EM PD - Ask Me Anything

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hey @gamerEMdoc thanks for doing this.
Question:
So I am a DO student with good board scores and lots of ECs. I had 1 audition lined up for august that just got cancelled (edit: and now will have to be online due to lack of open spots). So essentially, I will be applying with 2 non-residency EM SLOEs and a OSLOE from a residency program (ICU) at the institution I hope to match at. Does this put my app at a large disadvantage due to A. not have a residency SLOE and B. to not have 4 letters?
Thank you!
 
If all goes according to plan I should have 1 SLOE, 1 non-residency SLOE, and 1 narrative letter. Is this sufficient or should I try and ask for another letter?
 
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If all goes according to plan I should have 1 SLOE, 1 non-residency SLOE, and 1 narrative letter. Is this sufficient or should I try and ask for another letter?

Some programs want to see 4 LORs for an app to be marked complete, but I suspect that most who see 2-3 sloes in a normal year (1 this year) are content with that.
 
hey @gamerEMdoc thanks for doing this.
Question:
So I am a DO student with good board scores and lots of ECs. I had 1 audition lined up for august that just got cancelled (edit: and now will have to be online due to lack of open spots). So essentially, I will be applying with 2 non-residency EM SLOEs and a OSLOE from a residency program (ICU) at the institution I hope to match at. Does this put my app at a large disadvantage due to A. not have a residency SLOE and B. to not have 4 letters?
Thank you!

Yes it probably puts you at a disadvantage. How much of one, no one has any idea. We've never ever been through anything like this before.

Just out of interest, why are you not rotating in the ED at the institution you hope to match at?
 
Yes it probably puts you at a disadvantage. How much of one, no one has any idea. We've never ever been through anything like this before.

Just out of interest, why are you not rotating in the ED at the institution you hope to match at?
I am in VSAS limbo (not approved or denied), also we aren’t allowed to contact their clinical coordinator and mine at my school said that the EM elective was full. The other local institution isn’t taking outside students.
 
UPMC Pinnacle and UPMC Hamot still, to the best of my knowledge, have open audition slots this fall. They may not be where you want to match at, but they'll let you get a SLOE from an EM residency program.
 
hey @gamerEMdoc thanks for doing this.
Question:
So I am a DO student with good board scores and lots of ECs. I had 1 audition lined up for august that just got cancelled (edit: and now will have to be online due to lack of open spots). So essentially, I will be applying with 2 non-residency EM SLOEs and a OSLOE from a residency program (ICU) at the institution I hope to match at. Does this put my app at a large disadvantage due to A. not have a residency SLOE and B. to not have 4 letters?
Thank you!
ACOEP has a list of programs that still have audition rotation slots available for students. Check their social media pages.
 
Some programs want to see 4 LORs for an app to be marked complete, but I suspect that most who see 2-3 sloes in a normal year (1 this year) are content with that.

Is there anywhere we can check what a program requires to be marked complete? And is the "narrative letter" the MSPE/Dean's letter?
 
Is there anywhere we can check what a program requires to be marked complete? And is the "narrative letter" the MSPE/Dean's letter?

Maybe programs websites may include what they require to apply, but I’m not certain there is a central database that accurately has what each program requires. I presume that refers to the MPSE.
 
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Yeah we still have a ton of spots. I only have one student rotating this block. I'm sure plenty of places have spots. Not everyone uses vsas.

Do you think CORD was right in their 1-SLOE policy? I understand the extreme caution they took in order to equal the playing field as much as possible, but I've heard of a few programs that are gonna be using their sub-specialty rotations as a de facto EM rotation and have a good chunk of the rotation simply be EM shifts without any emphasis on the sub-specialty component. Would only still be getting a sub-specialty SLOE though.
 
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If all goes according to plan I should have 1 SLOE, 1 non-residency SLOE, and 1 narrative letter. Is this sufficient or should I try and ask for another letter?

I'd try and get one more letter, if possible. If you can't, don't sweat it.
 
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I'd try and get one more letter, if possible. If you can't, don't sweat it.
What about 1 SLOE, 1 OSLOE from my school's non-residency sub-I, 1 letter from an IM doc from 3rd year, and one narrative letter from the school? For some reason I was under the impression that 1 SLOE and 1 OSLOE was all we wanted to shoot for in order to limit aways we take up?
 
What about 1 SLOE, 1 OSLOE from my school's non-residency sub-I, 1 letter from an IM doc from 3rd year, and one narrative letter from the school? For some reason I was under the impression that 1 SLOE and 1 OSLOE was all we wanted to shoot for in order to limit aways we take up?

I think however you get to four letters, as long as one of them is a sloe from a residency, and especially if you have a second alternative sloe option (o-sloe, subspecialty sloe, nonresidency sloe), then you are good.
 
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Do you think CORD was right in their 1-SLOE policy? I understand the extreme caution they took in order to equal the playing field as much as possible, but I've heard of a few programs that are gonna be using their sub-specialty rotations as a de facto EM rotation and have a good chunk of the rotation simply be EM shifts without any emphasis on the sub-specialty component. Would only still be getting a sub-specialty SLOE though.

No. I think they should’ve limited it at two. However, once they did it, I tried to stay within the rules they set forth even though I didnt agree with them entirely.

This rule has completely gutted the number of rotators that I would normally have. We are operating at less than 50% capacity of students. We would have more than enough space to accommodate people doing a second rotation. It’s going to definitely hurt us in the match. But it is what it is.
 
No. I think they should’ve limited it at two. However, once they did it, I tried to stay within the rules they set forth even though I didnt agree with them entirely.

This rule has completely gutted the number of rotators that I would normally have. We are operating at less than 50% capacity of students. We would have more than enough space to accommodate people doing a second rotation. It’s going to definitely hurt us in the match. But it is what it is.

I have a strong feeling that literally all programs share your view. Hopefully, CORD decides to amend their original recommendation in light of the available slots nationwide!
 
I want to rotate with GamerEMDoc there I said it
 
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I have a strong feeling that literally all programs share your view. Hopefully, CORD decides to amend their original recommendation in light of the available slots nationwide!

They aren't going to ammend it. It would create chaos now changing the expectations.

This rule was basically nothing but a bailout for MD schools with onsite programs. For community programs and schools without home programs (DO schools) the rule never made any sense. MD schools didn't want there students to rotate outside of their system, they were clamping down and eliminating any aways. So this was going to disadvantage there students since they would only get one EM rotation. And so CORD "evened the playing field" by saying no one should do more than one.

It was dumb. MD students would have been just fine. There was no reason to say you couldn't do 2. I get that doing more than 2 could have created issues (like someone doing 7 when some people couldn't get one or two), but honestly, there was no reason to limit it at only 1 other than to appease big academic places that wanted to clamp down on their students rotating anywhere.
 
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Hi @gamerEMdoc, thanks for continuing to do this thread. What are your thoughts on applicants who apply to EM as well as another specialty? Do PDs generally ask students whether they're applying to anything else aside from EM, or if not, try to find that information out through other means? If you were to find out a student is applying to 2 specialties, would that information make you view that student more negatively or impact their ranking? This year is expected to be a particularly difficult match (especially for those applying outside their immediate geographic region), and I have heard some advice that it is reasonable to apply to 2 specialties to increase chances of matching in a particular region... but I am not sure how this would come across to a PD.
 
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@gamerEMdoc Is it considered a red flag to not honor your EM core? At my school (DO) our clinical grades are 100% shelf score and to honor you need 90%ile. I missed it by one point... Got a perfect eval from my preceptor (my core was at a ER with no residency), but will still just have a "P" for EM bc I didn't honor the shelf. I have 2 other clerkship honors if that matters in context lol.
 
Hi @gamerEMdoc, thanks for continuing to do this thread. What are your thoughts on applicants who apply to EM as well as another specialty? Do PDs generally ask students whether they're applying to anything else aside from EM, or if not, try to find that information out through other means? If you were to find out a student is applying to 2 specialties, would that information make you view that student more negatively or impact their ranking? This year is expected to be a particularly difficult match (especially for those applying outside their immediate geographic region), and I have heard some advice that it is reasonable to apply to 2 specialties to increase chances of matching in a particular region... but I am not sure how this would come across to a PD.

Looks bad to me unless the second specialty is a backup (ie ranking a few FP/IM programs to be safe while going for EM). As long as the primary specialty is EM, I don't think it looks bad. But if someone has 4 ortho publications and is the President of the ortho interest group, and applies EM, you probably just assume they are using you as a backup, and then that is a major turnoff. Why? Well, bc you know if a spot in their chosen field comes open down the road, they'll probably leave and take it. No reason to take that risk if you don't have to.
 
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@gamerEMdoc Is it considered a red flag to not honor your EM core? At my school (DO) our clinical grades are 100% shelf score and to honor you need 90%ile. I missed it by one point... Got a perfect eval from my preceptor (my core was at a ER with no residency), but will still just have a "P" for EM bc I didn't honor the shelf. I have 2 other clerkship honors if that matters in context lol.

The grading at every place is all over the place, especially at DO schools (some are PF, some Hon/P, some Hon, HP, P, some are letter grades, some are percentages)... there's just no standard. Even if it was, I don't think it matters without context. That's where the SLOE is helpful. The SLOE has a section as to what grade you assigned, and a percentage breakdown for how many you gave each grade for the sloes written the previous year. So missing honors at a place that gives 10% honors is VERY different than missing honors at a place that gives 90% honors. It's all about context.
 
Looks bad to me unless the second specialty is a backup (ie ranking a few FP/IM programs to be safe while going for EM). As long as the primary specialty is EM, I don't think it looks bad. But if someone has 4 ortho publications and is the President of the ortho interest group, and applies EM, you probably just assume they are using you as a backup, and then that is a major turnoff. Why? Well, bc you know if a spot in their chosen field comes open down the road, they'll probably leave and take it. No reason to take that risk if you don't have to.

As someone who has a bunch of ortho pubs but isn't applying ortho, this tightens my sphincter.
 
As someone who has a bunch of ortho pubs but isn't applying ortho, this tightens my sphincter.
But that suggests the question: did you change your mind? Or, were you of the mind that you intellectually favored ortho, but that's where it ended, when school ended? Or, if you are not into ortho, did you fake showing interest? I mean, if you are named in the pub, you didn't just crunch numbers or collect or enter data (especially if you have "a bunch"). Or, are your pubs all how ortho applies to EM? If you have ever attended ACEP, you might see EM folks that ARE really that into ortho.

See, these are questions that you may be asked. "Mr. KR, you've applied to EM, but you have many publications that are exclusively ortho. Tell me about that."
 
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Looks bad to me unless the second specialty is a backup (ie ranking a few FP/IM programs to be safe while going for EM). As long as the primary specialty is EM, I don't think it looks bad. But if someone has 4 ortho publications and is the President of the ortho interest group, and applies EM, you probably just assume they are using you as a backup, and then that is a major turnoff. Why? Well, bc you know if a spot in their chosen field comes open down the road, they'll probably leave and take it. No reason to take that risk if you don't have to.

That makes sense. What if the other specialty was neither a standard backup for EM, nor a much more competitive one with EM being the clear backup? Let's say anesthesia, or obgyn or such. Would that still look very bad to you?
 
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But that suggests the question: did you change your mind? Or, were you of the mind that you intellectually favored ortho, but that's where it ended, when school ended? Or, if you are not into ortho, did you fake showing interest? I mean, if you are named in the pub, you didn't just crunch numbers or collect or enter data (especially if you have "a bunch"). Or, are your pubs all how ortho applies to EM? If you have ever attended ACEP, you might see EM folks that ARE really that into ortho.

See, these are questions that you may be asked. "Mr. KR, you've applied to EM, but you have many publications that are exclusively ortho. Tell me about that."

Yea that makes sense. I went into med school with the sole intention of doing ortho and I was lucky enough to jump on with an attending at an academic hospital in town that wanted to do research but it wasn't at my home department so I was the only student on the projects. Only 2nd author on most but we cranked them out steady over 2 years. Now 3rd year hits and I'm like "uhhhh so about that 250 step 1 score I needed, thats gonna be a no from me dawg."
 
That makes sense. What if the other specialty was neither a standard backup for EM, nor a much more competitive one with EM being the clear backup? Let's say anesthesia, or obgyn or such. Would that still look very bad to you?

I've thought about this occasionally over the past few months, especially since I did not do any of my IM rotations due to COVID. While that may be seen as such blessing to those applying EM, I have wondered if I am doing myself a disservice by not experience general internal medicine. So, the thought of applying to both and deciding later in the fall has crossed my mind.
 
Very common to apply to EM and then IM as a backup.
I can think of 3 classmates doing this (we have a COVID panic chat group for all of us EM applicants). The plan is to go on with IM then CCM in case EM doesn't work out.

That's comforting to hear. I'm my own harshest critic -- I feel even peripherally entertaining another specialty while having just completed my only EM sub-i (and mostly enjoying it!) is a bit incongruous. It could be FOMO as well.

@gamerEMdoc maybe you can help me out -- what do you think are some tell-tale signs that someone is a better fit for hospital medicine versus emergency medicine? Do you view any of your residents or colleagues and say to yourself, "Man this person picked the wrong field," or some variation of that? I kinda crossed off IM after really not enjoying my Geriatrics rotation which was essentially a pseudo-IM rotation: come in at 5am to pre-round, round with attending, spend the rest of the day following up some details, leave at 5pm, and many hours in between of not do anything of much consequence, but I realize being a hospitalist or even a sub-specialist is a lot different than residency. And despite my comment a few messages before, I did do an elective with a hospitalist early on during third year (mainly because he was a chill preceptor). I thought a lot of the care provided was a bit boring and usually looked forward to his admitting shifts in the ED.

On the other side of things, I did about 20 shifts in the ED during third year as I picked up shifts with an attending I was friendly with (going on weekends or days off). I enjoyed those shifts too. I mean, I feel like its silly for me to even continue thinking like this I mean have a freaking Ultrasound rotation starting tomorrow so I think it may be more FOMO about finally going all-in on EM than missing out on some fable IM sub-specialty. Any advice or thoughts on my thought process. I am sure there are others in my boat...
 
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That's comforting to hear. I'm my own harshest critic -- I feel even peripherally entertaining another specialty while having just completed my only EM sub-i (and mostly enjoying it!) is a bit incongruous. It could be FOMO as well.

@gamerEMdoc maybe you can help me out -- what do you think are some tell-tale signs that someone is a better fit for hospital medicine versus emergency medicine? Do you view any of your residents or colleagues and say to yourself, "Man this person picked the wrong field," or some variation of that? I kinda crossed off IM after really not enjoying my Geriatrics rotation which was essentially a pseudo-IM rotation: come in at 5am to pre-round, round with attending, spend the rest of the day following up some details, leave at 5pm, and many hours in between of not do anything of much consequence, but I realize being a hospitalist or even a sub-specialist is a lot different than residency. And despite my comment a few messages before, I did do an elective with a hospitalist early on during third year (mainly because he was a chill preceptor). I thought a lot of the care provided was a bit boring and usually looked forward to his admitting shifts in the ED.

On the other side of things, I did about 20 shifts in the ED during third year as I picked up shifts with an attending I was friendly with (going on weekends or days off). I enjoyed those shifts too. I mean, I feel like its silly for me to even continue thinking like this I mean have a freaking Ultrasound rotation starting tomorrow so I think it may be more FOMO about finally going all-in on EM than missing out on some fable IM sub-specialty. Any advice or thoughts on my thought process. I am sure there are others in my boat...

I actually really liked IM. However, there were a few things that definitely pushed me towards EM instead. First, I disliked that the cases were mostly solved by the time you got them. I really like the undifferentiated case. Some people hate undifferentiated cases, and want an answer before they see them so they can go down a treatment algorithm. Others like the mystery.

Second, I really hated chronic care / outpatient medicine. I hated clinics so much. The last thing I ever wanted to do was manage someone's BP or DM on a chronic basis. For me, I loved acute care and acute care only.

Third, I felt like the vast majority of people going into IM weren't going into it for IM, but rather as a stepping stone to another field (cards, GI, nephrology, etc). That wasn't me. I really like having a broad knowledge base covering the gamut of medicine. I never wanted to subspecialize.

Fourth, IM isn't very procedural. Most procedures get consulted off in my experience. Once you subspecialize, the specialties have a ton. But IM residency, at least during my experiences as a student, they don't do many. And I love procedures.

All that being said, I could have been happy do IM, I just would have probably branched off into Pulm CC and just worked in an ICU.
 
I actually really liked IM. However, there were a few things that definitely pushed me towards EM instead. First, I disliked that the cases were mostly solved by the time you got them. I really like the undifferentiated case. Some people hate undifferentiated cases, and want an answer before they see them so they can go down a treatment algorithm. Others like the mystery.

Second, I really hated chronic care / outpatient medicine. I hated clinics so much. The last thing I ever wanted to do was manage someone's BP or DM on a chronic basis. For me, I loved acute care and acute care only.

Third, I felt like the vast majority of people going into IM weren't going into it for IM, but rather as a stepping stone to another field (cards, GI, nephrology, etc). That wasn't me. I really like having a broad knowledge base covering the gamut of medicine. I never wanted to subspecialize.

Fourth, IM isn't very procedural. Most procedures get consulted off in my experience. Once you subspecialize, the specialties have a ton. But IM residency, at least during my experiences as a student, they don't do many. And I love procedures.

All that being said, I could have been happy do IM, I just would have probably branched off into Pulm CC and just worked in an ICU.

Ya know, this is a great reply thanks. And while reading it, I kind of realized something -- and maybe it's a millennial thing idk -- but I think I was putting too much stock in the perfect specialty trope. I think on reflection, that probably does not hold true for many medical students and perhaps even attendings. We choose a specialty we enjoy and take the good with the bad. I've just come across medical students who talk about wanting to be a surgeon since they were nine or wanting to be a pediatrician since they were 18, and then I'm over here not sure if I made the right decision on which Netflix movie to watch tonight hahaha.
 
@gamerEMdoc Our school has advised that they expect this year to be a very 'local' match, with many students matching either to their home residency programs or in the immediate vicinity. I will be trying to match far outside of my geographic region, pretty much cross-country. I obviously will not be able to show my interest in any of those programs by doing an away this year. I also hear rumors that people will be applying broadly this year, since no one will be traveling for interviews and the cost of an additional application is so low. Given all that, are there any ways out-of-region applicants can demonstrate sincere interest to a PD to get an interview/serious consideration? For example, emailing a letter-of-interest directly to a PD before interview season starts, to explain why I am interested in their program even though I live and go to school across the country. Would PDs view something like this positively, or would they be likely to find it needy and annoying?
 
@gamerEMdoc Our school has advised that they expect this year to be a very 'local' match, with many students matching either to their home residency programs or in the immediate vicinity. I will be trying to match far outside of my geographic region, pretty much cross-country. I obviously will not be able to show my interest in any of those programs by doing an away this year. I also hear rumors that people will be applying broadly this year, since no one will be traveling for interviews and the cost of an additional application is so low. Given all that, are there any ways out-of-region applicants can demonstrate sincere interest to a PD to get an interview/serious consideration? For example, emailing a letter-of-interest directly to a PD before interview season starts, to explain why I am interested in their program even though I live and go to school across the country. Would PDs view something like this positively, or would they be likely to find it needy and annoying?

Do not start emailing programs for interviews now. It gets earlier and earlier every year and it annoys pds when you are only a month into interview season and people are already sending emails trying to get interviews. There are events like residency fairs for this reason. Make sure you attend (virtually) the emra residency fair and hit up all the programs in the region you want to be in and explain your situation. Its free, and its virtual this year, so there is really no downside to attend.
 
I have a dumb question that i'm sure has been covered before. I just finished my audition rotation. Do programs wait till ERAS opening date to upload my SLOE? I'm trying to figure out if i should ask them right now if they can send my SLOE in.

Most programs wait until closer to the date. SLOEs rankings are usually decided by a SLOE committee comparing all the students against each other as a group. So it doesn't make sense to write a SLOE in July if you haven't met the students from Aug/Sept yet. If they haven't uploaded it by Oct 1st, I think its reasonable to shoot an email to ask.

I usually tell students while on rotation just to ask the SLOE author what their process is to take away some of this anxiety. I usually try to tell students to expect it 2 weeks before ERAS opens for programs.
 
I know of program directors that have told their irl kids that are applying to EM to do more than 1 SubI and that PD's dont actually care. yeah the big academic places are super gung-ho about but most community places dont give a ****.

so that's great.
 
also I suspect that my SLOE will be harsh. on the SLOE website it says that a bottom 1/3 ranking is for applicants that will still match, but we all know in reality that an app with 1 eSLOE that says bottom 1/3 wont match
 
also I suspect that my SLOE will be harsh. on the SLOE website it says that a bottom 1/3 ranking is for applicants that will still match, but we all know in reality that an app with 1 eSLOE that says bottom 1/3 wont match

Dude I see you around this threat and others slinging BS about how the system is so unfair and designed against you and they’re secretly gonna DOA your app etc.

The data doesn’t lie. Low 1/3 matches, consistently. Low 1/3 students become bomb ass ER doctors all the time.

No you’re not matching Carolinas with a low 1/3. But you’ll match at a great program.
 
Dude I see you around this threat and others slinging BS about how the system is so unfair and designed against you and they’re secretly gonna DOA your app etc.

The data doesn’t lie. Low 1/3 matches, consistently. Low 1/3 students become bomb ass ER doctors all the time.

No you’re not matching Carolinas with a low 1/3. But you’ll match at a great program.

This might be an ignorant question but if it doesnt really matter whether your SLOE is good or bad, what's the point?
 
My first time around, I didn't match EM. I asked PD's for feedback on why I may not have matched. Aside from geography, they mentioned my one of my SLOEs was weak. Totally sunk me. Now, I have no idea about being ranked bottom 1/3 or not, so I can't comment on that.
 
Depends on the sloe. A low 1/3 sloe with no negative comments that was just at too competitive place for you, followed by better sloes? Not going to sink you. A low 1/3 SLOE filled with professionalism issues? Its gonna sink you.

The issue is the one sloe thing this year obviously. The fact that there isn't "room for improvement" very well could hurt students chances.
 
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This might be an ignorant question but if it doesnt really matter whether your SLOE is good or bad, what's the point?

Oh they matter. You CAN match with low 1/3 sloes. But you also very well may not. And you will very unlikely be matching at the top of your list. People with top 10 and top 1/3 sloes are often in the drivers seat of their match list.
 
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A program for an away needed paperwork to get us into their computer system by last Friday and I missed the email and didn't get it in until Monday.... someone tell me it's going to be okay? I haven't heard from them since and I'm having a mild panic attack on the daily thinking I screwed myself over for my 1 away... this isn't enough to take away a rotation is it?
 
A program for an away needed paperwork to get us into their computer system by last Friday and I missed the email and didn't get it in until Monday.... someone tell me it's going to be okay? I haven't heard from them since and I'm having a mild panic attack on the daily thinking I screwed myself over for my 1 away... this isn't enough to take away a rotation is it?

I mean its probably going to be ok, but idk, you should probably ask them? Like just call the program coordinator or whoever is the main contact for the rotation. Or whoever sent the email.
 
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I mean its probably going to be ok, but idk, you should probably ask them? Like just call the program coordinator or whoever is the main contact for the rotation. Or whoever sent the email.


I sent an email asking if they received my original email with the paperwork and haven't heard anything back, that was Monday. I've had issues with hearing back from them in that past, so I might call. Just didn't know if that would be too intrusive. I mean I still have 3 weeks until the rotation starts so it's not like it was paperwork due the week of the rotation
 
My first time around, I didn't match EM. I asked PD's for feedback on why I may not have matched. Aside from geography, they mentioned my one of my SLOEs was weak. Totally sunk me. Now, I have no idea about being ranked bottom 1/3 or not, so I can't comment on that.
Did you get into EM second time
 
@gamerEMdoc in your opinion what alternative sloes do you think will have “more weight” this year compared to prior years? You think it will be program dependent? Thanks.
 
I sent an email asking if they received my original email with the paperwork and haven't heard anything back, that was Monday. I've had issues with hearing back from them in that past, so I might call. Just didn't know if that would be too intrusive. I mean I still have 3 weeks until the rotation starts so it's not like it was paperwork due the week of the rotation

Just call, since it is time sensitive Use that as your excuse to call
 
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