Guide for EM re-applicants?

[Mat the coolcat]

Hi all,

I didn't match into emergency medicine last week, and I'm searching for a guide for re-applying if anyone has one; I'm a DO student who's definitely still set on re-applying EM for next year.

My mentor/advisor and I are still kind of at a loss for why I didn't match; I wasn't even on his radar for not matching. I had good scores, good grades, and I overall interview well (I think at least...), and my record is squeaky clean.

Maybe I had a bad SLOE, but I truthfully don't know, because I had 9 interviews initially and then got 3 more at better places after I sent in a late SLOE from a big-whig institution. Or maybe people started taking the SVI seriously (tanked that), but I truly don't know why I didn't match.

I scrambled into a TRI year at an institution with an EM program that historically has taken their TRI's, which is a huge plus. My plan is to bang out a few publications I've been procrastinating on, work my ass off at my TRI program, and brush up on my Spanish prior to re-applying next year. Gonna apply WAY more broadly too (still applied to 60+ programs last year).

All this said, if anyone has a written guide, or links to websites, or general advice to help me successfully reapply next year, I will forever be in your debt.

Thank y'all!

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[theSmurfette]

There’s this. But to me it was mostly common sense stuff. This is the only formal “guide“ that I was able to find online.

https://www.cordem.org/globalassets...018-advising-the-re-applicant.pdf?usp=sharing

 

[BigGAC1]

Sorry things didn't go your way. Fellow former EM applicant here. Didn't match EM (ended up in a categorical IM spot) and then decided to reapply as a PGY1. I still didn't match as a re-applicant so feel free to take any of my advice with a grain of salt, but if you have any specific questions I'm happy to offer any advice after having gone through the process twice.

 

[deleted436726]

Hi all,

I didn't match into emergency medicine last week, and I'm searching for a guide for re-applying if anyone has one; I'm a DO student who's definitely still set on re-applying EM for next year.

My mentor/advisor and I are still kind of at a loss for why I didn't match; I wasn't even on his radar for not matching. I had good scores, good grades, and I overall interview well (I think at least...), and my record is squeaky clean.

Maybe I had a bad SLOE, but I truthfully don't know, because I had 9 interviews initially and then got 3 more at better places after I sent in a late SLOE from a big-whig institution. Or maybe people started taking the SVI seriously (tanked that), but I truly don't know why I didn't match.

I scrambled into a TRI year at an institution with an EM program that historically has taken their TRI's, which is a huge plus. My plan is to bang out a few publications I've been procrastinating on, work my ass off at my TRI program, and brush up on my Spanish prior to re-applying next year. Gonna apply WAY more broadly too (still applied to 60+ programs last year).

All this said, if anyone has a written guide, or links to websites, or general advice to help me successfully reapply next year, I will forever be in your debt.

Thank y'all!

Are you me? I'm in a very similar situation :/

 

[gamerEMdoc]

Mat, don't sweat it. Sucks it happened to you, but you can absolutely recover after a failed match. The CORD reapplicant guide has some decent generalized info. If someone like your advisor has access to your ERAS app and is willing to advise which SLOEs to maybe replace, that will be helpful (because its usually just a single SLOE that needs to get the boot; I usually advise students to get rid of their bad SLOE and replace it with LORs from an TRI EM rotation and/or a LOR from their TRI PD.

Hit me up anytime you need advice. I'm always willing to help.

 

[deleted436726]

Mak, don't sweat it. Sucks it happened to you, but you can absolutely recover after a failed match. The CORD reapplicant guide has some decent generalized info. If someone like your advisor has access to your ERAS app and is willing to advise which SLOEs to maybe replace, that will be helpful (because its usually just a single SLOE that needs to get the boot; I usually advise students to get rid of their bad SLOE and replace it with LORs from an TRI EM rotation and/or a LOR from their TRI PD.

Hit me up anytime you need advice. I'm always willing to help.

Hi @gamerEMdoc, Would that combination of letters - a SLOE from your intern year home EM rotation + LOR from your TRI/TY PD - be sufficient for most EM programs? It seems like most places want 2 regular SLOEs.

 

[RainbowOtterz]

EM Advisor: The Re-Applicant Playbook
EM Match Advice: What if I don't match? What is the SOAP?
EM Match Advice Series: Advice for the Non-EM Resident Applying To EM

Here are a few other resources. The EM advisor blog has a lot of good information as does the CORD website already linked. I didn't match as a 4th year medical student in 2016 and did a GS prelim, I subsequently matched. My initial problem was how many programs I applied to and also I had red flags on my SLOEs. I ended up matching at a program I love.

What you need to do is fix whatever caused you not to match and reapply broadly. I reapplied to 126 programs and got a very good return. Maybe you didn't match because you passed through the swiss cheese model even if you're a great applicant, it happens. One big thing you need to concentrate on is being the best damn resident you can be as your PD will write a letter of rec for you.

 

[RainbowOtterz]

Hi @gamerEMdoc, Would that combination of letters - a SLOE from your intern year home EM rotation + LOR from your TRI/TY PD - be sufficient for most EM programs? It seems like most places want 2 regular SLOEs.

As a reapplicant your letters play by different rules. You need your intern PD to write a letter for you. If you can get a SLOE from intern year + another letter that would be great. My letters were from my PD, group SLOE from my intern year ED rotation, individual SLOE from intern year ED rotation, and letter from an EM advisor from medical school. No one ever brought up how I only had one real SLOE. They only brought up the strength of my letters. Also be prepared to answer "why didn't you match" in basically every single interview throughout the season.

 

[deleted436726]

EM Advisor: The Re-Applicant Playbook
EM Match Advice: What if I don't match? What is the SOAP?
EM Match Advice Series: Advice for the Non-EM Resident Applying To EM

Here are a few other resources. The EM advisor blog has a lot of good information as does the CORD website already linked. I didn't match as a 4th year medical student in 2016 and did a GS prelim, I subsequently matched. My initial problem was how many programs I applied to and also I had red flags on my SLOEs. I ended up matching at a program I love.

What you need to do is fix whatever caused you not to match and reapply broadly. I reapplied to 126 programs and got a very good return. Maybe you didn't match because you passed through the swiss cheese model even if you're a great applicant, it happens. One big thing you need to concentrate on is being the best damn resident you can be as your PD will write a letter of rec for you.

How many interviews did you have time to go on as a GS prelim?

 

[gamerEMdoc]

Hi @gamerEMdoc, Would that combination of letters - a SLOE from your intern year home EM rotation + LOR from your TRI/TY PD - be sufficient for most EM programs? It seems like most places want 2 regular SLOEs.

Yeah you have to realize that the two SLOE thing is for the traditional candidate. But places realize that not all candidates are the traditional candidate. Reapplicants are a bit different. Military GMOs leaving active duty are different candidates (almost always have no sloes). So yeah, there is generalized advice about number of SLOEs, but more important is that you definitely need a letter from your PD that is glowing, and an EM letter from a PGY1 EM year is def helpful if it can be arranged (not always possible).

 

[thegenius]

Sorry it didn't work out for you. Keep up the good fight. Keep at it. Remember these interviews are largely personality interviews...the docs want to know if they want to work with you. Some people don't realize it but sometimes they act or say things that make them less desirable to work with.

There was a DO med student tagging along with one of the other docs at my work and while he didn't say any one thing that was bad...his attitude was a little off putting. Well he was saying stuff to one of the scribes that was kind of mean.

Good luck!

 

[thegenius]

What you need to do is fix whatever caused you not to match and reapply broadly. I reapplied to 126 programs and got a very good return. Maybe you didn't match because you passed through the swiss cheese model even if you're a great applicant, it happens. One big thing you need to concentrate on is being the best damn resident you can be as your PD will write a letter of rec for you.

You f'ing serious? There can't be more than 126 programs?!?!?!

I applied to like 45....thinking I needed to because I was a older applicant. Wow

 

[Mat the coolcat]

Are you me? I'm in a very similar situation :/

Hey there. We're gonna make it through this. Idk about you, but after I was rid of all those pesky tears, I got a fire in my belly to succeed like never before.
"This is a setback, not a disaster, and these are the setbacks where greatness is formed." -My EM advisor/mentor

As a reapplicant your letters play by different rules. You need your intern PD to write a letter for you. If you can get a SLOE from intern year + another letter that would be great. My letters were from my PD, group SLOE from my intern year ED rotation, individual SLOE from intern year ED rotation, and letter from an EM advisor from medical school. No one ever brought up how I only had one real SLOE. They only brought up the strength of my letters. Also be prepared to answer "why didn't you match" in basically every single interview throughout the season.

I was specifically wondering about this, really appreciate this information. So do I not go back to programs I rotated at last year and ask them to re-send or re-write a SLOE? I'll get one this year at my TRI institution, but I'd like to throw a couple from last year in as they're from more renowned programs.

Mak, don't sweat it. Sucks it happened to you, but you can absolutely recover after a failed match. The CORD reapplicant guide has some decent generalized info. If someone like your advisor has access to your ERAS app and is willing to advise which SLOEs to maybe replace, that will be helpful (because its usually just a single SLOE that needs to get the boot; I usually advise students to get rid of their bad SLOE and replace it with LORs from an TRI EM rotation and/or a LOR from their TRI PD.

Hit me up anytime you need advice. I'm always willing to help.

Thanks gamerEMdoc, I will be sure to do so. And what I said to you before about you being of great help this last year still stands; I've been very grateful for your knowledge and expertise.
Are programs still able to access our ERAS applications? Or do they go by the wayside leaving us to re-enter everything next year?

I'll see what I can do about finding someone to do me a solid and tell me if I had a bad SLOE. I reached out to most the people who interviewed me today via email (will do more tomorrow), and s0 far none of them have been able to tell me any red flags. Swiss cheese is my current running hypothesis...

 

[thegenius]

Any data on this years match? How many spots went un-matched?

 

[Mat the coolcat]

You f'ing serious? There can't be more than 126 programs?!?!?!

I applied to like 45....thinking I needed to because I was a older applicant. Wow

Haha. There are I think around 220. I had a friend who applied to every single one of them two years ago. Bout 6.5k in app fees I think.

 

[Mat the coolcat]

Any data on this years match? How many spots went un-matched?

There were 29 positions at 14-15 places total for EM. It's on the 2019 application thread I think.

 

[thegenius]

I remember when I matched (9 years ago) that to have a 95% of matching you needed to have about 10 interviews. If you got to 12 it was 99%.

 

[Mat the coolcat]

I remember when I matched (9 years ago) that to have a 95% of matching you needed to have about 10 interviews. If you got to 12 it was 99%.

You're exactly right. I'm that 1/100...and I'm not even a serial killer...

 

[IH8ColdWeath3r]

Fellow DO. Current EM resident. I initially did not match into EM either. I had good board scores, good SLOEs (I think) but the reason I did not match is because I failed the COMLEX PE. Retook it in 1 month and passed, did absolutely nothing different. Did not matter because ACGME PDs cant wrap their head around how big of a joke that test is (Yes I said it, I know there are several PDs on here). In what world can they fail you and not provide a specific rubric that doesn't say exactly why you failed, in what cases you had deficiencies, and specifically point out what they were. No other test does this.

Anywho, I declined an IM offer, Anesthesia offer out of the match, and matched into a TRI program, and the TRI program took me into their EM program a few months in. Feel free to PM me.

What I can tell you is this - there is absolutely no substitute for hard work. Work your ass off, be nice to the nursing staff, and make friends with the fellow EM residents. They will all have some pull into whether you match or not. Clinically, read up on EM - know the basic clinical decision rules (HEART score, PERC criteria, CIWA, GOLD criteria, PECARN). Cannot tell you how many medical students rotate with us as fourth years, and even TRIs who want to do EM who have not bothered to look these things up. Look them up, understand when/how to apply them, and you will be sure to impress the right people.

If EM is truly what you want, then by all means do not give up and go or it. Unfortunatle that DO schools keep popping up despite the stagnant number of residency positions. I saw there have been SEVERAL new ones over the past two years. Our allopathic counterparts know and recognize this problem and have been more responsible, but that is another tirade/soap box for another day. All the best.

 

[RainbowOtterz]

How many interviews did you have time to go on as a GS prelim?

I went on 15, I received about 25 interviews the second time around. I used two weeks of vacation for my interviews and also went on some throughout the year. Thankfully I was on a few rotations where there were two interns on or CT surg at the VA.

You f'ing serious? There can't be more than 126 programs?!?!?!

I applied to like 45....thinking I needed to because I was a older applicant. Wow

There were ~150 ACGME when I applied. I left off a good amount of top tier places. Now there are likely a lot more programs with AOA.

I was specifically wondering about this, really appreciate this information. So do I not go back to programs I rotated at last year and ask them to re-send or re-write a SLOE? I'll get one this year at my TRI institution, but I'd like to throw a couple from last year in as they're from more renowned programs.
I'll see what I can do about finding someone to do me a solid and tell me if I had a bad SLOE. I reached out to most the people who interviewed me today via email (will do more tomorrow), and s0 far none of them have been able to tell me any red flags. Swiss cheese is my current running hypothesis...

You can consider reusing letters. The big thing is also now you will be a resident. Reusing old letters might not be the most helpful from when you were a medical student. I don't have the best answer for you truthfully. I feel like a consultant when I say "recommend" or "consider".

 

[gamerEMdoc]

Hey there. We're gonna make it through this. Idk about you, but after I was rid of all those pesky tears, I got a fire in my belly to succeed like never before.
"This is a setback, not a disaster, and these are the setbacks where greatness is formed." -My EM advisor/mentor


I was specifically wondering about this, really appreciate this information. So do I not go back to programs I rotated at last year and ask them to re-send or re-write a SLOE? I'll get one this year at my TRI institution, but I'd like to throw a couple from last year in as they're from more renowned programs.


Thanks gamerEMdoc, I will be sure to do so. And what I said to you before about you being of great help this last year still stands; I've been very grateful for your knowledge and expertise.
Are programs still able to access our ERAS applications? Or do they go by the wayside leaving us to re-enter everything next year?

I'll see what I can do about finding someone to do me a solid and tell me if I had a bad SLOE. I reached out to most the people who interviewed me today via email (will do more tomorrow), and s0 far none of them have been able to tell me any red flags. Swiss cheese is my current running hypothesis...

Yeah I still can access this past years applicants.

 

[towelonthefloor]

My experience from reapplying-

Make sure you know why you didn't match. For me, this was due to a bad SLOE that torpedoed my app- I still went on about 10 interviews but failed to match. I never used that SLOE when I reapplied, but it made me paranoid about using any of the SLOEs from medical school. Especially since each of the away rotations I constantly got good feedback. I reserved one SLOE from med school for programs that absolutely required two SLOEs and only sent it to a handful of programs. The new SLOE I got from my prelim year I made sure was positive. This sloe, in combination with my PD letter, essentially made my application. I applied to most programs with only one SLOE. For me, it wasn't worth the risk of sending out my old sloe when I really had no idea of the content. This probably have my interview numbers, but I ended up with 12 interviews and applied to about 100. I also had letters from my program's core faculty that were non EM but spoke about my clinical abilities at a resident level- I don't know how much weight these letters have, but I do agree its more weight than if these were from med school. Your PD letter and new SLOE will be the most important part of the application. I don't particularly recommend applying with one sloe. But if you doubt your previous letters at all, I would be cautious moving forward with the same set of letters from the previous match.

Some other tips:
- Once the dust of the match settles down, email the programs you interviewed at this past year for feedback. I did this and the handful of programs that emailed back were actually quite helpful
- Apply to a backup specialty. You are automatically seen as a red flag because of the reapplicant status. Plus youll at least have a job even if you don't match EM again.
- Intern year, especially knowing what you are doing now may not get you anywhere, is hard. This is particularly true if you are doing surgery. Your mindset will waiver. I know mine did. I started to question if any of this was worth it. But try to keep your perspective aligned with your goals.
- Use the resources at your program now. Ask them to re evaluate your entire application. Did they notice any red flags during your soap application? Do they have any ties to current programs? Make sure everyone knows you want EM. Faculty and your PD can mold your experience to what you want (as long as the program isn't malignant)
- Make sure you are able to schedule your EM elective for your new SLOE early on in the year.

 

[Mat the coolcat]

@towelonthefloor Thanks so much for this information, this is extremely helpful.

I had another question for y'all. One of the programs I interviewed at and asked advice for next year recommended that I take Level/Step 3 early on so that it can be in my ERAS application.
Is this a common thing to do? And if so, should I plan on taking both Step and Level 3? My suspicion is to only take level 3, because I already did relatively well on Step 1 and 2 (and my desire to save $$$).

 

[CajunMedic]

@towelonthefloor Thanks so much for this information, this is extremely helpful.

I had another question for y'all. One of the programs I interviewed at and asked advice for next year recommended that I take Level/Step 3 early on so that it can be in my ERAS application.
Is this a common thing to do? And if so, should I plan on taking both Step and Level 3? My suspicion is to only take level 3, because I already did relatively well on Step 1 and 2 (and my desire to save $$$).

I concur with @towelonthefloor's advice. That's pretty much what I did to successfully match this year.

To answer your question. My TRI had me take Level 3 by October 31st, unfortunately, it was the new version, so I didn't get mine back in time for rank list. Ideally, it would look good on your app, since passing it would be one less thing a program would have to worry about you.

Keep an eye on the ACGME website for the EM Residency Review Committee meetings, you can look in the Accreditation Data System after them and see what new programs are opening.

Going to a residency fair may, or may not be useful. I got a lot of face time at ACOEP, but only 1 interview out of it. People I know that went to ACEP had no luck at all.

Good luck to you and feel free to PM if you need any questions or resources

 

[Mat the coolcat]

I concur with @towelonthefloor's advice. That's pretty much what I did to successfully match this year.

To answer your question. My TRI had me take Level 3 by October 31st, unfortunately, it was the new version, so I didn't get mine back in time for rank list. Ideally, it would look good on your app, since passing it would be one less thing a program would have to worry about you.

Keep an eye on the ACGME website for the EM Residency Review Committee meetings, you can look in the Accreditation Data System after them and see what new programs are opening.

Going to a residency fair may, or may not be useful. I got a lot of face time at ACOEP, but only 1 interview out of it. People I know that went to ACEP had no luck at all.

Good luck to you and feel free to PM if you need any questions or resources

Hey thanks! That's super helpful. Do you know if I need to "do well" on Level 3? Or is passing it sufficient?

 

[towelonthefloor]

I’d only consider this if you need to make up for poor board scores. If you don’t do well and just barely pass, this may be seen as a red flag. And you don’t need anything else on your app that makes them question anything.
Plus studying during residency is quite hard. If you think you can ace the exam then sure go for it. I personally thought it would be too much to handle so I pushed my level 3 off until later this year, likely will take it beginning of my new residency program.
You can’t take step 3 unless you also took step 2 CS (the comlex PE equivalent).

@towelonthefloor Thanks so much for this information, this is extremely helpful.

I had another question for y'all. One of the programs I interviewed at and asked advice for next year recommended that I take Level/Step 3 early on so that it can be in my ERAS application.
Is this a common thing to do? And if so, should I plan on taking both Step and Level 3? My suspicion is to only take level 3, because I already did relatively well on Step 1 and 2 (and my desire to save $$$).

 

[Mat the coolcat]

I’d only consider this if you need to make up for poor board scores. If you don’t do well and just barely pass, this may be seen as a red flag. And you don’t need anything else on your app that makes them question anything.
Plus studying during residency is quite hard. If you think you can ace the exam then sure go for it. I personally thought it would be too much to handle so I pushed my level 3 off until later this year, likely will take it beginning of my new residency program.
You can’t take step 3 unless you also took step 2 CS (the comlex PE equivalent).

Ah, that is very good to know, for me and my pocketbook.

I bet I'll do fine on it, good test taker, but I definitely have enough other things going on that I don't want to put in enough work to ace it. So then the question becomes, "Do programs care about my score? Or just that i did okay and passed it?"

I kind of had wanted to take it early, just don't know if that's 100% tenable.

 

[gutonc]

Ah, that is very good to know, for me and my pocketbook.

Yeah that's kind of what I'm thinking as well. I bet I'll do fine on it, but I definitely have enough other things going on that I don't want to put in enough work to ace it. So then the question becomes, "Do programs care about my score? Or just that i did okay and passed it?"

I kind of had wanted to take it early, just don't know if that's 100% tenable.

Which has already been answered.

Do "well"...aka a flat or preferably upward trend from at least Step/Level 2? Nobody cares.
Do poorly...aka anything below your numerical Step/Level 2 score? Yes, they will care a lot.

 

[Mat the coolcat]

Which has already been answered.

Do "well"...aka a flat or preferably upward trend from at least Step/Level 2? Nobody cares.
Do poorly...aka anything below your numerical Step/Level 2 score? Yes, they will care a lot.

Thanks for being specific. Barely passing and decreasing on my score even a little bit are very different. I'll hold out til later to take it.

 

[Brigade4Radiant]

More US MD schools have opened up over the last decade than DO schools, soo....

For MD schools you need to have an associated hospital and residency spots so its a different thing

 

[IH8ColdWeath3r]

More US MD schools have opened up over the last decade than DO schools, soo....

How many opened up in the last 2-3 years compared to DO schools? Most of them that open do so with appropriate funding, appropriate staffing, and established hospitals for their students to rotate at with appropriate, good core rotations - as opposed sending students to fend for themselves, putting them through a "lottery" system, and most times leaving it up to the students to establish their own rotations. I mean come on, are we in nurse practioner school? If you're a DO, like myself, you should be outraged at this and demand better from your profession/professional organizations and the schools that open up that let these young idealistic kids in their early 20's take out 350K+ plus out in loans without having the means to at least ensure them adequate rotations to set them up for success so that they can learn what they need to learn and match...

 

[americanturkey]

Sorry you're going through this. I just matched on my reapply this year. Know that this is a thing that happens and you can recover from it. I managed to weasel into staying a us senior so I can't help too much with advice on swinging it from a transition year but contact the programs that rejected you and ask for advice. Most won't but 1-2 probably will give vague advice aND dis cuss it withe your home pd if you have one. Save a copy of your ERAS application because it may be handy to refer to and it gets wiped and reset at some point between now and next year.

With that many interviews I would guess at least some component of this situation is your interview skills/style. You will have to be awesome at this next year and also able to address this situation positively. Practice a ton. Like with people to ask you questions and give you feedback, read up on good interviewing, and even practice in front of a mirror or camera to make sure you don't have some weird tic or posturing.

Like many other people here...feel free to pm me if you want to talk about it more.