Thursday, September 26, 2013

Assessing Competitiveness - Part 1

Step 1 is to figure out how competitive a candidate your are.  Your advisor's should be able to help you sort yourself into one of three "buckets":  the average candidate, the above average candidate, and the below average candidate.

Above average candidates have:

  • Honors in everything clinical
  • Board scores that are above average (>240)

Above average candidates have little to worry about and should not be reading blog entry's on how to get a residency. Make a list of spots you like and would like to train (15-20).

An average candidate is going to match in EM if they make a reasonable list of programs to apply to.

The average applicant has:
  • Board scores that are in the neighborhood of average (~220  >220).
  • EM grades and letters that sum up as: going to do well in EM (Honors or High Pass with a supportive letter, & hopefully followed by Honors on the second rotation).
  • No red flags.
Goal is a diverse list in different regions of the country (25-40).

If you fall short on any of those criteria you should consider yourself to be a below average candidate and plan appropriately.  This means applying to lots of programs (40-50), not wasting money on the most competitive programs, and having a back-up plan for not matching in EM.

This is additionally complicated if you are an Osteopathic or Foreign Medical Graduate looking to join an Allopathic EM program.  Only some programs (68%) will even consider your application.  The programs open to you have their pick of candidates and they are looking for the cream of the crop.  If your not at least an average candidate AND you are from an Osteopathic or non-U.S. school, your chances are slim and you need a back-up residency plan like IM or Family Medicine.

Fortunately, the receptive programs are easy to find by going to their website.  Look at their "residents" pages and see where their residents came from.  If you see residents who are D.O.'s or are from your country/med school, they will probably give your application a fair review.

Now that you have a sense how competitive you are, you can try to figure out the programs...


  1. Hi Dr. Kellogg,

    Thank you very much for your informative post (and for the rest of this website, which has helped me immensely.) I'm a DO student applying EM this year and I'm wondering where to rank myself in terms of competitiveness: I did below average my first two years (3rd quartile class rank, 510 Level 1, 212 Step 1) with no red flags. However, things changed after I hit the wards, with honors in every rotation barring one high pass and increases in my Level 2 (655) and Step 2 (236). I've already rotated through two EDs in my area, with an Honors and High Pass respectively, and feel comfortable applying to those programs still in the osteopathic match. However, I'm wondering about the rest of the country. Specifically, will my stats help me get any interviews with historically ACGME programs? I'm not interested in something like MGH but I would love to interview at a low-to-mid tier MD program in a Midwestern or East Coast city (think Chicago, Detroit, or NYC) and am wondering if this is a possibility. Any advice is appreciated. Thanks!

    1. You have turned yourself into a very solid candidate who should match. EM programs put the greatest weight on EM rotations > 3rd year and step 2 > step 1. Lots of programs will be interested and you have done everything programs that are cautious about DO applicants look for: taking USMLE and having 2 SLOE's. If you apply to around 30 realistic programs you should get a good number of interviews. BUT programs only count as realistic if they have a history of taking a significant portion of DO's (1 every other year would not count). You can certainly apply to more programs that are less realistic, but those should not count towards your 30.

  2. I received around average step scores (step 1 = 232 and step 2 = 240) and received good clinical grades in my 3rd year rotations. I have also rotated through an ED rotation with a high pass, and am currently rotating in the ED. The one reg flag on my application is a delay for step 1 where I ended up having to take a year off. I am a US allopathic student. Will this categorize me as a below average student or should I not be too worried?

    1. I would not be too worried. Based on information you give you are an average candidate who should match so long as your application strategy fits your interests and level of competitiveness (~25 programs that make sense in terms of geography, mission, and perceived competitiveness... plus as many "reaches" as you want, so long as you have those core programs).
      What you should do is address this gap in your PS. That is where reviewers are most likely to look for an explanation when they find something like a gap/extension. Discuss the beneficial impact this had on your preparation for training in EM.

  3. Hi Dr. Kellogg,
    I just applied for this cycle. I have always done okay in medical school, I knew I was no star student, but I also never failed anything or ever did that poorly. I had gotten high passes in all my clinical clerkships, with one honors. However, I was just able to review my MSPE and while the comments from all my rotation are great and paint the picture of someone who is compassionate and committed to their patients and community, my class rank had me in the bottom quartile (which I was honestly a little shocked by). ultimately, how important is this class rank? will this really be something that will hold me back from interviews/being ranked?

    1. The MSPE doesn't carry much weight beyond for identifying red flags. A lower class rank does not count as a red flag. The things that get you highly ranked within a med school class is often performance in the pre-clinical courses that do not predict at all how people will do in residency. Your third year grades matter way more than a class rank. Your EM SLOE's matter more than any of that.