Elizabeth Karr is a 4th year medical student in the 2015 EM Match. This post is a 4th years perspective on what a 3rd year needs to know.
As I started Fourth Year, I was told that this year would be the hardest yet, and this advice has proven true. You start out going on your audition rotations, wanting to put your best foot forward and impress the people you are working with. However, you are also still learning the craft of Emergency Medicine (EM), formulating your differential, perfecting the three minute presentation, and learning the basics of emergency medicine. Then interviews start and you are traveling all the time, which is exhausting in and of itself, and on the interviews you are selling yourself. You have to answer the same questions 50 thousand times, and yet you still want to sound like you are not giving a rehearsed statement.
Fourth Year Rotations
What I now know at the end of it all: just take a breath, relax, and be yourself. Audition at sites whose residency programs truly interest you. Choose a program that you want to learn more about or a program you have heard is a great learning experience for students--not necessarily just your number one or two pick. If you have a number one choice, it may be better to do that as your second rotation. This will allow for your first rotation to polish your EM skills for your second rotation. The knowledge and skills you acquire will help you to shine at your top program. Also, if you are doing an away rotation in another specialty at a site you are interested in, contact the program director or student coordinator and see if you can do a shift in their emergency room and get an inside perspective on the program.
It is recommended you do your first audition rotation early in fourth year, because these are the rotations in which you will obtain your Standardized Letters of Evaluation (SLOE’s). SLOE’s are letters of recommendation that are often written by an Emergency Medicine residency, not just by individual physicians. If you look at the following link, it will make sense as to why this is so: http://med.fau.edu/pdfs/SLOE_Standard_Letter_of_Evaluation.pdf Ideally, you want to have at least two SLOE’s by the time applications are due in September. When you submit these, along with any other letters of recommendation, it gives programs a way to see how you compare, side-by-side, to other emergency medicine applicants. Programs also want to see that you are improving from one evaluation to another.
These SLOE’s will be obtained from your audition rotations, or possibly from a home rotation if your school has an EM program. As you start your first audition rotation, everyone is aware that it is your first rotation. You are not expected to know everything and have all the answers, or even earn the grade of honors. It is expected you are interested in the field of EM, you learn from your experiences day in and day out, and you show growth over the month-long rotation. It is appreciated if you show initiative; want to see patients, work on your differentials, volunteer to perform procedures even if you have never done it before. Most of all, just enjoy the experience. Don’t be set on trying to impress everyone, and be ready to admit when you didn’t ask your patients something, or if you don’t know the treatment for disease-X. You are not expected as a fourth year student to have all the answers.
As for the number of EM rotations you need to do, you have to do at least two in order to get two SLOEs. I have classmates that did five rotations, and others that only did two. It is up to you. I actually ended up doing a very late rotation in January, as that was the only time the program could accommodate me. That program director told me he really likes to see interested students doing rotations late in the season, because you stick out so much more in their mind when it comes to ranking for residency. With that said, programs are not likely to forget you if you rotate early in fourth year and are a good candidate for the program. January was also the end of interview season, and by that time, I was exhausted and yet still had to be on my A-game as I was rotating at a place which I was also interviewing at. However, a late rotation was a good reminder of how much I enjoy emergency medicine and why I was spending all the time and money going on interviews. If you are doing a late rotation, make sure you weigh the pros and cons.
Also, in third year or early in fourth year you should try to connect with a mentor: an advisor, faculty member, program director in whom you can share your application with and discuss any lingering questions. Most people in EM want to see you succeed and match into the program of your choosing. It is great to have someone to ask questions, look over your personal statement, advise to the number of programs to apply to, and give you an unbiased opinion on your competitiveness in the EM match.
Look for Elizabeth's next post, the Interview Season, coming soon...