MS3, strong IM application but considering EM now...help

[Perfect Hair Day]

Hello,

3rd year MD who is finishing up their IM rotation.
I've spent past 3 years (and then some) building a resume/CV/ERAS application that would be strong for the IM match (with an intent to subsequently pursue cardiology) but I think EM is a better fit for me all around.
I think it is most appropriately put, that I am on the fence between IM and EM, and I'll be applying to EM and combined IM/EM programs.

Undergrad: Cornell University
Medical School: A private school in Florida

Step 1: 247

Class Rank: 2nd quartile

AOA: no, GHHS: not sure, but remaining humble in my expectations

3rd year grades: 85+ in all clerkships so far (Peds, OB/Gyn, Psych).

Extracurricular: President of an IM subspecialty group that is very active on campus, Presient of a surgical interest group that organizes shadowing opportunities.

Research: Masters Degree w/ physiology research but no publications; summer research experience (PAID) between M1 and M2, but no publications or posters. Currently working on an Infectious Disease case report. Trying to grab onto an EM research project but so far no such luck.

Personal story is interesting: Diagnosed with cancer 4 days before medical school, did not defer my matriculation. Healthy and in remission (#blessed) and crushed my 1st and 2nd year courses and Step 1 cancer notwithstanding.

Question 1: Besides doing well in my home EM rotation and scheduling at least one away rotation (I likely will only be able to afford to do one away rotation), what else can I do in the next 7-8 months to bolster my application for EM?

Question 2: As the information above stands currently, does this paint the picture of someone who would be considered competitive/"interesting" for the EM match? The answer won't change my pursuit of EM, I'm just curious as to where I stand. The answer may guide my program selections, however.

Thanks!

-ButteredLobster

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[CliveStaples]

There's not a lot you really need to do. You've done well on Step 1 and assuming a similar or slightly improved CK score, you'll be academically eligible for most every program in the country.

CV wise, I found myself getting asked more about my personal interests than my research or extracurriculars, so give that portion of your application some thought. Your goal at that point isn't to be the best superstar on paper, but to be somebody people want to spend time around at 4am.

Do you have an EM program at your home institution? If so, I would schedule a meeting with the PD and let him/her know about your new interest in EM or EM/IM just to go ahead and put yourself on the program's radar since you haven't spent the past couple years getting connected.

Honestly the biggest portion of your competitiveness are yet to come: CK, SLOEs, and interviews really rule the day in EM nowadays so don't feel like you're too late to join to wagon!

 

[gman33]

Research is not that important, but is still nice.

Try to get to know the em faculty at your school. This can be shadowing, research, interest groups, etc.

Having a good letter from someone who actually knows you can be very helpful.

 

[Perfect Hair Day]

Research is not that important, but is still nice.

Try to get to know the em faculty at your school. This can be shadowing, research, interest groups, etc.

Having a good letter from someone who actually knows you can be very helpful.

Yeah, unfortunately it has been impossible to get a response from anyone of significance at my school. Program director, clerkship directors, dept chair - it's just been impossible, despite my persistence. I don't even have the luxury of just "showing up" in the ED because I'm on other clerkships.

Are the SLOEs from when I do my clerkships sufficient? Or do I need to also have other "regular" letters too?




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[gman33]

Yeah, unfortunately it has been impossible to get a response from anyone of significance at my school. Program director, clerkship directors, dept chair - it's just been impossible, despite my persistence. I don't even have the luxury of just "showing up" in the ED because I'm on other clerkships.

Are the SLOEs from when I do my clerkships sufficient? Or do I need to also have other "regular" letters too?




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SLOE is fine.
Try tracking down one of the EM residents. Maybe they can help.

 

[CliveStaples]

Does your medical school have an EM interest group? They may be the ones that organize EM mentorship or shadowing experiences.

 

[shoal007]

u need to work a full month and then some before you can make this decision. EM is sexy from the outside, but there is a lot of misery. Just make sure you understand this before jumping in, otherwise you'll be miserable too.

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[Perfect Hair Day]

Does your medical school have an EM interest group? They may be the ones that organize EM mentorship or shadowing experiences.

Yes. They don't really have any specific program or shadowing experiences - I'm a 3rd year student, so there really isn't any time to go and shadow.

u need to work a full month and then some before you can make this decision. EM is sexy from the outside, but there is a lot of misery. Just make sure you understand this before jumping in, otherwise you'll be miserable too.

I've worked in an ED before - 3 months after college and then for ~1 year before I applied to medical school. Of course, I was a volunteer and the nature of my responsibilities was different. Point is I'm no stranger to the environment of the ED. I really loved my time in the pediatric ED at my hospital and that's what ignited the interest in the field. Child came in with an acute asthma exacerbation, then I helped cast a broken arm, then we had a DDx of GBS vs. Myositis that turned out to actually be Kawasaki disease. Saw a patient with bilateral conjunctival swelling and pre-septal cellulitis that turned out to be a N. meningitidis infection. I'm attracted to the breadth of what is seen, and I like the problem-solving vs. having an alread worked up patient turfed to me as a floor doc.

 

[EM2Be2017]

All you need to do is get great SLOEs and do equally well on CK and you will be good for getting interviews. The cool thing about EM is that it's related in some shape or form to everything. EM docs see a lot of infectious disease, so I would imagine you could easily relate your research to being an EM physician. You don't need any other LOR besides the SLOEs, but you generally need three letters total. So if you did two EM rotations I believe you would need a regular LOR from EM faculty. I'm not too sure about this because I applied with only SLOEs, which from what I've seen is the most common thing to do. Interviewing for emergency medicine has been awesome. In many of mine we just talked about my hobbies and experiences. It's nothing at all like medical school interviews where they try to trick you or stress you out.

 

[EMapplicant2017]

Dude should start getting together VSAS stuff for away (s) asap for a good away/SLOE

 

[Epinephreus]

Congrats on seeing the light. The good thing is you do not need to impress anyone with ECs in EM. After having finished the interview season, they really just want people who are genuine, they trust will pass the boards, and are good personality fits. This is the time to start thinking about aways to make a meeting with your advisor. Get some EM shadowing experience if you haven't done an EM rotation yet. And ya, you shouldn't have a big problem. I know someone who switched from IM to EM 2 months into their fourth year, and they ended up at Cook County.

 

[Perfect Hair Day]

Thanks for the encouraging comments and advice everyone.

Adding: I just got my fall grade report for my first three clerkships

OBGyn 85
Pediatrics 83
Psychiatry 89

I've heard "3rd year grades matter more (than 1st/2nd) year" - how am I doing? Am I earning high enough for EM? The grading has been so subjective - frankly I thought I was like garbage on OB/Gyn but I felt like I crushed it on peds wards - my evals were lower for peds than they were for OB/Gyn. Do programs recognize the subjectiveness of 3rd year, or am I likely to just simply be beat out by someone with all HP/Honors at another school? (My school only reports numerical grades...)

 

[CliveStaples]

Thanks for the encouraging comments and advice everyone.

Adding: I just got my fall grade report for my first three clerkships

OBGyn 85
Pediatrics 83
Psychiatry 89

I've heard "3rd year grades matter more (than 1st/2nd) year" - how am I doing? Am I earning high enough for EM? The grading has been so subjective - frankly I thought I was like garbage on OB/Gyn but I felt like I crushed it on peds wards - my evals were lower for peds than they were for OB/Gyn. Do programs recognize the subjectiveness of 3rd year, or am I likely to just simply be beat out by someone with all HP/Honors at another school? (My school only reports numerical grades...)

My school only reports numeric grades as well. They'll either interpret it with the dean's letter or they won't care about it at all.

Step 2 CK and SLOEs rule the day - not even third year grades really matter that much. They really only matter insofar as you getting practice for CK on the shelf exams and you getting practice learning how to "play the game" so to speak so you'll be more likely to succeed on your EM AIs next year.

It's very challenging to try and evaluate medical students from different schools based on grades. And in EM where they really don't care about class rank, they're really just going to focus in on your boards and your letters to screen you for an interview.

 

[Perfect Hair Day]

My school only reports numeric grades as well. They'll either interpret it with the dean's letter or they won't care about it at all.

Step 2 CK and SLOEs rule the day - not even third year grades really matter that much. They really only matter insofar as you getting practice for CK on the shelf exams and you getting practice learning how to "play the game" so to speak so you'll be more likely to succeed on your EM AIs next year.

It's very challenging to try and evaluate medical students from different schools based on grades. And in EM where they really don't care about class rank, they're really just going to focus in on your boards and your letters to screen you for an interview.

Thanks for your post.

I am not certain I will be able to take Step2CK prior to ERAS submission, or at the very least I may not have my Step2CK score back by the time I submit ERAS. Will this hurt me if I still have a good Step1 score? Please keep in mind, while it would be nice to end up at someplace like Cook Co, USC+LAC, DenverHealth, I'm not prestige-driven necessarily.

 

[tux4]

I did a bunch of research, prob the least mentioned thing on my app


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[slatermd]

Thanks for your post.

I am not certain I will be able to take Step2CK prior to ERAS submission, or at the very least I may not have my Step2CK score back by the time I submit ERAS. Will this hurt me if I still have a good Step1 score? Please keep in mind, while it would be nice to end up at someplace like Cook Co, USC+LAC, DenverHealth, I'm not prestige-driven necessarily.

There are places that won't invite you to interview unless they've seen your CK score. It doesn't need to be in before ERAS submission, but to cause the least interference you want your score posted by mid to late September. Many programs won't start screening and downloading applications until the MSPE is available to them (October 1st), but some will start reviewing apps and offering interviews earlier. Many places will put your application on hold until your CK posts, and there's no way to know which programs will and which programs won't unless you email them all individually and ask. Don't do that, just take CK sooner. Your 247 can't save you from this. Most programs would rather interview an applicant with step 1 220/step 2 240 than someone with a 247 that hasn't taken CK. Given the uptrending application volumes in EM, having your application on hold for any reason is not what you want. There are things you can't control, like getting a response from your home institution PD, or whether or not people will upload your letters on time. But you can control when you take CK.

Along those same lines, as a previous poster mentioned, you need to start getting things ready for VSAS and you need to figure out where you will do an away rotation. About 70% of programs say they would consider an applicant with just one SLOE, but many will put your application on hold until you have two. This is a common problem for people who decide on EM late, but you've decided plenty early enough to dodge that bullet. For VSAS you'll need a passport style headshot and immunization records/titers (including this year's flu) certified by your school's employee/student health office. Many programs have other requirements like drug test and background checks but many don't. Get on VSAS and poke around to figure out where you're interested in rotating, and what they want from you. My EM aways were by far the best part of 4th year so get excited.

It's difficult to understand how different the EM application cycle is until you've gone through it, but most of the conventional wisdom you've heard pertaining to applying to other specialties is irrelevant. Your grades in non-EM clerkships couldn't matter less. Your research and your masters degree...well...sorry about that. It's a much nicer trinket for an IM application but it doesn't matter at all compared to your SLOEs. If you get great letters, then your extra curricular stuff comes into play. But if you get lukewarm SLOEs, a masters degree can't earn you consideration over all the people with the top-third SLOEs. Except maybe in those IM/EM programs. Who the heck knows about those.

The nice thing is EM people won't care that your application was so clearly teed up for IM. We know EM is the best and we're never surprised when people shift into it, whereas in other similarly competitive specialties, latecomers might not be as welcomed.