I'm really no expert but I did apply this year and got a good amount if interviews 22 interviews for 23 places I applied. Like others said as it stands you have an uphill battle. The single thing you can do is do well on step 2. I applied with a really good step 1 and studied my ass off for that. I maybe put in 1/4th the effort to step 2 and scored better than step 1. You don't have that luxury. Scoring really well on step 2 could essentially erase your poor step 1 score. You need to take step 2 as serious if not more so than step 1 as it could really eliminate your uphill battle if you do well. Step 2 is easier than step 1 so take advantage of that.
The next step is doing well on your EM rotations. In my interviews I got far more comments on my EM grades, slors, and comments than I did on my step scores. Getting honors in EM and great comments/slors is not rocket science. Here is Junge's guide to honoring an EM rotation. Take it with a grain if salt but u did get honors in 3 of 3 EM rotations 2 at "big names" and was emailed the comments that my residents and attendings wrote about me.
Like any rotation show up early and stay late. This shouldn't be hard because most student rotations are 8-9 hour shifts. Also in my opinion EM values the "team effort" more than other specialties. What I am saying is as a student you will probably only have two patients at a time, at least that is my experience. You are not there to move patients. While you are waiting for labs to come back or your patient is off for the CT you will have downtime. Don't just sit there; tell the nurses to grab you to start IVs. Most will be more than willing to teach you how to start them. After a few you can do them on your own and not only will the nurses love you for cutting down on their work but you can gain the skill and the residents and attendings will notice this. A comment on my slor was "a real team player. Insert name was starting IVs for the nursing staff. The whole department wanted insert name to stay a few more weeks." Second if there is a procedure in the department try to do it or at least watch it. I didn't do a single LP but watched many. Watching is better than sitting at the desk. Next I previously said you are not there to move patients but that is what the ED is all about. There is one aspect that a student can actually help move patients and that is lac repairs. Pick up all the lacs you can. If you don't pick them up offer to do them for the resident. As a student you are still honing your procedure skill and while you may not be allowed to do chest tubes, central lines ect. You can do lacs. You can work on your technique and free up your resident/attending to see other patients. Not only do you get to get more skills but also gets comments like "insert name did whatever he could to help the flow of the ed. He did an excellent job with a complex finger laceration while allowing me to see more patients. I would really enjoy working with insert name as he values teamwork." A resident or attending is proficient on lacs but you are not. You get to get your hands dirty and there is no more appreciative resident/attending than one that had a med student save them even 10 minutes even if you took 30 minutes to do it they just had to spend 30 seconds checking your work. The last thing is being nice to your patients. Your attendings have been doing this for 10-30 years. They have the right to be judgementsl or cynical. You don't. My second patient in the ed was a slam dunk drug seeker and I presented as that. I got slammed by my attending that I didn't have the knowledge to determine that and really I didn't. Luckily I got to work with that attending a few more times and got to prove that I was actually thinking of diagnoses before I jumped to that. With that said be nice to all your patients. You are a med student and have the most time out of anyone in the department. You have the time to really sit down and explain tests, diagnoses, or just talk. Believe me as "burnt out" as some EP's are they still enjoy patient care and your attendings will ask your patients what they thought about you. On one of my always I was assigned a "mentor" who was solely responsible for my grade. Little did I know she asked every patient what they thought of me. It ended up with a moment "med student _____ was really liked by all his patients. One patient even asked for Dr. Med student to come back to explain what I had told them. _____ is an asset to his patients."
Lastly if you want EM go for it. There are a lot of programs. I interviewed at 15 and would feel confident training at any of them. Even if you do poorly on step 2 this is not the time to save. Spending even extra $3,000 is pennies compared to the amount you spent on med school. Also $3,000 now may mean you make another $250,000 for the year youeould have spent doing a transitional year.
Sorry a very long post but I wanted to tell you the things that I felt I did right during my rotations. I think you will be just fine.
