ER residency advice

[manara123]

Hello everyone!

I could really use some advice please. I didn't get into an EM residency. Honestly academically and scores wise I'm not a very competitive applicant but I did multiple audition rotations and was told repeatedly that I excelled and was a great candidate. Unfortunately it seems that after they saw my academic record, they dropped me.
I know that it would be really difficult for me to get in. Im trying to figure out a better plan for next year. I honestly cannot imagine myself doing anything else.
I'm considering SOAP-ing into a transitional year and reapplying but I'm being advised against it. I really need advice on how to best increase my chances of getting into EM next year.
Please help me.

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[PrettyLadyDoc24]

Unless you plan to reapply, I don't think for this year you'll get in. Why are you being advised against it and by whom?

Also, there are emergency medicine fellowships after Family Medicine residency if you want to practice that specifically.

 

[Arcan57]

Not sure that it applies specifically to you OP but there's something applicants should consider regarding feedback during EM rotations.

Unlike most other rotations where you'll be with the same attending for 2 weeks to a month, often you'll have 3-5 attendings that you work with during an EM rotation. Additionally, the bar for acceptable med student performance in the ED is pretty low. These create some downstream consequences.

1) We're unlikely to give you honest feedback face to face. Nobody wants to crush someone's dreams if you've only met them once or twice. Due to the breadth of EM, a completely inadequate differential, poor procedural skills, and inability to actively manage more than 1 patient are taken as a given for students. Given the low baseline expectations, desire and prior academic success are used as surrogates for potential aptitude in EM. Given that most attendings you're working with will have no idea what your Step scores or prior clinical grades were, being eager and not actively killing a patient is usually enough to garner a "good job" if you ask us at the end of your shift. This won't translate into a high spot on the rank list though.

2) Any individual "you're the best student ever" is going to be diluted by the fact that you'll have multiple evaluators. While there truly are some rotation superstars that everyone loves and get in by sheer acclaim, most residents are going to be picked due to some combination of Step scores, EM clinical grades, and general likeability during interview/rotation. It was common for my residency program to accept requests for away rotations for students that had no hope of matching there. I'm sure most of those students got generically positive feedback during there rotation and received a SLOR that was mildly positive but didn't significantly change their competitiveness.

With the possible exception of transitioning to program that happens to have an EM spot open during the year (which wouldn't be a match thing anyway), doing a transition year isn't going to help you match into EM if you weren't competitive the first time. You'd be better off trying to get into a program that offers a path to board eligibility in something and then if you really want to going back and doing an EM residency.

 

[manara123]

Not sure that it applies specifically to you OP but there's something applicants should consider regarding feedback during EM rotations.

Unlike most other rotations where you'll be with the same attending for 2 weeks to a month, often you'll have 3-5 attendings that you work with during an EM rotation. Additionally, the bar for acceptable med student performance in the ED is pretty low. These create some downstream consequences.

1) We're unlikely to give you honest feedback face to face. Nobody wants to crush someone's dreams if you've only met them once or twice. Due to the breadth of EM, a completely inadequate differential, poor procedural skills, and inability to actively manage more than 1 patient are taken as a given for students. Given the low baseline expectations, desire and prior academic success are used as surrogates for potential aptitude in EM. Given that most attendings you're working with will have no idea what your Step scores or prior clinical grades were, being eager and not actively killing a patient is usually enough to garner a "good job" if you ask us at the end of your shift. This won't translate into a high spot on the rank list though.

2) Any individual "you're the best student ever" is going to be diluted by the fact that you'll have multiple evaluators. While there truly are some rotation superstars that everyone loves and get in by sheer acclaim, most residents are going to be picked due to some combination of Step scores, EM clinical grades, and general likeability during interview/rotation. It was common for my residency program to accept requests for away rotations for students that had no hope of matching there. I'm sure most of those students got generically positive feedback during there rotation and received a SLOR that was mildly positive but didn't significantly change their competitiveness.

With the possible exception of transitioning to program that happens to have an EM spot open during the year (which wouldn't be a match thing anyway), doing a transition year isn't going to help you match into EM if you weren't competitive the first time. You'd be better off trying to get into a program that offers a path to board eligibility in something and then if you really want to going back and doing an EM residency.

Wow. You bring up some really good points. Thank you. I'm applying to EM programs in the Osteopathic world. I was told they are more open to transitional year applicants. Do you have any insight on that?

 

[gman33]

Your best chance would to do an initial training year somewhere that also has an em program.

Do an early em elective and hope for the best.

Had a guy at my former program who did just that and we gave him a spot the next year.

Just reapplying with no personal connections is unlikely to work.

 

[Angry Birds]

Transitional Year would be a great idea, especially if you already have SLOR's in hand from medical school. Then, try to rotate in the ER of an EM residency program and excel.

Of course, getting into a TY is actually pretty competitive as well, at least from when I did it long time ago.

 

[manara123]

Unless you plan to reapply, I don't think for this year you'll get in. Why are you being advised against it and by whom?

Also, there are emergency medicine fellowships after Family Medicine residency if you want to practice that specifically.

I'm being advised against it because of funding issues. When you do a transitional year, hospitals now lose that money because you come in as a PGY-2. With everything now getting more and more competitive, they'd rather take a student fresh out of medical school than consider a transitional. I'm hearing this from Program Directors of EM and of other specialties. Also, the fellowships are apparently not accepted by most EM programs/hospitals. I was told by a PD that it's not "legit."

At this point, I'm being advised to pick a back up field of residency and either apply again or switch within residencies.

 

[bananasinpijamas]

Hello everyone!

I could really use some advice please. I didn't get into an EM residency. Honestly academically and scores wise I'm not a very competitive applicant but I did multiple audition rotations and was told repeatedly that I excelled and was a great candidate. Unfortunately it seems that after they saw my academic record, they dropped me.
I know that it would be really difficult for me to get in. Im trying to figure out a better plan for next year. I honestly cannot imagine myself doing anything else.
I'm considering SOAP-ing into a transitional year and reapplying but I'm being advised against it. I really need advice on how to best increase my chances of getting into EM next year.
Please help me.

I'm confused. I'm assuming you just didn't get any interviews and are now out of luck. I love EM, so I understand your pain. However, I have family responsibilities and if my luck is ****ty and I end up not matching, I will move on and take a different specialty. I will not sit around and reapply and waste a year's income, soul, and my motivation into that. I'm not you, and maybe you have more flexibility in term of income and life plans, but I would seriously consider scrambling into something else. I'm not a person that just gives up, but if giving it my all and doing great in rotation is not enough now as a brand new graduate, I know what my chances are for the next year. I'm not saying you are not capable of doing this or much more, but you would have to give it your all and even then have low expectations. Sorry things aren;t working out the way you expected it, who knows and maybe this year there are some SOAP spots. Consider talking to your school if you are dead-set on reapplying. They may let you extend graduation for you to do some research projects or something meaningful.

 

[abcdior]

as much as I can sense your attachment to EM, there are times in life when one needs to take a Socratic attitude towards reality

If your plan is to apply again next year to EM JUST for the sake of "getting another shot", what makes you think you will get in?
you will have two very significant forces against you: 1. AOA/ACGME merger 2. Re-applicant
what ways can you/ have you planned to strengthen you app? I do not feel like a transitional or research year (esp for EM) is beneficial, especially when the gap is this wide

I'd try to SOAP into ANYTHING (categorical) I can

it will only get harder from here if you secure a spot this year

GL