EM PD - Ask Me Anything

[gamerEMdoc]

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Like you, I've always been interested in the academic side of medicine/teaching and mentoring others. Which is why I'm considering taking an extra year between 2nd and 3rd year to be a teaching fellow. During this year, I have the option to get my MBA as well - while being on admin is a possibility wayyy down the line, I've never really considered getting a MBA. For the more competitive EM programs (like say EM programs in CA), how does an additional degree like a MBA or MPH look on an application? I know you've reiterated many times that SLOEs are #1 then board scores. So should I just save money and not go for an extra degree during that time? For those competitive programs in CA, should one consider research?

SLOEs are #1. I don't know that I've said boards are #2. Boards help you get interviews, but I'd venture to guess they do far less at getting you ranked highly on places lists. After SLOEs, I think the most important thing is the interview itself. How people fit in with the feel of the residency. Anything you do to make yourself more unique as a candidate will help with more competitive programs. Remember, there are many many people out there with great sloes and great scores. These programs have to compare and contrast some of the best of the best. So while things like research or an MBA isn't going to make a difference in your ability to match in EM, they COULD make a difference in the ability to match in a very specific program if its something that program values.

You also mentioned that you did a month of EM research - was that at your medical school or did you arrange for that?

My med school required a research project to graduate. I did a research elective my fourth year, and did it at a local residency program with one of their 3rd years. Just so happens, I really enjoyed the program, ranked them first, and ended up doing my residency there.

After reading through all your posts, I am genuinely interested in checking out your program - is it taboo to reveal where you work? If so, I'll just PM you!

Feel free to PM me. I generally don't post it openly bc I don't want people to think I'm here trying to recruit people.

What are sleepy EDs? Tried to do a simple Google search without any luck.

Slower EDs. There are many EDs out in more rural places that see very few people. You can work a night shift at one of our affiliated ED's that our residents sometimes moonlight at and see less than 5 people in 12 hours.

 

[gamerEMdoc]

I just got my step score, it's in the 200-210 range (US Student) even though I spent 9 months preparing along side my classes and seemed to spend more hours studying than my classmates. I know EM is growing rather fast and becoming more competitive. Realistically, how many programs do you think would not filter me out? What would you say I need to get on step 2 to even consider trying to match into EM if I'm willing to send out 100+ applications? Any advice for someone in my position other than trying to kill step 2?

I totally agree with the above posters. You can still match in EM. But you'll need decent SLOEs. Bad sloes will kill almost anyones app, even if they have oustanding scores. So if scores are lower, if you get bad sloes, its over. Assuming your SLOEs are decent, then you definitely have a shot. You can't fail step 2 (that would be a huge red flag), and you'll need to improve some. I'd be very aggressive about targeting community EM programs that are considered less competitive (bc of geography, newness, etc) in terms of getting rotations/sloes and during the application process.

 

[gamerEMdoc]

I just spend the last 24 hours reading through every post on this 20-page thread, and I have to say, @gamerEMdoc, you are a gem - I sincerely hope that you will still be around SDN and willing to help us out in a couple of years!

Well, if you spent 24 hours reading... I suppose I'll stick around a bit longer.

In all seriousness, I'm not going anywhere. This is a fun hobby of mine. I really enjoy coming here for the conversation with students and helping them navigate the waters of the pathway to EM. I'll be here as long as I am welcome.

 

[Apollyon]

In all seriousness, I'm not going anywhere. This is a fun hobby of mine. I really enjoy coming here for the conversation with students and helping them navigate the waters of the pathway to EM. I'll be here as long as I am welcome.

Screw you, pogue! GTFO NAO!

Oh, wait - you said "students". My bad! Sorry!

 

[gamerEMdoc]

Thanks for all the advice so far in the forum. Was wondering whether some programs such as yours might put added value on applicants being prior military/combat veterans in screening for interview invites?

Yes and no. I think everyone's prior work experience is relevant, not just military experience. I think its wonderful when candidates have experience in the military, however I think it can sometimes lead to a disadvantage if that experience was 4 years as a GMO. Life if they graduated med school then did 4 years as a GMO attached to a Marine Unit. They have to go from a leadership role into being an intern. They are far far removed from medical school or seeing really sick patients. That can be a downside. But all things considered, I think prior service is a positive. Full disclosure, I went through the HPSP program and was a Navy EM doc. I got out of the military 7 years ago.

 

[PowerfulDRE]

Whats the verdict on number of SLOEs? My home EM chair says that this year 2 SLOEs is all you need. Right now I have 1 SLOE from my home rotation and am going to be getting 1 SLOE from an away rotation but am getting kind of worried because most people are getting three.

 

[gamerEMdoc]

2 should be all you ever need any year. The last PD survey on this I saw showed about 95% of programs ok with 2. Something like 80% were ok with just 1.

The advantage of having enough rotations to get 3 is that it gives you flexibility if one rotation doesn't go as well as you expected. Lets say you get your grade/eval back and its very negative. Then you can just not submit that SLOE and use the other 2.

 

[mymembernames]

What are your thoughts (and others if they like to answer) about the lack of respect towards EM docs from other specialties?

 

[gamerEMdoc]

What are your thoughts (and others if they like to answer) about the lack of respect towards EM docs from other specialties?

It annoys me, but it’s never going to change. It’s just something that you have to live with if you’re going to go into emergency medicine. And but it really does make you treasure of the consultants that actually do get it and value you and your skill set.

 

[PowerfulDRE]

2 should be all you ever need any year. The last PD survey on this I saw showed about 95% of programs ok with 2. Something like 80% were ok with just 1.

The advantage of having enough rotations to get 3 is that it gives you flexibility if one rotation doesn't go as well as you expected. Lets say you get your grade/eval back and its very negative. Then you can just not submit that SLOE and use the other 2.

Does caliber of institution carry much weight? I genuinely enjoyed both of my rotations but I'm just worrying because advice I get from upper classmen since one of the sites was at a small hospital with a newer program.

 

[gamerEMdoc]

Depends on where you are applying. I work in a community EM program. The people that rotate at my place and apply to my place, in general, tend to have SLOEs from community EM programs. I tend to see SLOEs from similar places in general. So there's applicability there to my own institution. But its obvious, at least to me, that if a student does apply who has a SLOE that lets say is a "mid 1/3" but is from a highly competitive program, that is not the same as a student's mid 1/3 from a brand new community EM program. So I'm sure the reverse is true to an extent. I'm sure if I rated a student as a top 1/3 student at my institution, that Johns Hopkins would probably look at that and weigh that SLOE lower than a top 1/3 from the Univ of Maryland. How much weight does each program put into institutional prestige? Who knows. That's up to to each individual program to figure out.

I mainly care more about grade distribution (is a place too top heavy in their rankings or do they actually distribute their rankings evenly) when judging how true an SLOE rank is likely to be than I do about the name of the program.

 

[gamerEMdoc]

In your opinion, what Step 2 CK score would an applicant need to not "hurt" their application, if the Step 1 score was >260? Is it necessary to match it?

I doubt it matters if you have good SLOEs. If you went from a 260 to a 270 and got average SLOEs, you would do more damage at getting into a top tier program than if you had top tier SLOEs and scored a 240.

 

[tarsuc]

Can program directors filter repeat applicants just by using a filter?

 

[gamerEMdoc]

Im not completely sure because there are an overwhelming number of filters that you could build, but Id imagine so.

 

[liveonthewater]

Another SLOE question. I have 1 week left on my first away rotation. The student coordinator is the APD and it seems like she will be mainly writing our SLOEs along with the PD. I have only met the APD once since I've been here but have worked with the PD a few times. We are required to get written evaluations from residents while on shift which helps them to write the SLOE. I've received pretty good feedback from the residents but we don't see the evaluations.
My question is: How great can this SLOE be if the person writing it probably doesn't even know my name?

Other students I've talked to feel similar. Is it common to feel this way? If not, what can I do differently on the next rotation to put myself in a better position?

Appreciate your help!

 

[gamerEMdoc]

There has been a push for the SLOE to be more of a "group SLOE" as opposed to being written by a single individual. Why? Well, the more opinions, the more accurate the info. The most important part of the SLOE is the section that asks where a program anticipates ranking you. This isn't one persons decision during the rank process, so it makes little sense to have one person writing the SLOE making this decision. By having a single author, it allows for students just to ask someone the click well with, who will write them a good SLOE. But the power of the SLOE is that it tries to be objective, so not every SLOE will be a great one. A SLOE carries more weight when it is the combined opinion of the program, as opposed to a single persons opinion.

The majority of EM programs do SLOEs as a group. And while I try to work with every student at least once who rotates, I've definitely written SLOEs without working with people based on group feedback. And when I've worked several shifts with someone, their SLOE is still off of group feedback, not my personal experience.

As an example, this is our SLOE process:
- Each student gets an end of shift evaluation card that mirrors a SLOE, which gets uploaded into a database
- In early Sept, a group of faculty and our chiefs will meet to determine the SLOE rankings for the group of students from June-Sept (the majority of the SLOEs)
- Once the SLOE rankings are determined, I will write all the SLOEs using the committees rankings and comments from the end of shift rotation cards

I hope that helps explain the process.

 

[decgra]

As an example, this is our SLOE process:
- Each student gets an end of shift evaluation card that mirrors a SLOE, which gets uploaded into a database
- In early Sept, a group of faculty and our chiefs will meet to determine the SLOE rankings for the group of students from June-Sept (the majority of the SLOEs)
- Once the SLOE rankings are determined, I will write all the SLOEs using the committees rankings and comments from the end of shift rotation cards

I hope that helps explain the process.

What about the sloes of rotations before June?

 

[liveonthewater]

I hope that helps explain the process.

Wow, awesome. Thank you! Definitely helps understanding. Really appreciate it.

 

[gamerEMdoc]

What about the sloes of rotations before June?

Same. I said June because we don't get many people who are EM interested between Feb and May. Maybe a few stragglers, but generally we only have 3rd years rotating in June right before their 4th year. Sometimes in May, but almost never earlier than that.

Essentially all the candidates that rotated during SLOE season are lumped together and ranked against eachother. The students that finish later in September and October who still want SLOEs we just then compare them against the group we previously ranked and see where they fit in.

 

[decgra]

Same. I said June because we don't get many people who are EM interested between Feb and May. Maybe a few stragglers, but generally we only have 3rd years rotating in June right before their 4th year. Sometimes in May, but almost never earlier than that.

Essentially all the candidates that rotated during SLOE season are lumped together and ranked against eachother. The students that finish later in September and October who still want SLOEs we just then compare them against the group we previously ranked and see where they fit in.

Thanks, As a foreign student, its very hard to find rotation positions in EM during this peak season, but they're mostly available only between Jan and May. Do you think this could be a disadvantage, and affect the quality of the SLOE that we get, since it would be written up many months later? Is there anything we can do, to prevent this from happening and get a non biased SLOE?

 

[8741empls]

I realize letters other than SLOEs carry very little weight comparatively, but one of my letters will be from a community EM attending. I worked with this person prior to medical school, and was able to perform an EM elective rotation with them as an M3, so they know me well and have seen me work. They asked if I wanted the letter to speak to my clinical competence or my personal attributes. What would you look for in a non SLOE letter, or do those even get read?

 

[gamerEMdoc]

Thanks, As a foreign student, its very hard to find rotation positions in EM during this peak season, but they're mostly available only between Jan and May. Do you think this could be a disadvantage, and affect the quality of the SLOE that we get, since it would be written up many months later? Is there anything we can do, to prevent this from happening and get a non biased SLOE?

Yeah. It's a catch 22. IMGs can't get rotations to get SLOEs because there aren't enough rotations for US grads, and don't have a prayer to match without them. It's a very difficult situation. If you do secure a rotation outside of SLOE season, it's still a valid SLOE. I'd just make sure to ask the program if they will write you a SLOE before finalizing the rotation, because some programs won't write SLOEs after "sloe season".

 

[gamerEMdoc]

I realize letters other than SLOEs carry very little weight comparatively, but one of my letters will be from a community EM attending. I worked with this person prior to medical school, and was able to perform an EM elective rotation with them as an M3, so they know me well and have seen me work. They asked if I wanted the letter to speak to my clinical competence or my personal attributes. What would you look for in a non SLOE letter, or do those even get read?

I read all letters. I mean, I read the entire application before the interview, line by line, but I take application review to an OCD extreme. Hahaha. But like you said, it's unlikely to carry much weight. If you have two bad SLOEs and this non-SLOE letter, it won't help you. And if you have two great SLOEs and this letter that speaks glowingly, it's just going to confirm what the SLOEs say. So in the end, it is unlikely to make a huge difference either way. That doesn't mean don't get the letter. You can submit 4 letters, and most people only submit 2-3 SLOEs, so you have to have something to submit in that 4th spot. Might as well be something that speaks highly of you.

 

[8741empls]

I read all letters. I mean, I read the entire application before the interview, line by line, but I take application review to an OCD extreme. Hahaha. But like you said, it's unlikely to carry much weight. If you have two bad SLOEs and this non-SLOE letter, it won't help you. And if you have two great SLOEs and this letter that speaks glowingly, it's just going to confirm what the SLOEs say. So in the end, it is unlikely to make a huge difference either way. That doesn't mean don't get the letter. You can submit 4 letters, and most people only submit 2-3 SLOEs, so you have to have something to submit in that 4th spot. Might as well be something that speaks highly of you.

Thanks for the reply! When reviewing the application would you rather read a letter that speaks to an applicants attributes/personality or their clinical abilities? Or should I ask them to try to touch on both?

 

[gamerEMdoc]

Thanks for the reply! When reviewing the application would you rather read a letter that speaks to an applicants attributes/personality or their clinical abilities? Or should I ask them to try to touch on both?

I would just let them write whatever they want to write.

 

[Apollyon]

I read all letters. I mean, I read the entire application before the interview, line by line, but I take application review to an OCD extreme. Hahaha. But like you said, it's unlikely to carry much weight. If you have two bad SLOEs and this non-SLOE letter, it won't help you. And if you have two great SLOEs and this letter that speaks glowingly, it's just going to confirm what the SLOEs say. So in the end, it is unlikely to make a huge difference either way. That doesn't mean don't get the letter. You can submit 4 letters, and most people only submit 2-3 SLOEs, so you have to have something to submit in that 4th spot. Might as well be something that speaks highly of you.

You make it sound like the BNP!

 

[Taco-tsubo]

I realize letters other than SLOEs carry very little weight comparatively, but one of my letters will be from a community EM attending. I worked with this person prior to medical school, and was able to perform an EM elective rotation with them as an M3, so they know me well and have seen me work. They asked if I wanted the letter to speak to my clinical competence or my personal attributes. What would you look for in a non SLOE letter, or do those even get read?

I believe there's a SLOE template for "community EM" non-program rotations. If you worked with multiple attendings, they could co-sign this as a group. Might take a little effort on their part to fill it out if they aren't used to filling out SLOEs.
I used this; it was definitely read because I was asked specifically about some things that it mentioned.

Can't post a link because new account, but just search "SLOE for non-EM residency faculty"

 

[gutonc]

Hey gamerEMdoc!

Quick one for you

Is it worth scheduling an EM spot to get a SLOE if the program explicitly said they don't interview/rank IMGs (I'm an AUC student)?

I get it, but I'm wondering if this could do more damage than good.

Thanks!

This has been discussed previously in this thread. The SLOE has a box for "will you rank this person? Yes/No". If you get a SLOE from a place that explicitly says they won't interview/rank IMGs, that box will be checked "no", regardless of the rest of the SLOE. For many programs, that alone will be enough to sink your app. Don't do it.

 

[gutonc]

Thanks Gutonc!

Sorry I must have missed that earlier in the thread

To be fair (to you), the thread will be almost 1000 posts long when I finish typing.

 

[gamerEMdoc]

Hey gamerEMdoc!

Quick one for you

Is it worth scheduling an EM spot to get a SLOE if the program explicitly said they don't interview/rank IMGs (I'm an AUC student)?

I get it, but I'm wondering if this could do more damage than good.

Thanks!

This has been discussed previously in this thread. The SLOE has a box for "will you rank this person? Yes/No". If you get a SLOE from a place that explicitly says they won't interview/rank IMGs, that box will be checked "no", regardless of the rest of the SLOE. For many programs, that alone will be enough to sink your app. Don't do it.

Exactly. You could do well in the rotation, but if they don't rank IMGs, then the SLOE will be a DNR (Do not rank) SLOE and that can be the kiss of death on an application.

 

[gamerEMdoc]

To be fair (to you), the thread will be almost 1000 posts long when I finish typing.

I was #1000!

 

[gamerEMdoc]

I believe there's a SLOE template for "community EM" non-program rotations. If you worked with multiple attendings, they could co-sign this as a group. Might take a little effort on their part to fill it out if they aren't used to filling out SLOEs.
I used this; it was definitely read because I was asked specifically about some things that it mentioned.

Can't post a link because new account, but just search "SLOE for non-EM residency faculty"

There is a SLOE for non-EM residencies, but it is meant for places that regularly have students coming through, but don't have an EM residency. It still ranks you against the other students that rotated that year (by asking where you fell in the grade distribution) but it skips the part about where they would rank you. If you are the only EM interested student that did a rotation at some ED, a non-residency SLOE wouldn't be any different than a regular letter since you wouldn't be compared to other students.

 

[InternistDO]

Quick questions that have almost certainly been asked before: For 4th year summer, would August, Sept, Oct (home, away, away) be reasonable for obtaining SLOES (specifically the October one--would that be too late for interviews but early enough for ranking)?

And is there any advantage/disadvantage to rotating at "big name" vs not big name programs? I remember you mentioning this before but I can't find it. Something like there's a bigger chance you'll be an average student at LA County, but an honours student at a community residency?

Thanks!

 

[tarsuc]

Exactly. You could do well in the rotation, but if they don't rank IMGs, then the SLOE will be a DNR (Do not rank) SLOE and that can be the kiss of death on an application.

Thanks gamerEM doc. uttopian thought, but do you think its apossibilityy that we could mention to the coordinator or the PD who is preparing the SLOE about this quesion, and maybe plead with them to mention by the side, that the answer is NO because the program generally doesnt accept IMG's.

 

[gamerEMdoc]

Thanks gamerEM doc. uttopian thought, but do you think its apossibilityy that we could mention to the coordinator or the PD who is preparing the SLOE about this quesion, and maybe plead with them to mention by the side, that the answer is NO because the program generally doesnt accept IMG's.

I don't think its unreasonable to ask the SLOE author ahead of time for the rotation that if the program doesn't take IMGs, will you be able to get a SLOE that ranks your performance vs other students, or will your SLOE be an automatic "Do not anticipate ranking"

 

[gamerEMdoc]

Quick questions that have almost certainly been asked before: For 4th year summer, would August, Sept, Oct (home, away, away) be reasonable for obtaining SLOES (specifically the October one--would that be too late for interviews but early enough for ranking)?

That should be fine. If you rotated Aug-Oct, you'd have one SLOE when ERAS opens in September (Aug rotation) and two more coming during interview season. That's perfectly fine.

And is there any advantage/disadvantage to rotating at "big name" vs not big name programs? I remember you mentioning this before but I can't find it. Something like there's a bigger chance you'll be an average student at LA County, but an honours student at a community residency?

I think students over think this a bit. Rotate at where you think you may want to end up. If you want to match in a "big name" University program because that's important to you, rotate at them. If you want to match at a community EM program rotate there. If you want to match in California, rotate there. If you want to match in rural Alabama, rotate there. Don't pick your rotations based on "where can I get the best SLOE". Because the best way to match at a place is to go there and have a great rotation. So rotate at places you'd like to match.

Trying to play a game to maximize your SLOEs doesn't help. Because if you want to match at an elite name place, they probably are going to want to see SLOEs from other elite name places.

The key is rotating at places you want to end up at and that you think you'll have a reasonable chance of doing well/matching at. Realistically assess your competitiveness and think about what is important to you in terms of where you want to match.

 

[Yapyap]

What sorts of things will grant one a bottom 1/3 sloe ranking? (How much incompetence is tolerated before this kiss of death?)

 

[Bea5T]

May have been answered already but do PDs start looking at apps mid September? Or is it strictly after the Dean's letter comes out?

 

[DO3]

May have been answered already but do PDs start looking at apps mid September? Or is it strictly after the Dean's letter comes out?

Apps are reviewed as soon as ERAS opens regardless if there’s a deans letter or not. A dean’s letter isn’t really a high priority part of the application. It’s pretty much reviewed for red flags, and that’s it.

 

[Bea5T]

Apps are reviewed as soon as ERAS opens regardless if there’s a deans letter or not. A dean’s letter isn’t really a high priority part of the application. It’s pretty much reviewed for red flags, and that’s it.

In that case, if I won't have my second SLOE in til the end of September, should I send some type of update to programs I want to match into?

 

[DO3]

In that case, if I won't have my second SLOE in til the end of September, should I send some type of update to programs I want to match into?

Depends. Some programs won’t even review apps without SLOE’s. Some will. Probably the best way to go about it is to let the programs you are really interested know when all your SLOE’s are actually uploaded.

 

[theSmurfette]

In that case, if I won't have my second SLOE in til the end of September, should I send some type of update to programs I want to match into?

I think they get a notification in ERAS when there’s an update to the application. It never hurts to contact your top programs about the update UNLESS they say don’t contact us. Then they mean it!


Sent from my iPhone using Tapatalk

 

[Keladry]

In that case, if I won't have my second SLOE in til the end of September, should I send some type of update to programs I want to match into?

I didn't have my second SLOE til start of October, it was fine, I don't think I got any interviews (maybe just 1?) before the dean's letter was out and then I got a whole bunch when that/my second SLOE came out. I think even classmates who had 2 SLOEs in didn't hear from any programs before the dean's letter was out. They might be looking at apps - I def got a bunch of invites right on/after Oct 1 - but waiting for that regardless.

 

[gamerEMdoc]

What sorts of things will grant one a bottom 1/3 sloe ranking? (How much incompetence is tolerated before this kiss of death?)

Bottom 1/3 students are typically ones who struggle to formulate ddx and plans, don't take feedback to heart to improve, are very slow in the room, etc. One bottom 1/3 is not a kiss of death for an application, especially if its at a really competitive program, assuming the rest of the SLOEs are good. But no doubt, it does hurt the application. The "do not plan to rank" SLOE is a kiss of death and generally a student has done something pretty aggregious to earn that honor.

May have been answered already but do PDs start looking at apps mid September? Or is it strictly after the Dean's letter comes out?

Yeah, generally most start looking at apps once ERAS opens. I doubt many interviews will come out until after the first week of October. Last year a bunch of programs banded together to essentially create a window of time before invites went out. I'd imagine the same thing will happen, especially with ACEP the first week of October.

 

[lostdoc92]

@gamerEMdoc Sorry to bother you but I pretty much read the entire thread and you are a wealth of information! I am a newly minted 3rd year who has a 230s step 1 and a 510s comlex. I'm worried about my comlex score hurting my chances and was wondering what you thought of that.

Also I read on here that as DOs we tend to struggle with getting SLOEs since we don't have home institutions to at least guarantee 1 by Sept. 15th. Do you think its a good idea to go to ACEP this year for that purpose (network with programs, maybe give them a business card and hope they remember me a few months later), or will the M4s be dominating the field looking for interviews? I'm not looking to match into anything crazy prestigious but would also like a place with a decent amount of trauma. Thank you so much for all your help on here!

 

[gamerEMdoc]

It’s going to be a sea of MS4’s. I think MS3s trying to network for future rotations would only get lost in the shuffle. But IDK maybe someone else has done this in the past as an MS3. Personally I wouldnt waste my time in your situation. I doubt you’ll have trouble getting a few rotations at DO friendly sites. Your scores will be more than ok at many DO friendly community EM programs and former AOA places in terms of securing rotations.

 

[lostdoc92]

It’s going to be a sea of MS4’s. I think MS3s trying to network for future rotations would only get lost in the shuffle. But IDK maybe someone else has done this in the past as an MS3. Personally I wouldnt waste my time in your situation. I doubt you’ll have trouble getting a few rotations at DO friendly sites. Your scores will be more than ok at many DO friendly community EM programs and former AOA places in terms of securing rotations.

Thanks! Do you think I would have trouble ultimately matching to a mid-tier northeast program? I feel quite average with my scores and while according to the NRMP outcomes I have a decent chance of matching overall, I don't know where to focus my aways and applications.

 

[gamerEMdoc]

Thanks! Do you think I would have trouble ultimately matching to a mid-tier northeast program? I feel quite average with my scores and while according to the NRMP outcomes I have a decent chance of matching overall, I don't know where to focus my aways and applications.

Define “mid-tier”.

Anyone who follows my posts probably can guess, I hate terms like this because I don’t even know what that is. Is that based on prestige? Research dollars? Because none of that matters for 99 percent of EM graduates. Or is it based on Geography, because often the most competitive programs are all about location location location. But the specific location desires vary candidate by candidate, so while one candidate would love to match in CA, another might want to match in a rural program in the Southeast.

You will get adequate training at any ACGME site that you match at. And you will find that you may get better training from a productivity standpoint at a place you never heard of compared to a place with a prestigious name. So I’m not even sure what a “mid-tier” program looks like, because that’s very individualized. My “top tier” of my rank list was dominated by community EM programs because I loved my experience on those rotations, and I ranked on of the more “presitgious” University based programs on the East Coast dead last. So my top, mid, and bottom tiers of my list when I was entering the match wouldn’t look anything like someone elses who cared more about prestige. And that’s ok, it’s ok to have different interests/preferences. It’s ok to care about prestige. It’s ok not to care about it.

My point here is, don’t worry about some pre-conceived notion of “tiers” as if they matter. More importantly, worry about what type of program you want to end up (community, university, doesn’t matter), what geographic areas or type you want to end up at (rural, urban, specific region, etc) and then narrow it down to programs you think you’ll have a chance at (do they list a board cuttoff above yours, do they match DO’s, etc).

 

[gamerEMdoc]

Thanks! Do you think I would have trouble ultimately matching to a mid-tier northeast program? I feel quite average with my scores and while according to the NRMP outcomes I have a decent chance of matching overall, I don't know where to focus my aways and applications.

Lastly, unfortunately, no one can judge how competitive of an applicant you are by your boards alone. They aren’t the most important part of the application. I love NFL draft analogies when discussing the match. It would be like trying to tell a college QB what round he’ll be drafted in based solely on his 40 time at the combine without ever watching his gametape or looking at his college statistics. The 40 time may be a relavant score, but its a small part of the evaluation of the QB. There are great QBs who aren’t mobile (bad test takers who are stellar clinically) and speedy QBs who are total failures (great test takers who are terrible clinically).

Your SLOEs will dictate how competitive of an application you have, not your boards. If you get stellar SLOEs, your boards won’t matter. If you get terrible SLOEs, you could have scored in the 260’s and you still won’t match in EM. High boards help to get your application looked at, but your SLOEs will determine whether you get interviews and whether you’ll match.

 

[OneTwoThreeFour]

Lastly, unfortunately, no one can judge how competitive of an applicant you are by your boards alone. They aren’t the most important part of the application. I love NFL draft analogies when discussing the match. It would be like trying to tell a college QB what round he’ll be drafted in based solely on his 40 time at the combine without ever watching his gametape or looking at his college statistics. The 40 time may be a relavant score, but its a small part of the evaluation of the QB. There are great QBs who aren’t mobile (bad test takers who are stellar clinically) and speedy QBs who are total failures (great test takers who are terrible clinically).

Your SLOEs will dictate how competitive of an application you have, not your boards. If you get stellar SLOEs, your boards won’t matter. If you get terrible SLOEs, you could have scored in the 260’s and you still won’t match in EM. High boards help to get your application looked at, but your SLOEs will determine whether you get interviews and whether you’ll match.

Wait. Are you telling me I could be an NFL quarterback?