How many EM rotations should Class of 2022 prepare to do? Need some advice pls

[Yasuo]

We are able to start applying for electives/away rotaitons that open up in May for us. I know normally EM expects 2 SLOEs, but last year because of COVID, CORD suggested only getting 1 SLOE. What about this year?

The guidelines from the AAMC are also extremly confusing. For 2020-2021 cycle, they recommended no aways if you have a home program, and yet there are rotations currently available on VSLO for these months. The recent recommendation for the 2021-2022 cycle is that you should only do 1 away roation at all.

My situation is this: I have a home EM institution. I also have multiple EM programs in my state, a few of which I would love to match to.
- Should I aim to just do 1 away rotation at a program I’d love to match to and skip my home rotation altogether?
- Should I aim to do just my home insitution rotation and no away at all?
- Should I go ahead and set up both, and rotate at both home and away?

It’s just so confusing given that I’m not sure whether 1 or 2 SLOEs will be required, and I don’t want to “violate” any guidelines/recommendations.

Sorry for the rambling, maybe some of you are also confused and in a similar situation. Thanks for any advice you may have

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[gamerEMdoc]

I'd plan for one home, 1 away as of now. CORD hasn't weighed in on it yet. You can always cancel 1 later. I don't suspect they will recommend just 1 rotation this year, though I could be wrong. There's been discussion about this with some people still recommending 1, but a good bit of other PDs in recommending 2. I don't think there will be a consensus of 1, based on the discussions I've seen.

I think 1 home, 1 away with 2 sloes is what it should be. 2 aways for "orphan" students. There is very little reason ever to have more than 2 rotations and 2 sloes even in a normal year. I'd honestly prefer if this was the expectation going forward. Time will tell.

 

[Yasuo]

I'd plan for one home, 1 away as of now. CORD hasn't weighed in on it yet. You can always cancel 1 later. I don't suspect they will recommend just 1 rotation this year, though I could be wrong. There's been discussion about this with some people still recommending 1, but a good bit of other PDs in recommending 2. I don't think there will be a consensus of 1, based on the discussions I've seen.

I think 1 home, 1 away with 2 sloes is what it should be. 2 aways for "orphan" students. There is very little reason ever to have more than 2 rotations and 2 sloes even in a normal year. I'd honestly prefer if this was the expectation going forward. Time will tell.

Thanks a lot for your input. I guess the best plan of action for me right now might be to apply to some away spots to secure that first

 

[HemorrhagicShock]

Let me give you some real-life advice that I wish somebody gave me when I was a medical student going into EM.

Take care of yourself FIRST, then and ONLY then should you focus on helping others (and/or focusing on what other people think)

For your application cycle understand that all of your classmates, all of the EM hopefuls across the US (and some percentage of international candidates) are in direct competition with you for that spot. It sucks, but it's the truth. You must do everything you can to secure your spot, and if you are unhappy with the process, or think it's unfair, the only option is to get through it and change it from the top down once you're a top-ranking official.

Until then you have to play within the confines of the game, and occasionally that means stepping out of the norms if your desire is to win.

A fantastic example: our current application cycle. How many medical students were advised to schedule no more than 10 (or whatever the number was) interviews in order to "be fair" to everybody else. Now given how many medical students are Lemmings, I bet you a bunch of fantastic high-to-mid-range quality candidates did exactly that, thinking they were "doing the right thing." Guess who now feels screwed by that advice? Guess who may not match because of an anomalous year where PDs for some reason said "don't worry, 10 programs are more than enough!"

Guess who wins out? Yep, that rogue gunner who decided to apply to 30 programs, occupy 25 interview spaces, which all but guarantees they'll match in EM.

So the bottom line of my day-off rambling is that do whatever it takes to get into your chosen specialty. Do as many aways, home rotations, and interviews as you can possibly muster. Develop as many connections as you can while rotating at those programs. The PDs that would actually care about this are minimal, and if they DO care about stuff like that, you don't want to train at their program.

There is no reward for voluntarily playing fair when it comes to rotating, interviewing, and matching. This is pure competition and as you can see from the alarming numbers, there are still TONS of medical students aiming for EM. It behooves you to do whatever you can to get into a good program that will train you well and potentially set you up for a great fellowship match.

 

[gamerEMdoc]

Let me give you some real-life advice that I wish somebody gave me when I was a medical student going into EM.

Take care of yourself FIRST, then and ONLY then should you focus on helping others (and/or focusing on what other people think)

For your application cycle understand that all of your classmates, all of the EM hopefuls across the US (and some percentage of international candidates) are in direct competition with you for that spot. It sucks, but it's the truth. You must do everything you can to secure your spot, and if you are unhappy with the process, or think it's unfair, the only option is to get through it and change it from the top down once you're a top-ranking official.

Until then you have to play within the confines of the game, and occasionally that means stepping out of the norms if your desire is to win.

A fantastic example: our current application cycle. How many medical students were advised to schedule no more than 10 (or whatever the number was) interviews in order to "be fair" to everybody else. Now given how many medical students are Lemmings, I bet you a bunch of fantastic high-to-mid-range quality candidates did exactly that, thinking they were "doing the right thing." Guess who now feels screwed by that advice? Guess who may not match because of an anomalous year where PDs for some reason said "don't worry, 10 programs are more than enough!"

Guess who wins out? Yep, that rogue gunner who decided to apply to 30 programs, occupy 25 interview spaces, which all but guarantees they'll match in EM.

So the bottom line of my day-off rambling is that do whatever it takes to get into your chosen specialty. Do as many aways, home rotations, and interviews as you can possibly muster. Develop as many connections as you can while rotating at those programs. The PDs that would actually care about this are minimal, and if they DO care about stuff like that, you don't want to train at their program.

There is no reward for voluntarily playing fair when it comes to rotating, interviewing, and matching. This is pure competition and as you can see from the alarming numbers, there are still TONS of medical students aiming for EM. It behooves you to do whatever you can to get into a good program that will train you well and potentially set you up for a great fellowship match.

I respectfully disagree. First, you have ZERO data to back up the need to go on 25 interviews this year because we won't know until after the match what the failure to match rate at different interview numbers is. Second, the consensus statement on limiting interviews said that anything over 12 is likely to be unhelpful, and you really shouldn't go on more than 17. So you are flat out making up the number 10. But even if that were the number, I'd bet that 95% of people who ranked 10 programs match because... that's been the same percentage that match with those numbers for a long long time.

And you absolutely can hurt yourself by saying forget others, I'm doing what I want. The vast majority of candidates that applied this year did so with one EM SLOE. I'd estimate it was maybe 5% of the applicants that I saw that had 2. I didn't see anyone with 3 except reapplicants that were using old SLOEs. Someone applying with a ton of SLOEs would have stuck out like a sore thumb.

 

[Yasuo]

I respectfully disagree. First, you have ZERO data to back up the need to go on 25 interviews this year because we won't know until after the match what the failure to match rate at different interview numbers is. Second, the consensus statement on limiting interviews said that anything over 12 is likely to be unhelpful, and you really shouldn't go on more than 17. So you are flat out making up the number 10. But even if that were the number, I'd bet that 95% of people who ranked 10 programs match because... that's been the same percentage that match with those numbers for a long long time.

And you absolutely can hurt yourself by saying forget others, I'm doing what I want. The vast majority of candidates that applied this year did so with one EM SLOE. I'd estimate it was maybe 5% of the applicants that I saw that had 2. I didn't see anyone with 3 except reapplicants that were using old SLOEs. Someone applying with a ton of SLOEs would have stuck out like a sore thumb.

Another thing: The VSLO guidelines recommend no away rotations for the 2020-2021 academic year ending the end of June. That leaves me to do a home rotation in May or June. They then recommend only 1 away rotation for the 2021-2022 academic year, beginning August 1st. I'm required to do an IM Sub-I in August, soooo if I follow these recommendations, I'll have to do my 2nd EM rotation (away) in September. This would be considered the edge of "late" from what I've seen, although not a dealbreaker.

These AAMC recommendations are really making things confusing/tough

 

[HemorrhagicShock]

I respectfully disagree. First, you have ZERO data to back up the need to go on 25 interviews this year because we won't know until after the match what the failure to match rate at different interview numbers is. Second, the consensus statement on limiting interviews said that anything over 12 is likely to be unhelpful, and you really shouldn't go on more than 17. So you are flat out making up the number 10. But even if that were the number, I'd bet that 95% of people who ranked 10 programs match because... that's been the same percentage that match with those numbers for a long long time.

And you absolutely can hurt yourself by saying forget others, I'm doing what I want. The vast majority of candidates that applied this year did so with one EM SLOE. I'd estimate it was maybe 5% of the applicants that I saw that had 2. I didn't see anyone with 3 except reapplicants that were using old SLOEs. Someone applying with a ton of SLOEs would have stuck out like a sore thumb.

None of the numbers in my post were meant to be exact. Focusing on the numbers here is the straw-man. I fully admit that you have a better grasp on the exact data given your role, but my overarching conclusion is exactly the same.

This reminds me of the whole EBM argument, how there's a real and important difference between "well that's what the RCT says to do" vs. how that RCT result plays into the individual patient in front of you.

It's using data and statistical conclusions on a population scale in order to make decisions for the individual. While it's informative, it's nowhere near a black-and-white prescription.

The same applies to using ERAS data to decide on some theoretical max over which more applications aren't "helpful" (10 vs. 12 vs. 17 whatever the number is, doesn't matter for this argument). Sure that works for the population being studied, but what happens when you're the individual. What happens when you have $250,000 in debt and know that having to go through the match a second time is a potential career destroyer? What happens when the cost of adding on 5-10 additional interviews in the age of Zoom is fairly negligible considering the very real opportunity/economic costs of not matching.

What if I add a frustrated partner/spouse/child who has been waiting for you to be able to move back to a city closer to support systems or better schools? What if you're actually a slightly lower tier candidate or was one of the unlucky few that failed some dumb clinical test during med school and now have some silly red flag on your app?

Now add in some medical school or PD advisor saying "well the data says you only need 10/12/17/whatever" and "think of all the other candidates" and "it gives you a 97% (whatever the number is) chance of matching, don't worry!"

Do you honestly think that people in these individual situations are just gonna self-limit because "well that's what they told me to do!"

You can bet your tail that there are gonna be more than a handful of students that don't listen to that advice, and if you have an ounce of common sense, you're going to realize that "oh wow, I'm competing with them" and will adjust your strategy accordingly.

Regarding the second point (can't hurt yourself by saying forget others) - I texted a residency friend of mine who is an APD at a fairly name-brand program in CA. He and his program have interviewed "plenty" of students with 2 SLOEs this year. I asked whether 5% is was an appropriate ball-park and he said it was "much more" than that.

I want to be clear however that you give fantastic advice in general gamerEMdoc. You're a fantastic resource for those hopefuls who post here, and in general, your advice is good, but I want everybody to know that your individual experience as a PD is not always generalizable. And the further and further you get away from the process, the less you realize the true nature of what those medical students are experiencing/thinking.

 

[Rekt]

You can avoid all this nonsense altogether. I have a PhD in beating a dead horse, but no one's said anything yet. You should avoid EM altogether, you'll 100% regret it. What's your board scores?

 

[gamerEMdoc]

Another thing: The VSLO guidelines recommend no away rotations for the 2020-2021 academic year ending the end of June. That leaves me to do a home rotation in May or June. They then recommend only 1 away rotation for the 2021-2022 academic year, beginning August 1st. I'm required to do an IM Sub-I in August, soooo if I follow these recommendations, I'll have to do my 2nd EM rotation (away) in September. This would be considered the edge of "late" from what I've seen, although not a dealbreaker.

These AAMC recommendations are really making things confusing/tough

Not at all. You should have one SLOE by Sept. Another by Oct-Nov. my understanding is its expected that aways will happen later next year.

 

[gamerEMdoc]

None of the numbers in my post were meant to be exact. Focusing on the numbers here is the straw-man. I fully admit that you have a better grasp on the exact data given your role, but my overarching conclusion is exactly the same.

This reminds me of the whole EBM argument, how there's a real and important difference between "well that's what the RCT says to do" vs. how that RCT result plays into the individual patient in front of you.

It's using data and statistical conclusions on a population scale in order to make decisions for the individual. While it's informative, it's nowhere near a black-and-white prescription.

The same applies to using ERAS data to decide on some theoretical max over which more applications aren't "helpful" (10 vs. 12 vs. 17 whatever the number is, doesn't matter for this argument). Sure that works for the population being studied, but what happens when you're the individual. What happens when you have $250,000 in debt and know that having to go through the match a second time is a potential career destroyer? What happens when the cost of adding on 5-10 additional interviews in the age of Zoom is fairly negligible considering the very real opportunity/economic costs of not matching.

What if I add a frustrated partner/spouse/child who has been waiting for you to be able to move back to a city closer to support systems or better schools? What if you're actually a slightly lower tier candidate or was one of the unlucky few that failed some dumb clinical test during med school and now have some silly red flag on your app?

Now add in some medical school or PD advisor saying "well the data says you only need 10/12/17/whatever" and "think of all the other candidates" and "it gives you a 97% (whatever the number is) chance of matching, don't worry!"

Do you honestly think that people in these individual situations are just gonna self-limit because "well that's what they told me to do!"

You can bet your tail that there are gonna be more than a handful of students that don't listen to that advice, and if you have an ounce of common sense, you're going to realize that "oh wow, I'm competing with them" and will adjust your strategy accordingly.

Regarding the second point (can't hurt yourself by saying forget others) - I texted a residency friend of mine who is an APD at a fairly name-brand program in CA. He and his program have interviewed "plenty" of students with 2 SLOEs this year. I asked whether 5% is was an appropriate ball-park and he said it was "much more" than that.

I want to be clear however that you give fantastic advice in general gamerEMdoc. You're a fantastic resource for those hopefuls who post here, and in general, your advice is good, but I want everybody to know that your individual experience as a PD is not always generalizable. And the further and further you get away from the process, the less you realize the true nature of what those medical students are experiencing/thinking.

I do think the number is important and not a strawman. They picked those numbers for a reason. 12 is the point of about 99% match. After that the match rate curve flattens out. Adding 5 more builds in a buffer for the uncertainty this year. I highly doubt you’ll see anyone who ranked 17 programs not match this year. Im sure weirder things have happened, Im just very skeptical that it will.

I get that there will be people that over interview, Im not naive to that. That happens even in non-zoom years. Ill be very interested to see the NRMP data this year. It will provide a ton of insight into how students behaved when you remove the cost factor. Theres tons of speculation about everyone over interviewing, but we actually dont know that happened. Should be interesting, and could shape the future of the match if online interviews persist.

 

[RustedFox]

You can avoid all this nonsense altogether. I have a PhD in beating a dead horse, but no one's said anything yet. You should avoid EM altogether, you'll 100% regret it. What's your board scores?

Seriously.
I wish there were an easy way for me to get FM boarded.

Nothing is fun about supervising an adult daycare; which is 99% of EM after residency. This includes RN and PLP staff.

 

[MedScat]

Can we pleaseee not turn this into a "EM is doomed thread." We've read all the other threads, we get it. Maybe I'm soooo stupid for applying EM and maybe one day down the line i'll regret it but thats my path to follow - and the other ~3000 or so people who will be applying this year

 

[MedScat]

Now, speaking of away rotations - if there's a particular program that you want to do an away rotation that uses VSAS, is it appropriate to reach out to the clerkship director via email and express interest or should you just trust VSAS?

 

[Dr.Bruh]

None of the numbers in my post were meant to be exact. Focusing on the numbers here is the straw-man. I fully admit that you have a better grasp on the exact data given your role, but my overarching conclusion is exactly the same.

This reminds me of the whole EBM argument, how there's a real and important difference between "well that's what the RCT says to do" vs. how that RCT result plays into the individual patient in front of you.

It's using data and statistical conclusions on a population scale in order to make decisions for the individual. While it's informative, it's nowhere near a black-and-white prescription.

The same applies to using ERAS data to decide on some theoretical max over which more applications aren't "helpful" (10 vs. 12 vs. 17 whatever the number is, doesn't matter for this argument). Sure that works for the population being studied, but what happens when you're the individual. What happens when you have $250,000 in debt and know that having to go through the match a second time is a potential career destroyer? What happens when the cost of adding on 5-10 additional interviews in the age of Zoom is fairly negligible considering the very real opportunity/economic costs of not matching.

What if I add a frustrated partner/spouse/child who has been waiting for you to be able to move back to a city closer to support systems or better schools? What if you're actually a slightly lower tier candidate or was one of the unlucky few that failed some dumb clinical test during med school and now have some silly red flag on your app?

Now add in some medical school or PD advisor saying "well the data says you only need 10/12/17/whatever" and "think of all the other candidates" and "it gives you a 97% (whatever the number is) chance of matching, don't worry!"

Do you honestly think that people in these individual situations are just gonna self-limit because "well that's what they told me to do!"

You can bet your tail that there are gonna be more than a handful of students that don't listen to that advice, and if you have an ounce of common sense, you're going to realize that "oh wow, I'm competing with them" and will adjust your strategy accordingly.

Regarding the second point (can't hurt yourself by saying forget others) - I texted a residency friend of mine who is an APD at a fairly name-brand program in CA. He and his program have interviewed "plenty" of students with 2 SLOEs this year. I asked whether 5% is was an appropriate ball-park and he said it was "much more" than that.

I want to be clear however that you give fantastic advice in general gamerEMdoc. You're a fantastic resource for those hopefuls who post here, and in general, your advice is good, but I want everybody to know that your individual experience as a PD is not always generalizable. And the further and further you get away from the process, the less you realize the true nature of what those medical students are experiencing/thinking.

Just to offer a counter anecdote. There are nearly 50 people in my school going EM this year (when you combine both campuses) and a small minority did 2 aways this year. The ones that did were not competitive applicants (didn't take step or had low scores) which is why they did more and mostly applied and interviewed at former AOA programs and/or HCA places. And at least half of these people applied with one sloe but did another audition later in the cycle (oct-dec) and added the second sloe during the cycle. And I go to a DO where you could argue there was waaaay more pressure to do multiple auditions this year.

I know multiple people in my class that have been interviewing at top 10 EM programs (even ones that have never taken a DO) and all of them just had one SLOE. I also interviewed with multiple programs who said if anybody applied with 2 SLOEs that would randomly pick one to look at and not view the other. I

 

[gamerEMdoc]

Now, speaking of away rotations - if there's a particular program that you want to do an away rotation that uses VSAS, is it appropriate to reach out to the clerkship director via email and express interest or should you just trust VSAS?

I personally don't use VSAS, so I can't completely answer this question for you, but from what I've gathered from talking to other students, many have found that sometimes when they apply on VSAS, the spots are already taken up by people that contacted the program already. So I definitely don't think it hurts to email the program coordinator or clerkship director. Would I do that for every away I apply to? Probably not, but if there was one particular one that is your top choice that you REALLY want to do your away at, it probably wouldnt hurt.

 

[Rekt]

Just to offer a counter anecdote. There are nearly 50 people in my school going EM this year (when you combine both campuses) and a small minority did 2 aways this year. The ones that did were not competitive applicants (didn't take step or had low scores) which is why they did more and mostly applied and interviewed at former AOA programs and/or HCA places. And at least half of these people applied with one sloe but did another audition later in the cycle (oct-dec) and added the second sloe during the cycle. And I go to a DO where you could argue there was waaaay more pressure to do multiple auditions this year.

I know multiple people in my class that have been interviewing at top 10 EM programs (even ones that have never taken a DO) and all of them just had one SLOE. I also interviewed with multiple programs who said if anybody applied with 2 SLOEs that would randomly pick one to look at and not view the other. I

As someone who interviews, they're likely just saying this to make people feel better. It makes no sense.

I'm a DO that had 4 SLOEs. Got around 50 invites from 70 applications. Matched at my #1. Only had positives regarding my SLOEs and amount of aways. I think "too many aways" is just false and really on Gamerdoc on here says its bad. I got to explore all types of programs and locations.

 

[Dr.Bruh]

As someone who interviews, they're likely just saying this to make people feel better. It makes no sense.

I'm a DO that had 4 SLOEs. Got around 50 invites from 70 applications. Matched at my #1. Only had positives regarding my SLOEs and amount of aways. I think "too many aways" is just false and really on Gamerdoc on here says its bad. I got to explore all types of programs and locations.

I agree in a normal and previous years multiple aways are ideal especially for DOs with no hone program. But this year that wasn’t the case. Vast majority of applicants did one. My friends at multiple MD schools were physically disallowed from doing anything other than their home rotation for EM.

 

[LibBum]

Prepare for all scenarios - landing away rotations with resulting SLOEs or a single home EM SLOE w/ two supporting letters (EM sub-specialty SLOE, such as tox or US, or a general letter of rec from a different clerkship rotation). The curve ball of this cycle was the 3 supporting letter preference with the limitation of a single EM SLOE. I did not anticipate the need for general letters and had to hustle to obtain one from a MICU rotation (to go with a EM-US SLOE) before applications opened to programs. My EM clerkship director would not allow students to obtain general letters of rec from EM faculty mentors, so it was a dead end.

You can only control so much, so don't screw up the variables your able to influence - the EM shelf exam, being personable to everyone you work with in the ED (the residents will vouch for you during the end of season rank meeting - so don't burn the bridge to your home institution), and always be willing to help out the team.

 

[deleted547339]

0?

 

[Cath Up]

You can avoid all this nonsense altogether. I have a PhD in beating a dead horse, but no one's said anything yet. You should avoid EM altogether, you'll 100% regret it. What's your board scores?

Reading this thread... was waiting for your post

 

[RustedFox]

Reading this thread... was waiting for your post

He's not wrong.
I don't know where THIS year's grads are going to find jobs, let alone those in 2-3 years.

I don't know how ACEP is letting this happen. It's antithetical to their reason for existence... but... they're corporate simps anyways.

 

[Cath Up]

He's not wrong.
I don't know where THIS year's grads are going to find jobs, let alone those in 2-3 years.

I don't know how ACEP is letting this happen. It's antithetical to their reason for existence... but... they're corporate simps anyways.

And yours too Mr. Fox!

I don't argue it. If I had never seen this forum and believed EM to be stable with excellent job outlook I would likely be pursuing it.