How many EM rotations would you recommend?

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There are plenty of threads on this, but the min # of letters you need for your application is 3 preferably 4 with two of those being SLORs. Assuming your home institution has an EM residency program, you would probably do one EM rotation there and one away during early 4th year (July-Sept) to get those letters. I got one letter from a third year EM rotation, did two aways and got two SLORs plus a personal LOR from another attending. I also did an EM U/S rotation in Nov for fun and learning more than anything else.

So....two at a minimum.
 
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Well, my third year rotation wasn't a "real" EM rotation because it was at an institution without a residency program. If you get a SLOR from that rotation, I don't know if that changes anything because you should probably still do two EM rotations at the beginning of the 4th year.

Anybody else who had required/elective EM time during third year at an institution with a program?
 
CABG said:
I'm sure I want to do EM. I just completed a 3rd year EM rotation at my home institution, and now I'm wondering how many EM rotations I should plan for 4th year (one vs. two), and where I should do them (home vs. away). Your thoughts?
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a lot of books say 2-3 but I did a ton! it maybe a little overkill but I feel if you're gunning for a place that has potential , go check it out. after spending 1 mo somewhere, it'll give you a much better (or worse) feel for area and the program than just a 8 hr interview day.
 
What about for DOs looking into allopathic programs? Wouldn't you need to do a ton of EM rotations, since I've been told that as DO applying to allopathic programs, your chances of matching somewhere without rotating there are anorexic.

Any thoughts?
 
I think 2 is the perfect amount. One at your home institution and one away. More than that is overkill. It may keep you from getting exposure in other fields that can help you in the future. As EM physicians we are expected to have a very broad fund of knowledge. Rotations in Anesthesia, radiology, cardiology, derm, optho etc. may not be part of your curriculum in residency and med school would be a good time to get that exposure. You will be an EM physician forever and only a med student for one more year. This is your time to explore.
 
ephedra said:
I think 2 is the perfect amount. One at your home institution and one away. More than that is overkill. It may keep you from getting exposure in other fields that can help you in the future. As EM physicians we are expected to have a very broad fund of knowledge. Rotations in Anesthesia, radiology, cardiology, derm, optho etc. may not be part of your curriculum in residency and med school would be a good time to get that exposure. You will be an EM physician forever and only a med student for one more year. This is your time to explore.
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I agree with the two (minimum) and their distribution. However, rotations in medical school and their usefulness to your future practice are grossly over-rated. I did the cards (Harvey simulator/ekg month), derm, and optho rotations and had fun doing them. At the end of residency, was I significantly better at managing emergencies in those fields then my classmates? No. Some of the knowledge base transfers over from student to resident, but there's not as much overlap as you'd like to think.

So if you think a 3rd (or 4th) EM rotation is going to get you into a residency that will train you better, or be in a better location, or just generally make you a happier person, then go for it.
 
I agree that if there are certain programs that you want to visit to help your decision making process in choosing a residency then by all means go for it. I also agree that in certain med school rotations can be very limited in the amount of learning and transferability to residency.
I guess I was lucky in that my electives my fourth year were relatively high yield. I was able to do an anesthesia month which allowed me to place multiple central lines, float swans, 20 intubations and play with pressers in real time. Great physiology lectures and simulation. In addition I was able to do an ENT month which exposed me to everything from simple OM, and foreign bodies, to complicated neck masses and managment in the acute setting. In addition I found 3 weeks reading chest films with a radiologist helpful, and a month reducing fractures and splinting in an urgent care sports medicine clinic invaluable. However I have noticed that the autonomy and hands on training that medical students receive can be variable.
 
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CABG said:
What is the benefit of doing a rotation in EM at my home institution during 4th year when I have already done one during 3rd year? Are 3rd and 4th year rotations significantly different?
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It depends. I did a 3rd year rotation at my home program and 2 aways as a 4th year, but my home program didn't have an EM rotation so I couldn't get an "effective" slor from them (I had them do it in that style anyway, but whatever.)

If you do this, however, be prepared to answer the question "Why didn't you rotate at your home program as a 4th year?" on the interview trail. It looks funny and you have to have an answer. Mine was simply what I've said: I worked enough with my home faculty through the preceeding 3 years and wanted to see how programs with residencies functioned differently and see what different programs had to offer (I rotated at a very county place and a private place...)
 
I think when it comes to scheduling fourth year, you should really do one rotation at your home program (we cant do that in our third year at my program so all of us do it the first month of fourth year). There is something to be said to be one student of many students on a sub-I at your school though, I rotated in august with most kids in my class doing it in july, however I was the only rotating student from my institution who was going into EM (there were away rotators, however.)

I also think its a good idea to do a fun EM rotation like ultrasound, toxicology or something else during your fourth year (maybe not for a letter.)

I think one away is perfect either at a place you want to go to or if you were like me and didn't know where that was in the best location where you can have fun as well.

So i would do july away at a fun place, august at home (now oyu should have 3 SLOR's and 1 letter from an attending who loves you in any field).

Then schedule another fun rotation for mid-october to mid-novemeber or feburary for your "fun month". Just what I did and thought it worked out well.
 
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My school has a required 3rd year EM rotation, and I can tell you that the majority of us did another 4th year rotation at our "home" insitution. I put it in quotes because our school doesn't have an EM residency program, but our affiliated hospital does. I think that there are a couple of benefits of doing another EM month at home: 1. It gives you a chance to "warm-up" before going on your away audition rotations; 2. I think a 4th year letter would outweigh a 3rd year letter (I was told this by an advisor, but it may not be 100% true); 3. You're familiar with the home insitution (expectations, computer systems, logistics, etc.) and so would hopefully perform much more strongly and get a stronger letter; 4. Different level of autonomy as a 4th year med student

That being said, I tried to rotate at my home institution but was unable to because it was filled up for the time period I wanted. So I ended up doing 3 away rotations (which in retrospect was probably one too many), and so far it's worked out fine (got a lot of interviews at a lot of great places). So while doing a home rotation during 4th year is not required, the majority of students in my class did it anyway (or tried to).

As far as Peds EM, I think that you should just stick with doing adult EM rotations unless you are interested in pursuing Peds EM. This is just my opinion so feel free to ignore if you want to. 🙂
 
My school has the required 3rd year EM rotation as well. Every person I know who is doing EM from my school, however, did a 4th year rotation at our home institution (most of us in the first two months) in addition to that 3rd year rotation. I was told that they really don't like to do SLORs from your 3rd year rotation because what they expect from you as a 3rd year is very different from what they expect from you as a 4th year. Also, they made sure we each worked with the PD and assistant PD during our 4th year rotation so they could assess us better in writing the SLOR.

Most of us did 2 aways on top of that month at our home school. I did two. Why? One place I was really interested in but knew it was very competitive. I think I perform well clinically but may not look as competitive on paper since I'm not AOA, top of my class (which is what they tend to take). I did that rotation and absolutely busted my butt to make the honors and show how well I could do.

The second away was not as competitive but it was a completely different type of program (county) than I had experienced and I figured if I didn't try, I'd never know if that was what I actually wanted to do.

All 3 of the programs I rotated through were pretty different-academic, community, and then county. This worked out really well for me because I figured out what I want in a residency and was able to really talk about that in interviews when they asked me what I was looking for in a program. Several places asked me spefically to compare county programs to academic to community, which I would really have had no idea how to answer prior to my aways.

Good luck!

edit: I do know one guy at my school who only did one away + one at our school. But, he's 100% certain he wants to stay in this area and thinks he'll match here. Seems like a gamble though since our program traditionally only takes 2 students from our school!
 
You should do a second adult ED rotation early in your fourth year as previously mentioned. You need letters of recommendation and most applicants will have 2 adult months minimum at different locations.
 
I attended an SAEM meeting last year and they had a panel of PD's from some midwest(WI, IL, MI) programs. I think there was 5 or 6 of them. Anyway, they recommenced 1 SLOR or LOR(in SLOR format) from your home institution. If your home doesnt have a residency then you needed to get a SLOR from a place that did. They said more than 2mo of EM as a student was overkill, as they preferred to see a greater breadth of study. They also sounded suspicious of anyone that did not have a S/LOR from their home hospital. During 1 on 1 conversations with 3 of them, I was advised to make sure I showed an interest in EM by joining national groups, like SAEM and ACEP, and not spending all my time as a student in the ED. I know that 5or6 PDs out of like 150 is a small sample, but I followed that advice and got more interviews than I anticipated getting as an IMG.
 
Smashweasel said:
I attended an SAEM meeting last year and they had a panel of PD's from some midwest(WI, IL, MI) programs. I think there was 5 or 6 of them. Anyway, they recommenced 1 SLOR or LOR(in SLOR format) from your home institution. If your home doesnt have a residency then you needed to get a SLOR from a place that did. They said more than 2mo of EM as a student was overkill, as they preferred to see a greater breadth of study.
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I went to the same program for the mid atlantic states in sept, they quoted something very similar except get all SLOR's if possible from well known PD's, they would rather see them from away institutions, and didn't care much for what rotations you did as long as you nailed the EM ones. I aced all my EM's and that was a huge positive during my interviews.

bravotwozero said:
What about for DOs looking into allopathic programs? Wouldn't you need to do a ton of EM rotations, since I've been told that as DO applying to allopathic programs, your chances of matching somewhere without rotating there are anorexic.
Any thoughts?
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that's why I did so many EM's, they're all for allo match. I wouldn't say anorexic but there is some truth to that. some places will only take 1 DO/yr, others don't care what your initials are or where you came from, some no DO's at all. my buddy is a PD and as a DO if you don't have 95%> usmle, he won't look at you. look at NRMP stats, US seniors (MD) apply to 10 programs has a 99% chance of match, indep (DO and IMG) only has 90%. statistically....yeah it's slimmer
 
I have a question (from an US citizen IMG):

I did 1 ER rotation in 3rd year (in the states) -- no SLOR/LOR obtained.

This summer, I only have a chance to do 2 electives in the states. I guess there are 3 options:
1) 2 electives in adult ER -- this would make it a total of 3 ER electives done, which some of you have said is overkill, which I can understand.
2) 1 adult ER + 1 specialized ER (ie ultrasound -- btw, are these electives more for experience, or would one be able to get a worthwhile LOR from them?)
3) 1 ER & 1 in a relevant specialty (ie ortho, anesthesia, etc)

Also, any advice whether to do them in academic/community hospitals? I'd really appreciate your help!

So many options, so little time...
 
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strangelight - I would definitely do two adult ED months, and get SLORS from them. You will need these to be competitive in the match. You are already at a disadvantage for being an IMG. Do them at places that have residency programs, and even better, at places you are considering going.
 
^I agree. I would do 2 adult EM months, especially since you didn't get a SLOR from that 3rd year rotation you did. You absolutely need the SLORs and need to seriously rock the rotations (get Honors).
 
My school has a required 3rd year rotation. Great experience, but there's no residency program.

  • Should I get a LOR from them? SLOR format or not? (The SLOR seems to be written specifically for places with a residency program - how do you work around that?)
Planning to do a 4th year away somewhere to get a SLOR. Seems like it would be a waste of a month to do a warm-up at my institution again.

  • Thoughts? Am I putting too many eggs in one basket if this is my only SLOR?
I'm only planning one month of EM in my 4th year, plus one month of something related like tox.

  • Is it enough considering I did a 3rd yr rotation?
 
Prof Moriarty said:
My school has a required 3rd year rotation. Great experience, but there's no residency program.

  • Should I get a LOR from them? SLOR format or not? (The SLOR seems to be written specifically for places with a residency program - how do you work around that?)
Planning to do a 4th year away somewhere to get a SLOR. Seems like it would be a waste of a month to do a warm-up at my institution again.

  • Thoughts? Am I putting too many eggs in one basket if this is my only SLOR?
I'm only planning one month of EM in my 4th year, plus one month of something related like tox.

  • Is it enough considering I did a 3rd yr rotation?
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Basic Principles about Letters:

-Most applicants will have a solid application with two SLORs. If you're really trying to audition for specific programs, then three is okay.

-A SLOR carries more weight than a basic LOR written by an EM physician.

-General EM-month SLORs carry more weight than Subspecialty EM-month SLORs.

-An excellent Away SLOR carries more weight than Home SLOR (b/c the former don't have a vested interest in seeing you do well).

-Having an excellent SLOR from a place where you think you might want to go carries more weight at that program more than an excellent SLOR from another program. (Amazing, I know.) However, I also think that if you're interested in, say, Program A in City X, an excellent SLOR from Program B in City X will carry more weight than one from Program Q in City Y. My impression is that PDs in the same city trust the evaluations of each other over those of PDs on the other side of the country (with whom they may have had little to no contact).

-Variety of clinical sites is good, ie, exposing yourself to at least at least one academic and one county site will help you both: a) figure out what sort of program you want in residency and b) impress your interviewers by being able to talk as an better-informed applicant. However, if you've already had this exposure and know you want specifically county, academic, or community for residency, then it's cool to only rotate at programs that offer that type of experience.

So, regarding your situation, here's my two cents (redeemable to actual cash value of nil):

-You already did a home rotation as an MSIII. It helped your realize that you love EM and taught you the ropes of working in the department. Since they can't write you a true SLOR, it don't see much benefit in spending another month there. Get them to write you a good LOR (if possible, one formatted like a SLOR), and say thanks.

-Do two away rotations and get two SLORs. Your already used to life in the ED, so don't have any hesitation about being able to perform. Yes, what's expected of a fourth year is different than what's expected of a third year, but you've got a lot of experience under your belt. That being said, I'd try to schedule an easier away first and build up even more skill, then go to a crazy, higher-autonomy place second.

-Get your fourth letter from another faculty member at your school. For EM, you can get it from practically anyone, but I think letters from faculty in IM, FM, or Peds (rotations where you had to show a really broad spectrum of knowledge) or Surgery/Surgical Sub-specialties (rotations where you had to show endurance, teamwork, and some technical proficiency) are probably best. But what's most important is that the person knows you well and advocate strongly for your abilities.

Hope that helps.
 
I don't know what the weights are and the distance details but I can tell you a few solid across the board things from my buddies who are current program directors. as long as your transcript says you aced an EM rotation and the SLOR/LOR writer is an EM physician, that's what you need.

the SLOR is a faster, standardized way to help measure you against other students, it's based on a numerical scale as well as "chance of you matching to program x equation", also what is your EM experience. google SLOR and you'll see the form. it's not superior to the LOR, just scaled. on the bottom of the SLOR is a place to write some comments.

obviously your performance and character makes the letter but the name of the writer is what gives it validity and strength. PD's/CORD is a small world of who's who in EM and like any colleague, they have those more liked than others. you get a letter from someone they know/ or have worked/residency with, it's going to mean a lot more. of course rotating at the place, letting them see you perform, and nailing it will be the largest influence (google NRMP stats). if they like you, want you there, and you want to stay, it'll match. the letters I submitted were all from PD's at academic programs, 2 SLOR/2 LOR (those 2 wanted to write) and those 2 full page LOR's stood out significantly during interviews.

when asking for the LOR, first and foremost, work with and tell them your interest in EM, then ask "can you endorse me with a strong letter?". if not, what can I do to improve? they may even give you a copy so you can submit the 4 (max) strongest on ERAS then submit the rest to each interview. do a non academic place at first to sharpen your skills if needed. find a mentor. map out what programs you're interested in, go do a bunch of "audition" rotations (I don't believe in just going to 2), get the SLOR/LOR, see what you like, and shine. good luck! feel free to PM
 
I am a third year student working on putting together my schedule for fourth year.

I am trying to decide how many away-rotations to do. I will be doing an EM rotation in May (the LAST month of my third year). My advisor has suggested that I not do any EM rotations in my fourth year, and just do 2 away's.

The advice in this thread has me a little worried about that idea. Would I even be able to get a useful SLOR from my home institution if it was written based on my May (of third year) rotation?

I guess what I want to know is which situation would make me a more competitive applicant?
a) 2 away's, zero home rotations in my fourth year (but one at home during the very end of my third year)
or
b) 1 home and 1 away during my fourth year (in addition to the one at home in May)
or
c) Neither make me more competitive, and I should just decide what I want to do.
 
I think it depends on your institution, and how your advisor is. If they are an EM attending at an academic institution who will be writing your home SLOR, listen to them. If they are in some other field then email the clerkship director of your home rotation. I'd say to one home Sub I, one away sub I. Maybe you'd do the away in between the 3rd year rotation and home 4th year, or take step 2 in between them.

(My third year rotation was 2 weeks, so I had to do a EM sub I, if yours is a month that might be a bit different.) I'd like to throw out there that away sub Is are really tough, you are trying out at a new place, where you don't know anyone, don't know the computers, don't know where anything is. It was hard enough for a month, not sure that I would do two of them. If you want to see the ED of more than one away program I would think about doing one away sub I and one EM rotation in something else (ultrasound, tox, EMS etc)

Also in reading the above posts, I'm not sure I'd agree with not getting a SLOR from your home shop. I'm not a residency director but I think it'd be a red flag not to get a SLOR from where you go to medical school.
 
jbar said:
I think it depends on your institution, and how your advisor is. If they are an EM attending at an academic institution who will be writing your home SLOR, listen to them. If they are in some other field then email the clerkship director of your home rotation. I'd say to one home Sub I, one away sub I. Maybe you'd do the away in between the 3rd year rotation and home 4th year, or take step 2 in between them.

(My third year rotation was 2 weeks, so I had to do a EM sub I, if yours is a month that might be a bit different.) I'd like to throw out there that away sub Is are really tough, you are trying out at a new place, where you don't know anyone, don't know the computers, don't know where anything is. It was hard enough for a month, not sure that I would do two of them. If you want to see the ED of more than one away program I would think about doing one away sub I and one EM rotation in something else (ultrasound, tox, EMS etc)

Also in reading the above posts, I'm not sure I'd agree with not getting a SLOR from your home shop. I'm not a residency director but I think it'd be a red flag not to get a SLOR from where you go to medical school.
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Thank you so much for your response! I really appreciate it.

The advisor I spoke with is not an EM attending. He is an FM attending, but he told me that EM is becoming really competitive and was trying to advise me on how to make my application strong... but I suppose that since he's not in EM, he may not know exactly what they will be looking for. Also, my third year EM rotation is going to be 4 weeks long, so I guess that's something to consider.

You have given me a lot to think about. Thanks again!
 
I would do as many aways as you can. Also do them in the geographical areas that you're interested in, especially if it's far or very different from your home state. For example, I was interested in NYC so I did an away in NYC. It's okay if it's not exactly where you want to match the most, but just do one in that area since EM is a small world and I got a SLOR from my away in NYC. And it opened doors at other NYC prorams because later I had interviews where people told me that otherwise they wouldn't have given me an interview because they didn't think I was dead serious about wanting to come to NYC.
 
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