EM PD - Ask Me Anything

[surely]

Edited for clarity - I looked to see if this has been asked here before and as far as I can tell it hasn't, apologies if I am repeating a question:

Is it accurate that you cannot assign letters that aren't uploaded by the letter writer? I.e. I have my home SLOE available and uploaded, so no doubt I can assign that when I submit this week. But, my first away SLOE won't be available until October, I've been told to assign it now and it will automatically get sent to programs when it's uploaded but I don' think that's accurate?

Not 100% sure, but I can tell you I've never heard of that. Just assign it once it arrives, that's what I did.

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[surely]

If you were just a member of EMIG and did not do anything else, is it required to put that under "Experiences" on ERAS?

Not required at all, nor do I think any PD would care if you did include it.

 

[Tocacola]

Current applicant, searched through this thread and had trouble finding a solid answer. As ERAS deadline approaches, I pretty much have everything ready to go. I got a late start to aways, my home institution does not finish 3rd year until early July. I am concerned over my letter situation. I will have 2 non-SLOE LOR's ready to go. I finish this away on Friday and have talked with the program director and he has promised me he will turn it around by the Sept 18-19th. I will then start another away that won't finish until mid October.

My question is, what is the best way to submit my stuff this week?
Is it fine to just go ahead and make spaces for all four and they will just come in when they get here? Im concerned this will flag my transcript as "not complete" for a long time. Is there any benefit to just to not currently assigning the one that won't be in until mid October as by this point I will have long had 2 LOR + 1 SLOE in?

 

[Apollyon]

Current applicant, searched through this thread and had trouble finding a solid answer. As ERAS deadline approaches, I pretty much have everything ready to go. I got a late start to aways, my home institution does not finish 3rd year until early July. I am concerned over my letter situation. I will have 2 non-SLOE LOR's ready to go. I finish this away on Friday and have talked with the program director and he has promised me he will turn it around by the Sept 18-19th. I will then start another away that won't finish until mid October.

My question is, what is the best way to submit my stuff this week?
Is it fine to just go ahead and make spaces for all four and they will just come in when they get here? Im concerned this will flag my transcript as "not complete" for a long time. Is there any benefit to just to not currently assigning the one that won't be in until mid October as by this point I will have long had 2 LOR + 1 SLOE in?

Submit your app on time, with two non SLOEs. Get two SLOEs, upload them.
????
Profit!

Do NOT wait!! That is the key.

 

[gamerEMdoc]

To follow up on the required letters question, do most programs filter out incomplete applications? since most programs require 3 letters, if I only submit 2 (1 SLOE, 1 EM LOR) while waiting on my last SLOE is there a good chance my application won't even get looked at until that 3rd letter comes and my application is marked complete? I don't really have a relevant non EM letter to submit as a placeholder while I wait for my last SLOE, but also don't want to be passed over as incomplete by only submitting 2 letters initially. Sorry, I know we're starting to beat a dead horse with this question, just want to make sure I'm not shooting myself in the foot by initially submitting an incomplete application!

Just need to get your letters in during interview season. Dont worry about this.

 

[gamerEMdoc]

Hi! Im not sure if you're still taking questions but I came across this thread and thought it was worth a shot.. Im a 3rd year DO student very interested in applying EM. It has been my sole source of interest and focus for the last year or 2. Anyway I'm worried because I had to remediate a course in my first semester of M1. It was genetics, a 1 credit course. I failed because a car slid into me on the highway (in the snow) and I was late for a quiz that was 15% of my grade. My school has a zero tolerance policy and I shouldve left for the quiz earlier. I was wondering if this completely screws me for competitive EM residency programs. This has been a really difficult thought to bear. I ranked middle high of my class and had ZERO other academic difficulty. Scored a 240 on Step 1 and a 600 on COMLEX. Extracurriculars etc.

Thanks for your helo

Not sure if Im still taking questions? I replied like two posts above this one. Hahaha. Im ALWAYS taking questions, no worries.

As for your remediated course, its irrelevant to many programs you’ll apply and you have a legitimate explaination, I wouldnt worry at all about it in terms of matching EM.

As Surely said above, the biggest roadblock to matching at “competitive” programs is you being a DO. Many big name programs have very few if any DO residents.

Dont worry about the name of the residency in terms of quality. In terms of the quality of training you will receive, some of the best training you may receive could be at a program you never heard of.

 

[gamerEMdoc]

Edited for clarity - I looked to see if this has been asked here before and as far as I can tell it hasn't, apologies if I am repeating a question:

Is it accurate that you cannot assign letters that aren't uploaded by the letter writer? I.e. I have my home SLOE available and uploaded, so no doubt I can assign that when I submit this week. But, my first away SLOE won't be available until October, I've been told to assign it now and it will automatically get sent to programs when it's uploaded but I don' think that's accurate?

Im not sure, I havent seen the student side of ERAS for over 10 years, but as far as I know you can only assign a letter once its uploaded. But I could be wrong.

 

[gamerEMdoc]

Current applicant, searched through this thread and had trouble finding a solid answer. As ERAS deadline approaches, I pretty much have everything ready to go. I got a late start to aways, my home institution does not finish 3rd year until early July. I am concerned over my letter situation. I will have 2 non-SLOE LOR's ready to go. I finish this away on Friday and have talked with the program director and he has promised me he will turn it around by the Sept 18-19th. I will then start another away that won't finish until mid October.

My question is, what is the best way to submit my stuff this week?
Is it fine to just go ahead and make spaces for all four and they will just come in when they get here? Im concerned this will flag my transcript as "not complete" for a long time. Is there any benefit to just to not currently assigning the one that won't be in until mid October as by this point I will have long had 2 LOR + 1 SLOE in?

Yeah just submit and upload your sloes when they are available.

 

[Asiandunce]

Regarding away rotations and getting through geographic filters (that do not include your aways), you mentioned earlier that one could network around or email programs to look at your application early in interview season, then they would see that you rotated there and see some genuine interest.

I was wondering if you could elaborate on this approach? When you said emailing them early in the season, do you mean as soon as you can? Also, can you just email the programs and directly mention you did the away in the area or state, and just say you have a lot of interest?

Thank you!!

 

[gamerEMdoc]

I don't know that I said email early in interview season, if I did, that was probably a mistake on my end. Honestly, if people all start emailing all the programs they are interested in early on in September or early October, programs will get inundated with emails and then just ignore them all. I think a more reasonable strategy is to wait until the end of October at the earliest. By that point, interview season is only about a 1/4 to 1/3 of the way over, so there is still plenty of time to get interviews. ACEP is over. Most programs probably sent out their first round of interviews several weeks before, and they are going through the grind of figuring out who to extend their other interviews to. To me, the last week of Oct / first week of Nov would be a good time to contact them. Don't spam 100 programs at that point, but sending a handful of directed emails to programs you really were highly considering but hadn't heard back from yet is reasonable.

If you want to try to dig up some interviews at places outside your geographic compass, talking to programs you are interested in that are out of your geographic range at something like ACEP may be helpful as well.

 

[Mat the coolcat]

Edited for clarity - I looked to see if this has been asked here before and as far as I can tell it hasn't, apologies if I am repeating a question:

Is it accurate that you cannot assign letters that aren't uploaded by the letter writer? I.e. I have my home SLOE available and uploaded, so no doubt I can assign that when I submit this week. But, my first away SLOE won't be available until October, I've been told to assign it now and it will automatically get sent to programs when it's uploaded but I don' think that's accurate?

You are correct, you cannot assign them until they are uploaded.

 

[Waterlover]

Our school doesn't require Neurology as a rotation. Is it necessary to do a Neurology rotation for EM residencies? I've heard mixed things.

 

[surely]

Our school doesn't require Neurology as a rotation. Is it necessary to do a Neurology rotation for EM residencies? I've heard mixed things.

It's not necessary at all. I'm surprised you've heard mixed things. EM won't care, don't worry!

 

[borderlineinCle]

mentioned this on the WAMC thread, but... how strict are programs who have score cut-offs on the EMRA Match website? I've talked to a few PDs at regional ACEP + SAEM18 that said these were 'soft cut-offs' and to still apply. Very confusing.

 

[gamerEMdoc]

mentioned this on the WAMC thread, but... how strict are programs who have score cut-offs on the EMRA Match website? I've talked to a few PDs at regional ACEP + SAEM18 that said these were 'soft cut-offs' and to still apply. Very confusing.

Id imagine most are soft cutoffs they use to make filters and interview some candidates below the cutoff on a case by case basis.

 

[miacomet]

Id imagine most are soft cutoffs they use to make filters and interview some candidates below the cutoff on a case by case basis.

I realize it's heavy application season, and this is probably a spring question, but how do you counsel your residents on job searching, CMGs, longevity- essentially, what do you do for career counseling?

 

[AthleteDoc7]

One more question I hoped you could help with!

I’m currently on my first away and it’s been going really great. I actually have roughly a week left in the rotation, but the APD here (who’s a truly great guy) actually told us he’d write our SLOEs early as he knows we all want them in asap. I actually received notice it was uploaded today, which is great, except my last couple of shifts I’ve gotten some of my best feedback/shift evals and now I’m paranoid my SLOE could’ve been stronger with this feedback included (which he wouldn’t have had access to yet).

Is it possible for him to update the SLOE at the end of the rotation with this more personalized, positive feedback from these evals once they’re turned in, or is this more of a “once it’s in, its in” type of thing and my SLOE now just is whatever it is? I think it should be good either way, but I think the last couple shift evals had comments that could’ve made it even better. Thanks for any insight!

 

[gamerEMdoc]

I realize it's heavy application season, and this is probably a spring question, but how do you counsel your residents on job searching, CMGs, longevity- essentially, what do you do for career counseling?

Most of the residents that graduate have a geographic area in mind, and the job market in those areas dictate the job they take. While I prefer to be a hospital employee or part of a private group, I also understand that if someone wants to live in a specific city, they may have no choice but to work for a CMG. Much of this kind of stuff in residency (discussing longevity, finding a job, what you want out of a career, etc) comes longitudinally throught residency honestly, through discussions when its slow during the deptartment or when you are out of the department hanging out. We don’t have any formal process to address this, but residents know they can always discuss this with the attendings any time, and many of us will review contracts, discuss financial stuff, etc whenever the residents want.

 

[gamerEMdoc]

One more question I hoped you could help with!

I’m currently on my first away and it’s been going really great. I actually have roughly a week left in the rotation, but the APD here (who’s a truly great guy) actually told us he’d write our SLOEs early as he knows we all want them in asap. I actually received notice it was uploaded today, which is great, except my last couple of shifts I’ve gotten some of my best feedback/shift evals and now I’m paranoid my SLOE could’ve been stronger with this feedback included (which he wouldn’t have had access to yet).

Is it possible for him to update the SLOE at the end of the rotation with this more personalized, positive feedback from these evals once they’re turned in, or is this more of a “once it’s in, its in” type of thing and my SLOE now just is whatever it is? I think it should be good either way, but I think the last couple shift evals had comments that could’ve made it even better. Thanks for any insight!

I wouldn’t worry about it. Honestly, one or two evals doesn’t make or break a students evaluation one way or another. I’d just roll with the SLOE you got. If the feedback was going to change something drastically, the APD would probably offer to update the SLOE anyways.

 

[AthleteDoc7]

I wouldn’t worry about it. Honestly, one or two evals doesn’t make or break a students evaluation one way or another. I’d just roll with the SLOE you got. If the feedback was going to change something drastically, the APD would probably offer to update the SLOE anyways.

okay that’s good news. thanks a lot, as usual!

 

[NSLDX]

I've noticed a few programs that I applied to have sent out interview invites, but I haven't gotten anything. Does this mean I am rejected/won't be getting an interview from them?

Not necessarily, looking at the 17 - 18 spreadsheet most of the programs that sent out mid September interviews also sent out interviews in late September and October. I didn't see any programs that only sent out interviews early September.

 

[gamerEMdoc]

Programs generally send out invites on a rolling basis. I can’t speak for all programs, but I can explain what we do to give an example. Early on, in the first week when ERAS opens, we send out invites to the students that have rotated. That basically fills up the first month of interviews. Over the next 2-4 weeks, we start looking at a narrowed down list (based on multiple different filters) and send out the “first wave” of interviews. That might make up half to 2/3 of our total interviews. By that point, around the end of Oct / early Nov, we are reviewing a more broader segment of the applicants trying to fill out the rest of the interviews on a rolling basis as we approve them to interview.

I’m sure every program does this a little bit different, but for the most part, I’m sure its similar in the sense that interviews come out on a rolling basis. Noone is going to decide on Sept 20 that they know the exact 100 people they are going to invite. That’s not realistic. This is a long process, and it takes months to sort it all out.

Have patients, don’t worry if you aren’t hearing much right away.

 

[ScotlandEM]

Programs generally send out invites on a rolling basis. I can’t speak for all programs, but I can explain what we do to give an example. Early on, in the first week when ERAS opens, we send out invites to the students that have rotated. That basically fills up the first month of interviews. Over the next 2-4 weeks, we start looking at a narrowed down list (based on multiple different filters) and send out the “first wave” of interviews. That might make up half to 2/3 of our total interviews. By that point, around the end of Oct / early Nov, we are reviewing a more broader segment of the applicants trying to fill out the rest of the interviews on a rolling basis as we approve them to interview.

I’m sure every program does this a little bit different, but for the most part, I’m sure its similar in the sense that interviews come out on a rolling basis. Noone is going to decide on Sept 20 that they know the exact 100 people they are going to invite. That’s not realistic. This is a long process, and it takes months to sort it all out.

Have patients, don’t worry if you aren’t hearing much right away.

I second this (as I likely second everything you have said - you give superb advice on this forum, if you don't mind me saying!).

I feel like those programs that send their invites early also contribute to a lot of anxiety in the EM applicants. It is not done intentionally, but it most definitely happens. There have been attempts to move EM to a set day where everyone sends out the first wave of invites on a certain day, e.g. October 15th, but for some programs this wouldn't work as they have a process in place to get this done sooner, as they start interviewing sooner, etc etc.

I totally agree with the sentiment - 'be patient'. It is way too soon to start reading into this...

 

[LChristmas]

I second this (as I likely second everything you have said - you give superb advice on this forum, if you don't mind me saying!).

I feel like those programs that send their invites early also contribute to a lot of anxiety in the EM applicants. It is not done intentionally, but it most definitely happens. There have been attempts to move EM to a set day where everyone sends out the first wave of invites on a certain day, e.g. October 15th, but for some programs this wouldn't work as they have a process in place to get this done sooner, as they start interviewing sooner, etc etc.

I totally agree with the sentiment - 'be patient'. It is way too soon to start reading into this...

Is there a date this year that a large number of programs have decided to send out interviews?

 

[DrOMG]

I second this (as I likely second everything you have said - you give superb advice on this forum, if you don't mind me saying!).

I feel like those programs that send their invites early also contribute to a lot of anxiety in the EM applicants. It is not done intentionally, but it most definitely happens. There have been attempts to move EM to a set day where everyone sends out the first wave of invites on a certain day, e.g. October 15th, but for some programs this wouldn't work as they have a process in place to get this done sooner, as they start interviewing sooner, etc etc.

I totally agree with the sentiment - 'be patient'. It is way too soon to start reading into this...

Just curious, why is it that EM as a specialty is so delayed with invites compared to other specialties?

 

[theSmurfette]

Just curious, why is it that EM as a specialty is so delayed with invites compared to other specialties?

ACEP is in October. Last year it was mid-October. This year it’s the first week of October. Invites usually go out after that.


Sent from my iPhone using Tapatalk

 

[gamerEMdoc]

Just curious, why is it that EM as a specialty is so delayed with invites compared to other specialties?

I assume its for several reasons, though this is only my own hypothesis. First, EM is much more progressive about candidate and student evaluation than the other specialties of medicine. EM is still the only one that uses a Standardized LOR (the SLOE), and has so for over a decade. No other specialty, that I know of does this. EM was the first to adopt the SVI as well. So to an extent, EM as a specialty and the folks at CORD are always trying to improve the process. I’m not sure other specialties are nearly as progressive on this front.

The other issue is the SLOE. I love the SLOE, and I think it really makes candidate evaluation so much better, because it puts less importance on board scores and more importance on EM performance (which is what SHOULD matter). But if you worked in a field that didn’t have a SLOE, and everyone just had the same generic copy and paste LORs that really say little objective, then there isn’t much to evaluate in terms of deciding who to interview. You’d just use board scores and geography, and ERAS can do all that for you. So on day one, you could basically filter candidates down to the list you want to interview without ever actually looking at their applications. But in EM, where the SLOE is the most important part of the application, you have to open each app and review the SLOEs to know if you want to extend an invite. That takes considerable time. But it beats the alternative, which is just basically deciding strictly off board scores.

 

[gamerEMdoc]

ACEP is in October. Last year it was mid-October. This year it’s the first week of October. Invites usually go out after that.


Sent from my iPhone using Tapatalk

Oct 11th was what I found on the discussion forums on the CORD website. Which makes sense, it gives programs a week after ACEP and the Residency Fair. How many programs will stick to this, who knows.

 

[Rekt]

I assume its for several reasons, though this is only my own hypothesis. First, EM is much more progressive about candidate and student evaluation than the other specialties of medicine. EM is still the only one that uses a Standardized LOR (the SLOE), and has so for over a decade. No other specialty, that I know of does this. EM was the first to adopt the SVI as well. So to an extent, EM as a specialty and the folks at CORD are always trying to improve the process. I’m not sure other specialties are nearly as progressive on this front.

The other issue is the SLOE. I love the SLOE, and I think it really makes candidate evaluation so much better, because it puts less importance on board scores and more importance on EM performance (which is what SHOULD matter). But if you worked in a field that didn’t have a SLOE, and everyone just had the same generic copy and paste LORs that really say little objective, then there isn’t much to evaluate in terms of deciding who to interview. You’d just use board scores and geography, and ERAS can do all that for you. So on day one, you could basically filter candidates down to the list you want to interview without ever actually looking at their applications. But in EM, where the SLOE is the most important part of the application, you have to open each app and review the SLOEs to know if you want to extend an invite. That takes considerable time. But it beats the alternative, which is just basically deciding strictly off board scores.

I agree the SLOE has some utility, although still very subjective in my opinion, but what is the point to being blinded to them? It makes no sense. So if an applicant has decent to good scores but then gets a bunch bottom 1/3 SLOEs they usually have no way of knowing, so now they'll not match. If they knew, they could have at least applied FM or something.

Also it's very easy to like barriers that you never had to deal with, essentially every sitting PD right now.

 

[miacomet]

I agree the SLOE has some utility, although still very subjective in my opinion, but what is the point to being blinded to them? It makes no sense. So if an applicant has decent to good scores but then gets a bunch bottom 1/3 SLOEs they usually have no way of knowing, so now they'll not match. If they knew, they could have at least applied FM or something.

While PDs love SLOEs for obvious reasons, the use of such a non-objective measure isn't exactly "progressive" in my opinion. It certainly leaves the door open to all sorts of irrelevant information being used to assess an applicant, such as attractiveness, gender etc. I would like to think this doesn't happen, but the advantage of a more grades and exam-based screening is that people know exactly what they have to do and how to do it and that it's much harder to discriminate. It's much harder to be sure to hit it off with someone. I applied right at the beginning of this obsession with SLOEs, and I don't think the overemphasis on subjective measures is strengthening the field.

 

[gamerEMdoc]

While PDs love SLOEs for obvious reasons, the use of such a non-objective measure isn't exactly "progressive" in my opinion. It certainly leaves the door open to all sorts of irrelevant information being used to assess an applicant, such as attractiveness, gender etc. I would like to think this doesn't happen, but the advantage of a more grades and exam-based screening is that people know exactly what they have to do and how to do it and that it's much harder to discriminate. It's much harder to be sure to hit it off with someone. I applied right at the beginning of this obsession with SLOEs, and I don't think the overemphasis on subjective measures is strengthening the field.

Agree to disagree. I'm not sure how the SLOE is "non-objective", I base my rankings on all kinds of data I track on students including end of rotation test scores, their CV, their board scores, and their end of shift evaluations. And all of that is then discussed among a large group of faculty to decide where each student fits. It's hardly a subjective guessing game.

Regarding it being progressive, I wasn't referring to the political/social progressivism; rather was referring to the fact that EM is a field that is trying to push medical education / evaluation forward from the status quo.

Some of the best residents I have ever trained did not score all that well on the boards but were clinical all stars. Doing well on standardized tests doesn't make you a good EM doc. They are two COMPLETELY different skills. Its like trying to draft a left tackle based on their 40 yard sprint times. It's not a relevant measure when it comes to assessing which students will be excellent clinical EM docs. You mentioned grades, but grades and SLOEs fall into the same biases, so I'm not sure why you would say that grades should matter but SLOEs should not. SLOEs are mearly a form of grading that tries to standardize the process, by asking programs to show how many students they grade in each category. Without them, you are left trying to judge if an Honors at one place is the same as an A or B at another, vs a 90% at another, vs a pass at a pass/fail school; all different grading systems, all with their own different grade distribution. Grading is so all over the place that I stopped even looking at the EM grades students get because they just can't be compared from one place to the next.

Our job is built around being good with patients, having a good bedside manner, and fitting into the ED team. There is a huge social component to being an EM doc. So yes, fitting in matters. Your looks don't. Your race or sex doesn't. But being able to work together with a team and provide good patient care without the patients complaining about you is a big big deal.

 

[gamerEMdoc]

I agree the SLOE has some utility, although still very subjective in my opinion, but what is the point to being blinded to them? It makes no sense. So if an applicant has decent to good scores but then gets a bunch bottom 1/3 SLOEs they usually have no way of knowing, so now they'll not match. If they knew, they could have at least applied FM or something.

Also it's very easy to like barriers that you never had to deal with, essentially every sitting PD right now.

If the student gets 3 bottom 1/3 SLOEs, and they know it, tell me how they still match just because they now know? If they aren't a good student, them knowing doesn't make it easier for them to match in EM.

You could argue that if a student really isn't fit for EM, and gets multiple low 1/3 SLOEs, that someone should tell them to go in a different direction. And I'd agree. Ideally an advisor would do that. But that's not a problem with the SLOEs, its a problem with bad advisors.

The reason for the blinding process is because it leads to much more accurate scoring. I routinely see places giving SLOEs that are "middle 1/3" to students that got Honors on rotation. Some places will give up to 90% of their students "Honors". Because the grade isn't blinded. Many clerkship directors are just very uncomfortable being brutally honest with students, and so they over-inflate the grades. If you didn't blind the SLOEs, the exact same thing would happen. You'd see an over-abundance of Top 10% and Top 1/3, and the SLOE would be worthless within years.

 

[surely]

If the student gets 3 bottom 1/3 SLOEs, and they know it, tell me how they still match just because they now know?

The reason for the blinding process is because it leads to much more accurate scoring. I routinely see places giving SLOEs that are "middle 1/3" to students that got Honors on rotation. Some places will give up to 90% of their students "Honors". Because the grade isn't blinded. Many clerkship directors are just very uncomfortable being brutally honest with students, and so they over-inflate the grades. If you didn't blind the SLOEs, the exact same thing would happen. You'd see an over-abundance of Top 10% and Top 1/3, and the SLOE would be worthless within years.

If a student gets 3 bottom third SLOEs, the student will target newer programs, apply more broadly, maybe arrange a January audition rotation at a less competitive program. That would be a more successful strategy than applying to 20 competitive programs, 20 mid-range programs, and 5 newer programs.

 

[gamerEMdoc]

Also it's very easy to like barriers that you never had to deal with, essentially every sitting PD right now.

Every sitting PD hasn't had a SLOE written on them? I'd venture to say a large percent of sitting PDs and certainly APDs have actually.

 

[gamerEMdoc]

If a student gets 3 bottom third SLOEs, the student will target newer programs, apply more broadly, maybe arrange a January audition rotation at a less competitive program. That would be a more successful strategy than applying to 20 competitive programs, 20 mid-range programs, and 5 newer programs.

I guess. I doubt that would salvage someone with 3 low 1/3 SLOEs. I guess if someone had all mid 1/3 SLOEs and applied too competitively, then in that case it would make a difference knowing.

I think personally the biggest problem I see with students knowing, other than the grade over inflation, is that it allows the student to hide the SLOEs if they want. You could do 5 EM rotations, get 5 SLOEs, pick the best 2, and submit. So if two programs rated you has having major red flags, you could completely hide that from your application. Which you can't do about anything else in your application. You can't hide board failures. You can't hide 3rd year rotation red flag evaluation comments from rotations. You can't hide a LOA. You can't hide past misdemeanors. Etc. So any system where students were allowed to know their SLOEs would have to be balanced by a system where all the SLOEs were mandatorily submitted and could not be revoked.

 

[miacomet]

Agree to disagree.

Some of the best residents I have ever trained did not score all that well on the boards but were clinical all stars. Doing well on standardized tests doesn't make you a good EM doc. They are two COMPLETELY different skills. Its like trying to draft a left tackle based on their 40 yard sprint times. It's not a relevant measure when it comes to assessing which students will be excellent clinical EM docs. You mentioned grades, but grades and SLOEs fall into the same biases, so I'm not sure why you would say that grades should matter but SLOEs should not. SLOEs are mearly a form of grading that tries to standardize the process, by asking programs to show how many students they grade in each category. Without them, you are left trying to judge if an Honors at one place is the same as an A or B at another, vs a 90% at another, vs a pass at a pass/fail school; all different grading systems, all with their own different grade distribution. Grading is so all over the place that I stopped even looking at the EM grades students get because they just can't be compared from one place to the next.

Our job is built around being good with patients, having a good bedside manner, and fitting into the ED team. There is a huge social component to being an EM doc. So yes, fitting in matters. Your looks don't. Your race or sex doesn't. But being able to work together with a team and provide good patient care without the patients complaining about you is a big big deal.

All fields of medicine involved working with patients and communicating well with them; that's not unique to Emergency Medicine. I agree that finding out who can do that best is complicated, and it's unclear if a SLOE by faculty in which certain groups are overrepresented and others underrepresented is the best way to achieve that. With the disproportionate number of poor, female, immigrant, and minority patients seen in Emergency Departments, I would think special care would be needed to assure that the faculty writing SLOEs are representative of the populations whom we serve; statistically, this is not the case.

I would add that with the LONG history of racism and sexism in medicine, with the not unroutine requests of patients for physicians of a certain sex or gender and occasional acts of even more overt racism and sexism from our patient population, and with the underrepresentation of certain groups both within EM and medicine more generally, it's one thing to say someone's race or sex doesn't matter, but entirely another to say that evaluators don't have their own biases, either conscious or unconscious, that may alter their evaluations in ways that may impact students differently based on their race, gender, national origin, etc. "Fitting in" to one person may mean a positive attitude and a good sense of humor; to others it may (unconsciously) mean someone they feel "comfortable" with, which is often code for "someone like me" even if people are unaware that is what they are doing.

As a program director, I would hope your institution has instituted training in unconscious bias, both as it relates to patient care and also to fellow physicians. It's something that is starting to be incorporated into academic medicine, although it's very much in its infancy. Mount Sinai is reconsidering its participation in AOA for just this reason, in fact, as it was reported in the news a few weeks ago.

If your institution has not incorporated such training, I'd be happy to send resources your way! A great place to start would be with Dr Esther Choo as well as Dr Diane Birnbaumer, who have both written extensively on this subject.

 

[gamerEMdoc]

You don’t know anything about the diversity of the providers that make up my sloe committee or each individuals values. Nor about the committees in over 200 residencies. Im not going to continue this conversation with you, because you seem to be insinuating in a way that the evaluation process is wraught with racism and sexism, and as someone who takes this very very seriously in how this affects the careers of students, I am legitimately insulted by this insinuation.

I have volunteered countless hours of my time posting here at SDN to try to advise students that cant find good career advice elsewhere. I don’t know the race or the sex of most of the people I talk to and I dont care. I spend this time because I legitimately care about medical student education. The race or sex or orientation of a student is literally the last thing I would think about when grading a student. I jusy dont care, I just want to train great EM docs.

This is the last thing Im going to say on this matter. Id ask you to do the same and contact me directly by PM if you’d like to discuss this further. This is a thread for students to try to get application advice, not a thread for you to insult the ethics of PDs/APDs and the application process.

 

[borderlineinCle]

You don’t know anything about the diversity of the providers that make up my sloe committee or each individuals values. Nor about the committees in over 200 residencies. Im not going to continue this conversation with you, because you seem to be insinuating in a way that the evaluation process is wraught with racism and sexism, and as someone who takes this very very seriously in how this affects the careers of students, I am legitimately insulted by this insinuation.

I have volunteered countless hours of my time posting here at SDN to try to advise students that cant find good career advice elsewhere. I don’t know the race or the sex of most of the people I talk to and I dont care. I spend this time because I legitimately care about medical student education. The race or sex or orientation of a student is literally the last thing I would think about when grading a student. I jusy dont care, I just want to train great EM docs.

This is the last thing Im going to say on this matter. Id ask you to do the same and contact me directly by PM if you’d like to discuss this further. This is a thread for students to try to get application advice, not a thread for you to insult the ethics of PDs/APDs and the application process.

We all appreciate you greatly, gamerEMdoc!


Sent from my iPhone using Tapatalk

 

[gamerEMdoc]

I’m a bit concerned though because I applied to over 100 programs from anxiety despite having a fairly good application in regards to my home programs sloe and my board scores but I don’t know what my away sloe is, only that I received good feedback from the clerkship director, so do you think I got blindsided because I haven’t received any interviews yet?

It’s way way way too early to get concerned. Like... at all. ERAS opened less than a week ago. You may not get any interviews until mid-October, or at least only a few up until then. I know its anxiety provoking, because some programs use more discretion than others (which takes time) to decide who to invite, but you have to trust me that this is completely normal. I get tons of PMs yearly of students freaking out by the end of September with only a few interviews, and then by mid-Nov they always seem to have enough. Interviews will come slowly, but they will come.

If you have only a few interviews by Nov 1st, that’s when I’d start to get concerned. But we are a LOOOOONG way from Nov 1st.

 

[southerndoc]

It’s way way way too early to get concerned. Like... at all. ERAS opened less than a week ago. You may not get any interviews until mid-October, or at least only a few up until then. I know its anxiety provoking, because some programs use more discretion than others (which takes time) to decide who to invite, but you have to trust me that this is completely normal. I get tons of PMs yearly of students freaking out by the end of September with only a few interviews, and then by mid-Nov they always seem to have enough. Interviews will come slowly, but they will come.

If you have only a few interviews by Nov 1st, that’s when I’d start to get concerned. But we are a LOOOOONG way from Nov 1st.

Some programs haven't even started reviewing apps yet.

Ahh, 'tis the season...

 

[gamerEMdoc]

Some programs haven't even started reviewing apps yet.

Ahh, 'tis the season...

Which reminds me, I knew I had something to do this weekend...

 

[FoolishConsistency]

Hi EM Doc.

It's so nice of you to give such great insider advice to 4th years. I am sorry to take the attention away from the ongoing match topic for just a moment.

I'm an intern who matched into my 1st choice neurosurg program. Since starting, I have been miserable. This is very unexpected. At first, I thought it was just fatigue. But it's not. It's so much more. I could go on, but let me get to my question.

I love my hospital ED, all the docs, and all the residents. I recently completed an ED rotation and expressed my enjoyment to the PD. We talked further and he let me know how much the residents and staff enjoyed working with me. He told me if I had a change of heart, I should talk to him. He said the program would love to have me. We had this conversation on two occasions. The program has one currently unfilled position but it is a PGY-3. Does that matter?

If I talk to my PD and can get him on board, is there any way to move over without going back through the match?

 

[Mat the coolcat]

I assume its for several reasons, though this is only my own hypothesis. First, EM is much more progressive about candidate and student evaluation than the other specialties of medicine. EM is still the only one that uses a Standardized LOR (the SLOE), and has so for over a decade. No other specialty, that I know of does this. EM was the first to adopt the SVI as well. So to an extent, EM as a specialty and the folks at CORD are always trying to improve the process. I’m not sure other specialties are nearly as progressive on this front.

I fully agree with you. Ortho has actually started to do the SLOE too.

 

[gamerEMdoc]

I fully agree with you. Ortho has actually started to do the SLOE too.

I had no idea Ortho was using SLOEs. Very interesting.

 

[gamerEMdoc]

Hi EM Doc.

It's so nice of you to give such great insider advice to 4th years. I am sorry to take the attention away from the ongoing match topic for just a moment.

I'm an intern who matched into my 1st choice neurosurg program. Since starting, I have been miserable. This is very unexpected. At first, I thought it was just fatigue. But it's not. It's so much more. I could go on, but let me get to my question.

I love my hospital ED, all the docs, and all the residents. I recently completed an ED rotation and expressed my enjoyment to the PD. We talked further and he let me know how much the residents and staff enjoyed working with me. He told me if I had a change of heart, I should talk to him. He said the program would love to have me. We had this conversation on two occasions. The program has one currently unfilled position but it is a PGY-3. Does that matter?

If I talk to my PD and can get him on board, is there any way to move over without going back through the match?

Id talk to the EM PD but many times, they’d probably want you to enter into the match. But maybe not. You can transfer a resident from one program to another without the match process and you may get a few months of credit. But this will all be at the discretion of the EM PD. If they were already full (and didnt have an opening) and you wanted to transfer in outside the match, they would apply to the acgme for a temporary increase in residents to take you on.

Your neurosurgery program director should support you, most PDs will when they realize a resident is very unhappy in their field. In the end, it doesnt matter if they do or dont support you. You arent required to complete a residency when you match somewhere, the contracts are strictly year to year. You have no obligation to keep going after a year any more than the program has the obligation to keep you in the program if they think you arent cutting it.

 

[borderlineinCle]

I've heard some programs are sending invites early to AOA people because it tells how they did in school, especially because the deans letter hasnt been uploaded. Does that mean I'm in trouble if I'm lower third in class ranking? My SLOES were good from what I was told.

Dunno— my school doesn’t have AOA, gotten a few invites, too. This cycle is strange


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[gamerEMdoc]

I'm here in sunny SD. Hope to meet some of the SDN folks at the residency fair today if anyone is going.

 

[Apollyon]

I'm here in sunny SD. Hope to meet some of the SDN folks at the residency fair today if anyone is going.

I'm here, but I don't need to go to the fair. We're going to Morton's tonight.

 

[LChristmas]

Is there a feature within ERAS that notifies programs when an addition (SLOE, Step 2, etc) is made to an application, or should we send an email to the program coordinator?

 

[gamerEMdoc]

Is there a feature within ERAS that notifies programs when an addition (SLOE, Step 2, etc) is made to an application, or should we send an email to the program coordinator?

I dont think there is anything that notifies programs.