Aug 2, 2016
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Hey SDN...just wanted to get something off my chest.

I went into the match last year with 11 EM interviews...contacted by my number one program saying they were very interested in my application so of course, I ranked them first. Match day came and went...didn't match into EM. Ended up in a categorical FM spot. Fortunate that I matched...but extremely upset that I didn't match into my number one specialty. Step 1 210, step 2 245, passed step 2 CK, came from a good US allopathic school. Had great S/LORs from 2 EM faculty, 1 Ob/gyn and 1 IM. Definitely reapplying this year but trying to see what went wrong last year and how to improve for my application this year. My ERAS application is pretty much complete (waiting for 2 LORs) but I'm a little nervous about how to ask my current PD for "permission" to re-enter the match for EM. I am giving my current program 110% in every rotation (not slacking by any means). I knew that I wanted to do EM before I even entered medical school so of course, I was floored when I found out that I didn't match. Any advice you guys could offer would be absolutely awesome.
 

ToKingdomCome

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Dec 25, 2012
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If you dont mind me asking, what types of programs did you apply to. Mostly community or academic?

I'm sorry you didn't match and I would just be as surprised as you. Did you h ave any red flags?
 
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gman33

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Few questions.
Med school grades? Especially em.
How do you know your letters are great?

Talking to your PD is tricky.
A good one will understand and be supportive.
A bad one will start looking for a replacement now and may give you the boot if they find one.

Try to figure out why you failed the first time and determine if you'll have a good chance this time before messing things up with your current PD.
 
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TheDarkKnight16
Aug 2, 2016
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Few questions.
Med school grades? Especially em.
How do you know your letters are great?

Talking to your PD is tricky.
A good one will understand and be supportive.
A bad one will start looking for a replacement now and may give you the boot if they find one.

Try to figure out why you failed the first time and determine if you'll have a good chance this time before messing things up with your current PD.
The letters were good because I received direct feedback from the clerkship directors who wrote them. They told me what would be on the letters and all of my feedback was positive so...I assumed the LORs were ok.
Med school grades were average with 3 HP on my core rotations. HP and Honored my EM rotations.
I was able to talk with one of the PDs after match day and I was told that my percentile ranking was low when compared with the other applicants who applied...I didn't even know that was a thing they considered with applicants. Even though my step 1 was low, I was told during interview season that I made quite the comeback on Step 2 so it wasn't a big worry.
 
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TheDarkKnight16
Aug 2, 2016
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If you dont mind me asking, what types of programs did you apply to. Mostly community or academic?

I'm sorry you didn't match and I would just be as surprised as you. Did you h ave any red flags?
I had maybe a 60-40 mix of academic > community. My plan was to go for fellowship afterwards so I figured with a larger academic center, I would have an easier time doing research which would make me a more competitive applicant. My red flag would probably be the step 1 score. But I thought I made up for that on my step 2...I think a 35+ point increase would've been a definite improvement but IDK maybe they were looking for 50+??? Lol
 

gman33

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So you had a low class rank and a low step 1.

Rest of the application sounds average.

2 red flags got you knocked out.

If you reapply to every program, you'd hopefully match somewhere.

Only problem will be pissing off your PD and finding time to interview at 20 places.

Up to you if it's worth the risk.
 

Cinclus

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The letters were good because I received direct feedback from the clerkship directors who wrote them. They told me what would be on the letters and all of my feedback was positive so...I assumed the LORs were ok.
Yeah, sometimes they are still not OK. I talked to the CDs, got great feedback, and one of my letters was...not so great. I was fortunate to match, despite this.
 

racerwad

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Yeah, sometimes they are still not OK. I talked to the CDs, got great feedback, and one of my letters was...not so great. I was fortunate to match, despite this.
Agree with all of the above so far. I don't want to kick you while you are down, but clearly, your letters were not great. As it stands, it is not your scores and/or class rank were what kept you from matching. On rank day (at least at our program), those metrics are barely considered - they are what get you an interview. What gets you ranked is you.

Like with any job, you need both technical ability and social skills. Imagine if you were the one who is hiring: you wouldn't hire someone who is a total dunce, nor would you hire someone that you either couldn't teach or couldn't stand to be around. EM is somewhat unique because a good EP needs to be emotionally sensitive to people they have never met as well as be technically competent in a fairly broad range of things. Other specialities might allow you to focus on one end of the spectrum vs another (surgery vs peds psych, for example).

If I were you, I would approach someone who might have had access to your letters and/or ERAS app (former med school faculty or someone at a program you can trust) and ask them if there were any negative themes (or the absence of positive opinions as it pertains to interpersonal skills) in your SLOEs. Faculty who give good feedback face-to-face but write poor SLOEs are cowards who are doing a disservice to the people they are supposed to be taking care of. That said, when I think about the people I am personally familiar with who did not match in EM, it was because of their personality. They also got positive feedback around their technical skills, clinical competency, etc; in addition, they had great scores and grades throughout medical school. On paper, they were great, and their SLOEs probably highlighted how smart they were, the strength of their clinical abilities, etc. However, what was probably missing from their SLOEs, and evident during rotations or interviews, is that they were: weird, difficult to teach, lacked social competence, etc. You might hate me for suggesting this, but maybe this is also the case with you? Either way, many of these same folks were able to match to EM eventually, and I believe you can, too. It will probably take an uncomfortable amount of work to get there, but it is worth it. Good luck.
 
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TheDarkKnight16
Aug 2, 2016
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Agree with all of the above so far. I don't want to kick you while you are down, but clearly, your letters were not great. As it stands, it is not your scores and/or class rank were what kept you from matching. On rank day (at least at our program), those metrics are barely considered - they are what get you an interview. What gets you ranked is you.

Like with any job, you need both technical ability and social skills. Imagine if you were the one who is hiring: you wouldn't hire someone who is a total dunce, nor would you hire someone that you either couldn't teach or couldn't stand to be around. EM is somewhat unique because a good EP needs to be emotionally sensitive to people they have never met as well as be technically competent in a fairly broad range of things. Other specialities might allow you to focus on one end of the spectrum vs another (surgery vs peds psych, for example).

If I were you, I would approach someone who might have had access to your letters and/or ERAS app (former med school faculty or someone at a program you can trust) and ask them if there were any negative themes (or the absence of positive opinions as it pertains to interpersonal skills) in your SLOEs. Faculty who give good feedback face-to-face but write poor SLOEs are cowards who are doing a disservice to the people they are supposed to be taking care of. That said, when I think about the people I am personally familiar with who did not match in EM, it was because of their personality. They also got positive feedback around their technical skills, clinical competency, etc; in addition, they had great scores and grades throughout medical school. On paper, they were great, and their SLOEs probably highlighted how smart they were, the strength of their clinical abilities, etc. However, what was probably missing from their SLOEs, and evident during rotations or interviews, is that they were: weird, difficult to teach, lacked social competence, etc. You might hate me for suggesting this, but maybe this is also the case with you? Either way, many of these same folks were able to match to EM eventually, and I believe you can, too. It will probably take an uncomfortable amount of work to get there, but it is worth it. Good luck.
Thanks for the input racerwad. I know I can come across as quiet...I've been told that a few times in my MSPE. Personality wise, it's a weird match up for someone who wants to go into EM. However, I have never had any issues with procedural proficiency or clinical competence. I always take constructive criticism seriously and believe that I can always make room for improvement. It was definitely something that I thought about..."am I just a weird person"? Definitely crossed my mind a couple times. In all honesty, I'm just a cool, calm and collected individual who enjoys learning about and participating in trauma cases, toxicology rounds, prehospital ambulance runs and disaster codes.

I'm aware of the risks that I am taking with reapplying but if there is some chance that I can land into a medical career that I've been dreaming about from the day I chose medicine, the risks are worth it.
 
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TheDarkKnight16
Aug 2, 2016
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Agree with all of the above so far. I don't want to kick you while you are down, but clearly, your letters were not great. As it stands, it is not your scores and/or class rank were what kept you from matching. On rank day (at least at our program), those metrics are barely considered - they are what get you an interview. What gets you ranked is you.

Like with any job, you need both technical ability and social skills. Imagine if you were the one who is hiring: you wouldn't hire someone who is a total dunce, nor would you hire someone that you either couldn't teach or couldn't stand to be around. EM is somewhat unique because a good EP needs to be emotionally sensitive to people they have never met as well as be technically competent in a fairly broad range of things. Other specialities might allow you to focus on one end of the spectrum vs another (surgery vs peds psych, for example).

If I were you, I would approach someone who might have had access to your letters and/or ERAS app (former med school faculty or someone at a program you can trust) and ask them if there were any negative themes (or the absence of positive opinions as it pertains to interpersonal skills) in your SLOEs. Faculty who give good feedback face-to-face but write poor SLOEs are cowards who are doing a disservice to the people they are supposed to be taking care of. That said, when I think about the people I am personally familiar with who did not match in EM, it was because of their personality. They also got positive feedback around their technical skills, clinical competency, etc; in addition, they had great scores and grades throughout medical school. On paper, they were great, and their SLOEs probably highlighted how smart they were, the strength of their clinical abilities, etc. However, what was probably missing from their SLOEs, and evident during rotations or interviews, is that they were: weird, difficult to teach, lacked social competence, etc. You might hate me for suggesting this, but maybe this is also the case with you? Either way, many of these same folks were able to match to EM eventually, and I believe you can, too. It will probably take an uncomfortable amount of work to get there, but it is worth it. Good luck.
So, now I'm paranoid about reusing my SLOEs...should I try and secure additional SLOEs from attendings on my EM rotation next month? Also, if I honored/HP my EM rotations...why would the SLOEs still be not good...?
 
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TheDarkKnight16
Aug 2, 2016
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So you had a low class rank and a low step 1.

Rest of the application sounds average.

2 red flags got you knocked out.

If you reapply to every program, you'd hopefully match somewhere.

Only problem will be pissing off your PD and finding time to interview at 20 places.

Up to you if it's worth the risk.
I have vacation time during the heaviest interview months for EM. I think I'll be ok time wise.
I'll also check out regions that I didn't consider before. More places, more opportunities :)
 
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Cinclus

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So, now I'm paranoid about reusing my SLOEs...should I try and secure additional SLOEs from attendings on my EM rotation next month? Also, if I honored/HP my EM rotations...why would the SLOEs still be not good...?
You can still have a good grade along with a comment or two that will destroy you. Find someone to review your SLOEs. Your worrying is justified.
 

ordersol7

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OP I was in a similar experience to you last year. The difference is I postponed graduation rather than SOAP into family med or a prelim and switched gears to IM since I decided I could be equally happy doing hospitalist or icu work and felt making a last ditch effort to EM just wasn't worth it for me. I matched this year into a decent academic IM program. Not sure how much I could advise you but feel free to PM me. The self-doubt and stress I went through at the time was unreal as it must be for you.
 

racerwad

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So, now I'm paranoid about reusing my SLOEs...should I try and secure additional SLOEs from attendings on my EM rotation next month? Also, if I honored/HP my EM rotations...why would the SLOEs still be not good...?
If your next rotation is at a residency program, you should absolutely obtain a SLOE!

Like you, I am fairly quiet and introverted. If, left on my own, I'd just as soon not talk to anyone. Even on SDN, I only post a fraction of my thoughts and opinions. It is likely that, instead of being "bad" you were just "unnoticed." I wouldn't advise you to be someone else. Instead, when you are interviewing (which is every breathing moment from here until you match), you should find a way to sincerely share your interest and passion for EM with those around you, just like you did here:

... (I am an) individual who enjoys learning about and participating in trauma cases, toxicology rounds, prehospital ambulance runs and disaster codes.

(EM is the) medical career that I've been dreaming about from the day I chose medicine, the risks are worth it.
All I did was cut out the fluff and make the subjects of the sentences more clear. These are your own words. Make it happen.
 
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TheDarkKnight16
Aug 2, 2016
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If your next rotation is at a residency program, you should absolutely obtain a SLOE!

Like you, I am fairly quiet and introverted. If, left on my own, I'd just as soon not talk to anyone. Even on SDN, I only post a fraction of my thoughts and opinions. It is likely that, instead of being "bad" you were just "unnoticed." I wouldn't advise you to be someone else. Instead, when you are interviewing (which is every breathing moment from here until you match), you should find a way to sincerely share your interest and passion for EM with those around you, just like you did here:



All I did was cut out the fluff and make the subjects of the sentences more clear. These are your own words. Make it happen.
This just made my day. Thank you so much for your help. I'll be sure to post updates...hopefully I'll have good news come Feb! *fingers crossed*
 
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pencilcase

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People underestimate the power of LORs and for the most part assume most LOR writers are nice. Unfortunately, in the real world, people just ain't always that nice or they don't realize how much you are relying on them. Even a lukewarm LOR can hurt an application. Let alone one that discusses anything that may be regarded as "unprofessional". A lot of times you won't know that your LOR wasn't that great unless you read it. If there is any doubt about the strength of an LOR, I would consider not waiving my right for that one letter, reviewing it and then deciding whether to include it. In my opinion, it is better than sending that bomb to a program.

When you request an LOR, sincerely ask that person if they feel that the can write a strong letter of recommendation on your behalf to help you in your pursuit of Emergency Medicine. Make it clear that it is your dream to work in the ER and make it obvious that their letter would really help your application.
 
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