EM PD - Ask Me Anything

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@gamerEMdoc ,

First I want to express overwhelming gratitude for spending your free time answering and helping medical students out on this forum. I've been following this thread intermittently since it started (back when I was a scribe in the ED years ago) and I'm genuinely surprised you have been able to continue with it -- that's awesome. As well, you visited my DO school last year in Pennsylvania and you and your residents had wonderful advice to offer.

On that note, I recently received my Step 1 score of 243, and wanted to know how I should view the score relative to the increasing competitiveness of Emergency Medicine? I was going through the interactive charting outcomes program, but given that my COMLEX was a subpar 538, I actually couldn't quite place where I stand as an applicant. I know it is a good score, but is it good enough for me to be selective (i.e. D.C. programs, university-affiliated programs), or will being a DO remain another obstacle at those program?

On a somewhat related note, I have noticed an uptick in EM residencies being created -- namely from HCA hospitals; I've talked to some EM docs who say this is being done by c-suites and health administrators to bring the wages down in the specialty? Any thoughts on this?

Again, thanks for all you do!
 
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Doctor_Strange said:
First I want to express overwhelming gratitude for spending your free time answering and helping medical students out on this forum. I've been following this thread intermittently since it started (back when I was a scribe in the ED years ago) and I'm genuinely surprised you have been able to continue with it -- that's awesome. As well, you visited my DO school last year in Pennsylvania and you and her residents had wonderful advice to offer.
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You are very welcome. I'm genuinely surprised it still exists too. I promise to keep answering as long as people keep asking questions, I just always assumed eventually everyone would have lost interest in hearing me talk about SLOEs by now. Now I'm hoping that doesn't happen until I get this to at least 100 pages!

It's pretty cool that you got to be there for one of the EM interest group AMA sessions at your school. We are coming back this fall I think for another one, and our faculty are even talking about possibly arranging an US workshop at your school sometime in the future, but who knows how the logistics of that will work or what kind of time-frame that will be. I wish I could get out to more schools, its always fun to come out and talk to a lot of med students who are just trying to navigate what specialty to apply to, especially DO school where there just isn't as much of a EM presence so I like trying to do my part in helping students navigate there way in this specialty.

Doctor_Strange said:
On that note, I recently received my Step 1 score of 243, and wanted to know how I should view the score relative to the increasing competitiveness of Emergency Medicine? I was going through the interactive charting outcomes program, but given that my COMLEX was a subpar 538, I actually couldn't quite place where I stand as an applicant. I know it is a good score, but is it good enough for me to be selective (i.e. D.C. programs, university-affiliated programs), or will being a DO remain another obstacle at those program?
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DO will only be an obstacle at programs that don't really take DOs, regardless of scores. Otherwise, your scores are decent enough to match in EM. EM isn't is competitive as you may think. Sure, there are very competitive programs, but there's also programs where your scores will be more than competitive enough for. The match rate for a DO in the ACGME match in 2018 with a COMLEX of 500-550 was 83%. Your scores are more than good enough to match, your match success will depend on your SLOEs.

Doctor_Strange said:
On a somewhat related note, I have noticed an uptick in EM residencies being created -- namely from HCA hospitals; I've talked to some EM docs who say this is being done by c-suites and health administrators to bring the wages down in the specialty? Any thoughts on this?
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I think CMGs open residencies because they are looking at residencies as a business model that provides inexpensive government subsidized labor to staff their hospital and later becomes a recruiting pool for future staffing. I don't think their is anything more nefarious about it than that, I don't think their is any grand conspiracy by HCA administrators to flood the market to drive down salaries. They are simply using an EM residency as a staffing model.
 
gamerEMdoc said:
You are very welcome. I'm genuinely surprised it still exists too. I promise to keep answering as long as people keep asking questions, I just always assumed eventually everyone would have lost interest in hearing me talk about SLOEs by now. Now I'm hoping that doesn't happen until I get this to at least 100 pages!

It's pretty cool that you got to be there for one of the EM interest group AMA sessions at your school. We are coming back this fall I think for another one, and our faculty are even talking about possibly arranging an US workshop at your school sometime in the future, but who knows how the logistics of that will work or what kind of time-frame that will be. I wish I could get out to more schools, its always fun to come out and talk to a lot of med students who are just trying to navigate what specialty to apply to, especially DO school where there just isn't as much of a EM presence so I like trying to do my part in helping students navigate there way in this specialty.



DO will only be an obstacle at programs that don't really take DOs, regardless of scores. Otherwise, your scores are decent enough to match in EM. EM isn't is competitive as you may think. Sure, there are very competitive programs, but there's also programs where your scores will be more than competitive enough for. The match rate for a DO in the ACGME match in 2018 with a COMLEX of 500-550 was 83%. Your scores are more than good enough to match, your match success will depend on your SLOEs.



I think CMGs open residencies because they are looking at residencies as a business model that provides inexpensive government subsidized labor to staff their hospital and later becomes a recruiting pool for future staffing. I don't think their is anything more nefarious about it than that, I don't think their is any grand conspiracy by HCA administrators to flood the market to drive down salaries. They are simply using an EM residency as a staffing model.
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Thank you for a detailed reply!
 
How formal should the personal statement be?

My school advisor is a former path pd and she said my statement was alright but gave a lot of suggestions on making the language more formal.
 
Sorry if this has been answered elsewhere.. I couldn't find updated advice. How extensively should we include activities during undergrad? Jobs, volunteering, medical Extracurriculars, anything? I was planning to stick to only medical school experiences, but now rethinking.
 
Hey Gamer,

My first rotation said they plan to upload their SLOEs next Monday the 16th. There isn't much I can do about it but how much do you think that one day lapse is going to hurt my app? Everywhere seems to stress the "be complete by the 15th" and it's got me worried. Second and third sloes to be uploaded awhile later.

Cheers for all the advice in this thread, you're a legend.
 
mancub said:
Hey Gamer,

My first rotation said they plan to upload their SLOEs next Monday the 16th. There isn't much I can do about it but how much do you think that one day lapse is going to hurt my app? Everywhere seems to stress the "be complete by the 15th" and it's got me worried. Second and third sloes to be uploaded awhile later.

Cheers for all the advice in this thread, you're a legend.
Click to expand...
Would also love to hear an answer for this.

I completed 3 aways already (May, June, July), but none of the programs will be able to upload a sloe by sept 15th which I’m pretty bummed about.
 
This is probably a silly question, but I’ve grown a beard since my ERAS pic and I plan to keep it during interview season. Do I need to take an updated picture? Does this matter?
 
medhopeful82 said:
Sorry if this has been answered elsewhere.. I couldn't find updated advice. How extensively should we include activities during undergrad? Jobs, volunteering, medical Extracurriculars, anything? I was planning to stick to only medical school experiences, but now rethinking.
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Jobs/employment history is important. I would only otherwise include major awards or major activity, don’t include small volunteering things or clubs you were in.

Don’t overlook the importance of an employment history. I can’t be the only person who reviews the applications that considers it a bonus when you see somebody who had a service industry job like a bartender or waiter / waitress. Customer service skills are a huge part of our job, like it or not. Knowing that someone can deal with the American public without strangling them is always a bonus.
 
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attitudeofgratitude said:
How formal should the personal statement be?

My school advisor is a former path pd and she said my statement was alright but gave a lot of suggestions on making the language more formal.
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Write it like a normal person. Not like you are texting. But also not like Shakespeare.
 
pb34 said:
This is probably a silly question, but I’ve grown a beard since my ERAS pic and I plan to keep it during interview season. Do I need to take an updated picture? Does this matter?
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No, I’m pretty sure programs will be able to figure out it’s still you.
 
The Knife & Gun Club said:
Would also love to hear an answer for this.

I completed 3 aways already (May, June, July), but none of the programs will be able to upload a sloe by sept 15th which I’m pretty bummed about.
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This happens every year. Don’t worry just yet. Many programs right group SLOE’s. That’s what court recommends. Maybe we’ll meet in early September to decide what the rankings for all the students are rotated so for that year will be, and then will write them just before application season. We met at the beginning of September and I did all mine last week.

I know this can be stressful and confusing for students. I make a point of it to tell all the students that rotate earlier in the year that I will in fact have their SLOE written by September 15, but it’s not gonna happen until mid-September right before the deadline because of how our sloe process is. So far that has held off a ton of anxious emails on my end.
 
mancub said:
So I was told by the programs my SLOEs probably won’t be uploaded before Sep 15th.

Do I submit on the 15th anyway? Do I wait for the first SLOE to be submitted? If I do submit on the fifteenth do I have to update all the programs once my SLOE comes in? I have a non SLOE LOR in ERAS already.

As always, thanks for the advice!
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Yes, you should submit. I emailed the clerkship director in charge of one of my SLOEs and they don't even plan to have them ready before October 1st...
 
SLOE timeline update: PD at the current rotation said as long as a SLOE is in prior to Oct 1st (the dean's letter) applicants should be fine
 
My third LOR won't be in until right before Oct. 1st. I only have 1 SLOE and 1 LOR from different specialty. Is my app going to be considered incomplete until I get at least 3 LORs uploaded?
 
Dear GamerEMDoc,

Thanks for all the help.

Had a question:

I'm an old grad IMG with a range of work experiences since graduation.

Should I list the non-medical work experiences together as one work experience titled (non-medical work experiences), or is it better to list them individually?
 
Sorry to bother you @gamerEMdoc, but I had a quick question about personalized personal statements.

Im thinking of using my normal personal statement (1 page), plus tacking on about 1/3 page of "Why XYZ program" to the end of the PS for a few select schools. Would this be looked down upon because now I have a total of 1 and 1/3 pages of writing total in the PS section?
 
blah12346497 said:
My third LOR won't be in until right before Oct. 1st. I only have 1 SLOE and 1 LOR from different specialty. Is my app going to be considered incomplete until I get at least 3 LORs uploaded?
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Also needing this answer plz....
 
TexasMedicine said:
Also needing this answer plz....
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It will be program dependent. For the most accurate information, look at a program’s website for their application requirements. Most of them explicitly state their LOR and application requirements.

There are variations of anywhere from 2-3 LORs, and anywhere from 1, 2, or 3 SLOEs minimum or preferred, or some programs don’t explicitly state they require SLOEs, but just at least one LOR from an EM faculty member. There are all kinds of different requirements and you just gotta look for yourself.
 
The Knife & Gun Club said:
Sorry to bother you @gamerEMdoc, but I had a quick question about personalized personal statements.

Im thinking of using my normal personal statement (1 page), plus tacking on about 1/3 page of "Why XYZ program" to the end of the PS for a few select schools. Would this be looked down upon because now I have a total of 1 and 1/3 pages of writing total in the PS section?
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You can answer "why this program" on your interview. I don't think its necessary to put it in your personal statement. For a program, if I see that, I know they are writing the something different for every program they apply to. Which means they are being a bit disingenuous.
 
gamerEMdoc said:
Just wanted to say good luck to everyone now that apps are submitted! I was on ERAS Sunday afternoon already browsing applications. Hard to believe it’s that time of year already!
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What can we do when all our SLOE writers still haven't uploaded? Is it going to hurt my application and should I send emails updating all the programs once I do have my SLOEs in?
 
Dont start emailing programs this early. First, most programs are even looking at applications until October anyway. Second, you’re going to have one chance of emailing programs later to inquire about an interview. You dont want to contact them multiple times inquiring about your app. It is way too early to be emailing them.

Email the sloe authors and ask them for a timeframe when they anticipate the sloes to get written.
 
How bad is a Pass grade on an away rotation? Pretty disappointed needless to say.
 
g0tsnaked said:
How bad is a Pass grade on an away rotation? Pretty disappointed needless to say.
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Depends on the place. If they give 80% of their grades as HP or Honors, then that puts you in the bottom 1/4 and that doesn't look good. But if they only give 20-30% HP/Honors, then its not a big deal at all. Places with a decent grade distribution (how it should be in my opinion) where the higher grades are reserved for the truly standout students, a pass at a place like that is what the majority get.
 
@gamerEMdoc Thanks for doing this! I've been following this a lot and appreciate all you do for us! I have a question of my own - I have a misdemeanor charge that had a dispo of "deferred judgement" that was eventually expunged. The incident was almost a decade ago, and was a major lapse in judgement. Because of the expungement, I said no to the questions no ERAS asking if I was ever convicted or if I was concerned about future licensing, but just yesterday I was told by one of my friends a rumor that some states go absolute laser focused on your history and may reveal records, INCLUDING expungements if they were to do a thorough gvt check. Is this true, and if so, what should I do? I don't want to just shoot myself in the foot for no reason but I also don't want to come off as a jackass attempting to slide by the administration.

Thanks again.
 
Smurf4halp said:
@gamerEMdoc Thanks for doing this! I've been following this a lot and appreciate all you do for us! I have a question of my own - I have a misdemeanor charge that had a dispo of "deferred judgement" that was eventually expunged. The incident was almost a decade ago, and was a major lapse in judgement. Because of the expungement, I said no to the questions no ERAS asking if I was ever convicted or if I was concerned about future licensing, but just yesterday I was told by one of my friends a rumor that some states go absolute laser focused on your history and may reveal records, INCLUDING expungements if they were to do a thorough gvt check. Is this true, and if so, what should I do? I don't want to just shoot myself in the foot for no reason but I also don't want to come off as a jackass attempting to slide by the administration.

Thanks again.
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I mean at this point, your app is submitted so there isnt anything you can do. All you could do is be honest if you match at a place and the background check turns it up and it becomes an issue. You answered the questions honestly as you saw them at the time. Nothing you can do now.
 
Does it matter when during interview season that you schedule your interview? Is earlier better than late?
 
Hi Gamer, if we already have 3 SLOE's (I have 2 from residency programs and 1 from a non-residency third year EM elective) is there any point to asking for additional SLOE's from future auditions? I am currently in an audition that will end mid October and then I have another right after that will end mid November (both include an interview). I feel like I don't technically need these SLOE's but do you think the program will look down on it if I don't request one from them? Do they want to see their own SLOE in terms of my application to them on ERAS or is it enough to be here for a month and interview at each of these places while I'm here?

Thanks in advance!
 
Stephanopolous said:
Hi Gamer, if we already have 3 SLOE's (I have 2 from residency programs and 1 from a non-residency third year EM elective) is there any point to asking for additional SLOE's from future auditions? I am currently in an audition that will end mid October and then I have another right after that will end mid November (both include an interview). I feel like I don't technically need these SLOE's but do you think the program will look down on it if I don't request one from them? Do they want to see their own SLOE in terms of my application to them on ERAS or is it enough to be here for a month and interview at each of these places while I'm here?

Thanks in advance!
Click to expand...

I heard it doesn't count as a SLOE if it's from 3rd year but I'd be curious to see what he says
 
Stephanopolous said:
Hi Gamer, if we already have 3 SLOE's (I have 2 from residency programs and 1 from a non-residency third year EM elective) is there any point to asking for additional SLOE's from future auditions? I am currently in an audition that will end mid October and then I have another right after that will end mid November (both include an interview). I feel like I don't technically need these SLOE's but do you think the program will look down on it if I don't request one from them? Do they want to see their own SLOE in terms of my application to them on ERAS or is it enough to be here for a month and interview at each of these places while I'm here?

Thanks in advance!
Click to expand...

You really only need 2 sloes from residency programs. I don't believe anyone needs more than 3 max. So these late rotations aren't really expected to need SLOEs in most cases unless a student couldn't secure more early rotations. Sometimes students ask me for one in November, sometimes they don't. The ones that do I often ask them how many they already have and if they tell me 3 or 4, I flat out ask them if they really want me to write one or if its just out of courtesy they are asking. I honestly don't want to waste my time writing a letter on someone just because they feel like they HAVE to ask me to write one. So don't feel bad not asking for a SLOE. First, letter writers just went through their busy season, they are relieved not to have to write more letters. Second, they understand the process and realize that if this is your 4-5th EM rotation, you don't need a SLOE from them.
 
teeayejay said:
I heard it doesn't count as a SLOE if it's from 3rd year but I'd be curious to see what he says
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Every letter COUNTs, but there is a hierarchy to letters...

1. SLOEs from residency programs.





2. Non-residency SLOEs and subspecialty sloes
3. Generic LORs


There is a big gap between #1 and all other letters. But since 2 SLOEs are really the only necessary number of SLOEs needed, as long as you get 2 from a residency program, other non-residency sloes, subspecialty sloes, and generic LORs are fine to submit as long as you have 2 SLOEs from a residency program.
 
pb34 said:
Does it matter when during interview season that you schedule your interview? Is earlier better than late?
Click to expand...


Hey gamer, not to be a bother, but I wanted to see if you had an opinion on this? Thanks!
 
@gamerEMdoc sorry to ask yet another SLOE question but I just received my first one from an away rotation I did in June. Obviously I can’t know for sure where I am in the SLOE hierarchy but we also have a school mandated eval that the program has to complete and the program directors comments were “consistently excelled at HPIs and follow up, delight to have at our program, will be a good resident” but also that I was “At the average level of my peers” No negative comments.

I’m probably thinking waaaaay too much into this but it sounds like it’s probably a middle 1/3 SLOE. I did take an NBME type exam which I scored slightly below the average. Any thoughts?

PS: as always, thanks for all your advice and insight!
 
4thyeartoss said:
@gamerEMdoc sorry to ask yet another SLOE question but I just received my first one from an away rotation I did in June. Obviously I can’t know for sure where I am in the SLOE hierarchy but we also have a school mandated eval that the program has to complete and the program directors comments were “consistently excelled at HPIs and follow up, delight to have at our program, will be a good resident” but also that I was “At the average level of my peers” No negative comments.

I’m probably thinking waaaaay too much into this but it sounds like it’s probably a middle 1/3 SLOE. I did take an NBME type exam which I scored slightly below the average. Any thoughts?

PS: as always, thanks for all your advice and insight!
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Reading into school evaluations to figure out SLOEs is really tough, because some programs are very direct in their school evaluations, and some sugar coat them and make everyone sound good, then turn around and do the opposite in their SLOEs. Some people just will not give any negative feedback, no matter what, unless its blinded. Best guess would be that its a middle 1/3 since they said you were average level of your peers, but who knows. Its probably not a top 10. And its probably not a low 1/3.
 
4thyeartoss said:
@gamerEMdoc sorry to ask yet another SLOE question but I just received my first one from an away rotation I did in June. Obviously I can’t know for sure where I am in the SLOE hierarchy but we also have a school mandated eval that the program has to complete and the program directors comments were “consistently excelled at HPIs and follow up, delight to have at our program, will be a good resident” but also that I was “At the average level of my peers” No negative comments.

I’m probably thinking waaaaay too much into this but it sounds like it’s probably a middle 1/3 SLOE. I did take an NBME type exam which I scored slightly below the average. Any thoughts?

PS: as always, thanks for all your advice and insight!
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stay golden ponyboy

"will make a good resident" is nioce
 
Thank you so much Gamer!!!! I know I always say this but you're help means a lot, especially for me coming from a new school with not a lot of access to advisement on these topics.

One other question I have- I scheduled an interview to a program for November and for financial reasons it would be ideal to try and lump a few interviews from this area together, if possible. My school is also giving me that week off so there's even more of an incentive to interview that week as much as I can, to avoid taking time off from rotations. Is it rude to e-mail programs (I was thinking of waiting until 10/1) that I applied to in that area, to let them know I'll be in the area in case they were potentially considering me for an interview?

Thanks!
 
Stephanopolous said:
ring me for an interview?
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It's not rude to email program coordinators, but emailing programs that early when most of them haven't even started looking at applications is probably not going to gain you much traction, and you definitely don't want to have to keep emailing them multiple times. Programs aren't looking at apps this early, at least many aren't. Maybe they are looking at local ones. Maybe. But just because ERAS opened doesn't mean anyone is judging applications. Once MPSEs are released, then most programs will begin the process of looking at applications.

Sept 15th is merely just the day for apps to be submitted. Its not a day when all programs hunker down to start looking at everything. They wait because there is no MPSE and they wait because they know many students don't have their SLOEs yet.

So if you contact programs on 10-1 asking to bunch your interview for another one close by in November, the reality is, they may not even get to look at your app until November. So I wouldn't bank on this strategy working. If you are really worried about trying to batch interviews in a specific area together, then you may want to push back that interview, because tons of interviews are still coming out in November.
 
gamerEMdoc said:
It's not rude to email program coordinators, but emailing programs that early when most of them haven't even started looking at applications is probably not going to gain you much traction, and you definitely don't want to have to keep emailing them multiple times. Programs aren't looking at apps this early, at least many aren't. Maybe they are looking at local ones. Maybe. But just because ERAS opened doesn't mean anyone is judging applications. Once MPSEs are released, then most programs will begin the process of looking at applications.

Sept 15th is merely just the day for apps to be submitted. Its not a day when all programs hunker down to start looking at everything. They wait because there is no MPSE and they wait because they know many students don't have their SLOEs yet.

So if you contact programs on 10-1 asking to bunch your interview for another one close by in November, the reality is, they may not even get to look at your app until November. So I wouldn't bank on this strategy working. If you are really worried about trying to batch interviews in a specific area together, then you may want to push back that interview, because tons of interviews are still coming out in November.
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You have to be tired of typing the same thing, "most programs aren't looking at apps this early" hahaha
 
teeayejay said:
You have to be tired of typing the same thing, "most programs aren't looking at apps this early" hahaha
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I need dot phrases for:

You only need 2 sloes

Programs arent looking at apps until Oct

Your chance of matching depends on your sloes not your step score

Applying to every single program doesnt increase your match success. Apply smart within your region and to programs you’d be competitive at.
 
Hey Gamer, thanks again for all your help so far! With interviews coming up, do you have any advice on how to do well during interviews? What questions are appropriate to ask the faculty and residents during the interview? How do we figure out if we fit in well with the program in the limited time we have during the interview?
 
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