EM PD - Ask Me Anything

[gamerEMdoc]

Thank you both for your insight. It appreciate your perspectives. I definitely won't be putting all my eggs in one basket, considering the 20/2047 chance... I guess a follow up question is do you have any suggestions for a similar specialization, that would be more attainable?

I've only been exposed to EM, and I think I'm most attracted to it because of the schedule variability, and being able to see a wide range of cases.

IM to critical care fellowship
FP then work in an urgent care or a rural ED that hires FP docs

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[AlgernonMed]

Thanks again for all of your help! I was curious about away rotations and relative regional bias. As a student in the south, if I were to do an away at a location in, let's say, Pennsylvania (WellSpan York or Geisinger for instance), how much does that typically open the door to other programs in the area (like St Luke's or Conemaugh)? I have read and heard that if you want to break into a region that an away is essentially required. What's your perspective on this? Does it make a big difference on your end reviewing applications? Thanks again!


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[gamerEMdoc]

I think many programs are more familiar with the programs around them, and certainly a SLOE from a program in a similar region certainly helps make it look like you are interested in that area of the country when it comes time for interviews.

 

[huskerwolverine88]

Thanks for your time. I'm a second year medical student in Ireland and I was wondering if you're an IMG interested in doing EM in the states is there anything else you can do to make yourself competitive as compared to your American peers? Thanks so much!

 

[GandalfTheWhite]

Is what we do after match important at all (in terms of classes or EC)?
I can take off 2-3 months so I basically want to travel, but my deans are recommending 'taking advantage of the last few months of medschool to take classes I wont experience in my specialty'. Personally, traveling to tokyo and hong kong seems a better way to spend my time than shadowing in surgery or just seeing patients in clinic/wards. Atleast thats how I am thinking of it.

 

[doggydog]

Is what we do after match important at all (in terms of classes or EC)?
I can take off 2-3 months so I basically want to travel, but my deans are recommending 'taking advantage of the last few months of medschool to take classes I wont experience in my specialty'. Personally, traveling to tokyo and hong kong seems a better way to spend my time than shadowing in surgery or just seeing patients in clinic/wards. Atleast thats how I am thinking of it.

lol, tell your deans to leave you alone.

 

[Doctor_Strange]

How do you think you'll be incorporating the new video interview into your rank list this year?

What is your take on the current system of a July/August/September bottleneck for SLOEs? If you had the freedom to redesign the system, how would you go about it?

I ask the latter questions because as a middle-of-the-road DO applicant I'm feeling the frustrating insecurity of unfilled potential-SLOE rotation slots in the summer because of the backup of everyone applying to eleventybagillion July/August aways, so all my VSAS apps just look like they are eternally "pending host institution review". Its disheartening, because it feels like I'm precluded from pursuing EM before I even have the chance to show I can perform on an audition. Do you think the current setup in EM is a bottleneck by design? Or am I missing the point of it altogether? Is there a better way for the system to function?

As an incoming OMS-I, has it been your experience that your school does not provide enough resources or guidance in how to get such rotations, or is it something more? As in, other than not being able to get a home EM rotation, are there other disadvantages or obstacles DO students who want to pursue EM should expect to face other than what has already been discussed on this thread (i.e. lack of EM advisors, research opportunities)?

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[gamerEMdoc]

Is what we do after match important at all (in terms of classes or EC)?

Nope. Use this time to schedule the rotations you want to do, have interest in, would find fun, etc. Relax. Last few months of medical school are the best. No pressure, grades don't matter.

 

[gamerEMdoc]

As in, other than not being able to get a home EM rotation, are there other disadvantages or obstacles DO students who want to pursue EM face should expect to face other than what has already been discussed on this thread (i.e. lack of EM advisors, research opportunities

I think you nailed some of them. I think the main obstacles are:
- No home EM site
- Terrible advisor access for EM and a litany of bad advice re: EM application
- Shrinking number of AOA programs in the AOA match
- Difficulty securing away ACGME rotations in VSAS
- Potential for "DO bias" at some bigger academic programs
- The uncertainty of whether to take 1 or 2 sets of boards

I think that's mostly the hurdles I've perceived in talking to students and residents, but in the end I'm not a DO, so maybe others can weigh in if there are other hurdles they encountered.

 

[gamerEMdoc]

I'm a second year medical student in Ireland and I was wondering if you're an IMG interested in doing EM in the states is there anything else you can do to make yourself competitive as compared to your American peers?

The match rate in EM for IMGs is low. Very very low. And those that do match are usually US citizen IMGs that went to an international med school. Many didn't match initially and matched their second time through. As for non-US IMGs, its nearly impossible unfortunately.

 

[EMimg20]

The match rate in EM for IMGs is low. Very very low. And those that do match are usually US citizen IMGs that went to an international med school. Many didn't match initially and matched their second time through. As for non-US IMGs, its nearly impossible unfortunately.

All true.

As an IMG (US citizen) it was crazy hard. What I would do if I were you is look at every EM programs website and see which ones have students from IMG programs.

Send them an email directly, or send the Program coordinator (not program director) asking if you can be connected with them.

Focus on doing as many of your clinical hours in the US as you can.

Being an IMG is about risk - they (residency) don't know your school, and they don't know if your training prepares you for functioning as an intern in the US. The intern year in the US is vastly different to the U.K./Australia in terms of responsibility and expectations.

You have to go above and beyond, at your own expense to show that you are capable of operating in a US emergency room. I had 4 SLOE, 3 from EDs with associated residencies. Join SAEM, EMRA/ACEP, and AAEM and take advantage of every opportunity.

The extra hope for non citizens is to also find places that will sponsor your visa.

 

[gamerEMdoc]

See attached PDF from CORD re: advice for applying to EM. Nice summary of advice re: the whole process.

 

[Avalanche19]

@gamerEMdoc ERAS opened today for us. By my count there are 24 AOA programs and 160 ACGME programs listed. Is it a safe assumption to make that the all of the programs listed under ACGME programs will be exclusively in the ACGME match and (with few exceptions) all 3 year programs?

 

[gamerEMdoc]

@gamerEMdoc ERAS opened today for us. By my count there are 24 AOA programs and 160 ACGME programs listed. Is it a safe assumption to make that the all of the programs listed under ACGME programs will be exclusively in the ACGME match and (with few exceptions) all 3 year programs?

There will probably be some overlap. Programs that stayed four years can match in either match and could show up on both lists. Otherwise, if they are only on the ACGME list, then they are exclusively ACGME.

 

[Lexdiamondz]

Pardon if this has been asked before, but is it likely that an applicant with an otherwise okay application (decent board scores, clerkship grades, LORs) can be ranked to match with only one SLOE? I know several of my underclassmen applying VSAS right now with only their home rotation secured, and many are concerned about not being able to secure interviews with just one SLOE. Thanks!

 

[viper89]

There will probably be some overlap. Programs that stayed four years can match in either match and could show up on both lists. Otherwise, if they are only on the ACGME list, then they are exclusively ACGME.

I noticed that there are some AOA programs and programs with initial ACGME accreditation that are not listed at all on ERAS right now. Do you know why that is? Are they holding out to see which match they may participate in?

 

[gutonc]

I noticed that there are some AOA programs and programs with initial ACGME accreditation that are not listed at all on ERAS right now. Do you know why that is? Are they holding out to see which match they may participate in?

More than likely. Or they just haven't registered yet. Don't sweat it.

 

[gamerEMdoc]

More than likely. Or they just haven't registered yet. Don't sweat it.

I'm not even sure if ours is open for ACGME yet. I don't think it is.

 

[GandalfTheWhite]

What stuff should I buy or have during the SubI/Clerkship to have on me/on my person or white coat?

So far:
Stethoscope
EM apps Palm EM, PressorDex, MDCalc
Penlight
Trauma Shears
A handbook guide (EMRA vs Tintinalli)
(Reflex Hammer??)

 

[gamerEMdoc]

Thats about it. Basically a stethescope, smartphone, and trauma shears pretty much is all you need. Gone are the days of needing to carry 10 little books along with you.

 

[EMGui2017]

What stuff should I buy or have during the SubI/Clerkship to have on me/on my person or white coat?

So far:
Stethoscope
EM apps Palm EM, PressorDex, MDCalc
Penlight
Trauma Shears
A handbook guide (EMRA vs Tintinalli)
(Reflex Hammer??)

A personal recommendation would also be the antibiotic guide, I felt like there were super bonus points when I could provide drug regimens and doses with my patient plans. It is a quality resource that my residents even started stealing from me during shifts when they needed to double check something. I found it to be a quicker and more reliable than computer or apps for this purpose.

 

[TheMountainsAreCalling10]

A personal recommendation would also be the antibiotic guide, I felt like there were super bonus points when I could provide drug regimens and doses with my patient plans. It is a quality resource that my residents even started stealing from me during shifts when they needed to double check something. I found it to be a quicker and more reliable than computer or apps for this purpose.

Yes! The EMRA antibiotic guide is so damn handy. Even quicker to find an answer than using my phone.

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[gamerEMdoc]

Yes! The EMRA antibiotic guide is so damn handy. Even quicker to find an answer than using my phone.

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I personally have never been a big fan of national antibiotic guides for more advanced levels, but for students they are fine. I mean, they are an excellent starting point, but honestly, resistant patters are local, and antibiotic decisions should be based on the hospitals antiobiogram resistance data, not a national guide. But from a students perspective, its definitely a great starting point.

 

[DoctorS_]

Hi gamerEMdoc! Thanks for being so active on this board and answering our questions (and thanks in advance for any input you have for me)!

I'm a rising MS3, DO student, set to take COMLEX/USMLE next week, but I'm thinking of delaying or even cancelling Step 1. I'd rate myself an average-below average student. I've taken two NBME practice exams so far (3 weeks ago and 1 week ago) that project me to be < 210. I plan to take another one in the next few days, but if I do poorly, my plan is to forgo Step 1 and just plan to take (and rock) Step 2 CK (along with COMLEX) next year to submit when applying for residency. I truly believe that I will learn much better as MS3 rolls along since I've finally figured out how to study and because I learn much better when I'm hands-on. How big of a red flag would it be not to have Step 1?

 

[Old_Mil]

Sleep with a patient.

Or hospital staff. Don't do it. Work is work. There is an entire world out there to live your personal life in that won't have on the job repercussions if things go wrong (which, statistically, they probably will).

 

[gamerEMdoc]

Hi gamerEMdoc! Thanks for being so active on this board and answering our questions (and thanks in advance for any input you have for me)!

I'm a rising MS3, DO student, set to take COMLEX/USMLE next week, but I'm thinking of delaying or even cancelling Step 1. I'd rate myself an average-below average student. I've taken two NBME practice exams so far (3 weeks ago and 1 week ago) that project me to be < 210. I plan to take another one in the next few days, but if I do poorly, my plan is to forgo Step 1 and just plan to take (and rock) Step 2 CK (along with COMLEX) next year to submit when applying for residency. I truly believe that I will learn much better as MS3 rolls along since I've finally figured out how to study and because I learn much better when I'm hands-on. How big of a red flag would it be not to have Step 1?

I don't think there is an answer to your question, honestly. Conventional wisdom is, if planning to apply to ACGME programs, to take Step 1. But no one knows how the merger changed that. I personally don't like the idea of students having to take two boards, just because its expensive and I believe that you can extrapolate a COMLEX score to a USMLE score fairly easily. The ideal system to me would be one unified board system, with maybe a separate osteopathic board (maybe like a step 2 - ost). So DO students would take USMLE 1, 2, 2CS, and 2OST, while allopathic students would take 1, 2, and 2cs. I mean, I don't think that's going to happen anytime soon, but I think that would be the most ideal solution for students.

As for skipping STEP 1, I'm not sure what it gains you. You can't skip COMLEX1. And if you do poorly on COMLEX 1, you'll likely do poorly on USMLE 1, and vice versa. I don't know that skipping USMLE 1 hides poor performance somehow, since you can't skip COMLEX1.

My advice, if you've already paid for it and practiced for it... take it. Best case scenario is, you do better than you thought. Worst case scenario, you do exactly how you thought. But if you skip it and do poorly on COMLEX1, people are going to assume you would've done poorly on USMLE1. So you have nowhere to go but up. And like most things in life, once you face what you are most afraid of, usually the consequences aren't as bad as you thought.

 

[DoctorS_]

I don't think there is an answer to your question, honestly. Conventional wisdom is, if planning to apply to ACGME programs, to take Step 1. But no one knows how the merger changed that. I personally don't like the idea of students having to take two boards, just because its expensive and I believe that you can extrapolate a COMLEX score to a USMLE score fairly easily. The ideal system to me would be one unified board system, with maybe a separate osteopathic board (maybe like a step 2 - ost). So DO students would take USMLE 1, 2, 2CS, and 2OST, while allopathic students would take 1, 2, and 2cs. I mean, I don't think that's going to happen anytime soon, but I think that would be the most ideal solution for students.

As for skipping STEP 1, I'm not sure what it gains you. You can't skip COMLEX1. And if you do poorly on COMLEX 1, you'll likely do poorly on USMLE 1, and vice versa. I don't know that skipping USMLE 1 hides poor performance somehow, since you can't skip COMLEX1.

My advice, if you've already paid for it and practiced for it... take it. Best case scenario is, you do better than you thought. Worst case scenario, you do exactly how you thought. But if you skip it and do poorly on COMLEX1, people are going to assume you would've done poorly on USMLE1. So you have nowhere to go but up. And like most things in life, once you face what you are most afraid of, usually the consequences aren't as bad as you thought.

I suppose I figured as much. Thanks for the advice! Another option would be to delay USMLE until into 3rd year, therefore buying more time and adding clinical experience. Not sure if you have an opinion on that. Much appreciated either way.

 

[TheMountainsAreCalling10]

I suppose I figured as much. Thanks for the advice! Another option would be to delay USMLE until into 3rd year, therefore buying more time and adding clinical experience. Not sure if you have an opinion on that. Much appreciated either way.

4th year DO here - Delaying into rotations and expecting it to help you on step is not going to happen. Clinical knowledge isn't what's being tested on step 1 plus studying during rotations can be challenging. Delaying to get a better score, however, makes sense. Having a good (or at least close to average) step 1 sets you up so much better than just having comlex. But having a failed board exam - required or not will definitely hurt you. Just have to weigh how you're feeling but in the end, every recommendation I've heard for EM is to take both usmle and comlex. Good luck!

 

[gamerEMdoc]

I suppose I figured as much. Thanks for the advice! Another option would be to delay USMLE until into 3rd year, therefore buying more time and adding clinical experience. Not sure if you have an opinion on that. Much appreciated either way.

Never, ever, ever delay Step 1 into the clinical years. The things you learn in the first two years of medical school are very different from the things you will learn in third year. The knowledge tested in step one is very different then the knowledge tested in step two. The clinical years will help you prepare to pass step 2, but you'll forget all the obscure non-clinical stuff thats on Step 1.

 

[h0tsauc3]

Thank you for contributing all of this information gamerEMdoc - I have definitely found it useful so far! I have a question about doing a third EM rotation (in addition to my home program and 1 away). About me: US MD student from middle out the road allopathic school. Step 1 220, step 2 250s, mostly passes 3rd year clerkships with some HP, LOTS of research unrelated to EM (10+ abstracts, publications, posters, presentations - everything mostly in neuro), 1 small research grant and a 1st author in a solid journal. My advisor initially wanted me to do 2 aways + home, but is now saying maybe I should reconsider my second away. Any thoughts on this? My second away is scheduled for late september/early october. I will have 2 SLOEs before ERAS is submitted.

 

[AlgernonMed]

Thank you for contributing all of this information gamerEMdoc - I have definitely found it useful so far! I have a question about doing a third EM rotation (in addition to my home program and 1 away). About me: US MD student from middle out the road allopathic school. Step 1 220, step 2 250s, mostly passes 3rd year clerkships with some HP, LOTS of research unrelated to EM (10+ abstracts, publications, posters, presentations - everything mostly in neuro), 1 small research grant and a 1st author in a solid journal. My advisor initially wanted me to do 2 aways + home, but is now saying maybe I should reconsider my second away. Any thoughts on this? My second away is scheduled for late september/early october. I will have 2 SLOEs before ERAS is submitted.

It sounds like you'll have a pretty sweet application and I wouldn't be surprised if 2 SLOE's/Rotations would be plenty for you. Do you have anything in your application that shows dedication to EM? With that amount of research in neuro, it might be something to address. Just a thought from another applicant though. Good job on Step 2!

 

[tacos4life]

I think this might have been addressed before but thoughts on declining away offers? I had already accepted one in July but was accepted into another slightly more prestigious program in late August. My advisor said we wouldn't need more than 1 away, and aways get pretty expensive, so I quickly declined and sent them a follow up email, but now I am worried that I may not be competitive for that residency anymore...
Would it be worth it to set up a shadowing date at that program just to get some face time?
About me: 222 Step 1, Mostly High Pass clerkships, 244 Step 2

 

[h0tsauc3]

It sounds like you'll have a pretty sweet application and I wouldn't be surprised if 2 SLOE's/Rotations would be plenty for you. Do you have anything in your application that shows dedication to EM? With that amount of research in neuro, it might be something to address. Just a thought from another applicant though. Good job on Step 2!

Nothing specifically EM - some neurotrauma stuff though. I talked to some faculty about doing some research over the next few months in EM to express interest. Most of them seemed to say doing aways/applying was enough interest in itself - not sure if that's the case though. I don't think another project is going to get me more interviews, but maybe having some research connections in the field could. Also would be hard to do anything really meaningful with aways and interviews coming up. That step 2 was a grind!

 

[gamerEMdoc]

Nothing specifically EM - some neurotrauma stuff though. I talked to some faculty about doing some research over the next few months in EM to express interest. Most of them seemed to say doing aways/applying was enough interest in itself - not sure if that's the case though. I don't think another project is going to get me more interviews, but maybe having some research connections in the field could. Also would be hard to do anything really meaningful with aways and interviews coming up. That step 2 was a grind!

I wouldn't worry about trying to do more research to show EM interest. You've already had a ton of research in your background, even if it isn't EM specific, and research isn't usually a deal breaker in EM anyways.

 

[gamerEMdoc]

Re: the questions about the number of away rotations, that varies by candidate. For most allopathic candidates who have a home rotation, I think 1 or 2 away rotations are appropriate. For a decent candidate, 1 away should be all you need. Once you get 2 SLOEs, the other rotations after that are mearly for you to either check out a place you really want to go to, or boost your application status at a place you really want to be at.

For less competitive candidates, or for candidates with no home rotations, they are going to need to try to do like 3 aways. DO's will often do at least 3, just because they have no home rotations oftentimes, and because they are straddling between programs in two different matches, so they are rotating at some of each.

 

[EM-SLG]

What would you suggest to an EM PGY1 in terms of books/study materials?

 

[gamerEMdoc]

What would you suggest to an EM PGY1 in terms of books/study materials?

I don't think its likely or realistic for a resident to read an entire textbook, but I do think its important to try to cover the core content of EM yearly. Which is why I generally recommend getting through an online course (NEMBR or Hippo) or reading an EM review book yearly. It will help immensely when it comes time for the in service each year.

 

[Jabbed]

I don't think its likely or realistic for a resident to read an entire textbook, but I do think its important to try to cover the core content of EM yearly. Which is why I generally recommend getting through an online course (NEMBR or Hippo) or reading an EM review book yearly. It will help immensely when it comes time for the in service each year.

Soo.. TinTin, Rosen, or Harwood-Nuss?

 

[gamerEMdoc]

Soo.. TinTin, Rosen, or Harwood-Nuss?

I've always liked Tintinalli, but personally, Ive never read a text from cover to cover. But personally I learn more via video and audio.

 

[Elevencents]

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.

 

[adhdpowered]

I don't know if it truly is great for people with legitimate ADHD. I mean, you are literally interrupted every 5 minutes in the ED. There are constant distractions. If you had out of control ADHD, I'd imagine that would lead to considerable number of errors. It already does for people without ADHD. Not saying people with some ADHD tendencies don't find EM attractive and flock to EM, but I do think that people with legitimate ADHD that's uncontrolled could find it difficult.

As for bringing it up, there is no reason to. Medical stuff is off limits, however, not if you bring it up. So if you start talking about out of control ADHD in your interview, then its fair game for them to discuss. If its never brought up, they'll never know.

Now do people bring it up? Sure, all the time, jovially. Usually saying something in answering "why EM" to say "it seems like most ED docs have a little bit of ADHD" etc.

I view ADHD as "chronic under-stimulation". I think if you put an ADHDer in a predictable or repetitive environment, they would create their own chaos to make it more tolerable or interesting to them. They are best when dealing immediately with a new task on hand and once the plan is in place, they get bored and mentally move on. They suck at follow through. I don't think they are more error prone than anyone else. I think they will find more difficulty in an environment that is NOT "uncontrolled". They need a distraction from their distraction. The ER is varying degrees of controlled chaos. So, in my opinion, I do think they are especially well suited for ER work. I think they willingly work well in many environments that almost all others would consider intolerable.

 

[inandoutberger]

Hi gamerEMdoc,

Thanks for doing this. I am an OMS-IV at a DO school and have been gung ho Ortho since day 1 of med school until I had my first EM rotation in April and am now reconsidering.
Is it too late for me to find rotations and accumulate SLOEs for this year's match? I have one EM Letter of Rec from an EM doc at a community hospital that doesn't have residents and no aways in EM currently set up.
Step 1 240s, Comlex Level 1 600s, Comlex Level 2 pending. Would be interested in either match
Thanks so much

 

[gamerEMdoc]

Your board scores certainly will make you competitive, and hopefully you can squeeze in 2 aways. If you can get 2 away rotations at sites with residencies before the end of October in order to get two SLOES, you'll have no trouble matching.

As for securing those aways, that may be the hard part. Consider directly contacting programs that dont use VSAS since many of these may be easier to get a spot to rotate (less applicants since they arent on vsas). Also, consider writing to the progrma coordinator for any semi local programs around you to see if they can squeeze you in.

Best of luck!

 

[Faustian]

Sorry if this is an ignorant question, incoming OMS-I here.

Why don't all programs use VSAS? Is there a difference in programs that use or don't use VSAS?

 

[gamerEMdoc]

Sorry if this is an ignorant question, incoming OMS-I here.

Why don't all programs use VSAS? Is there a difference in programs that use or don't use VSAS?

VSAS isn't free, and I can't speak for everyone that doesn't use it, but I can speak from our standpoint. We have more applicants for rotation without VSAS than we can handle now, let alone getting way way more applicants asking for rotations if we used it. Also, many of the programs pass the cost of the service onto the students, and I think that isn't reasonable.

Personally, I think its just as easy for people to email us and ask for a rotation, and we then ask for some basic documents (CV,etc). I just don't see the need for the service, and I especially don't like the idea of making students pay just to apply to rotate somewhere.

 

[Faustian]

VSAS isn't free, and I can't speak for everyone that doesn't use it, but I can speak from our standpoint. We have more applicants for rotation without VSAS than we can handle now, let alone getting way way more applicants asking for rotations if we used it. Also, many of the programs pass the cost of the service onto the students, and I think that isn't reasonable.

Personally, I think its just as easy for people to email us and ask for a rotation, and we then ask for some basic documents (CV,etc). I just don't see the need for the service, and I especially don't like the idea of making students pay just to apply to rotate somewhere.

Thanks so much for your thorough answer!

 

[inandoutberger]

Your board scores certainly will make you competitive, and hopefully you can squeeze in 2 aways. If you can get 2 away rotations at sites with residencies before the end of October in order to get two SLOES, you'll have no trouble matching.

As for securing those aways, that may be the hard part. Consider directly contacting programs that dont use VSAS since many of these may be easier to get a spot to rotate (less applicants since they arent on vsas). Also, consider writing to the progrma coordinator for any semi local programs around you to see if they can squeeze you in.

Best of luck!

gamerEMdoc, thank you very much for your response.
I have one more question, and I apologize if you have answered already.
Are DO candidates competitive for ACGME residencies without any ACGME SLOEs, or should I try to get a SLOE from an AOA and an ACGME institution? Thanks again

 

[gamerEMdoc]

gamerEMdoc, thank you very much for your response.
I have one more question, and I apologize if you have answered already.
Are DO candidates competitive for ACGME residencies without any ACGME SLOEs, or should I try to get a SLOE from an AOA and an ACGME institution? Thanks again

To be honest, questions like this are hard to answer. I can tell you my perspective, and how my program views things, but I can't speak for hundreds of other programs out there. A few points on this murky situation:

1. A SLOE is a SLOE in my opinion, assuming its from a site that has an EM residency and has a fair number of students every year. I personally don't care if its ACGME or AOA
2. More competitive EM programs are likely going to want to see SLOEs from other competitive EM programs
3. Less competitive EM programs and community based EM programs are less likely to care assuming the SLOE is coming from a place with a residency and they are comparing you to a number of other students (ie, they don't only write 1-2 SLOEs a year)
4. Without any ACGME SLOEs, it could be perceived by programs that you are not really going to be doing the ACGME match. Remember, programs spend time and money on interviews too. Interviewing people who are really planning to go all in on the AOA match as an ACGME program is a waste of time, effort, and money, and wastes that interview spot that could be given to someone who actually was tending to be available to match.

I know that doesn't give you a firm answer to your question, and I don't think there is a definitive firm answer on this (much like asking "do i have to take the usmle boards? just step 1? both step 1 and 2?). All I can lend is my personal perspective.

 

[GandalfTheWhite]

To be honest, questions like this are hard to answer. I can tell you my perspective, and how my program views things, but I can't speak for hundreds of other programs out there. A few points on this murky situation:

1. A SLOE is a SLOE in my opinion, assuming its from a site that has an EM residency and has a fair number of students every year. I personally don't care if its ACGME or AOA
2. More competitive EM programs are likely going to want to see SLOEs from other competitive EM programs
3. Less competitive EM programs and community based EM programs are less likely to care assuming the SLOE is coming from a place with a residency and they are comparing you to a number of other students (ie, they don't only write 1-2 SLOEs a year)
4. Without any ACGME SLOEs, it could be perceived by programs that you are not really going to be doing the ACGME match. Remember, programs spend time and money on interviews too. Interviewing people who are really planning to go all in on the AOA match as an ACGME program is a waste of time, effort, and money, and wastes that interview spot that could be given to someone who actually was tending to be available to match.

I know that doesn't give you a firm answer to your question, and I don't think there is a definitive firm answer on this (much like asking "do i have to take the usmle boards? just step 1? both step 1 and 2?). All I can lend is my personal perspective.

So does a middle 1/3 sloe from a top institution carry more weight than a top 1/3 sloe from an average institution?

 

[inandoutberger]

To be honest, questions like this are hard to answer. I can tell you my perspective, and how my program views things, but I can't speak for hundreds of other programs out there. A few points on this murky situation:

1. A SLOE is a SLOE in my opinion, assuming its from a site that has an EM residency and has a fair number of students every year. I personally don't care if its ACGME or AOA
2. More competitive EM programs are likely going to want to see SLOEs from other competitive EM programs
3. Less competitive EM programs and community based EM programs are less likely to care assuming the SLOE is coming from a place with a residency and they are comparing you to a number of other students (ie, they don't only write 1-2 SLOEs a year)
4. Without any ACGME SLOEs, it could be perceived by programs that you are not really going to be doing the ACGME match. Remember, programs spend time and money on interviews too. Interviewing people who are really planning to go all in on the AOA match as an ACGME program is a waste of time, effort, and money, and wastes that interview spot that could be given to someone who actually was tending to be available to match.

I know that doesn't give you a firm answer to your question, and I don't think there is a definitive firm answer on this (much like asking "do i have to take the usmle boards? just step 1? both step 1 and 2?). All I can lend is my personal perspective.

This definitely helps and lends some insight, thank you !