EM PD - Ask Me Anything

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I don't even have one rotation set up. I've sent out lots of apps within a few days of them opening. and today I found out my level 2 PE is cancelled, probably going to have to reschedule for around november. this cycle blows.

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this is happening tomorrow. "EMRA Hangout about COVID's impact on ER clerkships"
 
I've wondered that. I've seen students that do like 7 EM rotations and I've always thought that was super wasteful. Ive wondered how doing more than 2 will be viewed this year. It all depends on how rotations open up. If the virus dies down by June for instance and all rotations are widely open, I doubt anyone will care that someone went on 3 rotations. However, if everyone is only getting 1-2 SLOEs because rotations are very hard to obtain, and someone has 4, I'd imagine that will be viewed as selfish.

There's just so much we aren't going to know until this is over unfortunately.
 
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Hi @gamerEMdoc -

Thank you for taking the time to answer so many questions. I've gotten a lot of good advice from this thread from watching from afar; and I've mostly tried to take these pandemic changes as they come. But, I'm pretty worried about this one. Because of closures, my Level 2 PE has been pushed back to December, with scores anticipated in February. I've heard it said before that programs can't rank you without proof of passing each part of your boards; and I'm wondering if this is true?

Thanks so much for the info
 
Hi @gamerEMdoc -

Thank you for taking the time to answer so many questions. I've gotten a lot of good advice from this thread from watching from afar; and I've mostly tried to take these pandemic changes as they come. But, I'm pretty worried about this one. Because of closures, my Level 2 PE has been pushed back to December, with scores anticipated in February. I've heard it said before that programs can't rank you without proof of passing each part of your boards; and I'm wondering if this is true?

Thanks so much for the info

No they can rank you, though some may choose not to. But that is in a regular year. This is not a regular year we are living in. I think there will be plenty of justification for not having the PE exam done on-time this year. Honestly, I wish USMLE would just waive the whole PE exam requirement for a year with all this chaos.
 
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Thanks for the insight. I suppose we will all just have to see what happens. I can't imagine this isn't going to be a widespread concern with two months of testing center closures and no availability to reschedule through the end of 2020 as of this afternoon. Stay safe!
 
Things didn't work out this year. Advisers say my SLOEs were middle 1/3 x3. What killed me were low board scores and comlex PE fail.

I managed to SOAP into a TY. I guess my question would be, "Is a solid TY + ED elective & SLOE + PD letter of rec enough to make up for the red flags that led to me not matching in the first place? Is FM -> EM fellowship an even remotely viable option? Or is the dream dead?"
 
PE failures and board failures are often times very difficult to overcome. If you have excellent SLOEs, people will take the chance, but average or worse SLOEs and a PE or board failure, and its a huge uphill battle. SLOEs can be changed, but board failures can't, on reapplication. So it does make it even harder the second time around. The thing that could save someone is if their TY was at a place with an EM residency and they could witness how you are clinically to know if the PE failure was a fluke or not. Otherwise, I'd say the odds are stacked against you. Maybe not impossible, but its a big longshot, and one I'd certainly plan to have a dually applied to backup this year.

Re: FM --> EM fellowship, its a viable option in terms of getting more experience to eventually work in an ED. Will you be as marketable as an ABEM certified ED doc? No. Will you be able to teach EM residents? No. But will it lead to more training before taking a rural EM job at an understaffed ED (as opposed to just working there straight out of FM residency)? Absolutely.
 
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So I have listened to a lot of little webinars about all this junk. It seems like the general consensus is as follows. These are all discussions between PD's and are all general recommendations but who knows if all the programs will follow suit, but I feel like they have no choice but to adhere.

- EM Programs are willing to take narrative LOR or SLOE's from non-residency programs
- 1 SLOE is plenty this year, 1 SLOE + 1 Narrative Letter = a complete application
- more than 2 SLOE's is a gigantic red flag, you will be seen as selfish
- be creative on how you can get LOR
- if it's a narrative LOR, let the letter show to your characteristics as a student on how you fit well in ER
- the timeline for everything will be pushed back, PD's will be accepting later applications
- letters from later rotations will still be valuable (Oct, November)
- seems like July/August rotations are more unlikely to happen than Sept/Oct rotations so apply for more later rotations
- everything is going through the same thing so sit tight
- be ready to be adaptable since that's what EM is all about
 
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Hey, sorry if this has been asked before but I’m a current fm pgy2 in nyc and am planning on pursuing a second residency in em. How feasible is this and do you have any advice?
 
Hey, sorry if this has been asked before but I’m a current fm pgy2 in nyc and am planning on pursuing a second residency in em. How feasible is this and do you have any advice?

The tough thing is you won't get sloes, they don't really apply to someone who has already completed a residency. On the other hand, you have several things going for you. One is a proven track record. If you have done well in your residency, not created any trouble, etc and you have good LORs coming from your program, you are essentially a known safe quantity for a PD. Second, someone coming off 3 years of say a IM residency arrives with a wealth of knowledge and training, as long as they recognize their deficiencies and remain humble in starting over (in EM we don't think about cases the same way, we consider worst case scenarios rather than most likely dx; lack of peds/trauma, etc). The other thing going for you is strictly the stress of applying. You will already have completed your backup. You don't "need" EM, persuing it would only be because you truly want to do the specialty which will speak to your level of dedication when you apply. If it doesn't work out, you can begin your career in your initial field.

Expect to be asked about what you perceive to be the downside from a programs perspective when training someone already trained in another field and have a good answer for it. Touch on things like having to retrain your thought process to a "worst first" way of thinking, having to not get ahead of yourself and realize you still have a lot to learn, etc.
 
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I had a quick question regarding sub-I etiquette. My school has cancelled all clinical medical student activities until the end of June. For a number of 3rd year students in my program this means that they are having their remaining clerkships cancelled. As a result of this, clerkships are being moved and rescheduled to the late summer/early fall. For many of us this means that we’ll be doing our home EM sub-I prior to completing all of the usual pre-req clerkships. In this situation, do you think it would be appropriate to explain to our EM evaluators that we have not yet taken certain clerkships (IM, neurology, etc) so that this is taken into account for when a SLOE is written, or do you think that this would be viewed unfavorably? I don’t want to come off as asking for favors or making excuses, but also am a little bit worried that I’ll be doing a sub-I (and possibly getting my only SLOE) prior to having completed an internal medicine rotation. Similarly, I understand that SLOEs are meant to rank students against each other, but given that some of us will have substantially differing levels of clinical experience based on how many clerkships we got through before COVID hit, do you think it would be appropriate to ask SLOE writers to provide an explanation for potential areas of weakness (I.e. doing a poor neuro workup in the context of having not yet completed a neurology clerkship), or does this defeat the purpose of using a SLOE to compare students against each other?
 
For many of us this means that we’ll be doing our home EM sub-I prior to completing all of the usual pre-req clerkships. In this situation, do you think it would be appropriate to explain to our EM evaluators that we have not yet taken certain clerkships (IM, neurology, etc) so that this is taken into account for when a SLOE is written, or do you think that this would be viewed unfavorably? I don’t want to come off as asking for favors or making excuses, but also am a little bit worried that I’ll be doing a sub-I (and possibly getting my only SLOE) prior to having completed an internal medicine rotation.

People have all kinds of different experiences before doing their EM sub-I's. Some have done prior EM rotations, some haven't. Some have had great 3rd year experiences, some haven't. Obviously this year, every student will have missed some rotations, just which rotations will be varied. So I think everyone will be at the same disadvantage, and no one is going to ask each individual student which rotations they missed in order to gauge how they should be ranked.

Similarly, I understand that SLOEs are meant to rank students against each other, but given that some of us will have substantially differing levels of clinical experience based on how many clerkships we got through before COVID hit, do you think it would be appropriate to ask SLOE writers to provide an explanation for potential areas of weakness (I.e. doing a poor neuro workup in the context of having not yet completed a neurology clerkship), or does this defeat the purpose of using a SLOE to compare students against each other?

How will people have "substantially differing levels of experience"? Everyone will have missed time. Neurology isn't even a required 3rd year rotation at some schools. Everyone comes into their EM sub-I's with a different background of clinical experience. That's just the reality, this year is no different. Honestly, I still think its a pretty even playing field. I wouldn't try to make excuses. If you feel weak in something, you should probably use some of the 3 months off to work on your knowledge base of that field rather than show up and make an excuse. Neuro is only like 80 pages in Tintinallis, you could learn a ton about neuro before your rotation if you wanted without going on a neuro rotation. So whether you think the excuse is a valid one or not, it will still be perceived as an excuse by the program. Just do your best, identify your weaknesses ahead of time and address them now while you have the free time, and it will all work out.
 
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Got it! Thanks for the advice! I definitely dont want to come off as making excuses and there is definitely plenty of time to study at this point. I'll plan to pick up a copy of Tintinallis and start reading!
 
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Got it! Thanks for the advice! I definitely dont want to come off as making excuses and there is definitely plenty of time to study at this point. I'll plan to pick up a copy of Tintinallis and start reading!

2nd best avatar on this forum.
 
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I have heard nothing from any of my VSAS applications but I just have to remember to be patient. So far, I have one EM rotation at hospital w/o a residency in June but nothing else after that. I really hope that I don't have to reapply to all the VSAS programs I applied to for July/August/September to see if I can get a Sept/Oct/Nov spot. All while trying (not succeeding) to study for step2.
 
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I have heard nothing from any of my VSAS applications but I just have to remember to be patient. So far, I have one EM rotation at hospital w/o a residency in June but nothing else after that. I really hope that I don't have to reapply to all the VSAS programs I applied to for July/August/September to see if I can get a Sept/Oct/Nov spot. All while trying (not succeeding) to study for step2.

I don't think that's an uncommon experience right now, but IDK, I cant speak for what every program is doing.
 
I don't think that's an uncommon experience right now, but IDK, I cant speak for what every program is doing.

I figure that most of these places have bigger things to worry about so i'm not trying to be bothersome, and only focus on the things I can control
 
I don't think that's an uncommon experience right now, but IDK, I cant speak for what every program is doing.

I just got one vsas app recently but tbd whether it gets cancelled or not! Every other place i've reached out to is saying they are not really doing anything yet so who really knows
 
My general understanding at this point is that there are currently conversations going on at a national level between stakeholders (med school deans, NBME, AAMC, LCME, residency program directors, etc.) to make some overarching decisions for this upcoming application cycle (we were told that a national coalition had been formed between these groups for this very purpose). Per my school admin NOTHING has been decided yet, but they are certainly floating multiple ideas and trying to weigh what will be in everyone’s best interests (delaying ERAS, relaxing graduation requirements, encouraging more remote residency interviews this year, etc.) in order to provide some national guidelines for everyone. I think that program directors are aware that these conversations are ongoing and likely are waiting on some final decisions to be made prior to processing applications and extending away rotation offers.
 
I've gotten one rotation approved outside of VSAS. Whether or not I will end up doing the rotation in July is of course subject to change depending on how the pandemic shakes out.

@gamerEMdoc , on an unrelated note I wanted to ask you if you think attending this kind of webinar has any utility for EM bound students: Welcome! You are invited to join a webinar: PCSS Waiver Eligibility Training for Osteopathic Medical Students. After registering, you will receive a confirmation email about joining the webinar.

I thought I had read somewhere about restrictions on residents prescribing Subutex, but I cannot remember when or where I heard/read that lol. Thoughts?
 
just got an email saying all VSAS apps are suspended for 2weeks till April 29th.
 
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I've gotten one rotation approved outside of VSAS. Whether or not I will end up doing the rotation in July is of course subject to change depending on how the pandemic shakes out.

@gamerEMdoc , on an unrelated note I wanted to ask you if you think attending this kind of webinar has any utility for EM bound students: Welcome! You are invited to join a webinar: PCSS Waiver Eligibility Training for Osteopathic Medical Students. After registering, you will receive a confirmation email about joining the webinar.

I thought I had read somewhere about restrictions on residents prescribing Subutex, but I cannot remember when or where I heard/read that lol. Thoughts?

Doubt that would be worth your time.
 
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@gamerEMdoc I must call upon your expertise once again. I've SOAPEd into surgical prelim year. I had some pretty late SLOEs and my first SLOE was perhaps poor because it was my first time in the ER ever, the other 2 came in end of October, but I am very very confident that 2 of them are either top 10 or 1/3. My app is very good overall with good scores and no red flags. I will be applying EM and Anasthesia and have an anesthesiology rotation scheduled during the first 2 months of my intern yar.

My questions is this. : My program does not have a home EM program (although various residents from different EM programs rotate through there) and I am unable to do outside rotation due to COVID. Which option will benefit me the most in your opinion.

1. Schedule an early EM rotation anyways during months of July or August followed by gas rotation. Try to get a sloe or individual LOR... from some one in the ED. And re-apply using that and my other 2 sloes from previous season. Downsides: I'll spend first 2 months away from my PD and am worried that I will not get much face time and that may negatively impact the letter from PD.

2. Normally go about my prelim year, get plenty of face time during first 2 months with all residents attendings and get a good LOR from my PD. Schedule EM in the winter months so I have more time to interview.

Essentially, I could have just asked this in one sentence... What's better for a re-applicant with already good SLOEs from previous season: A strong letter from the PD or a LOR and/or SLOE from a program without a residency that does not write sloes?
 
hey @gamerEMdoc

what happens if you took a prelim spot in the soap but then are offered a categorical spot before you start from another program.

Can the prelim program "release" you or is this a match violation?

Are you even allowed to talk to the other program, or is this a violation?
 
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@gamerEMdoc I must call upon your expertise once again. I've SOAPEd into surgical prelim year. I had some pretty late SLOEs and my first SLOE was perhaps poor because it was my first time in the ER ever, the other 2 came in end of October, but I am very very confident that 2 of them are either top 10 or 1/3. My app is very good overall with good scores and no red flags. I will be applying EM and Anasthesia and have an anesthesiology rotation scheduled during the first 2 months of my intern yar.

My questions is this. : My program does not have a home EM program (although various residents from different EM programs rotate through there) and I am unable to do outside rotation due to COVID. Which option will benefit me the most in your opinion.

1. Schedule an early EM rotation anyways during months of July or August followed by gas rotation. Try to get a sloe or individual LOR... from some one in the ED. And re-apply using that and my other 2 sloes from previous season. Downsides: I'll spend first 2 months away from my PD and am worried that I will not get much face time and that may negatively impact the letter from PD.

2. Normally go about my prelim year, get plenty of face time during first 2 months with all residents attendings and get a good LOR from my PD. Schedule EM in the winter months so I have more time to interview.

Essentially, I could have just asked this in one sentence... What's better for a re-applicant with already good SLOEs from previous season: A strong letter from the PD or a LOR and/or SLOE from a program without a residency that does not write sloes?

Normally I’d say the EM rotation, but if you are certain that your last 2 sloes were good, and the programs that wrote them will re-upload them, then you have your two sloes that you need already. The GAS rotation will be needed for your backup. And a good PD letter in this case probably is more important for rounding out your application. If you didn’t have those 2 SLOEs, I would have said getting an EM LOR would have taken priority.
 
hey @gamerEMdoc

what happens if you took a prelim spot in the soap but then are offered a categorical spot before you start from another program.

Can the prelim program "release" you or is this a match violation?

Are you even allowed to talk to the other program, or is this a violation?

My understanding is that its a match violation. When you enter the match, you do so under good faith that you are going to complete 1 year of training at that institution without leaving. Now, the program could be willing to release you, prelim programs very well may be willing to. But I would get their permission before talking to other programs, not after.
 
If anyone knows anybody that would be interested, we likely will have a PGY2 spot opening for July. We’ll be trying to get it posted on CORD and SAEMs vacancy sites. We aren’t under any pressure to fill the spot, we’ll be fine with being a resident down, but we’d like to fill it if we can. Ideally it would be filled by an EM resident with 1 year of experience already, but I think that’s just about impossible to have happen since most people who are pgy1s are just likely to finish out their program rather than move. But if anyone knows a PGY1 looking for a change of location/scenary, I’d appreciate it if you could spread the word to them. If anyone has questions, feel free to contact me.
 
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Hi @gamerEMdoc ,

I am an MS2 interested in going into EM. My step 1 before 3rd year has been cancelled, and it is looking like I will have to wait until after clerkship to take it. Any idea on how programs/VSAS will now give out aways for those without step 1 scores? I hear it is usually quite arbitrary, but was wondering what additional impact this may have.

Thank you for all the time you put into this, much appreciated!!
 
I'm confused, you have to wait until the end of 3rd year to take it? Why so late? I get that its cancelled now, but it can't be taken in like 6 months? I think not having a step 1 may hurt you in securing rotations. The only way it wouldn't would be if every student couldn't take the exam. If USMLE was suspended for like a year or something. At that point, if no one has a step 1, then programs aren't going to have a step 1 on anyone so they won't use it for selecting apps for rotation. If everyone else has a step 1 score, and you don't, you potentially are going to limit the places that are willing to let you rotate.
 
I'm confused, you have to wait until the end of 3rd year to take it? Why so late? I get that its cancelled now, but it can't be taken in like 6 months? I think not having a step 1 may hurt you in securing rotations. The only way it wouldn't would be if every student couldn't take the exam. If USMLE was suspended for like a year or something. At that point, if no one has a step 1, then programs aren't going to have a step 1 on anyone so they won't use it for selecting apps for rotation. If everyone else has a step 1 score, and you don't, you potentially are going to limit the places that are willing to let you rotate.

They have cancelled about half of all med students scheduled to take Step 1/Level 1 this summer and right now the earliest available dates to reschedule are August and September so many schools are planning to delay the requirement to complete Step 1/Level 1 until the end of third year due to the massive back log of examinees. I know there is also an increased push amongst students and deans for immediate P/F implementation for Step 1 because of these cancellations, do you think that is a legitimate possibility?
 
They have cancelled about half of all med students scheduled to take Step 1/Level 1 this summer and right now the earliest available dates to reschedule are August and September so many schools are planning to delay the requirement to complete Step 1/Level 1 until the end of third year due to the massive back log of examinees. I know there is also an increased push amongst students and deans for immediate P/F implementation for Step 1 because of these cancellations, do you think that is a legitimate possibility?

Possibility? Sure. Likelihood? Who knows. I get there will be a backlog and dates for Aug/Sept will be hard to come by, but why wouldn't it be done by March when apps for EM are looked at? That was my issue. I realize there will be a delay, but not having a score back a year from now seems like a big delay.
 
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What does pass/fail have to do with delaying/cancelling the exam? People will have to take the exam regardless.

That is my question yet a large group of students, most of them being people who got cancelled today, are now pushing for this since they are looking at the possibility of taking Step 1 during third year and don't think it's fair that they likely won't have a school-free dedicated while others will. I get why they would feel that way but I don't agree with it and don't think it's the answer. I also don't see how it's logistically possible in such a short timeframe but I just know students and some deans are starting to push for it.
 
Possibility? Sure. Likelihood? Who knows. I get there will be a backlog and dates for Aug/Sept will be hard to come by, but why wouldn't it be done by March when apps for EM are looked at? That was my issue. I realize there will be a delay, but not having a score back a year from now seems like a big delay.

According to some students who have a Prometric attached to their school, thousands of students have already been backlogged and they are cancelling thousands more exams throughout May and June and most people I know are not getting dates until August or September at the earliest. I would think most people would be able to have a score in by March but I know some schools also aren't being the most flexible about giving students time to study for and take Step 1 during third year.
 
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Yeah I'm assuming the P/F thing is just going to be solely about not having dedicated time off to study and having to take it during rotations. But in that case, everyone will be on the same page, so scores should be down accordingly across the board. I don't see scoring the exam this year as a problem since it will affect everyone who takes it, other than it increases student anxiety. Which I guess why it's going P/F in the first place. So I wouldn't have any issue with it going P/F now if they are planning on doing it anyway here shortly. But if it doesn't go P/F and it is still scored, I don't see it being a big problem.
 
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According to some students who have a Prometric attached to their school, thousands of students have already been backlogged and they are cancelling thousands more exams throughout May and June and most people I know are not getting dates until August or September at the earliest. I would think most people would be able to have a score in by March but I know some schools also aren't being the most flexible about giving students time to study for and take Step 1 during third year.

They shouldn't be giving them more time off. Students will have had months of significantly reduced time thanks to COVID. I can't see schools giving another free month to study. Study hard now, then just do practice questions throughout the year. Is it ideal? No. But longitudinal learning, as opposed to cramming a month before, is probably better for success anyway. Use any free time to your advantage.
 
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They shouldn't be giving them more time off. Students will have had months of significantly reduced time thanks to COVID. I can't see schools giving another free month to study. Study hard now, then just do practice questions throughout the year. Is it ideal? No. But longitudinal learning, as opposed to cramming a month before, is probably better for success anyway. Use any free time to your advantage.

Ok it seems that taking it during 3rd year will be my only choice then. Half of students will be taking it after the current dedicated, before starting 3rd year rotations. The other half of us will have to take it during 3rd year rotations. I know some schools take step 1 after 3rd year, but taking it during 3rd year seems to be the lesser option as it will come at the expense of my potential in not only the step 1 exam, but my ability to focus on 3rd year material (much of which do not overlap with eachother). I certainly do not think students taking it during 3rd year (I will have 1 day off during the week/end to take the exam) will be at an equal advantage as those who where able to focus on step 1 and 3rd year rotations separately. Could the potential disparity in scores for those taking the exam during rotations vs those who were able to take it when ready now be something that is considered?
 
I doubt anyone will consider it, just because there is no way of knowing when a student actually took it. Anyone who does poorly can just use the excuse of having to take it 3rd year, even if they didn't. And to be honest, at least with EM, boards just don't matter THAT much unless you are really gunning for a competitive program. So I doubt it will be that much of an issue.
 
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If anyone knows anybody that would be interested, we likely will have a PGY2 spot opening for July. We’ll be trying to get it posted on CORD and SAEMs vacancy sites. We aren’t under any pressure to fill the spot, we’ll be fine with being a resident down, but we’d like to fill it if we can. Ideally it would be filled by an EM resident with 1 year of experience already, but I think that’s just about impossible to have happen since most people who are pgy1s are just likely to finish out their program rather than move. But if anyone knows a PGY1 looking for a change of location/scenary, I’d appreciate it if you could spread the word to them. If anyone has questions, feel free to contact me.

Wanted to quickly follow up on this -- have you already received plenty of messages on this, or filled the spot? Otherwise, I have someone from my school who applied EM, did not match and is doing IM currently as a PGY1 in Pennsylvania who I would send your way unless it is already filled!

Thanks
 
He’s looking for a current EM PGY-1. A lateral move like this is almost certainly for someone looking for a change of scenery or for geography/location purposes.

Oh gotcha, I see I read it too quickly the first time around!
 
Wanted to quickly follow up on this -- have you already received plenty of messages on this, or filled the spot? Otherwise, I have someone from my school who applied EM, did not match and is doing IM currently as a PGY1 in Pennsylvania who I would send your way unless it is already filled!

Thanks

We had over 60 apps. If all works out, I believe we have it filled with our best case scenario possible. I couldnt be happier with how it all turned out. Crossing my fingers there are no hiccups administratively on the end of the releasing program.
 
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We had over 60 apps. If all works out, I believe we have it filled with our best case scenario possible. I couldnt be happier with how it all turned out. Crossing my fingers there are no hiccups administratively on the end of the releasing program.

60+? Wow. What are the reasons why people would want to leave their EM residency?
 
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in a normal application year, where does a step2 score rank when it comes to interviews?

do you think it will carry more weight or less weight this year, if you were to guess
 
Based on PD survey data, both sets of boards rank of mediocre importance. EM rotations at the program you are trying to match at, SLOEs, EM grades, interpersonal skills, and the interview are all much more important.

The only way I see boards carrying any more weight would be if EM rotations were cancelled and there were no SLOEs.
 
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In light of recent AAMC guidelines for Zoom interviews, any suggestions for interview questions applicants can ask PDs that will give them a better sense of a program's culture? It's obviously early, but I am starting a list I can just add to as I go
 
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In light of recent AAMC guidelines for Zoom interviews, any suggestions for interview questions applicants can ask PDs that will give them a better sense of a program's culture? It's obviously early, but I am starting a list I can just add to as I go

idk, this scares me for next year. Our culture, comraderie, and resident happiness is partially what sells our program. Its going to be MUCH harder to recruit anyone who didn't rotate. And from a student perspective, Id imagine many students will prefer to match at places they did rotate at bc all the rest would be a complete unknown.
 
idk, this scares me for next year. Our culture, comraderie, and resident happiness is partially what sells our program. Its going to be MUCH harder to recruit anyone who didn't rotate. And from a student perspective, Id imagine many students will prefer to match at places they did rotate at bc all the rest would be a complete unknown.
 
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