Firstly, how important is research to matching into med school affiliated EM residencies in desirable locations?
Not all that important. It's helpful, yes, particularly for programs that are more research heavy and have a higher proportion of their graduates going into academics as opposed to community medicine. Your board scores and performance on EM rotations in the 4th year of medical school will matter much much more heavily.
Would an EM research project completed during the summer between M1 and M2 suffice to be competitive, presuming strong board scores and evaluations? Or should one strive to do research along with school?
If you're bound and determined to get research done to "check the box" (which I don't think you need to do for EM) then that's fine. A more meaningful project will be something that you stick with a little bit longer. But a project whose work is done between M1 and M2 year may require work writing a publication and presenting research throughout the next year as well. Just keep in mind that this isn't bench research, so oftentimes projects won't line up very well with the summer. You may need to be more flexible if you want to latch onto a project.
What's the deal with away rotations? Are you supposed to them at the institution you wish to match at? Do you get housing? I understand that a component of the grade for some (or all?) consists of your performance on a shelf exam. Is the case for EM rotations? Since you need to do multiple EM rotations, would you take the exam multiple times.
So the purpose of doing an away rotation is to satisfy the Standardized Letter of Evaluation (SLOE) requirement, which for most EM programs is to have two of these letters. If your home institution in medical school has an EM program then that's one of them, so you'll need to do at least one away rotation to obtain the second letter. The letters are supposed to be written as a sort of collaboration from the entire program and consistent of several standardized questions that the program answers about your performance. You can google and find a sample of what the SLOE form looks like. Conventional wisdom states that doing these away rotations and performing well at them is also a good way to get your foot in the door at that specific program. In addition, it can open up an entire region to you that you may have otherwise had a harder time standing out from the crowd. For instance, if you're located in the midwest but are interested in several west coast programs, doing an away rotation at a west coast program will also help make your application appear more serious when you send applications out to other west coast program, and the letter from that program will carry more weight since its written by somebody they are more familiar with. I did two away rotations and one home rotation. At my home rotation, part of our grade was from the SAEM standardized exam. At one rotation it was from taking the NBME shelf exam. At the last rotation there was no exam. The SAEM exam has multiple forms so nobody ever takes the same exam multiple times. At the institution where the NBME shelf exam was administered, anybody who had taken it before was offered one of the SAEM test forms as a replacement.
Do you have any advice for obtaining strong (subjective) evaluations. The prospect of my competitiveness hinging on what my evaluators happen to think of me worries me. Are subjective evaluations more important for EM than for any other specialty?
Be awesome. But really, work hard. Don't sit on your haunches and be a wallflower. Go wherever the action is taking place. Offer to go see patients in a non-obnoxious way that doesn't give the resident you're working with more work to do. Be somebody we want to be around at 3am. Know enough medicine that we don't think you're dumb, but you don't need to be some type of EM rockstar who knows it all either. It might not seem fair, but for the rest of your career you're going to be evaluated subjectively by your program, the nursing staff, and your patients. You have to be able to "play the game" so to speak when it comes to demonstrating confidence and likability to other people. Every specialty has letters of recommendation as a part of the evaluation process; we just have a process that makes it to where our letters actually carry weight and ask the programs to compare the applicants more objectively than just "yeah, DubbiDoctor is great and did a good job."
What were the roles of mid levels in the EDs you've worked in/rotated at? Were they always distinguished from the physicians or were their roles ever close to being interchangeable? Since EM requires relatively few years of training, and mid level residencies have become more common, do you foresee hospitals hiring more midlevels (and thus fewer physicians) to reduce costs?
Our advance practice practitioners (PAs and NPs) work most of their clinical time in our "fast track" where they see low acuity patients that have been triaged to sitting in an open chairs area instead of being roomed in the main ER. In this sense, it allows us to see more sick patients. Our APPs also work a few shifts in the main ER. They generally see the lower acuity patients that get roomed. They generally do not take patients in our critical resuscitation rooms, our trauma bay, stroke alerts, and the like. I work in a very busy ER and their help is very appreciated. I see enough "bread and butter" emergency medicine in my training that I do not believe they are hurting my education and as I said before, all the critically ill patients are my playground exclusively. My experience is limited to my institution but I do not believe our APPs would ever feel comfortable being able to work in an ER completely independently. Emergency Medicine is complex and the breadth of knowledge is very wide and includes many aspects of critical care that really requires a board certified EM physician to handle. I do not foresee a significant decline in EM job opportunities as a result of APP use in the ER.
Are you doing a 3 year or a 4 year residency? Are you interested in any fellowships? Do you plan on pursuing an academic or community career? Do you see yourself becoming involved in research as an attending physician?
Three year residency for me. I did not apply to four year programs. I am considering a fellowship in ultrasound since it's a personal interest of mine, but I may also forego the formal fellowship. At this point in time I do not anticipate going straight into academics after residency. I would like to work independently in the community for a period of time and if I come to the point that I find that work unfulfilling, I would strongly consider coming back to academics. I like the environment and I like education, but I'm feeling the itch to leave the nest so to speak and learn my craft on my own. If I do come back to academics, at this point I do not foresee research being a significant portion of my career.
