EM PD - Ask Me Anything

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Hey Gamer! Thanks for all you do and the advice you give . As an IMG w/o an official EM faculty advisor you have been immensely helpful over the year.
I did have one question for you....so as I said I am a US IMG and have been fortunate and thankful to receive 15 interview invites (my scores were good and had likely top 1/3 SLOEs at 2/3 rotations based on feedback /school grades) , for mostly monetary, and location/logistic reasons I declined 5 of them and have one more interview pending in mid February.

I really do not see myself liking the area of this program and it will likely be #9 or 10 on rank list. If I do decline I will be at 9 contiguous ranks. Looking at the data I still am at 90%+ odds of matching.... I do not want to waste the programs time with me traveling to this program, I just am anxious about dropping another invite and going to 9 ranks, although I realize and am thankful for having this option to begin with.... I just think I need some reassurance or advice on how to proceed. Thank you!
 
Pretty unlikely. Though I've seen SLOEs that gave Honors and then selected "do not rank" and then justified it in the comments saying they don't rank non-US grads. Pretty BS thing to do IMO. My personal bias is, unless someone does something horrible, you shouldn't check the DNR box. Even if you don't rank IMGs, if that person was otherwise a top 1/3 or mid 1/3 candidate compared to others, they should be rated as such.

While I agree with the sentiment, I don’t think this is fair. I think you should be honest on the SLOE with the perceived ROL position. If you won’t rank them, say why. If they say why and you don't value that reasoning , then great, discard it and rank them according to your values. Maybe programs shouldn’t be biased against IMG’s or DO’s, but PD’s operate within a medical school/medical center and they have to perform within the deans expectations. Maybe we have been involved in different types of hospital systems, but there are institutional expectations in some places, whether we agree or not.
 
While I agree with the sentiment, I don’t think this is fair. I think you should be honest on the SLOE with the perceived ROL position. If you won’t rank them, say why. If they say why and you don't value that reasoning , then great, discard it and rank them according to your values. Maybe programs shouldn’t be biased against IMG’s or DO’s, but PD’s operate within a medical school/medical center and they have to perform within the deans expectations. Maybe we have been involved in different types of hospital systems, but there are institutional expectations in some places, whether we agree or not.

I would be fine with thatif in the sloe they said “if they werent an img, we would have ranked them as a ...” But saying nice things with little objective ranking, then checking DNR helps no one. And it would be nice if these places let all the USIMGs rotating there that no matter how they do, the best they can do is a do not plan to rank sloe.
 
Hey Gamer! Thanks for all you do and the advice you give . As an IMG w/o an official EM faculty advisor you have been immensely helpful over the year.
I did have one question for you....so as I said I am a US IMG and have been fortunate and thankful to receive 15 interview invites (my scores were good and had likely top 1/3 SLOEs at 2/3 rotations based on feedback /school grades) , for mostly monetary, and location/logistic reasons I declined 5 of them and have one more interview pending in mid February.

I really do not see myself liking the area of this program and it will likely be #9 or 10 on rank list. If I do decline I will be at 9 contiguous ranks. Looking at the data I still am at 90%+ odds of matching.... I do not want to waste the programs time with me traveling to this program, I just am anxious about dropping another invite and going to 9 ranks, although I realize and am thankful for having this option to begin with.... I just think I need some reassurance or advice on how to proceed. Thank you!

The fact you got 15 invites as a USIMG tells me your app is VERY good, and it is unlikely you’ll fall that far down your list. Still, considering USIMGs have more bias against them in the match, Im surprised you turned away many interviews initially. But that is in the past. The difference between 9 and 10 interviews is small, and if your app is as good as I expect, you probably wont go super far down your list anyway. I guess it depends on what your risk tolerence is. Personally though, unless the travel costs are pretty high, I’d keep the last interview.
 
I would be fine with thatif in the sloe they said “if they werent an img, we would have ranked them as a ...” But saying nice things with little objective ranking, then checking DNR helps no one. And it would be nice if these places let all the USIMGs rotating there that no matter how they do, the best they can do is a do not plan to rank sloe.

Agree transparency is key.
 
The fact you got 15 invites as a USIMG tells me your app is VERY good, and it is unlikely you’ll fall that far down your list. Still, considering USIMGs have more bias against them in the match, Im surprised you turned away many interviews initially. But that is in the past. The difference between 9 and 10 interviews is small, and if your app is as good as I expect, you probably wont go super far down your list anyway. I guess it depends on what your risk tolerence is. Personally though, unless the travel costs are pretty high, I’d keep the last interview.

Thanks I appreciate it! And yeah I can drive there so not terrible.
 
Hi, thanks for taking the time posting many answers on this thread. I've taken the time to look through most of the posts for answers but would appreciate some additional answers given my situation. I am finishing 3rd year end of April at top 30 MD school. Pretty average (or slightly below average) at my school: Step 1 high 230s, 5/7 clerkships have been Pass (10% rewarded H, 15% high pass) and I expect to just Pass the last 2 clerkships (FM/Peds) given that it seems impossible for me to letter anything. Assuming I do well on Step 2 in the 240s/250s and decent SLOEs in the top 1/3 to mid 1/3, I am concerned about some "yellow flags" on my application:

1. I failed my first shelf exam but successfully remediated it and moved on. This was the first shelf I took and wasn't sure what happened. Never had problems academically. How will residency programs look at this blemish? This will be reported in my MSPE as a small comment.

2. How will my straight Passes in clerkships affect my chances for interviews?

3. How will residencies look at my MSPE quartile ranking? Our school is "non-ranking" but they do clustered percentages. I may still be lucky and be within the middle 2/3s of students but how will I be seen if I fall into the bottom 1/3 of students in my class?

Note: Overall, I want to be a good candidate and get enough interviews to ensure a match. My goal is to really match at my home institution which has a good reputation in the midwest (just concerned because they haven't matched many of their home students in recent matches).
 
Hi, thanks for taking the time posting many answers on this thread. I've taken the time to look through most of the posts for answers but would appreciate some additional answers given my situation. I am finishing 3rd year end of April at top 30 MD school. Pretty average (or slightly below average) at my school: Step 1 high 230s, 5/7 clerkships have been Pass (10% rewarded H, 15% high pass) and I expect to just Pass the last 2 clerkships (FM/Peds) given that it seems impossible for me to letter anything. Assuming I do well on Step 2 in the 240s/250s and decent SLOEs in the top 1/3 to mid 1/3, I am concerned about some "yellow flags" on my application:

1. I failed my first shelf exam but successfully remediated it and moved on. This was the first shelf I took and wasn't sure what happened. Never had problems academically. How will residency programs look at this blemish? This will be reported in my MSPE as a small comment.

2. How will my straight Passes in clerkships affect my chances for interviews?

3. How will residencies look at my MSPE quartile ranking? Our school is "non-ranking" but they do clustered percentages. I may still be lucky and be within the middle 2/3s of students but how will I be seen if I fall into the bottom 1/3 of students in my class?

Note: Overall, I want to be a good candidate and get enough interviews to ensure a match. My goal is to really match at my home institution which has a good reputation in the midwest (just concerned because they haven't matched many of their home students in recent matches).

Ultimately most of this will be negates if you get great SLOEs, but if you are a very average student (all pass’s, low 1/3 mpse) getting two great sloes is less likely. While it can happen bc some students just fit really well in the ED, most of the time students that do average to below average on all their rotations are gonna do the same on their EM months as well. So ultimately its your SLOEs that will mostly determine your competitiveness, but your past history projects you more to be a middle of the road SLOE kind of person. Those people match. But you may have to have a broader application pool with some less competitive places on the list as well.

I doubt the failed shelf exam or the average clinical grades will matter much if you rock your EM rotations. But thats easier said than done.
 
Rank list done and submitted. 3rd years, I'm ready to start thinking about next year.

If you don't mind sharing, how far down do you guys normally go into the list? I've heard average overall is 6.5 spots/position.. is that about same for EM? do "top tier" programs really go over 1/2 way down the list?
 
I overheard many residents from different program that weren't highly competitive that they still match relatively high on their list (newer programs who has not graduated a class yet) as subjective as that sounds, I wonder how true that 6.5 spots/position really is.
 
I overheard many residents from different program that weren't highly competitive that they still match relatively high on their list (newer programs who has not graduated a class yet) as subjective as that sounds, I wonder how true that 6.5 spots/position really is.
It is in the publicly published NMRP data so probably very accurate. 6.8 spots for EM last year actually.
 
If you don't mind sharing, how far down do you guys normally go into the list? I've heard average overall is 6.5 spots/position.. is that about same for EM? do "top tier" programs really go over 1/2 way down the list?

The match data says the national average is around 6.5/spot, with just slight variation from year to year. As a program with 8 spots/year, we should be on average ending up at 52, which is in the middle of our list. Most years we are better than that, I think we’ve only gone below that once in our 4 years in the NRMP match. Back in the old AOA match, you interviewed less and matched much higher bc there was little competition, but unless you stack your match list with sure things to make yourself look good, you are going to go down to the middle no matter what program you are.

Every year I try to predict what number we’ll go down to. I’m calling it now. 40. Should be a good year.
 
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Hey gamer quick question...how low on your rank list do people you really liked during their interview but didn’t audition usually start? Is it along the lines of top 20 auditioners get the top 20 spots, then comes people you liked on interview, then the average auditioners, followed by average non auditioners etc? Basically wondering if you can get on a programs top 25 or so without auditioning. Thanks!
 
Hey gamer quick question...how low on your rank list do people you really liked during their interview but didn’t audition usually start? Is it along the lines of top 20 auditioners get the top 20 spots, then comes people you liked on interview, then the average auditioners, followed by average non auditioners etc? Basically wondering if you can get on a programs top 25 or so without auditioning. Thanks!

No. More than half my top 10 didn't rotate. Including 2, 3, and 4. If two people have equal apps, then I'll give the benefit of the doubt to the student I know, assuming we liked them here. But otherwise, I don't really have that huge of a boost to those that rotate. The reason that maybe 60% of our match list comes from people that rotate is that they rank us high because they had a great rotation, not because of some bias where we only rank rotators highly. Its just tough selling a program to people that didn't rotate.
 
I've got the opportunity to do a rotation at a residency late in my 3rd year (second to last rotation). I've heard that they are willing to give students late in their 3rd year SLOEs if you perform well. Would this letter be looked down upon since it would be written in my 3rd year instead of 4th? It would be nice to get an early letter just in case the dreaded VSAS doesn't pan out, however I don't want to depend on it if program directors would frown at the timing.

Thanks for answering all these questions! I know you gotta love your job if you're willing to do this.
 
Nope. The only way a 3rd year SLOE hurts is if the place judges you harshly because of unrealistic expectations. A 3rd year in June is no different than a 4th year in July, and they should be judged similarly. But a 3rd year in April is not the same as a 4th year in November. The SLOE differentiates if this is your first EM rotation/AI, and past experience should be used to judge the student. I have completely different expectations of students on their 1st AI vs their sometimes 5th AI.
 
I know this is highly dependent on specific programs, but on average, how long does it take for programs to submit SLOEs to ERAS?
 
@gamerEMdoc, another quick q regarding SLOEs and timing:

If I am planning on two SLOE rotations to be set up for July and Aug (home and an away), and then say there is another program that I'm super interested in (reach program) that only offers a sub-I rotation and no non-SLOE elective (US or Tox so I'm assuming I should expect a SLOE from them)... and also with my calendar I wouldn't be able to rotate there until mid-Sept to mid-Oct (17th or so)...Are there are issues with this from 1) adding a third SLOE late (in Nov or so), and 2) more importantly, in your experience, would a rotation with a mid-October finish cause problems with potential interview dates (of course would want to avoid looking bad having to leave during the rotation)??

Thanks in advance!
 
I know this is highly dependent on specific programs, but on average, how long does it take for programs to submit SLOEs to ERAS?

Depends when you rotate. If you rotate early, some will write them after the rotation, but many places wait and decide on their SLOE rankings as a group. So they will batch all the students that rotate from July to Sept, then write all the SLOEs right before ERAS opens. That's what we do. SLOE rankings by committee is typically considered the gold standard for SLOEs, since its not one persons opinion.

Personally, I tell all the students this at the time of their rotation so they don't get concerned. They are all written and uploaded before Sept 15th, I guarantee that. I just make sure they understand it won't be two weeks after their rotation if they rotate in July. We need a bigger cohort before deciding where everyone grades out. After September, I then write the SLOEs at the end of the rotation within a week or two typically.

Other places may not wait to group them like that and will just write them shortly after the rotation all season long.

Lastly, sadly, there are places that don't have their stuff together, and students have to hound them to upload a SLOE. Or they don't ever write it. Or they write a general generic LOR that's a few sentences long instead of a SLOE when the student thinks its a SLOE. This happens every year, I'll be interviewing someone and I'll ask them if they are getting a 2nd SLOE and they will tell me "I have one from program x". And I have to tell them, its not a SLOE.
 
@gamerEMdoc, another quick q regarding SLOEs and timing:

If I am planning on two SLOE rotations to be set up for July and Aug (home and an away), and then say there is another program that I'm super interested in (reach program) that only offers a sub-I rotation and no non-SLOE elective (US or Tox so I'm assuming I should expect a SLOE from them)... and also with my calendar I wouldn't be able to rotate there until mid-Sept to mid-Oct (17th or so)...Are there are issues with this from 1) adding a third SLOE late (in Nov or so), and 2) more importantly, in your experience, would a rotation with a mid-October finish cause problems with potential interview dates (of course would want to avoid looking bad having to leave during the rotation)??

Thanks in advance!

So you can get a subspecialty SLOE from an US/Tox rotation if they write them. Generally considered better than a standard generic LOR, but less important than a SLOE.

You only need 2 SLOEs. You don't have to have a 3rd. You need to have 4 LORs to upload. 2 should be a SLOE. What you choose to do with the other 2 can be any combination of SLOEs, subspecialty SLOEs, and LORs from EM or other specialties.

As for the rotation finishing in October, it won't make a difference. Everyone knows students have to leave and go on interviews during interview season. And October isn't typically a super busy interview months because often times interview dates aren't released until mid October anyways. Nov-Jan are usually the busiest interview months. You may get some interviews in October, especially at places you rotated at, but I wouldn't worry about being bombarded with October interviews while on that rotation.
 
Can someone please help me with this within the next few hrs. I had just under 10 em interviews and one psych interview and am not sure if I should rank the Psych. I applied to psych as a back up since I enjoyed my rotation but EM is really where my heart is at. My question is is better to have a psych residency or try to scramble? Thanks for all your help.
 
Can someone please help me with this within the next few hrs. I had just under 10 em interviews and one psych interview and am not sure if I should rank the Psych. I applied to psych as a back up since I enjoyed my rotation but EM is really where my heart is at. My question is is better to have a psych residency or try to scramble? Thanks for all your help.
Psych residency all day. Rank it.
 
Agreed. Psych is a good field actually and is in considerable demand. The question you have to ask yourself is Psych vs FP at a place you may not want to end up in because that is the likely scramble option. If the answer is psych, then rank psych. If you'd rather go FP or IM in an undesirable location where you have no control, then don't rank psych.
 
So scrambling into em or anesthesia is not an option normally?
 
Hey Gamer, as a PD at what point does a "leadership'' experience go from fluff to actually having some kind of impact? I'm sure theres tons of people involved in their schools EMIG, but how do you view state/national leadership roles (i.e. EMRA/ACEP), involvement in national conferences etc?

Or better put, what leadership roles have seen on an app that actually made you stop and think "damn."
 
Hey Gamer, as a PD at what point does a "leadership'' experience go from fluff to actually having some kind of impact? I'm sure theres tons of people involved in their schools EMIG, but how do you view state/national leadership roles (i.e. EMRA/ACEP), involvement in national conferences etc?

Or better put, what leadership roles have seen on an app that actually made you stop and think "damn."
hes addressed this, use the search function
 
Hey Gamer, as a PD at what point does a "leadership'' experience go from fluff to actually having some kind of impact? I'm sure theres tons of people involved in their schools EMIG, but how do you view state/national leadership roles (i.e. EMRA/ACEP), involvement in national conferences etc?

Or better put, what leadership roles have seen on an app that actually made you stop and think "damn."

Probably just echoing what i said before though I dont remember exactly what I said. Any leadership that requires real work, time and effort. Otherwise being something like a interest group club treasurer isnt all that impressive really. Owning your own business, being elected to a national position, that stuff is much more impressive from a leadership standpoint. While not a leadership activity per say, I always like people with customer service backgrounds (bartenders, servers) and college athletes. Good people skills and they generally know how to work hard and fit in a team environment.
 
How often is U/S performed by the EP directly? When I was a scribe, when an EP ordered a U/S, he would go onto the next patient and just get a report back. At the ED I currently rotate at, the doc himself has a Butterfly and U/S stuff himself, but I can't tell what is common or the standard amongst EPs? I know they have U/S fellowships, so when those docs go out into community practice (I know most remain in academics), do they just U/S everything themselves? I know the doc I am with currently enjoys U/S and bought the device himself and I enjoy it too, but not sure what to expect if I practice in the community.
 
How often is U/S performed by the EP directly? When I was a scribe, when an EP ordered a U/S, he would go onto the next patient and just get a report back. At the ED I currently rotate at, the doc himself has a Butterfly and U/S stuff himself, but I can't tell what is common or the standard amongst EPs? I know they have U/S fellowships, so when those docs go out into community practice (I know most remain in academics), do they just U/S everything themselves? I know the doc I am with currently enjoys U/S and bought the device himself and I enjoy it too, but not sure what to expect if I practice in the community.

Its a part of basic EM residency training. However, there are people that adopt it widely in their practice and there are people that don't. I've used US heavily since residency, both when I was out on my own in practice, and now when working with residents. I use it often to guide clinical decisions. I think it makes me more efficient, not less. There are others that disagree, or don't feel comfortable with their use of it. I get that. So its pretty variable.
 
Couldn't figure out how to search within threads but reposting the GamerEM advice about SOAP I could find.

>Getting a prelim (medicine or surgery) in a place with an EM residency is definitely your best step IMO if you are planning on re-entering the match for EM the following year. Rarely are candidates MORE desirable in the match the following year, and often they get less interviews after going unmatched, not more. But if you do well at a hospital where there is a residency, get along great with the EM residents there and they advocate for you, your chances to remain at that institution and match in EM there the following year are probably your best bet.


>Prelim year at a site with an EM residency is #1. Then Surgery>IM
 
Couldn't figure out how to search within threads but reposting the GamerEM advice about SOAP I could find.

>Getting a prelim (medicine or surgery) in a place with an EM residency is definitely your best step IMO if you are planning on re-entering the match for EM the following year. Rarely are candidates MORE desirable in the match the following year, and often they get less interviews after going unmatched, not more. But if you do well at a hospital where there is a residency, get along great with the EM residents there and they advocate for you, your chances to remain at that institution and match in EM there the following year are probably your best bet.


>Prelim year at a site with an EM residency is #1. Then Surgery>IM

Yep. Thanks for re-posting. But lets just hope no one is in need of this advice next week.
 
Hello gamerEMdoc,
Unfortunately, I did not do well on my step 1 and I am an avg DO student. Can you offer any advice on how to overcome my board scores? Also, how many places should I plan to apply to?
 
Hello gamerEMdoc,
Unfortunately, I did not do well on my step 1 and I am an avg DO student. Can you offer any advice on how to overcome my board scores? Also, how many places should I plan to apply to?
What is your Step and Comlex score? If complex is ok and step is passing you should target former AOA programs for auditions and residency. nearly every DO program converted for the merger and will likely take mostly DO applicants. And COMLEX is fine for majority of them. Obviously, improve on step 2 and Comlex 2 and crush auditions.
 
As above, community programs and former aoa programs will be your easiest route. But this will all depend on the ability to get rotations and that is now in question with covid. Without good sloes (usually the ticket to matching for a student with lower boards), Im honestly not sure how a student with lower scores will stand out. This year is gonna be anything but typical. Hopefully rotations dont fall through though.
 
FYI, with everyone finding out whether or not they matched tomorrow, I want to wish everyone good luck one last time. Every year I ask people the same thing. If you had contacted me asking for advice earlier in the year, after the match once you know how you did, please drop me a message if you had asked me for advice and let me know how you did and let me know if there was any advice you found particularly helpful or unhelpful. I'm always looking to know what helps for advising the next years class (assuming covid doesn't take me out).
 
Is (8/3 - 8/28) too late for my first EM audition? I haven't been able to get auditions for June or July.
 
Hey @gamerEMdoc thanks so much for all the info. Just found out my comlex PE exam was cancelled due to COVID and soonest I can reschedule is October. How important is it to have a passing grade in before applications go out? I'll be looking for openings everyday but how will this effect my app?
 
Hey @gamerEMdoc thanks so much for all the info. Just found out my comlex PE exam was cancelled due to COVID and soonest I can reschedule is October. How important is it to have a passing grade in before applications go out? I'll be looking for openings everyday but how will this effect my app?

Same boat as you. I am not too worried particularly if one is applying to programs that are not former AOA programs, as it seems everything COMLEX-related holds less weight if you have solid/good Step 1/2 scores in your app. IIRC, close to 50% of programs extend an interview invite as long as you have a Step 1 and one SLOE. The other 50% require a Step 2 (I could have my percentages off a bit, but point being COMLEX Level 2 PE does not seem to be a barrier). I could be wrong, but this is what I gather will happen!
 
On another topic, does anyone know when to expect to hear back from programs about audition rotations? I sent in bunch on VSAS and Clincian Nexus in the past day (I'm a bit behind), requesting dates from July to September. Seems the next batch of programs to open up on VSAS (ie when I can apply on time) is 04/01. I'm very uncertain of how to move forward with apps!
 
Hey @gamerEMdoc thanks so much for all the info. Just found out my comlex PE exam was cancelled due to COVID and soonest I can reschedule is October. How important is it to have a passing grade in before applications go out? I'll be looking for openings everyday but how will this effect my app?

It won’t effect it, just get it done by the time rank lists are made. If anyone asks, ”cancelled due to a global pandemic” seems like a good enough reason.
 
On another topic, does anyone know when to expect to hear back from programs about audition rotations? I sent in bunch on VSAS and Clincian Nexus in the past day (I'm a bit behind), requesting dates from July to September. Seems the next batch of programs to open up on VSAS (ie when I can apply on time) is 04/01. I'm very uncertain of how to move forward with apps!

I’m looking at ours after the match, but I don’t now if thats the smart thing to do or not with all the uncertainty. Most schools that rotate with us have pulled all their rotations. I don’t know when students will or will not actually be available. As of now, our hospital says students can still rotate but we have had no cases, I don’t know if that changes once it hits here in our county. There is so much uncertainty right now, I don’t really know if it makes sense to schedule people right now that may not be available on their end for a rotation that may not be available on ours.

Honestly, I’m at a loss for what to do here.
 
I’m looking at ours after the match, but I don’t now if thats the smart thing to do or not with all the uncertainty. Most schools that rotate with us have pulled all their rotations. I don’t know when students will or will not actually be available. As of now, our hospital says students can still rotate but we have had no cases, I don’t know if that changes once it hits here in our county. There is so much uncertainty right now, I don’t really know if it makes sense to schedule people right now that may not be available on their end for a rotation that may not be available on ours.

Honestly, I’m at a loss for what to do here.

Appreciate the honesty. Given what the AAMC recently announced, I suspect no one really knows what will transpire over the next few weeks. The thought of not having a single away prior to ERAS opening is a bit nauseitng to say the least!
 
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.
 
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