Emergency Medicine 2013-2014 Residency Cycle

[Apollyon]

The problem with 12s is they become 14-15s too often at some places. That is too long.

If you are leaving at 10pm after coming in at 7am, the PD will be all over that like white on rice in a glass of milk on a paper plate in the middle of a snowstorm (or should be).

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[EM4Reals]

The problem with 12s is they become 14-15s too often at some places. That is too long.

I'm at a place that works 12s. We are never there longer than 30min after our shift ends and thats only because of sign out.

 

[EMdoc10]

Cool to read different perspectives/preferences on 8s vs 12s. Good thing we have people who like both, or there'd be a prob! After 3 sub-Is, I've learned I hit-the-wall by hour 8ish. Can we list other 12'ers besides USC-Palmetto & USF-Tampa? Thanks

 

[TooMuchResearch]

Cool to read different perspectives/preferences on 8s vs 12s. Good thing we have people who like both, or there'd be a prob! After 3 sub-Is, I've learned I hit-the-wall by hour 8ish. Can we list other 12'ers besides USC-Palmetto & USF-Tampa? Thanks

The EMRA Match App is more or less accurate for shift length.

 

[EMdoc10]

One of the many aspects that attracts me to EM is the laid-back, casual, non-hierarchical work environment. At all of the places I Sub-I'ed at, attendings were on a first-name basis with the residents. I thought that was the norm for EM until I encountered the contrary on the interview-trail.

 

[EMdoc10]

Can someone (current residents/FL natives) rank ORMC, UF-Gainesville, and USF EM based on reputation & prog strength? And any major pros/cons? I understand the answer is multifactorial but I'm out-of-state w no knowledge/insider info on them. Thanks!

 

[swamprat]

When r u guys sending letters of intent or however you phrase it? I feel like if your going to do it it prob should be soon now that nrmp is open.

 

[secants]

To add on the previous question: How far before the rank deadline is the optimal time to send an intent to your #1? I know many people who are still interviewing until the end of January so I'm assuming by first week of Feb?

 

[shenanigi]

I doubt letters of intent matter at all in the end.

 

[namethatsmell]

I doubt letters of intent matter at all in the end.

If you tell a program that they're your #1in concrete terms and will be ranking them as such it will probably either

a) bump you up a few spots

or

b) have no impact whatsoever.

There's no downside to sending a note like this, provided you're only sending it to one place.

 

[EsTxDr]

When r u guys sending letters of intent or however you phrase it? I feel like if your going to do it it prob should be soon now that nrmp is open.

What exactly are you guys saying in these letters? I mean specifically how are you wording it?

 

[Alvarez13]

Yah, I can't find a ton searching on letters of intent. I have a number 1 for sure and would love to send them something.

 

[filhodeinferno]

I am wondering about the strategy of the ROL from the programs' perspective. As applicants, we are told to simply rank the programs we like the best at the top, regardless of our likelihood of matching there. Does the same rule apply for the programs? From what I understand about the algorithm, it doesn't give priority to the programs in getting their highest ranked applicants, so does that mean that they will rank someone higher that is more likely to match with them, or are they the same as the applicants in that they just rank the best applicants highest?

In a nutshell, my question is why does the letter of intent make a difference? I'm not suggesting that it doesn't, as some programs I've interviewed at hinted that I'd be ranked higher if I contacted them later expressing my continued interest. Is it all just so the program can feel good about not sailing to far down their rank list to fill their spots?

 

[QuackaDO]

I am wondering about the strategy of the ROL from the programs' perspective. As applicants, we are told to simply rank the programs we like the best at the top, regardless of our likelihood of matching there. Does the same rule apply for the programs? From what I understand about the algorithm, it doesn't give priority to the programs in getting their highest ranked applicants, so does that mean that they will rank someone higher that is more likely to match with them, or are they the same as the applicants in that they just rank the best applicants highest?

In a nutshell, my question is why does the letter of intent make a difference? I'm not suggesting that it doesn't, as some programs I've interviewed at hinted that I'd be ranked higher if I contacted them later expressing my continued interest. Is it all just so the program can feel good about not sailing to far down their rank list to fill their spots?

Great post and interesting thought. I'm going to an interview tomorrow and this very thing might be my question I ask to the PD when they ask "do you have any questions??". I have a relationship with the program and PD so it's not like I'm asking a total stranger the question or else I wouldn't do it but I think he will be honest with me as much as possible but the thing to keep in mind is whatever I find out is just one program... not all will do the same thing most likely but maybe he can give me some insight and I'll post back if it does

 

[Szent]

One of the PD's along the interview trail mentioned that some programs have to report how "successful" they were in match to other higher-ups. Success being determined by how high the people that matched into the program were on their program's list.

The PD explained that such a move is entirely political and that they do not do things that way.

 

[filhodeinferno]

One of the PD's along the interview trail mentioned that some programs have to report how "successful" they were in match to other higher-ups. Success being determined by how high the people that matched into the program were on their program's list.

The PD explained that such a move is entirely political and that they do not do things that way.

Interesting. Besides the accountability to higher ups, the only other reason that I can see why a letter of intent would matter to a program is to get people who are more excited about being there, thus creating a more cohesive group of residents.

 

[QuackaDO]

Interesting. Besides the accountability to higher ups, the only other reason that I can see why a letter of intent would matter to a program is to get people who are more excited about being there, thus creating a more cohesive group of residents.

Supposedly, at least at the majority of the places I've interviewed at, they claim that's the biggest reason they interview... so they can find the people that really want to be there and to make a nice cohesive group. The exceptions are the snooty type places that want to say they only match the top candidates and don't care if their place was first or last on the applicant's list, as long as they are competitive and make the program look good but I think those type of places are few and far between in EM... or so I hope.

 

[EsTxDr]

HA wow. only snooty places want to match the top candidates. That's cray cray. Its obviously a solid combo of the both - top applicants who they believe want to be there. I will still send a letter to my first 2 or 3 places... but I seriously doubt it will change anything.

I can't speak for him but I think you misread his point. Not that places dont want to match "top candidates" but there are places that place much more importance on numbers and scores than things like gestault and "fit". They prefer only the highest scores and since the first round is interview invites that sets the tone for their entire rank list. I happen to agree, there are programs like that and I attempted to keep them off my application from the beginning. Some I did, some I found out later were on my list. There are places that place much less emphasis on scores. Obviously anyone getting interview invites can handle the curriculum.

Just to clarify, are you sending "you are ranked #1" letters to your top 2 or 3 places? Or just general love letters?

 

[red10]

Just joking. No, I am not telling multiple programs they are number one. Just one. And send a note to maybe 2 other places, with some wording that I'm not sure about yet.

And yeah, I know, I get the whole "fit" thing and "we want people who want to be here" but still, I do not think it is as black and white as you're saying - that either programs appreciate fit or else they want 260 board scores (I know you didn't say exactly that, just saying it for effect). I think all programs want both a great candidate and a good fit - the better programs just have the benefit of being able to pick from those with the high board scores, so maybe they unfairly get the reputation of only matching those types of people. Though, I wouldn't even really know how to pick up on the fact that a place would be like that... how does that become obvious during the interview?

I had a program that asked me almost zero questions about myself during the interviews. No "i see you're interested in this or did research in that" just "what questions can i answer for you?" every interview. Maybe they really wanted to sell their program to me or thought they could figure out my interests by the Qs I asked, but really it just left me feeling like they had already decided their rank list based on the paper application and I was just there to confirm I was not a serial killer. Maybe they were one of those programs whose focus was more on "we want great numbers" than "we want passionate/fun/hardworking/relatable/whatever people who we think will work well together"

 

[GreenEydGem]

I am wondering about the strategy of the ROL from the programs' perspective. As applicants, we are told to simply rank the programs we like the best at the top, regardless of our likelihood of matching there. Does the same rule apply for the programs? From what I understand about the algorithm, it doesn't give priority to the programs in getting their highest ranked applicants, so does that mean that they will rank someone higher that is more likely to match with them, or are they the same as the applicants in that they just rank the best applicants highest?

In a nutshell, my question is why does the letter of intent make a difference? I'm not suggesting that it doesn't, as some programs I've interviewed at hinted that I'd be ranked higher if I contacted them later expressing my continued interest. Is it all just so the program can feel good about not sailing to far down their rank list to fill their spots?

From a program perspective, we try to approach interviews as a way to see if the applicants are a fit for us and vice versa. If you receive an interview offer, there is something they see in your application that draws them to want to meet you in person. In person is more about fit. Historically in programs I've worked in, we try to not do a ROL based on who we think might want to come here and we try to not speculate where we think applicants might match. It just drags out an already painful process and makes everyone more anxious. Some programs use a scoring system during interviews and create their lists based on numerical scores alone.

As for letters of intent, I've seen some very formal letters being sent via email and then followed up with a postal mail letter. I think that's overkill. An email expressing your interest is certainly a nice touch. If a program is really interested in you, chances are you'll get an email or phone call from one of the faculty that interviewed you asking if you had any questions etc. Again, in past programs we've made these calls/emails and usually state something like "we wouldn't be unhappy if you were on our match list". It doesn't violate the match rules and we weren't telling the applicant where we were ranking them or if we were ranking them.

This is a painful process for everyone, but my heart totally goes out to the applicants. Make a "Pro's" and "Con's" list and also include gut feeling. You'll know you have the right ROL when you see it.

My comments might not have answered any of your questions, but I am just offering perspective.

Best of luck to all!

 

[EsTxDr]

Wait, should you not tell your top 3 or 4 programs that they're your #1? Is that bad?

I've learned over the last few years not to make ANY assumptions about medical students.

And yeah, I know, I get the whole "fit" thing and "we want people who want to be here" but still, I do not think it is as black and white as you're saying - that either programs appreciate fit or else they want 260 board scores (I know you didn't say exactly that, just saying it for effect). I think all programs want both a great candidate and a good fit - the better programs just have the benefit of being able to pick from those with the high board scores, so maybe they unfairly get the reputation of only matching those types of people. Though, I wouldn't even really know how to pick up on the fact that a place would be like that... how does that become obvious during the interview?

Yeah, I didn't say either or, but there are programs who are definitely interested in a certain level of board scores (been told that in no uncertain terms by a PD) and then try to do the whole "fit" thing within that pool of superboards they have created. My philosophy if I were a PD would be to invite those I feel can master the curriculum and be successful and then forget board scores and get to know applicants. There are these programs and PDs as well (I've interviewed at some). Obviously there is a gradient between, "I only want 270's" and "I dont even want to know board scores" but thats not what I'm speaking to. I'm speaking to the philosophy, the drift or ideology of the PD and program. I think it can very easily be picked up on in interviews, etc. Of course I've been interviewing people for a living for most of my life!

I would also say its a mistake to refer to programs with high interest in board scores as "better programs". I completely disagree with the notion that higher board scores = better program or applicant. (and in the interest of full disclosure my board scores aren't too bad).
I think everyone has their own "fit" and there will be some obvious opposites in this whole process. And thats ok, we need all kinds.....well most kinds that is.

Not really disagreeing with you, just clarifying my take on it and getting on my soapbox a bit.

Best of luck to all!

Thank you for commenting, its really great to get input from your "side" of the situation.

 

[QuackaDO]

I can't speak for him but I think you misread his point. Not that places dont want to match "top candidates" but there are places that place much more importance on numbers and scores than things like gestault and "fit". They prefer only the highest scores and since the first round is interview invites that sets the tone for their entire rank list. I happen to agree, there are programs like that and I attempted to keep them off my application from the beginning. Some I did, some I found out later were on my list. There are places that place much less emphasis on scores. Obviously anyone getting interview invites can handle the curriculum.

Just to clarify, are you sending "you are ranked #1" letters to your top 2 or 3 places? Or just general love letters?

Yup, you basically summed up what I was trying to say and thought was pretty clear but might have been ambiguous.

 

[filhodeinferno]

This is a painful process for everyone, but my heart totally goes out to the applicants. Make a "Pro's" and "Con's" list and also include gut feeling. You'll know you have the right ROL when you see it.

My comments might not have answered any of your questions, but I am just offering perspective.

Best of luck to all!

Thank you very much for you input. I liked pretty much every program that I interviewed at, but there were 2 or 3 that just "clicked" during the interview day. I could see what about me led them to invite me to interview, and I felt like their system was built for someone like me. Based on what you've said, I think I'll just send a brief email to these 2 or 3 programs stating that I feel like I would fit in well there, and a few reasons as to why I feel that way. That should be enough, I hope.

 

[hotsoup]

>>>I had a program that asked me almost zero questions about myself during the interviews. No "i see you're interested in this or did research in that" just "what questions can i answer for you?" every interview.

Me too! I actually had several programs with interviews like this. I can understand leaving a few minutes for questions at the end of an interview, but opening a conversation with "ask me your questions" seemed a bit unfair. I felt disappointed that after I put in so much time and effort to travel there, they hadn't seemed to have read my file and didn't seem interested in getting to know me. More importantly, the kinds of questions I'm actually interested in (what is the work/life balance, is the program friendly, how are the attendings) are better directed to residents, not program directors. Really don't understand why programs did interviews like this.

 

[GreenEydGem]

I've learned over the last few years not to make ANY assumptions about medical students.



Yeah, I didn't say either or, but there are programs who are definitely interested in a certain level of board scores (been told that in no uncertain terms by a PD) and then try to do the whole "fit" thing within that pool of superboards they have created. My philosophy if I were a PD would be to invite those I feel can master the curriculum and be successful and then forget board scores and get to know applicants. There are these programs and PDs as well (I've interviewed at some). Obviously there is a gradient between, "I only want 270's" and "I dont even want to know board scores" but thats not what I'm speaking to. I'm speaking to the philosophy, the drift or ideology of the PD and program. I think it can very easily be picked up on in interviews, etc. Of course I've been interviewing people for a living for most of my life!

I would also say its a mistake to refer to programs with high interest in board scores as "better programs". I completely disagree with the notion that higher board scores = better program or applicant. (and in the interest of full disclosure my board scores aren't too bad).
I think everyone has their own "fit" and there will be some obvious opposites in this whole process. And thats ok, we need all kinds.....well most kinds that is.

Not really disagreeing with you, just clarifying my take on it and getting on my soapbox a bit.



Thank you for commenting, its really great to get input from your "side" of the situation.

Luckily, I've always worked in programs where we actually look at the entire ERAS packet. As for the "fit" thing ... don't underestimate it. When I look at a rank list before submitting it with the Program Director and faculty, we definitely remember the great things in their application, how great or poor they did in their interview and then, yes, we ask would they be a good fit in our program? Would we be okay sending them to another facility to represent us? Things like that. It does matter! Board scores are nice, but I don't care if someone has a 260 or 220 as long as they have integrity, work hard and represent my program well.

Your definition of "better programs" may be different than others. We interviewed high boards score applicants and lower (not anyone who failed) scores too. Scores are just one part of a bigger application packet. I don't know any program in any specialty that puts high stock in board scores.

You're certainly welcome to your opinion. I've been doing this type of work for a very long time. I've seen the good, the bad and the ugly with programs and applicants.

Again, best of luck to you all! I know you will get into a great program!

 

[illegallysmooth]

Has anyone heard from a program that they require the comlex PE or USMLE CS score before they will rank an applicant?

 

[EsTxDr]

Luckily, I've always worked in programs where we actually look at the entire ERAS packet. As for the "fit" thing ... don't underestimate it. When I look at a rank list before submitting it with the Program Director and faculty, we definitely remember the great things in their application, how great or poor they did in their interview and then, yes, we ask would they be a good fit in our program? Would we be okay sending them to another facility to represent us? Things like that. It does matter! Board scores are nice, but I don't care if someone has a 260 or 220 as long as they have integrity, work hard and represent my program well.

Your definition of "better programs" may be different than others. We interviewed high boards score applicants and lower (not anyone who failed) scores too. Scores are just one part of a bigger application packet. I don't know any program in any specialty that puts high stock in board scores.

You're certainly welcome to your opinion. I've been doing this type of work for a very long time. I've seen the good, the bad and the ugly with programs and applicants.

Again, best of luck to you all! I know you will get into a great program!

I believe you and I are saying the same thing.

 

[littlejuan]

Has anyone heard from a program that they require the comlex PE or USMLE CS score before they will rank an applicant?

Never heard that, but I did have one program that asked if I had taken CS already. They didn't say anything about it being required for ranking though.

 

[JediZero]

Has anyone heard from a program that they require the comlex PE or USMLE CS score before they will rank an applicant?

Yes, two Osteo programs that explicitly require PE scores. One was more of a technicality, the other was a (truly stupid) dealbreaker.

 

[MalachiConstant]

Yes, two Osteo programs that explicitly require PE scores. One was more of a technicality, the other was a (truly stupid) dealbreaker.

My scores came in just in time for one program that was explicit about needing a complete file to be considered. I suspect I got hung out to dry at another place who weren't as direct about it and made their decision pretty early.

 

[GreenEydGem]

Never heard that, but I did have one program that asked if I had taken CS already. They didn't say anything about it being required for ranking though.

We prefer Step 2 be submitted before ranking, but next year we'll make it required in order to be ranked.

 

[EsTxDr]

We prefer Step 2 be submitted before ranking, but next year we'll make it required in order to be ranked.

Interesting. Is there something pushing this or is it just something your program has decided? I'm just curious. Are people getting ranked and failing to get it completed?

 

[EsTxDr]

Yah, I can't find a ton searching on letters of intent. I have a number 1 for sure and would love to send them something.

Stoopid interview season. I'm starting to weaken to the idea of sending out a letter to my #1.

 

[GreenEydGem]

Interesting. Is there something pushing this or is it just something your program has decided? I'm just curious. Are people getting ranked and failing to get it completed?

I guess I would wonder why a student wouldn't want Step 2 submitted before interview season was over. It certainly strengthens their file and shows commitment. We also like to see a higher score on Step 2 than Step 1. It's our programs decision, but a lot of programs in all specialties are moving towards this. Emergency Medicine is so competitive, I would think that applicants would want to show/put every effort forward to help their application.

 

[littlejuan]

Aaaah! How am I going to rank?! Why is this so nerve-racking? As far as Step 2, I am extremely happy I took it right after finishing 3rd year. My Step 1 was fine, but I actually managed to improve over 30 points on Step 2 which I don't think would have happened had I waited to take it later in the year.

 

[gutonc]

I guess I would wonder why a student wouldn't want Step 2 submitted before interview season was over. It certainly strengthens their file and shows commitment. We also like to see a higher score on Step 2 than Step 1. It's our programs decision, but a lot of programs in all specialties are moving towards this. Emergency Medicine is so competitive, I would think that applicants would want to show/put every effort forward to help their application.

Advising from the "Dean's office" side of things remains somewhat behind the times. Some places are still going with the "if you have a good Step 1 score, you don't need Step 2 until after you rank" line that was kind of true 5 or 10 years ago but is patently false today.

 

[EMmotherhen]

We require Step 2 to rank. You can interview without it but you'll be on the Round 2 invitation list since there are so many who already have it posted. But you will not rank unless a Step 2 is posted in ERAS in time for making out our list. If Dean's Offices are telling you otherwise then please listen to those of us on this post. We know what we require and expect.

 

[tele turnin]

Question about sending letters to top pick. Email or by snail mail? Not sure if one is superior to the other. Thoughts...

 

[EsTxDr]

I guess I would wonder why a student wouldn't want Step 2 submitted before interview season was over. It certainly strengthens their file and shows commitment. We also like to see a higher score on Step 2 than Step 1. It's our programs decision, but a lot of programs in all specialties are moving towards this. Emergency Medicine is so competitive, I would think that applicants would want to show/put every effort forward to help their application.

I agree with you, just an interesting move. Seems to be more about getting those scores in to see that desired upswing in step 2 vs step 1. I wanted it out of the way personally, so I took it very early. But I agree with @gutonc that Dean's offices are indeed giving that unfortunate advise. As are residents and attendings really. I hadn't heard to wait until after rank, but definitely have heard (multiple, and I mean multiple) times to wait until after interviews, at least first few "rounds". Speaks to the need for good solid mentor/adviser in this process, especially at schools without EM programs. My mentor saved my life in this process.

Question about sending letters to top pick. Email or by snail mail? Not sure if one is superior to the other. Thoughts...

Snail mail has gone the way of the dodo.

 

[shenanigi]

Question about sending letters to top pick. Email or by snail mail? Not sure if one is superior to the other. Thoughts...

Prob doesn't matter either way

 

[EsTxDr]

Prob doesn't matter either way

Came very close to sending one out this week and have decided against it. For this and other reasons.

 

[GreenEydGem]

I agree with you, just an interesting move. Seems to be more about getting those scores in to see that desired upswing in step 2 vs step 1. I wanted it out of the way personally, so I took it very early. But I agree with @gutonc that Dean's offices are indeed giving that unfortunate advise. As are residents and attendings really. I hadn't heard to wait until after rank, but definitely have heard (multiple, and I mean multiple) times to wait until after interviews, at least first few "rounds". Speaks to the need for good solid mentor/adviser in this process, especially at schools without EM programs. My mentor saved my life in this process.


Snail mail has gone the way of the dodo.

Whether you like it or not, scores matter. Always have and always will to some programs BUT not all specialties.

 

[EsTxDr]

Whether you like it or not, scores matter. Always have and always will to some programs BUT not all specialties.

Yeah I feel like we are missing each other somehow. I agree with you, was just curious as to the impetus for change.

I may not have been clear but I dont hold disregard for board scores. I have a different philosophy on choosing applicants than some programs, but dont harbor ill will towards board scores (except that I had to take them!).

 

[illegallysmooth]

I was actually wondering specifically about the step2 CS or comlex PE (maybe I shouldn't have used the word "score" as it's a pass/fail test). Not the written test. But thanks for the responses.

 

[shenanigi]

Just how smooth is illegally smooth?

 

[QuackaDO]

Just how smooth is illegally smooth?

I hear it's slicker than owl ****... or so the story goes.

 

[Siggy]

Advising from the "Dean's office" side of things remains somewhat behind the times. Some places are still going with the "if you have a good Step 1 score, you don't need Step 2 until after you rank" line that was kind of true 5 or 10 years ago but is patently false today.

Heck, I know of hospitals where it's essentially a hospital wide policy to have a full set of boards (1, 2 and CS/PE) in order to be ranked. Don't take CS/PE in time? You'll be removed from the rank list. ...and yes, it's because the hospital has been burned in the past with a matched applicant who ended up in the 1% [who failed the CS/PE).

 

[deleted547339]

Heck, I know of hospitals where it's essentially a hospital wide policy to have a full set of boards (1, 2 and CS/PE) in order to be ranked. Don't take CS/PE in time? You'll be removed from the rank list. ...and yes, it's because the hospital has been burned in the past with a matched applicant who ended up in the 1% [who failed the CS/PE).

Supposedly they increased the fail percentage of CS this year.

 

[TooMuchResearch]

I agree with you, just an interesting move. Seems to be more about getting those scores in to see that desired upswing in step 2 vs step 1. I wanted it out of the way personally, so I took it very early. But I agree with @gutonc that Dean's offices are indeed giving that unfortunate advise. As are residents and attendings really. I hadn't heard to wait until after rank, but definitely have heard (multiple, and I mean multiple) times to wait until after interviews, at least first few "rounds". Speaks to the need for good solid mentor/adviser in this process, especially at schools without EM programs. My mentor saved my life in this process.


Snail mail has gone the way of the dodo.

The thing about getting advice from mentors is that it will vary widely. The two EM PDs I asked last year said "we don't need step 2 to interview, but we like it to rank. If your Step 1 is good enough, then take 2 whenever."

 

[FiveIronFrenzy]

Speaking of Step 2 and the like...

I just got my results for Step 2 CS and was wondering about the process for updating programs. Can you resubmit your NBME transcript to programs through ERAS as soon as you get your results? Just want to make sure this gets to people before ROLs are due.

thanks everyone!