EM PD - Ask Me Anything

[gamerEMdoc]

No way. I'd be way more impressed by someones bravery for using reaper as their photo!

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Members don't see this ad.

 

[green lantern]

No way. I'd be way more impressed by someones bravery for using reaper as their photo!

I guess that would stand out but only if people knew what it meant.

Sent from my SM-G386T using SDN mobile

 

[Status Sciaticus]

No way. I'd be way more impressed by someones bravery for using reaper as their photo!

We cant sent separate photos to different schools can we?
If not, look out for a supplemental document with a Reaper headshot

 

[green lantern]

We cant sent separate photos to different schools can we?
If not, look out for a supplemental document with a Reaper headshot

Just send a video doing a wicked death blossom and you will be good.

Sent from my SM-G386T using SDN mobile

 

[Status Sciaticus]

Just send a video doing a wicked death blossom and you will be good.

Sent from my SM-G386T using SDN mobile

Quintuple Kill = automatic interview invite

 

[Fetor Hepaticus]

Sir,

What's your take on the SVI which I just found out last week when I registered for MyERAS? Reason I am asking is because I am more of introvert and am horrible at hypothetical scenario questions.

 

[gamerEMdoc]

Sir,

What's your take on the SVI which I just found out last week when I registered for MyERAS? Reason I am asking is because I am more of introvert and am horrible at hypothetical scenario questions.

I posted this back in April. My opinion hasn't changed much. Just too early to tell how it will be used, what if any the cost will be to the student, etc.

My first reaction was "whats the point". Then I thought about it, and maybe it has potential to help those that score low on boards but are clinically good get some interviews since its another way for programs to filter applicants other than just a board score. In the end, like anything, I think We just need to see what it is, how it will be used, and how its implemented. If its free and helps open up some doors for students then Id welcome it. If its going to lead to a costly process that is not in the students best interest, then Id obviously be against it.

 

[surfdoc29]

@gamerEMdoc

A quick question for you regarding SLOEs and letters of rec if you don't mind. I have finished my 2 EM rotations and will have SLOEs from both of them. I know we are supposed to have at least 3 letters, and I've heard of some people getting an individual letter from a faculty member with whom they worked closely. My issue is that I worked with a different attending every shift at my home institution, so I don't necessarily feel that they really got a chance to know me.

What are your thoughts on getting a letter from a faculty member of a different specialty, mainly as a character reference? I worked with the same family medicine preceptor for 2.5 years during my primary care apprenticeship my school has us do, and I feel he could write me a stellar letter regarding my character.

Thanks in advance for your thoughts!

 

[gamerEMdoc]

w we are supposed to have at least 3 letters,

You should get two sloes. Anything more than two is a bonus, but not necessary. Plenty of places will even consider applications with only one. But definitely shoot for two. I'm not aware of any trend where programs are requiring three sloes.

The advantage of having a third sloe would be that it would allow you to use your two best. If you get a pass on your first rotation, and honors the next two, you can use the last two sloes as your two when you submit to programs.

You can submit up to four letters I believe to any program. They don't have to be all EM letters, most people submit letters from other specialties as well.

I've heard of some people getting an individual letter from a faculty member

If you have a faculty member that you work really well with, and they want to write a personal letter, I think that's reasonable. Especially if it somebody you worked a ton with. But SLOEs are generally supposed to be based on group opinion, not individual opinion according to CORD ( Council of residency directors, they are the ones that make the sloe).

What are your thoughts on getting a letter from a faculty member of a different specialty, mainly as a character reference?

I would venture to say most people have at least one letter from the different specialty. Some rotation that they did really well on and they get a letter as a charachter reference. As an example, back when I submitted to ERAS I submitted to sloes, an FP letter, and and IM letter.

 

[surfdoc29]

I would venture to say most people have at least one letter from the different specialty. Some rotation that they did really well on and they get a letter as a charachter reference. As an example, back when I submitted to ERAS I submitted to sloes, an FP letter, and and IM letter.

Awesome, thanks very much for the response!

 

[Waterlover]

Can you go more into a description on doing an EM/IM combined residency and how realistic it is to be an ED doc and an internist? I like the idea of both and am wondering if there's a way to really practice both?

 

[gamerEMdoc]

Can you go more into a description on doing an EM/IM combined residency and how realistic it is to be an ED doc and an internist? I like the idea of both and am wondering if there's a way to really practice both?

Well, the rise of hospitalists allow for shift work, so someone that wants to do both jobs could. I just don't get it personally though. I mean, I loved IM. But I see IM patients all day long in the ED, work less shifts than an IM hospitalist, and make more money. I just don't get the draw to want to do both. The one exception I guess would be if there was a big desire to do a critical care fellowship and be boarded in IM/CC and EM. Splitting time between the ED and ICU. I could see that maybe.

 

[Waterlover]

Well, the rise of hospitalists allow for shift work, so someone that wants to do both jobs could. I just don't get it personally though. I mean, I loved IM. But I see IM patients all day long in the ED, work less shifts than an IM hospitalist, and make more money. I just don't get the draw to want to do both. The one exception I guess would be if there was a big desire to do a critical care fellowship and be boarded in IM/CC and EM. Splitting time between the ED and ICU. I could see that maybe.

Thank you so much!

 

[neurosis99]

Is it just the places I'm rotating or is it hard to honor EM months? I just went HP/HP after working way harder than I did during core clerkships and picking up good evals along the way. Do the grades not really matter for our application? Both told me they would write good SLOEs, for what it's worth. One of them also said they honor 50% and HP 50%, and I'm not really sure what I could've done differently. What a strange process...

 

[Jabbed]

Do you rank students without CS scores?

 

[gamerEMdoc]

Is it just the places I'm rotating or is it hard to honor EM months? I just went HP/HP after working way harder than I did during core clerkships and picking up good evals along the way. Do the grades not really matter for our application? Both told me they would write good SLOEs, for what it's worth. One of them also said they honor 50% and HP 50%, and I'm not really sure what I could've done differently. What a strange process...

That's going to be HIGHLY variable. Every place emphasizes different things and grades differently. I wouldn't worry about it too much.

Do you rank students without CS scores?

Usually by the time we send in our rank list, most students had passed the CS exam.

 

[Waterlover]

@gamerEMdoc Sorry another question, I apologize if this has been talked about already. Can you talk about the significant differences and pros/cons in doing a 3 year vs. a 4 year residency?

 

[nonamesleft]

@gamerEMdoc Sorry another question, I apologize if this has been talked about already. Can you talk about the significant differences and pros/cons in doing a 3 year vs. a 4 year residency?

Osteopathic EM programs
Post # 1543 in case the link didn't work correctly

 

[lucid_leprechaun]

@gamerEMdoc Sorry another question, I apologize if this has been talked about already. Can you talk about the significant differences and pros/cons in doing a 3 year vs. a 4 year residency?

Not an attending, but as a former applicant the main difference is academics, elective time. Usually more emphasis on fellowship/leadership roles from 4yrs, although possible from both. Often a year of "sub attending"

 

[Status Sciaticus]

Not an attending, but as a former applicant the main difference is academics, elective time. Usually more emphasis on fellowship/leadership roles from 4yrs, although possible from both. Often a year of "sub attending"

Over here we call it pre-tending. Get it?

Personally, I am a solid opponent of a 4 year program for several reasons. Its an extra year the hospitals get for cheap labor under the guise of "electives". Your interest grows and you lose a years worth of attending salary (atleast 300K). Secondly, they dont enhance your experience in a way you cant do it yourself. Some will argue that it provides you with extra training and that 3 years is not enough to learn EM. Well, my counter even 4 years isnt enough, but you can get extra training for several years outside of residency through just working. If you dont like being the ultimate person accountable or want a safety net, then I can see that argument, but you have to be in that position someday.

On the topic of fellowships, yes it is true that 4 year programs will choose applicants that did a 4 year residency. However, there are several fellowships that do fill with 3 year applicants. The main reasoning for this is that an R4 is not being supervised by a fellow that has the same level of training as him/her, which is a fair point.

 

[SpacemanSpifff]

Over here we call it pre-tending. Get it?

Personally, I am a solid opponent of a 4 year program for several reasons. Its an extra year the hospitals get for cheap labor under the guise of "electives". Your interest grows and you lose a years worth of attending salary (atleast 300K). Secondly, they dont enhance your experience in a way you cant do it yourself. Some will argue that it provides you with extra training and that 3 years is not enough to learn EM. Well, my counter even 4 years isnt enough, but you can get extra training for several years outside of residency through just working. If you dont like being the ultimate person accountable or want a safety net, then I can see that argument, but you have to be in that position someday.

On the topic of fellowships, yes it is true that 4 year programs will choose applicants that did a 4 year residency. However, there are several fellowships that do fill with 3 year applicants. The main reasoning for this is that an R4 is not being supervised by a fellow that has the same level of training as him/her, which is a fair point.

Point, counterpoint: with the caveat that I had/have no strong opinion about the universal superiority of 3 vs 4 (it's a personal decision)...
If the bolded above is true, then I agree, not worth the extra time. There were programs that I looked at where I felt that an extra year of training would be low yield because it was another year of "more of the same". The ones I chose to interview at packed added value into the four years, whether that was the way you could utilize your elective time, unique opportunities in critical care, or more time with access to resources that would enable me to launch an academic career.

 

[lucid_leprechaun]

Point, counterpoint: with the caveat that I had/have no strong opinion about the universal superiority of 3 vs 4 (it's a personal decision)...
If the bolded above is true, then I agree, not worth the extra time. There were programs that I looked at where I felt that an extra year of training would be low yield because it was another year of "more of the same". The ones I chose to interview at packed added value into the four years, whether that was the way you could utilize your elective time, unique opportunities in critical care, or more time with access to resources that would enable me to launch an academic career.

Agreed, not all 4 year programs are created equal. There are also some programs that treat the 4 years as 1+3, with a first year full of floor months more in line with the traditional intern year.

 

[Status Sciaticus]

Agreed, not all 4 year programs are created equal. There are also some programs that treat the 4 years as 1+3, with a first year full of floor months more in line with the traditional intern year.

Point, counterpoint: with the caveat that I had/have no strong opinion about the universal superiority of 3 vs 4 (it's a personal decision)...
If the bolded above is true, then I agree, not worth the extra time. There were programs that I looked at where I felt that an extra year of training would be low yield because it was another year of "more of the same". The ones I chose to interview at packed added value into the four years, whether that was the way you could utilize your elective time, unique opportunities in critical care, or more time with access to resources that would enable me to launch an academic career.

Both valid points. My question is why do an extra intern year of off service rotations that may not be beneficial to your career choice? the 3+1 programs that offer optional 4th year is a solid compromise. There are also several 3 year programs that offer longitudinal tracks or mini-fellowships where several blocks are focused on say Tox or sports medicine or ultrasound. That way, you avoid working an extra year just for elective's sake.

@SpacemanSpifff It would depend on what unique opportunities you talk about. Personally, if I am at a program that offers 3 elective blocks, I would use that time to pursue these unique opportunities without giving up a year of my life and a year of lost attending salary. If you are pursuing academic medicine, then absolutely a 4 year program may give you a leg up at 4 year programs and many 3 year programs, but a 3 year program may not be as selective. So ultimately it comes down to if you want that safety net for an additional year, some extra months of electives, and an immediate academic career path.

Itll come down to preference, but both programs will provide you with what is required by the RRC to make you a good EP.

 

[nonamesleft]

Why is EM/IM five years when med/peds is only 4? Is there that much overlap between specialties for the latter program than for the former?

 

[Jabbed]

Usually by the time we send in our rank list, most students had passed the CS exam.

So.. would not having a CS score at the time of ROL submission affect your ranking of the applicant?

 

[gamerEMdoc]

So.. would not having a CS score at the time of ROL submission affect your ranking of the applicant?

Probably not, assuming the candidate didn't take it and fail it the first time, and hadn't taken their repeat attempt yet.

 

[gamerEMdoc]

In general, EM grades are far more important than other rotation grades. And no, a "pass" on an EM rotation is not a "red flag". Plenty of places are strict graders and 50-70% of the folks rotating get a "pass". Red flags are things like taking a year off because you got dumped while in med school, failing boards multiple times, having an evaluation point out some unprofessional behavior, etc. Getting a "pass" on a rotation is most certainly not a red flag.

 

[aspiringdoc094]

In general, EM grades are far more important than other rotation grades. And no, a "pass" on an EM rotation is not a "red flag". Plenty of places are strict graders and 50-70% of the folks rotating get a "pass". Red flags are things like taking a year off because you got dumped while in med school, failing boards multiple times, having an evaluation point out some unprofessional behavior, etc. Getting a "pass" on a rotation is most certainly not a red flag.

You mentioned that taking a year off is a red flag. I decided to take a year off after my second year since my practice exam scores were in the danger zone of failing step 1. I reevaluated my study approach and decided to focus more on question banks. I took the exam last October and received a 230 so the change paid off. I spent the remainder of my time off doing research and am now rotating as a 3rd year student. If I do well on step 2 and have good SLOEs will the year off make a significant impact on me matching into ER?

Thanks for taking time out to answer our questions!

 

[gamerEMdoc]

You mentioned that taking a year off is a red flag.

No, I said taking a year off because you got dumped (or insert other social stressor). You can take time off for legitimate reasons in medical school. After all, tragedies happen.

 

[aspiringdoc094]

No, I said taking a year off because you got dumped (or insert other social stressor). You can take time off for legitimate reasons in medical school. After all, tragedies happen.

Haha gotcha, I hope my reason won't be frowned on upon too much. Would you recommend I address this in my personal statement or should I only explain it if asked about it?

 

[surfguy84]

@gamerEMdoc thanks for answering questions.

I am a DO student with low 240s Step 1/660s COMLEX. Any idea what my odds are of getting a UC or staying west coast? Also, do you think I'd be safe completely avoiding AOA programs with my scores?

Also, how big of an issue would it be if I get mostly HP during rotations?

 

[gamerEMdoc]

Haha gotcha, I hope my reason won't be frowned on upon too much. Would you recommend I address this in my personal statement or should I only explain it if asked about it?

I would probably explain it in the personal statement.

 

[gamerEMdoc]

@gamerEMdoc thanks for answering questions.

I am a DO student with low 240s Step 1/660s COMLEX. Any idea what my odds are of getting a UC or staying west coast? Also, do you think I'd be safe completely avoiding AOA programs with my scores?

Also, how big of an issue would it be if I get mostly HP during rotations?

Matching in emergency medicine has far more to do about performance on emergency medicine rotations then it does board scores. So it's hard to tell you how competitive you will be just based on board scores alone. That being said, with your scores, you should be competitive in the ACGME match assuming you do ok on rotations and have decent sloes. HP, top 1/3 type sloes with your board scores will net you more than enough interviews that you shouldn't have to worry about doing the AOA match. From a geographic standpoint, thats a trickier question, I wouldnt pin my hopes on the west coast entirely, not saying you cant do it, Id just make sure to have some backup interviews on the east coast just in case.

 

[Siggis_is_good]

I just posted this on a different thread, but I think it's actually way more appropriate here...

As a long time lurker, and 4th year currently applying, I have a question (primarily geared toward those who regularly author or reads SLOEs). Why are we as applicants not allowed to see our SLOEs?

I know my clinical grades and USMLE, but EM is unique in that the most important part of our application and marker of competitiveness is a pretty big unknown. A SLOE isn't a typical recommendation letter, instead, it represents your "real" sub-I grade and evaluation (basically a MSPE for EM and we get to read our actual MSPEs!). Despite all the variation in sub-I grades and grading schemes across programs (Honors/Pass/Fail, Honors/HP/P/F, just Pass/Fail?), we all get a real standardized and hidden bottom line "grade" at the end of the day (top 10%, top 1/3, middle 1/3, and bottom 1/3). I'm not sure why we have to have the smoke and mirrors and mind games of trying to translate our sub-I grade and comments into how strong our SLOE is. It just adds more stress to what is already a pretty stressful processes.

The way I see it, if a program is super transparent, and your sub-I grade/feedback perfectly and clearly correlates with your SLOE, then great! You have literally gained no new information by reading your SLOE. If there's a pretty big discrepancy, that's a pretty big red flag, likely reflecting poorly on the education leadership in that program (If you really thought a student was bad, isn't the goal of education is to give them honest feedback so that they can improve?). I don't see what positive incentive keeping SLOEs secret has. Would programs really write them differently if they knew applicants could read them?

The only possible "pro" toward keeping SLOEs hidden that I can think of is the "Where would you rank this applicant?" question, which is a slightly different question from the global assessment, and someone could argue that reading it constitutes a match violation (since no one is forced to say where they would rank someone... despite all the games played during the interview season). Then again, isn't this just the "objective" answer to the "How competitive do you think I am question?" that we are all encouraged to ask our PDs? I fully admit that, selfishly, it feels like really useful information to have as an applicant.

I'm genuinely curious what you think. Maybe all EM sub-I's can at least switch to a standardized grading (top 10%, top 1/3, middle 1/3, and bottom 1/3) so that anxious applicants that keep hearing how EM is getting more and more competitive can have at least a little more concrete knowledge in what is a very nebulous and anxiety provoking process.

 

[gamerEMdoc]

First, they are only blinded if you waive your right to see the letter. This is the same as any other letter for ERAS. If you choose not to waive the right, its noted on the SLOE. Personally, I wouldn't write one for a student that didn't waive the right to see the letter. I get this is anxiety provoking for the students, but the reason the SLOE is so important is that it is an honest evaluation and assessment of a student. As soon as you know that the student is going to see the evaluation, that objectivity goes away, and the SLOE becomes worth WAY LESS to the application.

Personally, I like a system where EM performance (via blinded SLOE) is weighted much more highly than something like board scores. But if you take away the importance of a blinded objective evaluation, then all of a sudden we are back to ranking students based on boards and class rank, which is not, in my opinion, the way to find good ED docs.

Is the system more anxiety provoking for students. Yes. However, its in the students best interests in the end, because the most fair system is one where the people with the best chance of matching are the people that perform the best in the ED, and there is no more fair system than that.

 

[Jabbed]

First, they are only blinded if you waive your right to see the letter. This is the same as any other letter for ERAS. If you choose not to waive the right, its noted on the SLOE. Personally, I wouldn't write one for a student that didn't waive the right to see the letter. I get this is anxiety provoking for the students, but the reason the SLOE is so important is that it is an honest evaluation and assessment of a student. As soon as you know that the student is going to see the evaluation, that objectivity goes away, and the SLOE becomes worth WAY LESS to the application.

Personally, I like a system where EM performance (via blinded SLOE) is weighted much more highly than something like board scores. But if you take away the importance of a blinded objective evaluation, then all of a sudden we are back to ranking students based on boards and class rank, which is not, in my opinion, the way to find good ED docs.

Is the system more anxiety provoking for students. Yes. However, its in the students best interests in the end, because the most fair system is one where the people with the best chance of matching are the people that perform the best in the ED, and there is no more fair system than that.

Just curious why you feel so strongly that an evaluation will lose objectivity if it is not blinded to the student. None of my M3/M4 evals are blinded.

Given that SLOEs are of almost singular importance in determining how competitive an applicant is, how can applicants get an idea of where they stand so they can at least figure out which programs to target for applications?

 

[gamerEMdoc]

Just curious why you feel so strongly that an evaluation will lose objectivity if it is not blinded to the student. None of my M3/M4 evals are blinded.

Non-blinded evals lead to grade inflation. Yes, none of your M3/4 grades are blinded, but if you look at the grade distribution at many schools its very very skewed at the top end. People will not be open and honest about a candidates weaknesses if students can see their sloes. Plus, they can pick which ones to submit, which further skews it. You could do five rotations, get five sloe's, and then just send out the two best ones to programs when you submit. Which means the sloe's become less meaningful and less trustworthy at best, and worthless at worst.

I get the anxiety over this, but this system is one that works very well as is and has for years.

 

[Jabbed]

Non-blinded evals lead to grade inflation. Yes, none of your M3/4 grades are blinded, but if you look at the grade distribution at many schools its very very skewed at the top end. People will not be open and honest about a candidates weaknesses if students can see their sloes. Plus, they can pick which ones to submit, which further skews it. You could do five rotations, get five sloe's, and then just send out the two best ones to programs when you submit. Which means the sloe's become less meaningful and less trustworthy at best, and worthless at worst.

I get the anxiety over this, but this system is one that works very well as is and has for years.

How can I judge my competitiveness in order to come up with a list of target programs? My grades/Steps/ECs are strong, but I am worried about applying top-heavy especially if I've got a hidden SLOE bomb.

 

[surely]

Non-blinded evals lead to grade inflation. Yes, none of your M3/4 grades are blinded, but if you look at the grade distribution at many schools its very very skewed at the top end. People will not be open and honest about a candidates weaknesses if students can see their sloes. Plus, they can pick which ones to submit, which further skews it. You could do five rotations, get five sloe's, and then just send out the two best ones to programs when you submit. Which means the sloe's become less meaningful and less trustworthy at best, and worthless at worst.

I get the anxiety over this, but this system is one that works very well as is and has for years.

Despite the system working very well, the problem of over-application has really ramped up in the last couple years, with the average applications per student sitting at over 44 for the most recent season. I've spoken with a PD who's part of a task force (or, for Brooklyn 99 fans, a Do Group) to combat this problem. This is a big expense for students, and the PD states that it has impacted programs by forcing them to review more applications and hold more interviews. I know we've discussed this in the past, and if I remember correctly, you said that programs don't increase the number of people they interview or review just because they receive more applications... However, if you look at the PD survey put out by the NRMP each year, you'll see that more interviews are being conducted for roughly the same number of spots compared to a few years ago.

My proposed solution:

1. Require programs use eSLOEs, which automatically record and report the number of students who receive Top 10%, Top 1/3rd, Middle 1/3rd, and Bottom 1/3rd, as well as the number of students falling into each of the other standardized question ranks.
2. Make these rankings visible to students.
3. Require students to register for a Rotation ID from CORD for each EM rotation they complete, which is searchable by AAMC applicant number on CORD and needs to be listed on each eSLOE, and require students to sign an agreement that they will submit an eSLOE from each EM rotation.

By cross-referencing these IDs, PDs can enforce the requirement that no eSLOEs be withheld from programs. Plus, since students will know they have absolutely no opportunity to hide a bad SLOE, it may even cut down on people doing "too many aways," which would cut down on the yearly VSAS circus. The narrative portion of the eSLOE can continue to be hidden from students, since this seems to be something PDs feel strongly about.

These steps should sufficiently combat grade inflation, while giving applicants a more transparent assessment of their competitiveness and therefore driving down the problem of rampant over-application.

 

[surely]

Showerthought inspired by the above:

It's apparently very important for programs to receive lots of standardized, non-biased information about their applicants to help them select their best fit. Applicants should be able to see the same type of standardized, non-biased information about programs and away rotations, to help us select our best fit.

SAEM or CORD or someone should host a website with standardized away syllabi, listing things like what the grade distribution/SLOE rating distribution was for the prior year, required assignments, what exam is administered, what the cut-off is for Honors, what the shift eval card looks like, number of shifts, do students present to attendings, are students interviewed during their away, are interviews granted to all rotating students, what percentage of rotating students actually ended up in each tier of the rank order list, what percentage of rotating students end up actually matching at this program, when does VSAS open for the program, when are VSAS applications actually reviewed, what is required for VSAS (just to minimize having to cross-reference VSAS...which has some incorrect dates, anyway), etc.

They should also require programs to keep their information up-to-date on the EMRA Match website with number of required letters of recommendation, USMLE cut-offs, EMR used, number of shifts per month in each year, shift length, resident conference info, block schedules, descriptions of moonlighting opportunities ($, distance from main site, type of gig, availability of shifts), available fellowships, information about where alumni tend to go post-graduation. I've already seen some inaccurate EMRA Match information about shift length that makes me wary of trusting the information there, and digging through potentially outdated program specific websites is a big pain.

Tl;dr: Objective data is good!

 

[Siggis_is_good]

Despite the system working very well, the problem of over-application has really ramped up in the last couple years, with the average applications per student sitting at over 44 for the most recent season. I've spoken with a PD who's part of a task force (or, for Brooklyn 99 fans, a Do Group) to combat this problem. This is a big expense for students, and the PD states that it has impacted programs by forcing them to review more applications and hold more interviews. I know we've discussed this in the past, and if I remember correctly, you said that programs don't increase the number of people they interview or review just because they receive more applications... However, if you look at the PD survey put out by the NRMP each year, you'll see that more interviews are being conducted for roughly the same number of spots compared to a few years ago.

My proposed solution:

1. Require programs use eSLOEs, which automatically record and report the number of students who receive Top 10%, Top 1/3rd, Middle 1/3rd, and Bottom 1/3rd, as well as the number of students falling into each of the other standardized question ranks.
2. Make these rankings visible to students.
3. Require students to register for a Rotation ID from CORD for each EM rotation they complete, which is searchable by AAMC applicant number on CORD and needs to be listed on each eSLOE, and require students to sign an agreement that they will submit an eSLOE from each EM rotation.

By cross-referencing these IDs, PDs can enforce the requirement that no eSLOEs be withheld from programs. Plus, since students will know they have absolutely no opportunity to hide a bad SLOE, it may even cut down on people doing "too many aways," which would cut down on the yearly VSAS circus. The narrative portion of the eSLOE can continue to be hidden from students, since this seems to be something PDs feel strongly about.

These steps should sufficiently combat grade inflation, while giving applicants a more transparent assessment of their competitiveness and therefore driving down the problem of rampant over-application.

That sounds like a really nice solution. I don't necessarily feel so strongly about reading the narrative portion- it just feels so pointless to have two grades, an "in name only" sub-I grade and a real hidden global assessment bottom line, which may or may not correlate. It would be great to know if I have to apply to 20 vs 40 vs 60 programs...

 

[gamerEMdoc]

In the end, honestly, its not that difficult. If you honors a rotation, I highly doubt you are getting a low 1/3 sloe. If you get a HP, its probably a top 1/3, unless the rotation gives everyone hon or hp, but its a middle 1/3 at worst. If the rotation is pass/fail, then it makes its more difficult, but then you can always ask the sloe writer for match advice and feedback while on rotation. I almost guarantee even if students knew their sloe ranks, they would still over apply, although it could make a minor difference in the number.

If you got more than 2 sloes, but are only going to submit 2, submit the two from rotations where you got the best grade/feedback. If you have a rotation where you got negative feedback, then don't use that sloe unless you have to. You dont need to submit more than two.

 

[gamerEMdoc]

It's apparently very important for programs to receive lots of standardized, non-biased information about their applicants to help them select their best fit. Applicants should be able to see the same type of standardized, non-biased information about programs and away rotations, to help us select our best fit.

I agree, the more objective data the better. I get people dont like anonymous evals, but every year on SDN when it comes time for students to describe their rank lists and provide feedback on the places they interview, they do so anonymously. Why is that anonymous? Because its the only way to make sure it is honest and objective.

 

[gamerEMdoc]

Last two things on this:

1. when I write a sloe, i provide comments similar to those in the students school eval. I generally never sandbag a student with neg feedback on a sloe unless it was feedback given to them in person or on their schools eval.

2. Like it or not, you are applying for a job still and the market dictates that you are not in the drivers seat. The market is in the employers favor. You may not like the rules, but you have to play the game. Dont like it? Tough. There's a thousand people behind you willing to play the game to compete. Im not saying this to be mean or harsh, Im saying it because its good advice. This is a competition. You are competing with thousands of students. You cant go into the super bowl and demand the nfl change the penalty rules because you dont like them. I share #2 bc I honestly think its good life advice that many wont tell you. Everything you want will not be given to you. You will not like certain rules, certain processes, etc. But in the end of the day, systems are built by the people in the driver seat. The market dictates who can be choosy and who cant. In three years, when you graduate from residency and you enter a market where are physicians are a shortage, you are in the driver seat. Hospitals have to compete for you. The situation is completely flipped. Do you think hospitals enjoy the fact that they have to continue to pay people more money, get bigger bonuses, develop recruitment strategies, etc. Nope. However, that's what the market dictates, and you have to do what you have to do to survive.

I wholeheartedly believe there are two types of people in this world. The people that read point #2 and get upset/angry/defensive and feel like the system is unfair and who will continue to complain. And the people that say "game on", who dont let the annoyances and hassles bother them, and who will run through a brick wall if its btw them and their goal. The world isnt built around you and its not always fair. Tough. Run through the wall.

 

[surely]

I agree, the more objective data the better. I get people dont like anonymous evals, but every year on SDN when it comes time for students to describe their rank lists and provide feedback on the places they interview, they do so anonymously. Why is that anonymous? Because its the only way to make sure it is honest and objective.

Not sure it's a fair comparison.

SLOEs: Important to students and programs, but not visible to students. Can make or break someone's chance at matching. If visible to the student, would help the student understand his/her competitiveness and decide how broadly to apply, resulting for a win-win for students and programs alike. Still relatively anonymous, since the feedback and tertile ranking can't be traced to any one attending or resident.

SDN feedback on programs: Important to students and programs, visible to both. Students and programs can both act on the information within. De-anonymizing this would not be a win-win, as it would not improve the actionability of the information for the program, but would open the student up to retaliation (see also: incident last year where a PD was able to identify the author of an anonymous ROL and called her out for previously stating she was enthusiastic about his program).

To put this back-and-forth into context, I don't think this is an End of the World concern by any means, but I do think the way SLOEs are handled could be optimized a bit without sacrificing utility. One day, when I'm in charge of CORD... and pigs are flying...

 

[Fetor Hepaticus]

Sir,

Just few quick questions which I know its probably silly for you but for me given that I never did ER rotation during medical school and when I did my rotation at my IM program which doesn't have ER residency... I am not sure what's considered gold standard..

What study material is considered as gold standard for EM while during residency and later preparing for board? For IM, its MKSAP and MedStudy

What about question bank? What's considered gold standard and what are other options out there? IM: MKSAP is gold standard but UWorld its highly recommended by all as well

Just wanted to get a head study after I am done with my ABIM exam... that's all. Thanks. =)

 

[gamerEMdoc]

Sir,

Just few quick questions which I know its probably silly for you but for me given that I never did ER rotation during medical school and when I did my rotation at my IM program which doesn't have ER residency... I am not sure what's considered gold standard..

What study material is considered as gold standard for EM while during residency and later preparing for board? For IM, its MKSAP and MedStudy

What about question bank? What's considered gold standard and what are other options out there? IM: MKSAP is gold standard but UWorld its highly recommended by all as well

Just wanted to get a head study after I am done with my ABIM exam... that's all. Thanks. =)

From a study standpoint, if you like a video based board review series Id say Hippo EM or the NEMBR Streaming course. Both are excellent streaming board review options.

From a question standpoint, ROSH review and PEER are the two most popular.

 

[Wroooong]

Thanks for answering our questions, gamerEMdoc. I have a specific one regarding my letters. I'm in the fortunate position that I'll have 2 SLOEs (Most likely H/H, maybe H/HP) by the 15th, plus a strong letter from an EM attending I worked with. Only issue is that neither of these SLOEs are really 'aways'. My school is affiliated with 2 EM residencies, one competitive one, one pretty good one. I couldn't get my desired away (on the west coast) until Oct. How limiting is not have a real away SLOE in my first batch? I'll of course add the new one in Nov, but that's a little late it seems.

 

[gamerEMdoc]

Thanks for answering our questions, gamerEMdoc. I have a specific one regarding my letters. I'm in the fortunate position that I'll have 2 SLOEs (Most likely H/H, maybe H/HP) by the 15th, plus a strong letter from an EM attending I worked with. Only issue is that neither of these SLOEs are really 'aways'. My school is affiliated with 2 EM residencies, one competitive one, one pretty good one. I couldn't get my desired away (on the west coast) until Oct. How limiting is not have a real away SLOE in my first batch? I'll of course add the new one in Nov, but that's a little late it seems.

That's going to be more than ok

 

[KShah1]

gamerEMdoc, I have two questions if you don't mind.

I am applying AOA and in terms of applications, I have 1 SLOE, and I have another pending. I'm also doing one more EM rotation after this one (my third). However, I heard some people have been receiving interview invites and what not. As such, would you recommend that I upload 2 other letters that aren't SLORS (IM) so that my application is complete or are these not really factors early in the game for interview invites? I was planning on uploading each SLOR as I get them, but wasn't sure if I should just upload 2 more strong letters so I can be complete in terms of letters.

Also, I have not taken COMLEX 2 CS but completed PE already with a pass. As such, how big of a disadvantage is this? I suspect this is the limiting factor more so then above but wanted to see what you thought about this.

Thanks!