EM PD - Ask Me Anything

[gamerEMdoc]

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Is there any precedence to starting residency early?

This is what I signed up for, I'd rather be helping in any capacity than waiting while I "shelter in place." I realize that as an intern my confidence can be my greatest liability, but I don't expect to be working as a provider. Any job from cleaning to drive thru testing will allow me to contribute.

No. And I'm not even sure of the logistics. You'd have to graduate to get a training liscense. Every new hospital employee and volunteer has to go through all the HR/on boarding training, let alone all the medical orientation for a new trainee that takes forever. I highly doubt places are going to want to do all that orientation stuff for one person that wants to start early, only to then do it all again. Your time will come soon enough, but I appreciate the go getter attitude.

If anything, I've been wondering quite a bit how places will plan on altering their on boarding and orientation. With large groups being banned, conferences going virtual, and pretty much any hospital meeting that isn't related to COVID being cancelled, I have no idea how the plans to orient new trainees will occur as this drags on. I also don't know how programs in fields that match a significant number of non-US IMGs are going to get their trainees if travel bans in certain countries remain in place or if travel bans get more stringent, which is more than less likely to occur.

Lots of questions, few answers. Super exciting and nerve wracking at the same time to watch something like this play out. People are constantly trying to think on their feet and figure things out. We are moving our lecture series to an online meeting space, a good bit of our conference is based on the flipped classroom model of learning and requires group participation, so it could be a challenge. But we have a decent plan laid out. My next step after looking apps for rotation is to start to plan for what happens if schools ban away rotations and we can't have anyone rotate. Especially if schools don't allow students to do in person rotations. I've considered trying to come up with ideas for a simulation based rotation centering around directed readings and oral board simulation cases, along with participation in our weekly conferences. IDK if its something realistic that I'd be able to handle.

At the very least, once I'm more familiar with virtual conferences and meetings, I thought I'd offer to do virtual AMA Q+A sessions for any EM interest groups that don't have decent advisers at their school (I'm looking at you DO schools). I go to one med school every year and do a long Q+A session about EM and applying to EM for 2nd years, but doing it virtually would allow 3/4's to participate (who are all over the place in DO schools).

I don't know, times are changing. I'm just trying to figure out how I can reach out to students to help advise them on the match if I can't have students rotate. I may have a lot of free time on my hands.

 

[gamerEMdoc]

Got my list. Keeping my mouth shut for 24 hours is one of the hardest days of the year. Good luck tomorrow all.

 

[gamerEMdoc]

Haha over or under on your ROL total slot prediction?

Under. I guessed 40, we matched 8 of our top 1/3. Statistically our best match in the ACGME match yet.

 

[AppleB]

Hey, long time lurker,
Not sure if this is a silly question, but do you think it is still valid to apply on VSAS even though my target programs are saying we are not accepting students at the moment due to COVID?
I don’t want to miss out on any opportunity and but don’t want to seem annoying.
Thanks

 

[gamerEMdoc]

Hey, long time lurker,
Not sure if this is a silly question, but do you think it is still valid to apply on VSAS even though my target programs are saying we are not accepting students at the moment due to COVID?
I don’t want to miss out on any opportunity and but don’t want to seem annoying.
Thanks

I don't know; this is an unprecedented situation. If a place isn't accepting applications, why would they still receive apps on VSAS?

 

[gamerEMdoc]

FYI...

I know the need for SLOE transperancy is something students and programs will never agree upon. But I did want to update students on something that happened, because I think it pretty much ends the chance of SLOEs EVER being transparent in the future. Apparently a student got a hold of a SLOE in the SOAP process word for word, and then made hostile threats regarding legal action against the program that wrote it. This led to complaints to CORD and CORD released a statement clarifying SLOEs and waivers of the right to see letters based on the ERAS terms and conditions. Once waived, apparently in the ERAS Terms and Conditions, that means students are to know absolutely nothing about the content of the letters, and programs that violate that could lose access to ERAS services and the ability to write letters in the future.

While I'm usually pretty tight lipped about individual sloe content, I've tried to give students an idea of their competitiveness in vague feedback. Definitely something I'm just not going to be able to do even vaguely. All discussion about SLOEs with students will be off the table now for all programs if people are obeying the rules, and those that don't could face severe repercussions.

Thought you all should be aware. Sorry.

 

[attitudeofgratitude]

FYI...

I know the need for SLOE transperancy is something students and programs will never agree upon. But I did want to update students on something that happened, because I think it pretty much ends the chance of SLOEs EVER being transparent in the future. Apparently a student got a hold of a SLOE in the SOAP process word for word, and then made hostile threats regarding legal action against the program that wrote it. This led to complaints to CORD and CORD released a statement clarifying SLOEs and waivers of the right to see letters based on the ERAS terms and conditions. Once waived, apparently in the ERAS Terms and Conditions, that means students are to know absolutely nothing about the content of the letters, and programs that violate that could lose access to ERAS services and the ability to write letters in the future.

While I'm usually pretty tight lipped about individual sloe content, I've tried to give students an idea of their competitiveness in vague feedback. Definitely something I'm just not going to be able to do even vaguely. All discussion about SLOEs with students will be off the table now for all programs if people are obeying the rules, and those that don't could face severe repercussions.

Thought you all should be aware. Sorry.

That’s insane. It seems like a great way to be blackballed from EVERY EM program ever. Heck from every residency ever if word got around.



That being said… I sympathize with the student. A lot. I understand the anger and confusion that comes with slowly realizing you’ve been lied to and your career is over before it ever began. When you have another wise fine application and you aren’t getting interviews… you start to think… is it my SLOEs? But no everyone gave me overall positive feedback. Everyone said my SLOEs would be fine. People who can read my SLOEs say they’re fine and not to worry…



Now I think… add on the heightened emotions of SOAP week. The straight adrenaline, the not sleeping or eating… I can see how someone would do something that stupid.



The weird thing is that people think the solution is LESS transparency. As if everyone who has to SOAP without other red flags won’t figure out “it’s the SLOES” (from reading GamerEM repeating it 20 times on the match thread ). Maybe if there was more honest and open feedback students could assess their situation, improve, and not be in a terrible situation feeling like they’d been stabbed in the back.

 

[gamerEMdoc]

That’s insane. It seems like a great way to be blackballed from EVERY EM program ever. Heck from every residency ever if word got around.



That being said… I sympathize with the student. A lot. I understand the anger and confusion that comes with slowly realizing you’ve been lied to and your career is over before it ever began. When you have another wise fine application and you aren’t getting interviews… you start to think… is it my SLOEs? But no everyone gave me overall positive feedback. Everyone said my SLOEs would be fine. People who can read my SLOEs say they’re fine and not to worry…



Now I think… add on the heightened emotions of SOAP week. The straight adrenaline, the not sleeping or eating… I can see how someone would do something that stupid.



The weird thing is that people think the solution is LESS transparency. As if everyone who has to SOAP without other red flags won’t figure out “it’s the SLOES” (from reading GamerEM repeating it 20 times on the match thread ). Maybe if there was more honest and open feedback students could assess their situation, improve, and not be in a terrible situation feeling like they’d been stabbed in the back.

I agree that transparency would aid in the process for students, but I also agree with CORD that if it was completely transparent, then SLOEs would become pretty useless, everyone would just say nice things. They'd be worthless.

I always thought there should be some middle ground, and I thought the role of a good adviser was to be that middle ground. Basically read the sloes, relay some general advise based on the SLOEs but not disclosing what's in them. And to an extent that can still happen. CORD suggested advisers can still tell candidates if they are competitive or not, but that's pretty much it. Any specific details at all about the content of the SLOEs is off limits.

 

[Gustavo99]

I agree that transparency would aid in the process for students, but I also agree with CORD that if it was completely transparent, then SLOEs would become pretty useless, everyone would just say nice things. They'd be worthless.

I always thought there should be some middle ground, and I thought the role of a good adviser was to be that middle ground. Basically read the sloes, relay some general advise based on the SLOEs but not disclosing what's in them. And to an extent that can still happen. CORD suggested advisers can still tell candidates if they are competitive or not, but that's pretty much it. Any specific details at all about the content of the SLOEs is off limits.

Do EM Advisors at our home institutions see our away SLOEs? Mine gave me the impression during advising sessions that they didn't know, and were giving me advice by taking into consideration what I thought my SLOE grades were at aways.

 

[gamerEMdoc]

Do EM Advisors at our home institutions see our away SLOEs? Mine gave me the impression during advising sessions that they didn't know, and were giving me advice by taking into consideration what I thought my SLOE grades were at aways.

Depends if they have access to eras. I do, but not all our faculty do. Also, if they interviewed you, they would have access to them. Alternatively, the EM PD or program coordinator would have access to ERAS and could get them for them.

 

[Doctor_Strange]

FYI...

I know the need for SLOE transperancy is something students and programs will never agree upon. But I did want to update students on something that happened, because I think it pretty much ends the chance of SLOEs EVER being transparent in the future. Apparently a student got a hold of a SLOE in the SOAP process word for word, and then made hostile threats regarding legal action against the program that wrote it. This led to complaints to CORD and CORD released a statement clarifying SLOEs and waivers of the right to see letters based on the ERAS terms and conditions. Once waived, apparently in the ERAS Terms and Conditions, that means students are to know absolutely nothing about the content of the letters, and programs that violate that could lose access to ERAS services and the ability to write letters in the future.

While I'm usually pretty tight lipped about individual sloe content, I've tried to give students an idea of their competitiveness in vague feedback. Definitely something I'm just not going to be able to do even vaguely. All discussion about SLOEs with students will be off the table now for all programs if people are obeying the rules, and those that don't could face severe repercussions.

Thought you all should be aware. Sorry.

Wow, that answers why that student was SOAP-ing anyhow...

 

[UCLABruwins]

With the now endless hours to fill with everything closed and the cancellation of all post-match trips, do you think residency program's may allow allocated educational stipends for use of EM related educational materials prior to starting officially in July?

 

[WildcatS11]

Under. I guessed 40, we matched 8 of our top 1/3. Statistically our best match in the ACGME match yet.

Congrats man that’s great!

 

[gamerEMdoc]

With the now endless hours to fill with everything closed and the cancellation of all post-match trips, do you think residency program's may allow allocated educational stipends for use of EM related educational materials prior to starting officially in July?

IDK, I doubt it, because that all comes out of a budget by academic year. However, most programs are moving to virtual conferences. I'm considering inviting all our new matches to ours once we get it up and running, it would be totally voluntary on their end but may give them something to do if they are bored out of their mind right now. So I suppose you could inquire at the place you matched about attending their virtual conference assuming they are doing that.

 

[Mat the coolcat]

FYI...

I know the need for SLOE transperancy is something students and programs will never agree upon. But I did want to update students on something that happened, because I think it pretty much ends the chance of SLOEs EVER being transparent in the future. Apparently a student got a hold of a SLOE in the SOAP process word for word, and then made hostile threats regarding legal action against the program that wrote it. This led to complaints to CORD and CORD released a statement clarifying SLOEs and waivers of the right to see letters based on the ERAS terms and conditions. Once waived, apparently in the ERAS Terms and Conditions, that means students are to know absolutely nothing about the content of the letters, and programs that violate that could lose access to ERAS services and the ability to write letters in the future.

While I'm usually pretty tight lipped about individual sloe content, I've tried to give students an idea of their competitiveness in vague feedback. Definitely something I'm just not going to be able to do even vaguely. All discussion about SLOEs with students will be off the table now for all programs if people are obeying the rules, and those that don't could face severe repercussions.

Thought you all should be aware. Sorry.

While I completely understand this, it's also very hard to stomach. Not everyone writes SLOE's fairly, and I think if this kind of scrutiny is going to happen, there should be some kind of tighter regulations/rules on how SLOE's are made. Lot's of loop holes can happen (unfortunately was the brunt of one), where one person ends up writing a backstabbing and biased SLOE that brings the applicant to their knees in the SOAP.

I know it's uncommon (as it should be), but as someone who went through this and SOAP'ed to a TRI last year because of this and heard "YOU didn't match??" many times this year, I don't like this.

Oh and without that bad SLOE, I matched EM this year. 🙂

 

[boolin_1]

I am finding out programs to apply to via VSAS. How late is too late if their application is already open? For example, I have a friend who matched IM in Brooklyn, and I see some programs from Brooklyn opened 3/1 and I am thinking of applying there. I'm from the south and I want a rotation up north somewhere so I can break some of the regional bias.

Basically, how late is too late for applying to VSAS programs?

 

[gamerEMdoc]

I am finding out programs to apply to via VSAS. How late is too late if their application is already open? For example, I have a friend who matched IM in Brooklyn, and I see some programs from Brooklyn opened 3/1 and I am thinking of applying there. I'm from the south and I want a rotation up north somewhere so I can break some of the regional bias.

Basically, how late is too late for applying to VSAS programs?

I doubt it is too late, but I'm not sure how you are going to know unless you just apply? You could always email the program coordinator and ask them if they are still accepting apps via VSAS or if they are full.

 

[gamerEMdoc]

While I completely understand this, it's also very hard to stomach. Not everyone writes SLOE's fairly, and I think if this kind of scrutiny is going to happen, there should be some kind of tighter regulations/rules on how SLOE's are made. Lot's of loop holes can happen (unfortunately was the brunt of one), where one person ends up writing a backstabbing and biased SLOE that brings the applicant to their knees in the SOAP.

I know it's uncommon (as it should be), but as someone who went through this and SOAP'ed to a TRI last year because of this and heard "YOU didn't match??" many times this year, I don't like this.

Oh and without that bad SLOE, I matched EM this year. 🙂

I totally agree, but I don't know how it can be fixed. Personally, I don't let one bad SLOE faze me when ranking candidates, I look at all the SLOEs as a complete picture. If all SLOEs are low 1/3 with damning comments, I'm probably not interviewing that person and if I am, they are likely low on the list. But a single bad SLOE with otherwise fine SLOEs is a perfectly rankable candidate. I have residents in my program who had a bad SLOE. Its one persons opinion. The only time Im going to trust one persons opinion is if I wrote it.

 

[awkitkat]

I am finding out programs to apply to via VSAS. How late is too late if their application is already open? For example, I have a friend who matched IM in Brooklyn, and I see some programs from Brooklyn opened 3/1 and I am thinking of applying there. I'm from the south and I want a rotation up north somewhere so I can break some of the regional bias.

Basically, how late is too late for applying to VSAS programs?

I would email the coordinator before applying on VSAS if the application has been opened for a while. Last year, I applied to some that were still “open” on VSAS but we’re actually already full.

 

[joeschmoejohndoe]

CORD put out a statement in terms of COVID's effect on away rotations and application components. How seriously do you expect that these recommendations will be followed:
a) I'm not very familiar with them, are they an organization with any actual sway in the field or did a group of docs just slap a name on an org they created? and b) they are expressed as recommendations and not mandates (will people actually follow them)
It seems like most of my classmates are still planning on applying to multiple aways, will I be disadvantaged if I follow these guidelines?

https://www.cordem.org/globalassets...ittee-in-emergency-medicine-_-white-paper.pdf

 

[gamerEMdoc]

CORD is the group that invented and studied the SLOE (they invented it in 1997 I think), changes it from time to time, etc. CORD stands for Council of Residency Directors (for EM) but its not just a group of PDs. To simplify, its basically the EM group for residency admin/academics types focused on residency and student education. SAEM is also an academic group as well, but their more research focused. An oversimplification because there is overlap there.

How much will programs use their suggestions? Who knows. They carry immense weight in the academic EM world. But this is an unprecedented time in history and we have no clue how any of this will play out. We could all have normal rotations and everyone will expect 2 SLOEs. We could shut down all med student rotations for a year and schools shut down and we have no match next year (highly doubt that). My point is, we have never lived through anything like this, and probably will never again. Everything is changing by the day. So I don't think anyone knows how this is all going to shake out right now.

My best guess is, how programs interpret apps will just depend on what happens, not CORDs recommendation from a few weeks ago. If this all blows over and rotations are business as usual, programs are going to expect 2 sloes just like they always have. If it doesn't and there is mass cancellation of rotations, then they won't because they can't because no one will have them.

 

[deuist]

No. And I'm not even sure of the logistics. You'd have to graduate to get a training liscense.

I have read that several medical schools are trying to graduate their fourth year students early so they can start work as residents. Like you, I just do not understand how the logistics of graduating medical school early is going to be of any benefit. Are these residents who are starting early and off cycle expecting to graduate early as well? How long does it take a hospital to secure a training license? How is HR supposed to ensure that everyone gets health insurance and other necessary benefits?

 

[Enik]

Hi GamerDoc, I need your help with my situation. I had a bad sloe really screw with my season followed by 2nd sloe which didn't get uploaded till end of October (i suspect it was luke warm). Long story short I had 2 more EM sloes which didn't get submitted until after January so I don't think they mattered at that point. I got high 240s on both steps and went on 9 Interviews... didn't match. Going to start pre-lim surgery at a super busy penetrating trauma center. Luckily my pre-lim program allows for 3 elective months. I'm looking how to come out on top of this next year.
1. How do I address not matching in my PS?
2. The place I'm at does not have an EM residency... should I ask an individual doc or the EM PD to write a sloe for me? Also should I still include 2 sloes from last season both of which gave me an H? I
3. How many apps should I send out? I sent out 50 initially and 50 more (in November) this season. When I re-apply to some of the same places will they see me as a re-applicant? Should i target different areas ? or is applying to same places I've already applied to worth the shot.
4. Any other tips ? I feel like I got screwed big time by something that's unknown to me. I rotated at a program that gave me an H and the PD told me how much he would love for me to come there and that my app was glowing... He didn't rank me to match. Im 99% certain that there is no comments about me being not receptive to feedback, professionalism or any negative character traits... that's just not me.

 

[gamerEMdoc]

I have read that several medical schools are trying to graduate their fourth year students early so they can start work as residents. Like you, I just do not understand how the logistics of graduating medical school early is going to be of any benefit. Are these residents who are starting early and off cycle expecting to graduate early as well? How long does it take a hospital to secure a training license? How is HR supposed to ensure that everyone gets health insurance and other necessary benefits?

no, my understanding is it doesn’t count for their time in training. Basically it allows them to be paid at an intern rate. You dont even have to have matched at that program. One of my matched residentsis from a NY med school and was offered to graduate early and work in NY as an intern early. Then I guess she would be let go to start residency.

Idk. I’m not really sure it’s a really good idea for students to be doing this. I get the desire to make a little bit of money, but it’s not like New York City residencies pay well, and that’s a pretty damn dangerous situation to be in right now. Especially if you’re just going to be going there and working for a month or two before moving to your own residency. You’re putting a lot of things at risk. Including starting your own residency on time. I personally wouldnt do it but to each their own.

 

[gamerEMdoc]

1. How do I address not matching in my PS?

Be open and honest about it, its ok to say you didn’t apply as broadly as you should have; stress the skills you’ve gained by doing a prelim year, etc.

2. The place I'm at does not have an EM residency... should I ask an individual doc or the EM PD to write a sloe for me? Also should I still include 2 sloes from last season both of which gave me an H?

I’d try and reuse any SLOEs that you think will be good if the places that wrote them will reupload them. I’m not sure what you mean by asking the EM PD, you said the place doesn’t have an EM residency. Why would they have a PD? Do you mean the Dept Chair? Or do you mean your prelim PD?

Personally I think if you can get what you perceive to be your two best SLOEs from last year reuploaded, then I’d get a letter from your prelim PD and maybe a letter from the ED chair or a doc in their ED. If they don’t have a residency, unless they write a bunch of SLOEs for med students that rotate in the ED, then it doesn’t make sense to get a SLOE from them.

3. How many apps should I send out? I sent out 50 initially and 50 more (in November) this season. When I re-apply to some of the same places will they see me as a re-applicant? Should i target different areas ? or is applying to same places I've already applied to worth the shot.

I’d apply to anywhere within the region where your school was, where your prelim year is, and where your home town is. Then fill in the rest with programs you’d view as not real competitive. Re-applicants have to realize the chances are lower when they try to reapply. Don’t shoot too high.

4. Any other tips ? I feel like I got screwed big time by something that's unknown to me. I rotated at a program that gave me an H and the PD told me how much he would love for me to come there and that my app was glowing... He didn't rank me to match. Im 99% certain that there is no comments about me being not receptive to feedback, professionalism or any negative character traits... that's just not me.

A few things.

First, you may not have been screwed by your SLOEs, you may have been screwed by your timing. You had one SLOE which you think was bad until the end of Oct. This means when most programs decided on the bulk of their interviews, you had one SLOE and its wasn’t good. And you had only applied to 50 places. Then you finally got a 2nd, and you think it was pretty average. I assure you no one even saw the last two SLOEs if they were being uploaded in January. That was way too late to be getting letters. I realize that if that was the only time you could get rotations, you have to do what you do. But this was not well planned out.

Second, the program that said they liked you may have liked you. That doesn’t mean they should rank you to match. I have students in my top 30 every year that I’d be THRILLED to match, but if I match 8 of my top 15 one year (unlikely), and I don’t get the stellar candidate that is ranked at like 17... oh well. Doesn’t mean I wouldn’t love to match #17, but sometimes a program has a great year in the match. Students often times really like their 2nd and 3rd programs on their lists, but when they match at their #1, I doubt many of them feel like liers because they said they really liked their 2nd/3rd programs. It is what it is. That program director may have really honestly liked you and would have been happy had you matched there. But that doesn’t mean you warranted to be ranked to match. Those are two very different things.

My main advice would be to ask whoever wrote two SLOEs that you think will be your best if they would be willing to reupload them for this coming application year when you reapply. If they will, that will make your road ahead much easier. Try to get an EM rotation early on. Since they have so much elective time, you could possibly explore if they have ever had a resident do an outside rotation, and if so you could always try and get a rotation at a place with a residency working as a resident in the ED for the month. Not all places allow this, and it will take time to setup since you’d need to have a program letter of agreement to do so. But if it is an option, that would definitely be good.

 

[Enik]

^^^ Thank you so much for the advice !!! you're a saint.

 

[adrenalinejunkie]

@gamerEMdoc absolutely down for a virtual Q&A and can get my school's EMIG involved too

Question for ya: Making my 3rd year rotation schedule and along with our core rotations: FM, IM, etc, we need to do 1 elective and 1 GME elective during third year. I plan to do my elective early on (EM at a local hospital to get my feet wet) and I want to do my GME elective in April or May (near the end of 3rd year) and was wondering if there were any EM residencies in the country that take rising 4th years. Programs that I've researched so far won't take anyone March, April, May, or June. Just trying to see if it's plausible to get one SLOE under my belt prior to July. I figured you may know the answer to this or point me in the right direction - thank you!

 

[gamerEMdoc]

^^^ Thank you so much for the advice !!! you're a saint.

sainthood isnt granted until after death. Sooooo.... it may be a few weeks until you can say that!

 

[kaygeebee]

@gamerEMdoc thanks so much for being so helpful, especially for those of us who attend schools with zero EM advising who are figuring everything out on our own

 

[gamerEMdoc]

@gamerEMdoc thanks so much for being so helpful, especially for those of us who attend schools with zero EM advising who are figuring everything out on our own

Always, I'm gonna help for as long as I can, which hopefully is at least another 40 years or so. More time to post when I'm retired! Lets hope we all make it to then and can have a good chuckle when the thread gets to its 10,000th page.

 

[gamerEMdoc]

FYI all 3rd year SDN folks, I'm currently looking through apps for next years rotations. If you did contact me before asking about a rotation, do me a favor and send me a PM so I can look out for your app when I go through them.

 

[gamerEMdoc]

For 4th years who's schools have closed down, if you want to get a head start on residency, ALIEM has a great free 8-week bridge to EM study primer. You do one EMRAP C3 podcast a day, one blog topic review, and ECG cases. It's a 5 day a week schedule over 8 weeks. All resources are free. It's really well laid out.

If there are 3rd years that want to apply to EM next year and you have a few months off thanks to social isolation, this would be a really great primer leading into your 4th-year rotations and would really put you way ahead of the game from an EM knowledge base perspective.

I know for many, this time off is much needed and the last thing people want to do is study, but I've been asked a lot about resources of what you can do with rotations being canceled, so I thought I would pass this along.

Bridge to EM: Senior Medical Student Curriculum (2nd Edition, Updated 2024)

"Bridge to EM" is an 8-week curriculum for senior medical students, who are preparing to start residency in emergency medicine.

www.aliem.com

 

[gamerEMdoc]

Been a rough couple weeks for many of my colleagues and former residents around the country. Just at the tip of the iceberg in our area personally, so I expect April/May will be rough. Kudos to any residents/attendings and students (if there are any) that are still fighting the good fight out there in the ED. Same to all members of the healthcare team (midlevels, nurses, techs, medics, etc). When this is all said and done, the country will move on an never remember what all of us in healthcare faced, much in the same way the country waves the flag and celebrates the military when a war first starts and then quickly forgets them a little while later. But we in healthcare should never forget the sacrifices every one of us made. I'm super proud of the entire medical community for the guts they've shown and will continue to show in the face of this. Much like the WWII generation is the greatest generation, I think we are quickly proving ourselves to be the greatest healthcare generation. Doctors, nurses, techs... all putting their own health, and their families, at risk for the greater good in a race to combat this. Its an incredible display of courage that all of you in the healthcare community should be inspired by. So much of the daily news and social media cycle focuses on the negatives (the deaths, the quarantines, the lack of PPE, the treatment by admin, etc). But I do think everyone should take a second each day and realize really what we are doing. We'll almost certainly never see anything like this again in our lifetime. Or our children or grandchildren's lifetime. The people on the front lines of this crisis will always remember and never forget. Much love and respect to all of you out there.

 

[Mat the coolcat]

Been a rough couple weeks for many of my colleagues and former residents around the country. Just at the tip of the iceberg in our area personally, so I expect April/May will be rough. Kudos to any residents/attendings and students (if there are any) that are still fighting the good fight out there in the ED. Same to all members of the healthcare team (midlevels, nurses, techs, medics, etc). When this is all said and done, the country will move on an never remember what all of us in healthcare faced, much in the same way the country waves the flag and celebrates the military when a war first starts and then quickly forgets them a little while later. But we in healthcare should never forget the sacrifices every one of us made. I'm super proud of the entire medical community for the guts they've shown and will continue to show in the face of this. Much like the WWII generation is the greatest generation, I think we are quickly proving ourselves to be the greatest healthcare generation. Doctors, nurses, techs... all putting their own health, and their families, at risk for the greater good in a race to combat this. Its an incredible display of courage that all of you in the healthcare community should be inspired by. So much of the daily news and social media cycle focuses on the negatives (the deaths, the quarantines, the lack of PPE, the treatment by admin, etc). But I do think everyone should take a second each day and realize really what we are doing. We'll almost certainly never see anything like this again in our lifetime. Or our children or grandchildren's lifetime. The people on the front lines of this crisis will always remember and never forget. Much love and respect to all of you out there. View attachment 300247

Hell yeah man!

 

[pillowsnice]

How does the introvert succeed in meshing well with the residents in a away rotation? I'm not the typical outdoorsy, extroverted type of person that EM seems draw in, and I feel that sometimes it takes time for people to get to know me. Is this going to be a death sentence for my SLOEs? How do I make myself stand out in a good way?

Im particularly worried about this that you mentioned a few months back:
"I know of one case, through SDN. Good applicant, very good student. Had outstanding boards and went to a great school. They had two sloes that probably sandbagged his chances, I think its because they were both from pretty competitive places and they were a very quiet person. So they probably didn't stand out on rotation much and their SLOEs suffered because they were rotating with some of the best of the best people unfortunately. Still should have matched in my opinion, they had like 14 interviews at great places. So it can happen, its just highly highly unlikely."

 

[hopefulERdoc251]

Hi @gamerEMdoc, quick question regarding aways. With all the turmoil regarding CoVID, would you recommend e-mailing coordinators to see if they're still considering applications? I have about 10-12 applications sent out and have heard radio silence from everybody except for one which I had applied to before the CoVID issue. Don't wanna come off as annoying. Thanks!

 

[gamerEMdoc]

Hi @gamerEMdoc, quick question regarding aways. With all the turmoil regarding CoVID, would you recommend e-mailing coordinators to see if they're still considering applications? I have about 10-12 applications sent out and have heard radio silence from everybody except for one which I had applied to before the CoVID issue. Don't wanna come off as annoying. Thanks!

Yeah, I think its reasonable to email coordinators to find out if their institutions are going to be having rotations or not.

 

[gamerEMdoc]

How does the introvert succeed in meshing well with the residents in a away rotation? I'm not the typical outdoorsy, extroverted type of person that EM seems draw in, and I feel that sometimes it takes time for people to get to know me. Is this going to be a death sentence for my SLOEs? How do I make myself stand out in a good way?

Im particularly worried about this that you mentioned a few months back:
"I know of one case, through SDN. Good applicant, very good student. Had outstanding boards and went to a great school. They had two sloes that probably sandbagged his chances, I think its because they were both from pretty competitive places and they were a very quiet person. So they probably didn't stand out on rotation much and their SLOEs suffered because they were rotating with some of the best of the best people unfortunately. Still should have matched in my opinion, they had like 14 interviews at great places. So it can happen, its just highly highly unlikely."

I don't know the answer to this question. EM is a very social field, requiring constant communication. So people who just kind of keep to themselves and are very quiet kind of stick out in the ED. That doesn't mean you need to suddenly become a super social person and all of a sudden be the life of a party. The ED is a work environment, most of the communication that is going on during a busy shift is about work and patient care. You have to be effective at doing that, seeing people, presenting cases, and communicating about followup of people. If you just sit by yourself and keep to yourself and avoid discussing cases, or telling someone you rechecked on someone and they are worse, etc... there is no way of knowing what you are doing, what your thought process is, and if you are even interested in being there.

So don't worry about this from a social standpoint. Some people are more introverted socially and that is totally ok. If it is really slow one shift and you don't want to chit chat about sports, the news, your interests, or whatever, I doubt anyone is going to care. Its more important that you effectively communicate regarding patient care. That is what you are auditioning for.

 

[pillowsnice]

I don't know the answer to this question. EM is a very social field, requiring constant communication. So people who just kind of keep to themselves and are very quiet kind of stick out in the ED. That doesn't mean you need to suddenly become a super social person and all of a sudden be the life of a party. The ED is a work environment, most of the communication that is going on during a busy shift is about work and patient care. You have to be effective at doing that, seeing people, presenting cases, and communicating about followup of people. If you just sit by yourself and keep to yourself and avoid discussing cases, or telling someone you rechecked on someone and they are worse, etc... there is no way of knowing what you are doing, what your thought process is, and if you are even interested in being there.

So don't worry about this from a social standpoint. Some people are more introverted socially and that is totally ok. If it is really slow one shift and you don't want to chit chat about sports, the news, your interests, or whatever, I doubt anyone is going to care. Its more important that you effectively communicate regarding patient care. That is what you are auditioning for.

Thank you! I have done a EM rotation already at my home institution and I felt that I was fine at communicating patient care, it was the social aspect that worried me more.

 

[Mat the coolcat]

Thank you! I have done a EM rotation already at my home institution and I felt that I was fine at communicating patient care, it was the social aspect that worried me more.

I have a couple friends that are introverted EM residents that were worried about this as well when they were in your shoes, and honestly probably half of them went on to do critical care fellowships, which made total sense. The others are just complete machines in the ED that work straight through the shift without taking little breaks to chit chat. They have their little corner, and everyone just lets them be unless they need something.

Agree with everything Gamer said, also would like to add that you should try to just make sure you show them you're compassionate. Often times introverts (in any specialty) get misconstrued as uncaring, even though this obviously isn't true.

Good way to do this without changing your personality/mentality is just adding little blurbs in your presentations about the patient's perspective/feelings and how you took that into consideration when coming to your plan. You know, all that humanistic stuff that we all blew off til the next OSCE...haha.

Best of luck!

 

[clocks123]

With the likelihood that many students will not be able to do aways this year, what do you feel like would be the most important part of the application? Will having zero SLOEs (from not having a home EM program) be unintentionally looked down upon compared to those who have 1 SLOE?

 

[gamerEMdoc]

With the likelihood that many students will not be able to do aways this year, what do you feel like would be the most important part of the application? Will having zero SLOEs (from not having a home EM program) be unintentionally looked down upon compared to those who have 1 SLOE?

I don't know because I've never been involved with a global pandemic like this before and programs have never faced this from a program or med school perspective. So I have no idea. No one does. CORD said we should take this into account when looking at apps next year, but programs can't be forced to do so. If someone has no SLOEs and other people somehow get 2, they may still just look at the people with 2. Programs can do whatever they want.

I suspect it will come down to statistics. If 90% of students have no SLOEs, then programs will be forced to not look at SLOEs. If 90% of students have at least 1 SLOE, but only 10% have more than one then programs will put weight in 1 SLOE. How programs view the weight of the SLOE will all be dependent on how many they start seeing applicants have, and they'll have to adjust their expectations accordingly.

I don't think anyone can predict right at this moment how all of this will shake out. This could be a two-year problem considering a vaccine won't be available for another 18 months. We may see a giant spike then level off in summer, only for the fall/winter to see another huge spike. If schools just don't let their students rotate during any of this time, then I'd imagine their students won't graduate. What schools are doing now, pulling everyone off rotation, is fine for 2 months. But if this is a 2-year problem, then there has to be some sort of plan going forward because we can't expect students to have zero clinical experience and just be able to start residency.

My point is, there is a lot up in the air right now. I don't see many thoughts about the long term on this from a planning perspective, even though the CDC director has said this is a 2-year process we'll be going through. It seems like everyone is just looking at this month to month and hoping it goes away. So right now we are all just stuck going month to month and seeing what happens.

 

[Enik]

@gamerEMdoc

I have a small dilemma and I was hoping you'd chime in. As you know I did not match this year. I got 4 SLOES last season and 2 of them (H, H) I believe are really good (although one of the places did not match me). Anyhow, I plan to re-apply gas and EM next this season and have my first elective as gas and i have option of doing an elective in EM at a neighboring hospital (my hospital does not have home EM program) to potentially get a new SLOE. However, if I spend 2 months my my intern year on electives, it will give me little time to work and interact with my surgery prelim PD and i fear that asking him for a LOR might be difficult. I don't know how we get evaluated on electives but If i have 0 face time with the PD by the time September comes around I don't know if he would write me a strong LOR (which from my understanding is just as important as a SLOE). What do you feel would be the better course of action.

 

[gamerEMdoc]

Do the electives and get the LOR from your surgery PD a little later in the season. I'd rather see a more recent SLOE than a PD LOR anyway if you can get one. Interview season runs through January, you'll have time to get the PD letter in.

 

[Stephanopolous]

For 4th years who's schools have closed down, if you want to get a head start on residency, ALIEM has a great free 8-week bridge to EM study primer. You do one EMRAP C3 podcast a day, one blog topic review, and ECG cases. It's a 5 day a week schedule over 8 weeks. All resources are free. It's really well laid out.

If there are 3rd years that want to apply to EM next year and you have a few months off thanks to social isolation, this would be a really great primer leading into your 4th-year rotations and would really put you way ahead of the game from an EM knowledge base perspective.

I know for many, this time off is much needed and the last thing people want to do is study, but I've been asked a lot about resources of what you can do with rotations being canceled, so I thought I would pass this along.

Bridge to EM: Senior Medical Student Curriculum (2nd Edition, Updated 2024)

"Bridge to EM" is an 8-week curriculum for senior medical students, who are preparing to start residency in emergency medicine.

www.aliem.com

I tried looking into this but it seems like you need an EMRA membership, I had one but it expired. Its saying I need $195 for the resident/student membership 😱

 

[EMikate]

I tried looking into this but it seems like you need an EMRA membership, I had one but it expired. Its saying I need $195 for the resident/student membership 😱

Steph, I've been doing the non-EMRA stuff until I get my new residency EMRA membership. There are two articles/podcasts per day and 3 EKGs that you don't need EMRA membership for. I'll go back and do all the EMRA stuff once I get my membership renewed!

 

[Stephanopolous]

I tried looking into this but it seems like you need an EMRA membership, I had one but it expired. Its saying I need $195 for the resident/student membership 😱

Smart! Thanks Em <3

 

[hopefulERdoc251]

@gamerEMdoc

Hi Gamer, sorry for the repeated tag. I was wondering if you think it'd be worth doing an Audition rotation in October - November? So far I have 0 aways but just received info that one program has availability in Late October - Early November. I will have 1 to 2 SLOE's from my home institution (our hospital system has 2 residency programs at separate places that home students may be able to rotate through). Would you think it'd be worth while getting a second or third SLOE that late in the cycle? Thanks!

 

[gamerEMdoc]

On a NORMAL year you only need 2 SLOEs. You do not need more than 2 SLOEs. You only need 2 SLOEs. So you should go on enough rotations to get 2 SLOEs. That way you get your 2 SLOEs.

Hahaha. Sorry to be repetitive, but I just wanted to make that as very clear because I get asked all the time about what if I can't get a third SLOE by date X. It's an irrelevant question, but its something that just keeps getting asked.

As for your personal question, take the rotation when you can get it. If you already have 2 sloes and don't need that one, great. A third rotation is fine because it will still give you facetime at another residency program. If you want to get a SLOE from that one just to have another because the rotation went great, fine. So I would take it. But don't worry if you only have two SLOEs by Oct/Nov because...

You only need 2 sloes.

 

[The Knife & Gun Club]

On a NORMAL year you only need 2 SLOEs. You do not need more than 2 SLOEs. You only need 2 SLOEs. So you should go on enough rotations to get 2 SLOEs. That way you get your 2 SLOEs.

Hahaha. Sorry to be repetitive, but I just wanted to make that as very clear because I get asked all the time about what if I can't get a third SLOE by date X. It's an irrelevant question, but its something that just keeps getting asked.

As for your personal question, take the rotation when you can get it. If you already have 2 sloes and don't need that one, great. A third rotation is fine because it will still give you facetime at another residency program. If you want to get a SLOE from that one just to have another because the rotation went great, fine. So I would take it. But don't worry if you only have two SLOEs by Oct/Nov because...

You only need 2 sloes.

I feel like this may be a year where getting 3 sloes May even be looked down upon - how do you feel about that?

In the recent aliem podcast about SLOEs the 3 PDs/aPDs they had on seemed to suggest students shouldn’t be doing more aways than necessary because there will be such a shortage this year.

They seemed to agree on 1, MAYBE 2 slows being sufficient and 3 being a bit disrespectful.

I don’t envy what all the students and program leadership are gonna have to go through this year.