how you define brilliance.

If by brilliance, you mean every patient is managed correctly, and every time a consultant is called, the diagnosis is correct, and the like, then that has value.

If by brilliance, you mean someone who is able to localize a neurological lesion after a 30 minute H&P rather than simply get imaging, or after 45 minutes is able to correctly diagnose a chronic illness, then that is a liability in EM. Yes, I have seen that.

The dirty truth is that when it comes to hiring, we are looking for people who will make our jobs easier, and I believe residency faculty are looking for the same thing. If I end up spending 3 hours a week cleaning up your problems, you will not last long. If I think I might be spending 3 hours a week doing that, I will not hire you. I also believe that is true in residency selection.

There are some specialties where ability is everything: a neurosurgery program will put up with almost anyone if they think they are going to be the next Spetzler. If James Andrews wanted to come to our institution, our CEO would let him get away with anything. Even today he could have a harassment suit a week, he could have it in his contract that he could punch the CEO in the nose every Tuesday morning. The revenue - directly and indirectly - he would bring in would dwarf anything else.

But the bottom line is that there is no Emergency Medicine physician who is so good that it would overshadow everything else. But don't feel bad, that is true for Radiology, Anesthesiology, Pathology, and most other specialties.

 

[miacomet]

As for brilliance being a liability in the community, it depends a bit on how you define brilliance.

If by brilliance, you mean every patient is managed correctly, and every time a consultant is called, the diagnosis is correct, and the like, then that has value.

If by brilliance, you mean someone who is able to localize a neurological lesion after a 30 minute H&P rather than simply get imaging, or after 45 minutes is able to correctly diagnose a chronic illness, then that is a liability in EM. Yes, I have seen that.

The dirty truth is that when it comes to hiring, we are looking for people who will make our jobs easier, and I believe residency faculty are looking for the same thing. If I end up spending 3 hours a week cleaning up your problems, you will not last long. If I think I might be spending 3 hours a week doing that, I will not hire you. I also believe that is true in residency selection.

There are some specialties where ability is everything: a neurosurgery program will put up with almost anyone if they think they are going to be the next Spetzler. If James Andrews wanted to come to our institution, our CEO would let him get away with anything. Even today he could have a harassment suit a week, he could have it in his contract that he could punch the CEO in the nose every Tuesday morning. The revenue - directly and indirectly - he would bring in would dwarf anything else.

But the bottom line is that there is no Emergency Medicine physician who is so good that it would overshadow everything else. But don't feel bad, that is true for Radiology, Anesthesiology, Pathology, and most other specialties.

I dunno- I see a lot of docs screwing up and admin not really caring, interestingly, and not just at my shop.

Agreed with everything else you said, and I would add that if you are a brilliant iconoclast, do not do EM. It's a field for average-bright folks, not the brilliant, unless you want a 100% tox career, which is a rarity.