Tuesday, June 6, 2017

The Standardized Video Interview - What Applicants Need to Know

The CORD Student Advising Task Force just published an explanation of the new mandatory AAMC Standardized Video Interview (SVI) “pilot”.  If this is the first you have heard of this, we urge you to read the CORD EM blog summary and the related materials from the AAMC (links are included on the CORD blog).  In this post we are going to attempt to address what this requirement means for students in the 2018 NRMP match.  

“Do I have to do this?”

Yes.  Anyone applying to Emergency Medicine is going to be prompted to sign up and and create these videos.  If the AAMC is happy with the results, this may get expanded to applicants applying to all specialties in future years.  There is no cost to applicants to complete this and some programs may consider your application incomplete if they do not have results.  And we are not going to know which programs that will be.  If you want to do EM, do the video interviews.  

“What are programs going to do with this information?”

Programs will receive your score on the video interview and have the option to view the actual videos.  What programs do with this information is up to them.  This is the first year programs will receive SVI data, so program directors do not know how well this score will correlate with other information like SLOE’s, the MSPE, and most importantly: the impression made during the interview day.  

There are a few realistic options for what programs will do with the SVI:

Option A:  The program looks at the SVI and uses it to help them differentiate between two candidates who are otherwise very similar, offering an interview to the student with the better SVI performance.

Option B: The program does not use the SVI information to determine who to interview but subsequently compares SVI data to their own impression from the interview. This would help them know if they are going to use the SVI data in the future.

Option C: The program makes no use of the SVI information as it is unclear if this will continue to be available in subsequent years and they don’t want to spend time on something that will not be available in the future.

What are program directors actually going to do?

Application review is a time-consuming process that requires trained faculty to do it well.  Each program has a finite amount of application review resources to throw at this task.  Programs do not know if the SVI scores represent information that is important to them and they do not have time to personally review the actual videos (18 minutes x 1000+ applicants!!).  

Program directors will be offered training on how to understand the SVI data in August.  At that point they will decide how they are going to use this information this year.  Each program already has a system in place for application review and they are unlikely to incorporate the SVI data into that system until they know if it provides useful information.  There may very well be a few early adopters among the program directors, but not enough that students should change anything about their application plans based on this.

Students applying for EM in the 2018 match should complete the SVI, there is no upside to not doing it.  However, you should not be worried that your “performance” will hurt your chances at getting an interview.


For more information on the  the SVI take a look at this ALiEM EM Match Advice video.  This is a panel discussion with a representative from the AAMC.  

Adam Kellogg is an Associate Residency Director, former Clerkship Director, and previous Chair of the CORD-EM Student Advising Task Force. The opinions in this blog post are his and do not represent those of CORD-EM or of his employer.

Monday, March 13, 2017

"No Match" Day

Today applicants in the NRMP match find out if they successfully matched to a program. Unfortunately not every applicant with their sights set on Emergency Medicine received good news today. This post is to direct you towards help on what to do next:

For those without a match the SOAP process started at 11 am today and goes until Thursday, March 16th at 11 am.  


These two posts will guide you through the process of deciding what you should do now and planning your re-application:
The advice contained in the above posts will help you decide how best to spend the next year and what you should be considering when evaluating your options. 

Best of luck.



Monday, February 13, 2017

Rank List Resources

For students in the 2017 ACGME match your certified Rank List is due at 9 am on February 22.  There are lots of great resources to help you figure out how to put this together.  In this post we are going to connect you with a couple of those:

The EM Advisor comprehensive guide to creating your “perfect” Rank List.  This was updated last year by Tony Zhang, an Emergency Medicine Resident and member of the CORD Student Advising Task Force. Written by someone who recently went through this process and with recommendations supported by data and expert opinion of a group committed to increasing transparency in the match process and the quality of advising. A version of this guide is part of the CORD SATF Applying Guide to Emergency Medicine.

EMRA just published something with a similar goal: Creating the Perfect Rank Order List: Real Advice from Current EM Residents.  They used a different format to develop their recommendations, sending a survey to residents training in Emergency Medicine and drawing themes from those responses.  They do a nice job showing the variety of different viewpoints and approaches that can be taken in creating a Rank List. Definitely worth a read.

Creating your Rank List is your final anxiety-inducing task of your year long application process.  Once you get this done you can sit back and relax.

Best of luck!

Sunday, January 1, 2017

Happy New Year!... and on to the 2018 Match...

The 2017 Match is just a couple months away.  This post is for those planning to apply for Emergency Medicine in the 2018 Match. 

Like everything else in EM, advanced planning is the key to success in the Match. This post is the updated guide to the resources on this blog.

Throughout the year various authors contribute "Posts" that appear in reverse chronological order on the landing page.  Standard blog set-up.  

Down the right hand side of the web-page you will find a "Featured Post", a topic that we want to keep at the top even as other posts come up.  


Below that is a collection of static "Pages". These cover a variety of topics pertinent to the different stages of your application and contain general advice.  These are updated periodically to reflect changes in the Application and Match process. 
The most frequently viewed are:



Below the "Pages" are the collection of "Labels" - all the Posts on the site sorted by topic.  The most useful are linked across the top of the web-page, just below the header. These can help you find more on a specific topic.

**********

The advice you find on this blog is not one-size-fits-all. We try to reflect the consensus opinions of the membership of Clerkship Directors in Emergency Medicine (CDEM) and the Council of Residency Directors (CORD)but we do not speak for them. Nor does their membership always agree. When something is controversial, we try to address that controversy. We believe we are a source of sound, balanced, and accurate advice on becoming an emergency physician in the United States. We also have no doubt that you will find different opinions elsewhere. 

To help you sort through all of the differing opinions you may find, you need the guidance of a local EM advisor, in addition to your Dean. You need someone who knows the EM application process and can help you navigate issues specific to students from your school and region. If you cannot find anyone, or you need advice from a different region you can find help from residents who just went through this process provided by the EMRA mentorship program

Adam Kellogg is an Associate Residency Director and a previous Emergency Medicine Clerkship Director.  He is the past-chair of the CORD EM Student Advising Task Force and a member of the SAEM Resident and Student Advisory Committee. He has written for EM Resident about Diagnosing the Match

Monday, November 14, 2016

Application Overload

The Emergency Medicine match feels more competitive than ever before.  This perception is NOT supported by the best available data from the NRMP.  

The Numbers

There has been a steady increase in the number of applicants to EM each year, mostly driven by an increase in the number of allopathic graduating seniors (see Table 1 below). The number of "non-traditional applicants" (including osteopathic and international graduates) has actually leveled off.  

At the same time, opportunities to train in EM have increased. The number of PG1 positions available in the EM match has steadily gone up (blue line in Table 1).  This increase comes from both new programs opening and class expansion in existing EM programs. The result is that the ratio of available training spots to the number of applicants has not significantly changed. The ratio of available spots to those who want them is the same.  

Table 1 - Proportional increase in both number of applicants and number of training positions in Emergency Medicine.


What has changed is the number of programs that each student applies to (see Table 2).  For many years the average number was approximately 25 programs applied to per student.  Starting in 2010 there has been a dramatic increase from year to year in the number of programs applied to by each applicant. The trend is similar among "non-traditional" applicants.  

Table 2 - Increase in programs applied to per allopathic applicant in the match.  

The Consequences

Each residency program is receiving dramatically more applications. This has made the competition greater for their interview offers. Not for the actual interviews, because the relative number of applicants has not changed - just for the interview offer.

Programs have had to change how they review applications and choose who to offer interviews to. Faculty time is a finite resource at most programs. There may not have been more time available to dedicate to in-depth application review. Furthermore, the time period to review applications was compressed in 2013 when the MSPE release date moved up to October 1st.

Programs had little choice but to become more efficient at reviewing applicants. Options include only reviewing parts of the application, those portions felt to be more objective or higher yield (the SLOE's). Another option is to make greater use of the filters ERAS provides, such as setting a cut-off for step 1 scores.  Additionally, programs can give more attention to applicants from schools or regions that have been high yield in the past.  
With this increase in efficiency comes a loss of variability in applicant review. The same group of applicants will appear strong to most programs. These applicants will then receive the majority of the interview offers. This fortunate group of applicants will need to reject interview offers before they "trickle down" to the rest of the pool.

Some of the fortunate will choose to do more than the 12 interviews they need to be >95% assured of matching. Even so, most programs have responded to the overload of applications by interviewing greater numbers of applicants in the hopes of not missing anyone they want to meet.

In Summary

  1. The perception that EM is getting more competitive is not real
  2. There is greater competition for early interview offers
  3. Interview offers are concentrated in a fortunate few
  4. Interview opportunities will "trickle down" to most applicants
  5. For advice on how to get those interviews check out the FAQ section on this post on Acing the Interview


Adam Kellogg is an Associate Residency Director and a former Clerkship Director. He is a past Chair of the CORD Student Advising Task Force, whose mission is to improve the quality of the advising students receive who are applying to Emergency Medicine.


Tuesday, October 18, 2016

Acing the Interview

Your applications are in and interviews are rapidly approaching, so lets go over how to ace the interview

Firstly, lets address interview etiquette:
In recent years faculty have noticed some disturbing trends - from the moment you accept your interview you are representing yourself and your school.  Avoid unprofessional behavior by following these recommendations.

When you receive an invitation the majority of programs will be using an online service for booking. Go on line when you are off duty. Choose a slot that works for your schedule. Avoid doing this while you are working clinically - your patients deserve your attention when you are duty. For index details see our page on scheduling.

If you find that you need to change or cancel your interview, do so as far in advance as possible so that another applicant has the opportunity to take the slot. Never cancel within a week of your interview - you will be costing another applicant an interview and insulting the program that has been saving you a spot. Cancelling at the last minute is considered unprofessional behavior and may even be referred back to your own program or dean. If you realize you will not attend an interview for any reason notify the program as soon as you know.

Not showing up for a scheduled interview is absolutely unacceptable. If there is an emergency notify the program immediately.

Suits are expected - try your suit on and ensure it fits. Wear comfortable shoes - you will be walking.

Plan for travel and weather - Nearly all programs have a pre-interview event the night before you interview. Plan 2 days per interview - meaning you can fit 2 per week easily, but 3 will often lead to issues. You want to be early so leave plenty of time and dress appropriately.  When flying don’t check your bag to ensure your suit makes it to your interview with you. The Interview Day page gives you in depth answers to all your questions on the day itself.

Success is achieved with knowledge and planning:

Be realistic 
  • Similar to your applications the goal is targeted interviews that allow you to compare and contrast programs and find your fit. More is not always better. 
  • You should aim for 10-12 interviews this gives you a 95-99% chance of matching and is the best you can do.
  • Most students match in their top 3, so 12 is plenty for almost everyone.
  • It is expensive and time consuming to interview - don’t accept more than 12 interviews:  you will either cancel them or not be at your best when attending. 

Be yourself 
  • You want to be you. The interview is your opportunity to see how you fit at each program. This only works if you are yourself (the non-trash-talking, well dressed version of yourself).
Be enthusiastic 
  • While this sounds easy it can get hard after you have been on a bunch of interviews.
  • Use your body language to show your interest. Lean forward, make eye contact, and smile (in a not creepy fashion)
  • Ask questions that you care about. 

Be Informed 
  • Do your research ahead of time to understand each program and develop questions specific to each program. Again, they should be questions that matter to you, so you can reflect on the individual program.
  • If you know who you will be interviewing with look at the program website and learn what their role is. Then you can better ask questions to their interests, experience, and strengths.
ALiEM has a great Do's and Dont's post that goes into the many pitfalls of residency interviewing.

Frequently Asked Questions:

  • Does it matter if I book an interview at the beginning or end of the season?
    • No. Programs realize you are booking when you can attend. We will not read disinterest if you book and interview later in the calendar.
  • Do I have to answer questions about my marital status, family planning or sexual orientation ?
    • No. We should not ask you personal questions that are not directly referenced in your ERAS application. Only if you choose to bring them up will they be discussed.
  • Should I schedule my top choice last?
    • It makes little difference what order you put your interviews. If you will feel more confident having a few already done before your dream program go ahead and schedule that way. Most students find that their dream program changes and becomes clear regardless of the order.
  • Do I need to go to the pre-interview dinner?
    • Yes. Make every effort to be at the pre-interview event at each program. This allows you to meet residents in a casual setting and get a real feel for the program. It also shows the program how you interact in a social setting and gives them a picture of your fit with their residents.
  • What if I checked my bag and it was lost?
    • Let the program know. It happens every year and we understand, but avoid this by carrying your bag on.
  • What should I wear to the pre-interview event?
    • These events are usually casual - a nice outfit you would wear to go to dinner with friends will be fine.
  • How many interviews do I need?
    • 10-12 predicts better than 95% of matching, but you only need one. The NMRP has data for match success by number of interviews feel free to peruse. 
  • What is the biggest mistake you see in interviews?
    • Swearing, talking poorly or disrespectfully toward another program, and appearing disinterested. The sloppily dressed candidate, slouching with no questions, and who doesn’t want to have a conversation is not appealing, no matter how good they look on paper.
  • What questions should I expect?
    • Expect to be asked about your interests, research, and experiences both clinically, academically, and those outside of medical school. If it on ERAS it is likely to come up at some point. 
    • If I have a red flag will it come up during interviews?
      • Yes, programs will want to hear in your own words how you have dealt with adversity. 
    • Should I rehearse my answers?
      • This can help and hurt. You want to be comfortable and honest, but don’t rehearse your answer word for word to where it seems practiced or insincere. If you get the chance, do a mock interview with an advisor or use the HireVue pilot study to get some common questions under your belt. 
  • What if I’m not getting enough interviews?
    • First Trouble shoot the common errors that hold up interviews:
      • Check your spam folder - that is where all of mine were. 
      • Check ERAS and make sure you have released your USMLE/COMLEX transcripts and designated your letters. Ensure everything you can control is uploaded and available.
      • Make sure you have time open in December and January for interviews that may come in later.
    • There are a few options. if you have a late letter that might not have been seen, target a few programs you are really interested in that you feel you are a good match for and email their residency coordinator to give them a heads up to recheck you application. Do this at only a few programs - do not bombard your entire list.
    • Talk to your advisor and have them look over your application. They can’t tell you what your letters say but they can help try and trouble shoot your application and see if there is anything that you can do specific to your situation.
    • Consider a back-up plan. You don’t need to enact it but think about what you will do if you don’t match, so you have a plan in place.
  • Why not just apply to another 50 programs?
    • While this is tempting, shock and awe rarely works. If you are not getting interviews, more this far into the season is unlikely to fix the problem. 
    • There is a steadily diminishing return for applications beyond 30. This costs you money and is unlikely to help.




In short be professional, sign up for 10-12 interviews, be a non-trash talking, well dressed, interested version of yourself. Plan ahead for pre-interview events, weather and traffic so you are on time and get the full experience. As you go through your interviews, allow yourself to focus on how you fit at each program, and what matters most to you during this next phase of your training.


Lucienne Lutfy-Clayton MD FACEP
Associate Program Director EM UMMS Baystate

True story - literally every interview offer she received was rejected by her medical school email account - it took her until November 1st to figure it out and finally start scheduling. Interviewed at 10 programs and she matched at her #1 choice. 

Wednesday, September 14, 2016

Applying Wisely - EM Match 2017

This is an update of a post from last year. This is a long one with many links to other materials.  The goal was to make a one stop guide to submitting your application by September 15th.


Application season is about to begin in full force for students applying for allopathic (ACGME) residencies in Emergency Medicine (EM).  As an advisor the most common question I am hearing is “How many programs should I apply to?”.  This is a great question.  This is a timely question (you have been able to submit applications since early September and programs will see them on September 15th).  This also may be the wrong question to be asking.  


In this post I am going to recommend that you approach choosing which programs to apply to with the goal of making a high quality, high yield application list specific to you.  This is an alternative to the “shotgun” approach that you may be hearing recommended - “apply to 50 or more programs”.  


The Goal

You need to get enough interviews.  The magic number of interviews completed to assure matching is 10-12 (95-99% chance of matching in EM).  And because the match is student weighted the majority of applicants get into one of their top 3 programs with many getting their #1.  If you have 10 - 12 interviews you are going to match (unless you bomb all of them).  For a much deeper dive into match data and what it means, take a look at this article from EM Resident: Diagnosing the Match.  You can also have a look at the data from NRMP for yourself.


So why not just apply to 50 or more programs when ERAS makes it so easy?  This is your future, what is a few more hundreds of dollars?  The problem is that even if you shotgun out 50 applications you may still not get 10-12 interviews if you choose those programs poorly.  So even if you are determined to go "shock and awe" with your applications, you are still going to need to be smart about which programs to apply to.  


Applying Wisely

In order to build a quality list of programs to apply to, you need to answer these four question for yourself:
  1. Where you need to be?  
  2. How do you want to train?
  3. How competitive are the programs you are looking at?
  4. How competitive are you?


Location, Location, Location

There are ~170 allopathic EM programs.  Applying to all of them is crazy (and not effective).  Most applicants have a regional preference (ie - northeast, west coast, Texas, etc).  Others have a type of area they want/need to live in (ie -urban with public transport, or rural so they can raise chickens, or suburban with access to a large enough city to support an EM program).  You should choose an area, or type of area, that interests you and let that narrow your focus.  Within these areas will be a variety of programs that are likely to be looking for different things in their applicants and to have different levels of competitiveness.  That variety will be really important in keeping your application balanced.   


Program Characteristics

Every program in EM is held to rigorous standards by the ACGME and RRC to ensure you emerge as a competent Emergency Physician (EP).  How they get you there can be quite variable.  These characteristics can help you sort the programs and to start determining which ones are going to be a better fit for how you want to train.  


Some common examples of easy to determine characteristics are how many years the training is (3 years vs. 4 years), the types of off-service rotations they do, the patient population, the sites they rotate at, the structure of their didactics, the fellowships available, their research emphasis, etc.  For a little more depth on these consideration have a look at this page:  Choosing where to Apply.  

To actually figure out where to apply: look at the EMRA Match Residency Index.


You should use these characteristics to help you pre-screen programs.  However, your eventual decision on how to rank them will be strongly influenced by factors that are hard to assess from reviewing a programs web site:  their culture of wellness, their education and adult learner philosophy, the residents happiness and satisfaction, and whether you feel like you would fit in.  This is why we still do interviews.  


Program Competitiveness

In the last couple years some private companies have attempted to help students applying to EM rank the EM Residency Programs.  Lacking access to actual program data they relied upon alumni rankings of the programs.  I have no idea if this actually resulted in a list of which programs provide the best training (though I have my doubts).  I am certain that their lists did not address the most meaningful measure of program competitiveness from the standpoint of the applicant:  How many people applied to the program?  That is not publicly available information.  


You can estimate which programs get the most applications, as we outline in this post we did on Assessing PROGRAM Cometitiveness.  
To sum up, the more of these characteristics a program meets, the more applications they are likely to receive:
  1. Is the program in a highly desirable place to live?
  2. Does the program have “name brand” recognition that would look impressive on your CV?
  3. Is the program “EM famous” for their faculty or their longevity within the specialty?


The programs that receive the most applications can fill all their interview slots with above average applicants.  So how do you know if you are above average?


Your Competitiveness

While determining program competitiveness is an inexact science (to put it charitably), assessing your own competitiveness is somewhat easier to do.  This is a guide to Assessing YOUR Competitiveness that we previously wrote.  
To sum up - the applicant field breaks up into three broad categories:
  1. Above average and have it made
  2. Average and will match
  3. Below average and at risk


Where you fall is based mostly on your board scores and the EM rotation grades and SLOE’s that came from those rotations.  These are the characteristics that all programs will give some weight to.  The other characteristics of your application (clinical grades, work and service experiences, scholarship and research) can all have an impact on how programs rate your application and whether they offer you an interview.  This will not be consistent from program to program, or reviewer to reviewer.  Thus you need to get your application in front of a variety of reviewers at realistic programs.  


Summary

To sanely navigate the match process: gauge your competitiveness and build a list of programs to apply to that has a foundation of realistic programs, with appealing characteristics, that are in areas that work for you and your family.  You can apply outside of this group, because you never know what might catch a reviewers eye, but you cannot consider those applications to be a realistic part of your foundation.
If you are an above average candidate you have the option to be a "sniper".  Choose 20-25 programs that highly interest you and get all the interviews you need.  


If you are an average candidate, you are going to match.  Choose 20-25 programs that appear realistic and add another 10 or so that may be a stretch.


If you are at risk, or in an applicant group that many programs will not seriously consider (Osteopathic students, those training Internationally), you should apply to ~40 realistic programs.  Any program that does not seem realistic does not count towards your 40.  
For more detailed perspective for Osteopathic applicants have a look at this page of Advice for Osteopaths.  International Applicants should read this post by Max Hockstein, MD.


You need a real advisor

You also need to get some personalized advice.  These recommendations are a good place to start but are too generic to use as your sole source of advice.  EMRA has a great mentorship service you should use.  Feel free to contact us with specific questions in the comments or via email.  EMRA also maintains a page of other resources for medical students that can connect you with more opinions and advice.


Good luck and get those applications in!


Adam Kellogg is an Associate Residency Director and a former Clerkship Director. He is a past Chair of the CORD Student Advising Task Force, whose mission is to improve the quality of the advising students receive who are applying to Emergency Medicine.