Official WAMC thread for EM applicants

[Falconclaw]

i know my home school sloe is excellent because im very, very close to the EM doc who writes them. i think my away sloe is good because of the comments that were written for the grade. i had that first EM doc look over the away sloe and he said the sloe was good, no red flags.

yeah, iv been told that i should get more invites in Nov and Dec since by then they'll be able to factor in my CS pass and altho only 40% of invites are sent out after Oct, I'll be competing against less qualified applicants for the remaining invites.

im not that worried about matching, esp since I think I'd always match at my home school, but I guess it's more distressing that I thought I was a very competitive applicant and I knew the CS fail would hurt me but I thought that more programs would overlook it because it's such a silly test and my other step scores are so high, but i guess most PD's are very red flag focused and care more about ferreting out bad things than necessarily caring that much about good things. also third quartile doesnt help i guess.

it just feels so arbitrary because if I'd just been told that people do fail the CIS part of CS, i wouldve studied more for it and passed the first time. but whatever nothing i can do now i guess.

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[Falconclaw]

just did the stats, here's what i have so far:

by (inside) i mean home or away
oh and i guess il also add that i applied disproportionately to programs that were higher up on doximity by reputation

 

[EMThrowaya761]

Midtier East Coast MD applicant:
250s Step 1&2, Passed CS
Honors home and 2 aways but unsure exact SLOE ranks (have been told they aren't concerning for whatever that's worth)
Strong leadership and volunteering ECs, weaker research but a few publications
Honors/HP preclinical and clinical grades
Red Flag: Professionalism comment in MSPE for something very dumb in an EC from first year that I addressed in my PS.

Sitting on 6 interviews from 100+ applications. Worried I'm getting screened and have been rejected from most of the places that have sent them out already. Is the fact that the professionalism comment exists at all truly that damning? Was told I would have a great shot of matching even with the red flag by applying to 50+ programs before the cycle began so obviously fairly concerned. Have sent some LOIs to programs I have connections to but haven't heard back, so not sure how to further advocate for myself.

 

[gamerEMdoc]

Is the fact that the professionalism comment exists at all truly that damning?

Yeah it is. It all depends on the rest of your application. If you have a great app with great SLOEs, then programs are going to be more willing to overlook the professionalism citation. It's a high risk, high reward situation for the programs. But if you are more of the "middle 1/3" SLOE variety, there are a ton of people available to interview in that group, there is zero reason to take a chance on someone with possible professionalism concerns. Just like the NFL. If you are a phenom who gets caught smoking weed, you'll still probably get drafted in the first round. But if you are a middle rounder who does the exact same thing, you are falling off most teams draft charts.

 

[EMThrowaya761]

Thanks for the reply. I've been trying to tell that to my school's admin but they don't seem to care. Incredibly frustrating that it overshadows everything else on my application and with blinded SLOEs I'm not certain where I fall. Although the lack of invites might speak to that more than I'd like.

 

[gamerEMdoc]

Thanks for the reply. I've been trying to tell that to my school's admin but they don't seem to care. Incredibly frustrating that it overshadows everything else on my application and with blinded SLOEs I'm not certain where I fall. Although the lack of invites might speak to that more than I'd like.

The school admin isn't going to budge on a professionalism violation. Why would they. If they do budge and erase them from someones MPSE, it makes a professionalism violation a worthless slap on the wrist. It's the threat that it does effect your application that makes such a thing carry weight on their end.

 

[lucid_leprechaun]

Midtier East Coast MD applicant:
250s Step 1&2, Passed CS
Honors home and 2 aways but unsure exact SLOE ranks (have been told they aren't concerning for whatever that's worth)
Strong leadership and volunteering ECs, weaker research but a few publications
Honors/HP preclinical and clinical grades
Red Flag: Professionalism comment in MSPE for something very dumb in an EC from first year that I addressed in my PS.

Sitting on 6 interviews from 100+ applications. Worried I'm getting screened and have been rejected from most of the places that have sent them out already. Is the fact that the professionalism comment exists at all truly that damning? Was told I would have a great shot of matching even with the red flag by applying to 50+ programs before the cycle began so obviously fairly concerned. Have sent some LOIs to programs I have connections to but haven't heard back, so not sure how to further advocate for myself.

Good news is that you will likely Match unless it was a bad violation. It looks like you fall mid tier based on stats, unknown SLOES. Sounds like you applied to many programs so that’s good.

 

[Falconclaw]

Good news is that you will likely Match unless it was a bad violation. It looks like you fall mid tier based on stats, unknown SLOES. Sounds like you applied to many programs so that’s good.

jeez step 1 in the 250s is mid tier now? isnt EM step 1 avg in the low 230s?

 

[gamerEMdoc]

jeez step 1 in the 250s is mid tier now? isnt EM step 1 avg in the low 230s?

Step scores dont dictate application strength

 

[EMThrowaya761]

Good news is that you will likely Match unless it was a bad violation. It looks like you fall mid tier based on stats, unknown SLOES. Sounds like you applied to many programs so that’s good.

So far every interviewer who has asked has seemed receptive to me explaining the circumstances and my growth since. There's probably some bias since they were willing to interview me in the first place though. Definitely a situation where not being being blinded to SLOEs would be helpful.

 

[Falconclaw]

Step scores dont dictate application strength

arent they the single biggest factor though? or for you personally would you say its more about just clearing a certain number, and beyond that they dont matter as much and med school grades, SLOEs, LORs and research matter more?

 

[gamerEMdoc]

arent they the single biggest factor though?

No. They aren't the single biggest factor, they aren't even close to being the single biggest factor. They rank in the middle of importance of things on being considered on the application. In the most recent PD survey, they were strikingly middle of the road in importance when they ranked a ton of different aspects of the application. LOR in your specialty (SLOES), grades in the specialty, and away rotation performance in the specialty blew every thing else away in terms of importance. Step 1 score was pretty middle of the road and outweighed by a ton of other factors.

Survey attached. Use the index to go to the EM section.

 

[gamerEMdoc]

I think the misconception of the importance of board scores for EM hurts many candidates. They believe the myth that its their magic ticket into their dream EM residency, and if they aren't very good clinically, they get upset that the system is broken because they didn't get interviews at their dream programs that they deserve because of their board scores. They think they got blindsided by one bad SLOE, and blame the SLOE system, but in reality, the SLOEs rarely deviate; programs are pretty consistent about who is and who is not a good student clinically. Students that have one bad SLOE typically have multiple bad sloes, and vice versa.

We just need to stop perpetuating this myth about board scores as students and advisors. Just shoot for average or above average, and work on being a good student clinically and you will be FINE. If students put 1/10th of the time studying how to give an effective quick efficient presentation and how to formulate DDXs for common ED complaints that they do studying for step 1 and step 2, they'd easily excel and at a minimum would be a top 1/3 candidate. But instead, students study like crazy for a test of mediocre importance, then show up completely unprepared to excel clinically. Then get upset when their clinical grade isn't what they deserve based on how good their boards say they are.

Sorry for the rant. I just don't know how else to make this point clearer. I've been posting the same thing over and over for years and I just feel like the message somehow just gets lost.

 

[borderlineinCle]

I think the misconception of the importance of board scores for EM hurts many candidates. They believe the myth that its their magic ticket into their dream EM residency, and if they aren't very good clinically, they get upset that the system is broken because they didn't get interviews at their dream programs that they deserve because of their board scores. They think they got blindsided by one bad SLOE, and blame the SLOE system, but in reality, the SLOEs rarely deviate; programs are pretty consistent about who is and who is not a good student clinically. Students that have one bad SLOE typically have multiple bad sloes, and vice versa.

We just need to stop perpetuating this myth about board scores as students and advisors. Just shoot for average or above average, and work on being a good student clinically and you will be FINE. If students put 1/10th of the time studying how to give an effective quick efficient presentation and how to formulate DDXs for common ED complaints that they do studying for step 1 and step 2, they'd easily excel and at a minimum would be a top 1/3 candidate. But instead, students study like crazy for a test of mediocre importance, then show up completely unprepared to excel clinically. Then get upset when their clinical grade isn't what they deserve based on how good their boards say they are.

Sorry for the rant. I just don't know how else to make this point clearer. I've been posting the same thing over and over for years and I just feel like the message somehow just gets lost.

You mean real medicine isn’t like a multiple choice test ?


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[gamerEMdoc]

You mean real medicine isn’t like a multiple choice test ?


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The boards no doubt show how much medicine you know, but you just need to be competant from a medical knowledge standpoint. The rest of EM comes down to some trainable and some not trainable inherent qualities. Things like good social skills, customer service skills, multitasking, adaptability, working under pressure, etc. None of this can be tested in an exam, and all of it is more important from an employer standpoint than scoring extremely high on a knowledge test.

If you have to choose your colleague, anyone would take someone is just competant in knowledge but is excellent at multitasking, good socially with staff and patients, and who takes direction well over someone who has a superb medical knowledge base but cant multitask or has personality flaws when dealing with the staff, nurses, or patients.

The problem is, this stuff is unmeasurable, and as young scientists, students want objective data, and I respect that. But while clinical performance isnt easy to measure and can lead to subjective bias, it still remains a far more accurate predictor of who will excel in residency than board scores, which is why SLOEs and EM grades remain far more important, and why that will never change.

 

[Falconclaw]

The boards no doubt show how much medicine you know, but you just need to be competant from a medical knowledge standpoint. The rest of EM comes down to some trainable and some not trainable inherent qualities. Things like good social skills, customer service skills, multitasking, adaptability, working under pressure, etc. None of this can be tested in an exam, and all of it is more important from an employer standpoint than scoring extremely high on a knowledge test.

If you have to choose your colleague, anyone would take someone is just competant in knowledge but is excellent at multitasking, good socially with staff and patients, and who takes direction well over someone who has a superb medical knowledge base but cant multitask or has personality flaws when dealing with the staff, nurses, or patients.

The problem is, this stuff is unmeasurable, and as young scientists, students want objective data, and I respect that. But while clinical performance isnt easy to measure and can lead to subjective bias, it still remains a far more accurate predictor of who will excel in residency than board scores, which is why SLOEs and EM grades remain far more important, and why that will never change.

Thank you, your perspective is valuable and does make sense.

Apparently my away SLOE is actually quite good. An assoc PD at my home program thinks I'm just being screened out from many places cuz of the CS fail. Oh well. I guess it's probably part of the same algorithm that many places use. I was hoping that my above average Step 1 and CK scores would counteract that but I guess not, so much of this process seems to be more about avoiding red flags and not having bad stuff on your app versus actually having good and unique things. I'm lucky that my home institution is quite strong and seems happy to take me.

 

[gamerEMdoc]

Yeah the CS fail can be a big red flag for many places. It doesn't have a high failing percentage, and it gives immediate concern there could be something about the clinical skills, personality, or patient interactions that could be trouble. It's a tough one to overcome, with the exception of actually rotating at places who then see first hand your actual clinical skills. So the best chances to match with someone with a CS failure is going to be at the places they rotated, assuming they did well there.

 

[Falconclaw]

Yeah the CS fail can be a big red flag for many places. It doesn't have a high failing percentage, and it gives immediate concern there could be something about the clinical skills, personality, or patient interactions that could be trouble. It's a tough one to overcome, with the exception of actually rotating at places who then see first hand your actual clinical skills. So the best chances to match with someone with a CS failure is going to be at the places they rotated, assuming they did well there.

yeah i mean i can go on a whole rant about why the CIS portion of CS is nonsense but that would obviously be pointless. im doing ok i suppose on interviews from lower tier or newer programs but not as well with the better and more established ones, and i do see why when you just have so many qualified and talented applicants you might as well not even take a chance on anyone, even if the chance that a CS fail means anything is just 5% (arbitrary number). but yeah might just let my home institution save the day.


in your view do letters of interest do anything?

 

[gamerEMdoc]

yeah i mean i can go on a whole rant about why the CIS portion of CS is nonsense but that would obviously be pointless. im doing ok i suppose on interviews from lower tier or newer programs but not as well with the better and more established ones, and i do see why when you just have so many qualified and talented applicants you might as well not even take a chance on anyone, even if the chance that a CS fail means anything is just 5% (arbitrary number). but yeah might just let my home institution save the day.


in your view do letters of interest do anything?

Yes, especially at places that are out of your geographic window. The place is geographically close to almost certainly have already looked at your application and had made a decision about you. Places outside of your geographic window may never have looked at your application. I guess theoretically in your case, since you do have that CS failure, it’s possible that place is close by you could’ve screamed you out with a no board fail filter, so maybe a loi would help get them to look at you too. For the most part, LOI‘s help at places that may have filtered you out and never looked at your app.

 

[Falconclaw]

Yes, especially at places that are out of your geographic window. The place is geographically close to almost certainly have already looked at your application and had made a decision about you. Places outside of your geographic window may never have looked at your application. I guess theoretically in your case, since you do have that CS failure, it’s possible that place is close by you could’ve screamed you out with a no board fail filter, so maybe a loi would help get them to look at you too. For the most part, LOI‘s help at places that may have filtered you out and never looked at your app.

gotcha, thanks, i appreciate the advice.

 

[Pilgrimage]

Hey guys!

Current M3 considering EM but scared the door might be closed to me by this point.

Where I am right now:

-US MD with a Step score of 212
-Failed a clerkship shelf exam, which will reflect as a clerkship "Fail" on my transcript, with a "Pass" put next to it, after I pass the retake shelf exam. To be clear, I did pass the clinical and professionalism parts of the clerkship, but the shelf exam failure means I failed it overall.
-Pretty standard clerkship performance, aside from the one shelf failure. No honors, but no red flags either.
-No real research, extra-curriculars, or networking in EM at the moment. And I fear the demands of M3 may make these things hard to accrue at this point.

For complicated family-personal reasons, I'm most interested in matching at 1 of the 3 EM residencies around my mid-size Midwestern city- where I was born, raised, and attend medical school. To my limited understanding, these three programs are well-regarded but not particularly competitive as far as EM programs go.

I realize my medical school career has not been perfect and may limit me. I could see myself doing something else, but a part of me is drawn to EM. Odds are often fickle, but chance me, please.

 

[gamerEMdoc]

Hey guys!

Current M3 considering EM but scared the door might be closed to me by this point.

Where I am right now:

-US MD with a Step score of 212
-Failed a clerkship shelf exam, which will reflect as a clerkship "Fail" on my transcript, with a "Pass" put next to it, after I pass the retake shelf exam. To be clear, I did pass the clinical and professionalism parts of the clerkship, but the shelf exam failure means I failed it overall.
-Pretty standard clerkship performance, aside from the one shelf failure. No honors, but no red flags either.
-No real research, extra-curriculars, or networking in EM at the moment. And I fear the demands of M3 may make these things hard to accrue at this point.

For complicated family-personal reasons, I'm most interested in matching at 1 of the 3 EM residencies around my mid-size Midwestern city- where I was born, raised, and attend medical school. To my limited understanding, these three programs are well-regarded but not particularly competitive as far as EM programs go.

I realize my medical school career has not been perfect and may limit me. I could see myself doing something else, but a part of me is drawn to EM. Odds are often fickle, but chance me, please.

The good thing is, none of what you listed will break your application. As I've said like countless times, your SLOEs will dictate your competitiveness as a candidate. So if you are able to get a rotation at two of those programs you want to end up at, and you have a great rotation, get excellent SLOEs from them, then you'll match at one of them, I don't care what your step 1 score is. The problem is, your chances of being a standout EM candidate on shift to get those SLOEs if you have an average knowledge base and average clinical performance on other rotations. Afterall good students are good students in the ED too.

I guess my point is, all isn't lost, it will definitely depend on how you perform on your EM AIs. But the arrow isn't pointing up based on your third year performance, so you need to hope your clinical skills just will look better in the ED than they have on your current 3rd year rotations, or you need to work on skills that will make you standout on your EM rotation (quick, accurate H+Ps; EM directed ddx's; quick directed presentations, etc).

 

[surely]

Hey guys!

Current M3 considering EM but scared the door might be closed to me by this point.

Where I am right now:

-US MD with a Step score of 212
-Failed a clerkship shelf exam, which will reflect as a clerkship "Fail" on my transcript, with a "Pass" put next to it, after I pass the retake shelf exam. To be clear, I did pass the clinical and professionalism parts of the clerkship, but the shelf exam failure means I failed it overall.
-Pretty standard clerkship performance, aside from the one shelf failure. No honors, but no red flags either.
-No real research, extra-curriculars, or networking in EM at the moment. And I fear the demands of M3 may make these things hard to accrue at this point.

For complicated family-personal reasons, I'm most interested in matching at 1 of the 3 EM residencies around my mid-size Midwestern city- where I was born, raised, and attend medical school. To my limited understanding, these three programs are well-regarded but not particularly competitive as far as EM programs go.

I realize my medical school career has not been perfect and may limit me. I could see myself doing something else, but a part of me is drawn to EM. Odds are often fickle, but chance me, please.

Feel free to message me the names of those programs and I can confidentially give you a slightly more experienced take on how competitive they are.

 

[GonnaBeADoc2222]

As a non-academic EM attending I'm always surprised how de-prioritized USMLE scores are in the EM residency selection process. These scores are an extremely objective measure of medical knowledge and to write them off as "just a test" and "not a measure of how good a physician you will be" is short sighted I think.

Yes, a pattern of behavior across all rotations (em and non) should be pretty representative of the product you are getting as an intern. However, why should a low grade in your internal medicine rotation be buffered by a high grade in em, but not vice versa?

Rotations are very much a "game." We all know those people who are actually pretty sh***y in real life but somehow get honors in all their rotations. Conversely, there are those that might come off as rough around the edges in a limited interaction, but are actually awesome once you get to know them, especially in a more social setting.

We took a handful of people who rotated with us as medical students into our residency because they were "so good!" and a few turned out to be absolute *****s in the ED.

I'm not trying to devalue rotation grades either, but to say there's a small difference between a 260 and a 220 candidate is not true.

And I'm sorry, but it's a pet peeve of mine to refer to "customer service" abilities. It's this, among other careless residency program behaviors (seemingly limitless expansion of the number of residency programs to name one) that's enabling the corporatization of our field. I'd much rather have a competent a** diagnose my zebra condition than a smiling fool send me home to die.

 

[gamerEMdoc]

As a non-academic EM attending I'm always surprised how de-prioritized USMLE scores are in the EM residency selection process. These scores are an extremely objective measure of medical knowledge and to write them off as "just a test" and "not a measure of how good a physician you will be" is short sighted I think.

Yes, a pattern of behavior across all rotations (em and non) should be pretty representative of the product you are getting as an intern. However, why should a low grade in your internal medicine rotation be buffered by a high grade in em, but not vice versa?

Rotations are very much a "game." We all know those people who are actually pretty sh***y in real life but somehow get honors in all their rotations. Conversely, there are those that might come off as rough around the edges in a limited interaction, but are actually awesome once you get to know them, especially in a more social setting.

We took a handful of people who rotated with us as medical students into our residency because they were "so good!" and a few turned out to be absolute *****s in the ED.

I'm not trying to devalue rotation grades either, but to say there's a small difference between a 260 and a 220 candidate is not true.

And I'm sorry, but it's a pet peeve of mine to refer to "customer service" abilities. It's this, among other careless residency program behaviors (seemingly limitless expansion of the number of residency programs to name one) that's enabling the corporatization of our field. I'd much rather have a competent a** diagnose my zebra condition than a smiling fool send me home to die.

For every resident that has had good clinical grades but turned out to not be a strong resident, there are just as many cases (or more) of residents who score well on the boards and don't do as well as a resident. I definitely don't discount board scores, in fact I rate them over the importance of non-EM clinical grades, but I don't think they reliably predict at all how you actually perform in the ED. Being a good ED doc is just as much about being good with people, being a good problem solver, and being good at multitasking as it is having a good knowledge base. They are all important, but boards only tests one. Rotation performance tests all of those skills. I have always been a top 5% test taker on my boards. And I wasn't nearly the best resident in my program in training, as painful as that is to admit. Knowledge base only gets you so far.

Board scores do predict one thing pretty reliably. That's resident in service scores and the ability to pass the written board when you finish. Test scores predict who can take tests. SLOEs predict who can practice EM effectively. And having done this for years, I can assure you, that a student with stellar SLOEs and mediocre boards almost always outperforms the student with mediocre SLOEs and high scores when they become residents. If this wasn't the case, and boards were more important than clinical grades in the ED, then PDs around the country would just rank their list by board scores. It would certainly be a heck of a lot easier afterall.

 

[Stephanopolous]

Hello guys, first time browsing through this thread and very happy I found it. Lots of good info here and overall I’m getting the impression that SLOE and step 2 are important factors with the former even more so.

I’ll skip the wamc post but I would like to stay involved on this thread for advice and to post progress. I worked in 2 ED’s prior to med school, one as a chief scribe and one as a clinical research assistant. Also worked and continue to work as a paramedic before and during med school (I love EMS and have kept my license up because of that). Did below avg on step 1 (218) and above average on level 1 (616). So far doing great on clinical rotations (highest marks from preceptors and positive feedback; above average on IM shelf).

I’m wondering if I can get some insight on how we should decide on whether or not we need a backup plan? I can’t picture myself doing anything else other than EM. I honestly don’t even want a back up plan but I realize that match is better than no match.

Also wondering- can the SLOE come from a third year elective rotation in EM at a community hospital? Or is it better to focus on obtaining these from an away rotation at a center that has a residency.

Thanks in advance for the advice!


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[8741empls]

Hello guys, first time browsing through this thread and very happy I found it. Lots of good info here and overall I’m getting the impression that SLOE and step 2 are important factors with the former even more so.

I’ll skip the wamc post but I would like to stay involved on this thread for advice and to post progress. I worked in 2 ED’s prior to med school, one as a chief scribe and one as a clinical research assistant. Also worked and continue to work as a paramedic before and during med school (I love EMS and have kept my license up because of that). Did below avg on step 1 (218) and above average on level 1 (616). So far doing great on clinical rotations (highest marks from preceptors and positive feedback; above average on IM shelf).

I’m wondering if I can get some insight on how we should decide on whether or not we need a backup plan? I can’t picture myself doing anything else other than EM. I honestly don’t even want a back up plan but I realize that match is better than no match.

Also wondering- can the SLOE come from a third year elective rotation in EM at a community hospital? Or is it better to focus on obtaining these from an away rotation at a center that has a residency.

Thanks in advance for the advice!

There is honestly no way to know if you need a backup plan at this point. A 218 will not stop you from getting enough interviews if you apply thoughtfully (I say this from experience). But it will likely make getting EM rotations a bit more difficult (also experience). Apply early and broadly, and maybe reach out early to a couple that don’t use VSAS. Continue to work hard in your clerkships and earn high scores. Take step 2 seriously and score well. I would have a score in ERAS when applications open. Learn to give a very good, concise EM presentation (most important part). If you are a teachable, normal human your experience will be a huge asset to you in rotation. Pair that with a great ED presentation and you will look like a rockstar. If you can have 2 good SLOEs in ERAS early in the season with an improved step 2 score, you should be fine. Unless something drastically changes between this season and next.

You can get a letter from a community rotation and they have non academic SLOEs but it in no way replaces an actual SLOE. You need two from GME programs. I used a regular LOR from community EM with two SLOEs and that seemed to be fine.

You didn’t ask this, but if you are near an EM program I would reach out to their leadership in attempt to find a mentor. If that doesn’t happen reach out to leadership early in your sub-I month and ask for a time to sit down and discuss your application. This is common and was well received at both of the places I rotated and it helped a lot.

 

[Stephanopolous]

There is honestly no way to know if you need a backup plan at this point. A 218 will not stop you from getting enough interviews if you apply thoughtfully (I say this from experience). But it will likely make getting EM rotations a bit more difficult (also experience). Apply early and broadly, and maybe reach out early to a couple that don’t use VSAS. Continue to work hard in your clerkships and earn high scores. Take step 2 seriously and score well. I would have a score in ERAS when applications open. Learn to give a very good, concise EM presentation (most important part). If you are a teachable, normal human your experience will be a huge asset to you in rotation. Pair that with a great ED presentation and you will look like a rockstar. If you can have 2 good SLOEs in ERAS early in the season with an improved step 2 score, you should be fine. Unless something drastically changes between this season and next.

You can get a letter from a community rotation and they have non academic SLOEs but it in no way replaces an actual SLOE. You need two from GME programs. I used a regular LOR from community EM with two SLOEs and that seemed to be fine.

You didn’t ask this, but if you are near an EM program I would reach out to their leadership in attempt to find a mentor. If that doesn’t happen reach out to leadership early in your sub-I month and ask for a time to sit down and discuss your application. This is common and was well received at both of the places I rotated and it helped a lot.

Thank you for the feedback. I actually didn’t consider the fact that my step 1 score could block me from away rotations. Yikes. I’ll be taking step 2 in June so I anticipate having scores back early enough for when ERAS opens. Def have been taking it seriously and studying continuously throughout rotations.

I’m currently working on obtaining a mentor that’s associated with an academic program. Hopefully all goes well but it’s been a little tough with getting good communication back.

I think I’ll plan on using LOR from my em elective like you mentioned instead of a sloe. I feel very comfortable with my presentations so far. I’m definitely going to focus on making them as good as possible before auditions. So far my preceptors have complimented me on how I present patients. I watch videos on the web pages of the big em associations on good patient presentations so I think that has helped me.


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[8741empls]

Thank you for the feedback. I actually didn’t consider the fact that my step 1 score could block me from away rotations. Yikes. I’ll be taking step 2 in June so I anticipate having scores back early enough for when ERAS opens. Def have been taking it seriously and studying continuously throughout rotations.

I’m currently working on obtaining a mentor that’s associated with an academic program. Hopefully all goes well but it’s been a little tough with getting good communication back.

I think I’ll plan on using LOR from my em elective like you mentioned instead of a sloe. I feel very comfortable with my presentations so far. I’m definitely going to focus on making them as good as possible before auditions. So far my preceptors have complimented me on how I present patients. I watch videos on the web pages of the big em associations on good patient presentations so I think that has helped me.


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It won’t make it impossible. I got some great rotations with an identical score. Finding a mentor is really tough for DO students with no program. GamerEMDoc has been an amazing resource for those of us without mentor ship here. If you haven’t I would read his entire thread. You are welcome to PM me if you have any questions you think I could help with. Best of luck!

 

[Stephanopolous]

It won’t make it impossible. I got some great rotations with an identical score. Finding a mentor is really tough for DO students with no program. GamerEMDoc has been an amazing resource for those of us without mentor ship here. If you haven’t I would read his entire thread. You are welcome to PM me if you have any questions you think I could help with. Best of luck!

I really appreciate the advice and your willingness to help! I’ll definitely check his thread out. Thank you.


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[gamerEMdoc]

GamerEMDoc has been an amazing resource for those of us without mentor ship here.

Thanks!

 

[gamerEMdoc]

I worked in 2 ED’s prior to med school, one as a chief scribe and one as a clinical research assistant. Also worked and continue to work as a paramedic before and during med school (I love EMS and have kept my license up because of that). Did below avg on step 1 (218) and above average on level 1 (616). So far doing great on clinical rotations (highest marks from preceptors and positive feedback; above average on IM shelf).

The low step 1 is unlikely to hinder you unless you really want to be at a competitive program. I guarantee you, with your clinical background in EMS and scribing, you'll standout clinically. Most of the students that I've had who were EM scribes for some time have been excellent, they just have EM specific clinical skills many students don't have yet early in their 4th year. While the step 1 score may hinder you at some places, you'll likely standout clinically, and at many programs, that's all you need to do.

I’m wondering if I can get some insight on how we should decide on whether or not we need a backup plan? I can’t picture myself doing anything else other than EM. I honestly don’t even want a back up plan but I realize that match is better than no match.

I'm guessing you won't need a backup based solely on what I know of your background as a scribe/medic. You can never decide that question of a backup based on low boards (or high boards). The competitiveness of the application is based on the competitiveness of your SLOEs, and unfortunately you are blinded to that. Having a mentor either in person or online that can review your app in the fall, and give you an idea early on if you should be ok or not, or if its time to cut bait and apply to something else is invaluable.

Also wondering- can the SLOE come from a third year elective rotation in EM at a community hospital? Or is it better to focus on obtaining these from an away rotation at a center that has a residency.

I'd personally only get SLOEs from EM residencies, community or university. Getting a SLOE from a non-residency based site doesn't make much sense to me. Yes, a modified SLOE exists, but it's only supposed to be from sites that see a ton of students. Most of the non-residency based SLOEs I wind up seeing are pretty worthless, the preceptor only gets a few students a year and sometimes its the only SLOE they wrote all year. That isn't real helpful.

If you do have to rotate at a non-residency site in your third year, thats fine. Use it as practice. Hone your skills to gear up for your 4th year auditions.

 

[liveonthewater]

Hello guys, first time browsing through this thread and very happy I found it. Lots of good info here and overall I’m getting the impression that SLOE and step 2 are important factors with the former even more so.

I’ll skip the wamc post but I would like to stay involved on this thread for advice and to post progress. I worked in 2 ED’s prior to med school, one as a chief scribe and one as a clinical research assistant. Also worked and continue to work as a paramedic before and during med school (I love EMS and have kept my license up because of that). Did below avg on step 1 (218) and above average on level 1 (616). So far doing great on clinical rotations (highest marks from preceptors and positive feedback; above average on IM shelf).

I’m wondering if I can get some insight on how we should decide on whether or not we need a backup plan? I can’t picture myself doing anything else other than EM. I honestly don’t even want a back up plan but I realize that match is better than no match.

Also wondering- can the SLOE come from a third year elective rotation in EM at a community hospital? Or is it better to focus on obtaining these from an away rotation at a center that has a residency.

Thanks in advance for the advice!


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Are we the same person? We got the same score on Step 1, and if I remember correctly the same score on Level 1. I'm also an EMT (never got my medic). I'm a 4th year tho, currently interviewing for EM. I only applied to one specific geographic region, ~50 apps. Included in those were many of the former AOA programs. So far, I have received >20 invites. I was able to decline many of the invites and will only be going to established ACGME programs. I have been surprised at some of the programs that offered me an invite. Not trying to toot my own horn but I want stress that even as a DO with a low Step 1, you are absolutely, 100% still in the game! I was in your same position this time last year, wondering if I how or if I was even competitive. As a DO, this feeling is even stronger. I'm about to go in for a shift but I encourage you to PM me and I can give you a lot more specific advice. I was lucky to have many people (now residents) ahead of me to help guide me on this crazy path. Since I've gone through it I can also speak to my own mistakes as well as the things I did right.
I can expand on this if you PM me but to sum it up:
1. Make sure you get away rotations at well-known/established ACGME programs. Especially the ones you are interested in training at.
2. Perform very well on those away rotations and get amazing SLOEs (this should be #1 but you have to get the AIs first).
3. Kill Step 2. I posted on a thread a while back on my experiences with this.

But seriously, PM me if you are interested in my n=1 advice. It's a long, difficult, stressful process and being a DO will unfortunately only make it more difficult but it absolutely can be done as long as you stay on top of it.

 

[miacomet]

The boards no doubt show how much medicine you know, but you just need to be competant from a medical knowledge standpoint. The rest of EM comes down to some trainable and some not trainable inherent qualities. Things like good social skills, customer service skills, multitasking, adaptability, working under pressure, etc. None of this can be tested in an exam, and all of it is more important from an employer standpoint than scoring extremely high on a knowledge test.

If you have to choose your colleague, anyone would take someone is just competant in knowledge but is excellent at multitasking, good socially with staff and patients, and who takes direction well over someone who has a superb medical knowledge base but cant multitask or has personality flaws when dealing with the staff, nurses, or patients.

The problem is, this stuff is unmeasurable, and as young scientists, students want objective data, and I respect that. But while clinical performance isnt easy to measure and can lead to subjective bias, it still remains a far more accurate predictor of who will excel in residency than board scores, which is why SLOEs and EM grades remain far more important, and why that will never change.

Remember that many fields DO emphasize board scores, and someone taking Step 1 hasn't started clinicals and doesn't know what field they are going into, so it makes sense they would want to rock them. Schools without a big EM emphasis may really promote board scores as the secret to matching well, which is probably true in medicine or peds.

 

[gamerEMdoc]

Remember that many fields DO emphasize board scores, and someone taking Step 1 hasn't started clinicals and doesn't know what field they are going into, so it makes sense they would want to rock them. Schools without a big EM emphasis may really promote board scores as the secret to matching well, which is probably true in medicine or peds.

Excellent point. Although advice like "rock the boards" never made much sense to me. Is there honestly any medical students out there who don't try to do well on the boards? My advice is more that if you try hard to do well on the boards and it doesn't turn out as well as you'd like, you'll still be ok for EM if you are good clinically. It's not that you shouldn't try to do well on the boards, I'm just assuming that's a given that every student is trying to do well on them.

 

[lucid_leprechaun]

Hi y'all

MS3 here, wanted to have a rough understanding of where I stand, namely in the "tiers" of programs I would be a fair applicant for, as I dont have great insight into what is available for me.

Top 15 med school, probably bottom 50% of class
STEP1: 241 STEP2: 251
Clinical Rotation grades: All Passes, High Pass in surgery
Electives: Honors in Anesthesia, Radiology, awaiting EM SubI and Genmed SubI
Good EC's, few posters and oral presentations, 1 pub in JAMA.

As mentioned before, I would mainly like to know where I stand in terms of which programs would be considered a reach for me and what would be fair game. My clinical rotation grades were pretty poor and I am afraid that's holding me back. Thank you very much.

So your board scores are OK, but I’ll reiterate your away rotations will make your competitiveness. Take this from someone who has interviewed. Unless you got a 200 or 290 on Steps it will be unlikely to matter.
That being said, work hard on rotations, study, get feedback. You should be successful.
As for tiers, it will depend on SLOES. You can have Step 1 > 270, however bad SLOES will get you 2 interviews, not matched.

 

[gamerEMdoc]

Hi y'all

MS3 here, wanted to have a rough understanding of where I stand, namely in the "tiers" of programs I would be a fair applicant for, as I dont have great insight into what is available for me.

Top 15 med school, probably bottom 50% of class
STEP1: 241 STEP2: 251
Clinical Rotation grades: All Passes, High Pass in surgery
Electives: Honors in Anesthesia, Radiology, awaiting EM SubI and Genmed SubI
Good EC's, few posters and oral presentations, 1 pub in JAMA.

As mentioned before, I would mainly like to know where I stand in terms of which programs would be considered a reach for me and what would be fair game. My clinical rotation grades were pretty poor and I am afraid that's holding me back. Thank you very much.

All that can be gleaned from this info is that you have the basics to match in EM if you do ok on your EM rotations. Nothing more, nothing less. You can't make any assumptions about your competitiveness based on third year data when it comes to EM because it leaves out the most important part of the application which is basically the deciding factor in whether you will match at all, and if so, where you will match.

Without knowing how you do on your EM rotations (and how your SLOEs are as a result) no one is ever going to be able to tell you what "tier" of residency you will be a fair applicant for. You could have 260 board scores and if you do terrible in your fourth year EM rotations you will go unmatched and you could have 225 board scores and match at a good program if you do well clinically and get good sloes. Boards, ECs, research, etc. None of this will be the biggest factor in dictating if you match and where you match.

I understand why students want to know how competitive they are as early as possible. I really do. But you have to realize, that's like asking a bank how big of a home loan can I get by telling them your birthday and what car you drive, but withholding your credit score and yearly income.

 

[8741empls]

Hi y'all

MS3 here, wanted to have a rough understanding of where I stand, namely in the "tiers" of programs I would be a fair applicant for, as I dont have great insight into what is available for me.

Top 15 med school, probably bottom 50% of class
STEP1: 241 STEP2: 251
Clinical Rotation grades: All Passes, High Pass in surgery
Electives: Honors in Anesthesia, Radiology, awaiting EM SubI and Genmed SubI
Good EC's, few posters and oral presentations, 1 pub in JAMA.

As mentioned before, I would mainly like to know where I stand in terms of which programs would be considered a reach for me and what would be fair game. My clinical rotation grades were pretty poor and I am afraid that's holding me back. Thank you very much.

So your board scores are OK, but I’ll reiterate your away rotations will make your competitiveness. Take this from someone who has interviewed. Unless you got a 200 or 290 on Steps it will be unlikely to matter.
That being said, work hard on rotations, study, get feedback. You should be successful.
As for tiers, it will depend on SLOES. You can have Step 1 > 270, however bad SLOES will get you 2 interviews, not matched.

I agree about your scores putting you in the running for any program so long as you ha e the clinical performance (as reflected in SLOEs) to back it up. The question is, why are you performing poorly on clinical rotations and can you correct that moving into 4th year on EM sub-Is? SLOEs will dictate your competitive window more than anything else in your application. Schedule a time to meet with the leadership at your first EM rotation halfway through the month and actively seek and act on feedback through your rotations. Practice EM presentations now.

Edit. Didn’t see GamerEMDocs response. Defer to him.

 

[gamerEMdoc]

I agree about your scores putting you in the running for any program so long as you ha e the clinical performance (as reflected in SLOEs) to back it up. The question is, why are you performing poorly on clinical rotations and can you correct that moving into 4th year on EM sub-Is? SLOEs will dictate your competitive window more than anything else in your application. Schedule a time to meet with the leadership at your first EM rotation halfway through the month and actively seek and act on feedback through your rotations. Practice EM presentations now.

Edit. Didn’t see GamerEMDocs response. Defer to him.

I agree. Knowing that clinical performance in the ED is by far and away the biggest driver of the competitiveness of your application, my first question when looking at that WAMC post was, why is this candidate getting all "pass" on 3rd year rotations. Is it because the school is super competitive, and doing some EM aways at less competitive sites may allow them to break out of that shadow? Or is there something clinically that is keeping them from standing out. If there is, that needs to be identified ASAP before heading out for 4th year rotations.

The best things you can work on for 4th year rotations, that can be worked on virtually in any rotation leading up to your EM rotations:
- Getting faster and faster at doing pertinent patient evaluations so you aren't in the room for 30 minutes getting H+Ps on your first EM month
- Learning how to present cases succintly
- Learning to develop a sound ddx and plan to present with your case presentation for whatever you see
- Gaining experience with any procedures you can get your hands on

 

[Falconclaw]

At this point in the cycle, is there still a fair chance of getting a couple additional interview invites or not so much?

 

[gamerEMdoc]

Maybe. Typically January is a heavy cancellation month, So for programs that are still interviewing in January, there may still be a few interviews to be had if the programs try to fill those spots. We decided to try to mitigate cancellations this year by interviewing more people early and only interviewing into the first week of January. With only 3 more weeks of interviews left, we’ve had only a few cancellations and have been able to fill them quickly. Im going to try to to the same in future years, because the last few weeks at the end of January are a ghost town, everyone cancels and its hard to get people to fill at that point.

 

[eatkalteenbars]

At this point in the cycle, is there still a fair chance of getting a couple additional interview invites or not so much?

I got a call today that I had gotten off of a waitlist that I didn’t know I was on. (Unfortunately I missed the call and the spot was filled by the time I called back.)

 

[Stephanopolous]

Are we the same person? We got the same score on Step 1, and if I remember correctly the same score on Level 1. I'm also an EMT (never got my medic). I'm a 4th year tho, currently interviewing for EM. I only applied to one specific geographic region, ~50 apps. Included in those were many of the former AOA programs. So far, I have received >20 invites. I was able to decline many of the invites and will only be going to established ACGME programs. I have been surprised at some of the programs that offered me an invite. Not trying to toot my own horn but I want stress that even as a DO with a low Step 1, you are absolutely, 100% still in the game! I was in your same position this time last year, wondering if I how or if I was even competitive. As a DO, this feeling is even stronger. I'm about to go in for a shift but I encourage you to PM me and I can give you a lot more specific advice. I was lucky to have many people (now residents) ahead of me to help guide me on this crazy path. Since I've gone through it I can also speak to my own mistakes as well as the things I did right.
I can expand on this if you PM me but to sum it up:
1. Make sure you get away rotations at well-known/established ACGME programs. Especially the ones you are interested in training at.
2. Perform very well on those away rotations and get amazing SLOEs (this should be #1 but you have to get the AIs first).
3. Kill Step 2. I posted on a thread a while back on my experiences with this.

But seriously, PM me if you are interested in my n=1 advice. It's a long, difficult, stressful process and being a DO will unfortunately only make it more difficult but it absolutely can be done as long as you stay on top of it.

I'm so psyched that you have a similar background as me and I really appreciate the response! I'm definitely going to PM you. What do you mean by AI? I'll check out your step 2 post also, thank you!!!!!

 

[gamerEMdoc]

What do you mean by AI?

AI = Acting internship. Fancy name for "4th year rotation in the field you want to go into".

 

[theonlytycrane]

@gamerEMdoc Can you speak to the difference of importance between SLOE vs. MSPE (4.8 vs. 3.3 out of 5.0 respectively on the 2018 NRMP PD survey). Will the MSPE basically have comments from SLOEs + class specific data?

I'm an M2 very interested in EM, so I'm trying to figure out how everything works. Thanks for the help

 

[gamerEMdoc]

The SLOE is a letter of evaluation you get from a 4th year EM rotation. The comments and rankings on the SLOE are not seen by your school, and are not on the MPSE. Programs are asked to be as constructive and honest as possible in the SLOEs and PDs view them as the most important aspect of the application, since they are basically asking specifically how you perform on your EM rotation and how the program plans on ranking you on their match list compared to other students.

The MPSE is basically a summary of your medical school performance. Preclinical grades, clinical grades, class rank. Some of these are more helpful than others. If they were more standardized, they'd probably be more helpful. But different schools have different grading systems. Some places rank or provide quartiles, some don't. Not all schools are upfront with their grade distribution. So it makes it hard to compare student performance at one school vs the next sometimes which devalues some of the importance of the MPSE in my opinion.

 

[theonlytycrane]

@gamerEMdoc Does research (in EM or outside of EM) matter to you?

I'm trying to figure out how much to keep investing a non-EM project that I have pretty much no interest in. I presented a poster, but more work would be done to write a paper for it. I'm wondering if I should keep at it, scrap it, or switch to EM-related research? I have no intention to do research in residency and beyond (I'm interested in community EM).

 

[r-e-l-a-x]

I can tell you from my n=1 that i have no papers or publications or anything and i got tons of interviews. I also have below average board scores so it was really just SLOEs that opened the doors. After 10 interviews have been asked about research zero times.

 

[gamerEMdoc]

@gamerEMdoc Does research (in EM or outside of EM) matter to you?

I'm trying to figure out how much to keep investing a non-EM project that I have pretty much no interest in. I presented a poster, but more work would be done to write a paper for it. I'm wondering if I should keep at it, scrap it, or switch to EM-related research? I have no intention to do research in residency and beyond (I'm interested in community EM).

Not really. I'm impressed by someones research if the candidate has a legit interest in research, has been involved in several studies, and has a few publications. That's impressive, and could be an asset having them in your program, because finding people who will help churn out publications is helpful for the faculty. But that's assuming the person is good clinically. You aren't going to take a candidate who is a bad clinical student because they do research. Otherwise, people just doing a single token project just to do a project to pad their resume isn't really important to me.

 

[liveonthewater]

I can tell you from my n=1 that i have no papers or publications or anything and i got tons of interviews. I also have below average board scores so it was really just SLOEs that opened the doors. After 10 interviews have been asked about research zero times.

I second this. N=2