Applying - What is a "Red Flag"?

Updated August 2016

"Red Flag" is a term common in medicine, like the "Red Flags" for spinal cord compression in back pain.  It indicates warning signs for more serious disease and it has been adopted by application reviewers to refer to signs in an application that raise concerns about the qualities of an applicant. 

Knowing if you are an applicant that will raise "Red Flags" in the mind of a Program Director is really important for planning your application strategy.  You will need to do everything you can to make these "flags" as small as possible.


What are common "Red Flags"?

Failing a step of the Boards.  A great fear for program director's is that their graduates will not pass the boards when they finish.  Not passing the USMLE or COMLEX is a strong predictor of struggling to pass later exams.  Most advisors will recommend addressing any mitigating circumstances that led to failing the boards in your Personal Statement.  Even low scores, borderline for passing, can scare off some programs. 

Repeating a preclinical course or year.  Another sign of academic struggle. Also needs to be addressed.

Repeating a clerkship.  Failing a clinical experience will almost always be interpreted as a result of professionalism deficiencies. These are deal breakers to most Program Directors and need to be explained.

Academic misconduct.  Get caught cheating and you are in a lot of trouble. For your school to still graduate you, you must have convinced them that it was a misunderstanding or that you have been rehabilitated. In a competitive specialty like EM, there is little reason for a Program Director to bother taking the chance.

Unexplained gaps in your career. Big unaccounted for chunks of time are concerning. There can be really good reasons that these happen. But if left unexplained, application reviewers may just assume you were in prison or rehab.


What do I do if I have a "Red Flags"?

There are two approachesthat most applicants use:
  1. Hope they go unnoticed or that some reviewers of your application will not be dissuaded. This is often wishful thinking, depending on how visible the "Red Flag" is in your application.
  2. Get in front of them - Use your Personal Statement to explain mitigating circumstances and how you emerged from this better prepared for a career in EM. This is almost always a better way to go. Things happen, life is complicated, and reviewers can understand this. If you give them the chance.  

12 comments:

  1. I just found out I failed Step2CS. I am an average applicant. How much of trouble am I in for the upcoming cycle?

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  2. While probably not as bad as failing the clinical knowledge portions, this is going to be a problem. Programs that don't know you are going to be concerned about your ability to connect with patients and work with staff.

    You need to retake and pass ASAP to prove that it was a fluke. You should also start working on a back-up plan should you not get enough EM interviews. If you need to match this year, you may want to consider an additional specialty to apply in. If extending med school is an option for you, that would allow you to retake CS and to complete more rotations that will show up in next years application - more data that better describes your actual communication skills. Have a look at: http://emadvisor.blogspot.com/2015/03/so-you-did-not-match.html

    For this years application - this needs to be discussed in your Personal Statement: http://emadvisor.blogspot.com/p/applying-personal-statement.html That is the first place most application reviewers will go looking for an explanation.

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  3. Happy thanksgiving Adam!
    In spite of a redflag that I am worried about, I currently have a total of 9 interviews and waitlisted at a couple of places. I am however still very concerned about not matching. I have a feeling a lot of programs did not offer me an interview because I was filtered out. The truth is, even if I have 20 interviews, a part of me would still be concerned about not matching.
    Do programs go back and re-analyze applications before final rankings or are rankings based solely on how you interviewed? .i.e. is it always true that once you get an interview, you are on a level playing field with everyone else being interviewed at that program?
    How comfortable should I feel about matching with only 9 interviews?

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  4. I think you are in a pretty safe position to match. Programs where you rotated could have given you a courtesy interview, or not be worried because they feel they know you. But, any program that invited you solely on the strength of your application is not that worried about your Red Flag. Each program is looking for different qualities in an applicant and believe in different predictors of success. So it is not surprising that something that scares off one program won't matter to another.

    As for danger of not matching: 9 interviews is great at this point, and you will probably get a few more. The match rate with 9 last year was well over 90%. There is no number of interviews that get's you to a match rate of 100%. There will always be a few people who have great applications that get them lots of interviews but who really struggle at those interviews. There are no guarantees, and having a back-up plan is always a good idea, but based on having 9 interviews already you should be okay.

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  5. Hi,

    I have a question regarding application for EM. I am an Osteopathic student who ran into a few issues when trying to take my Comlex and USMLE Step 1. Basically family and personal health problems and was recovering from Surgery. I took the comlex but did poorly not because of my lack of knowledge but rather my inadequate testing skills. I passed by the skin of my teeth, however because I passed I cannot retake it. I also canceled my Step 1 because I was afraid failing it or doing really poorly would look worse.
    I am now realizing into my fourth year that I should have taken it anyways. So I am trying to apply to both AOA and ACGME programs however, I have a terrible comlex score looming over my head and I intend to do much much better on Comlex 2 and Step 2 towards the beginning of August so that my scores are released by early September. My question is, how will my late SLORS and late score submissions by the AOA application's standards affect my overall application and chances of interviews. If it does affect me, how badly do you think that would be and what can I do to really improve my application for the AOA match? I am trying to get some additional research on my CV and I have rejoined the fire department, because I also love being a firefighter/EMT. Your advice is truly appreciated.

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    Replies
    1. Having a low comlex/step 1 score is difficult to overcome. The best action you can take is exactly what you are doing: take step 2 early. Your score should be with plenty of time for ACGME programs to use it as part of their decision whether to offer an interview or not.
      The AOA application process starts so early that there is going to be less you can do. You should certainly address your low score in your Personal Statement. When your COMLEX 2 posts, that will be a good time to politely update AOA programs on the additional information in your application. Hopefully that will help you secure a few late interviews (and they all count).
      A low step 1 is going to rule you out for some progams. However, most look at you as a whole applicant and recognize that test scores are not the most important determinant of your success as an EM resident. Excelling on your EM rotations (and getting good SLOE's) will make programs want to ignore a low step 1.
      Good luck!

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  6. Hello,

    I want to take your opinion about a critical issue in my plan. I am an intern(the final year med student) in Turkey. I am currently studying for Step1. I will take the test in September, I suppose. But I am going to graduate soon. Nowadays I am considering the idea of taking a time out (leave of absence) from my faculty just before my graduation, so I will be able to search and apply for an elective as a student. Some people around me say it worths, some say it doesn't.

    I heard that Hands-On USCE is positive and the gaps during the medical education is negative. So I am trying to calculate the net effect of the two opposite impacts of these two factors on my future residency applications.

    Okay, let's say somehow I will be able to start my two months long clerkship just two months after Step1. In that scenario, I will be extending my faculty 8 months for 2 months of electives.

    I wonder your point of view. Is this a wise strategy or an absurd idea?
    Looking forward to hear your advice.

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    Replies
    1. Thank you for the question. I don't have enough knowledge of the system for EM training in Turkey, so I am going to try to answer based on the ASSUMPTION that you are planning to try to get a residency in the United States.
      This is going to be hard as an International Student, but not impossible. You need to do rotations in a hospital with an EM residency in the United States. If you cannot get those clinical experiences you will not be able to match directly to EM. You may need to match into another specialty and then reapply for EM once you have clinical experience as a resident physician.
      I don't entirely follow what your options are as you have laid them out - but the one you need to pursue is the one that gives you the best chance to rotate in a U.S. ED with a residency.
      I hope that helps.

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  7. Hello,

    I have some red flag issues I need to address. I was convicted of a misdemeanor reckless driving charge prior to medical school. I drank and drove and was pulled over on my way home. I take ownership for what I did and acknowledge my mistake. It has been almost 5 years since the incident. Otherwise, I am a competitive applicant (250+ Step 1, several honors). How do I approach this red flag on ERAS and my personal statement? What are my chances of matching?
    Thank you

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    Replies
    1. Your chances of matching are very good. This will hurt you with some programs, particularly those in states where it is difficult to get a medical license with a DUI/OUI. That can be a hard thing to predict so you will want to make sure you apply to multiple states (a necessity anyway, except in NY).

      There is a field in the ERAS application that gives you a chance to explain any legal troubles. This is where you will want to explain this episode and what you have done to remediate this. You should not need to further explain elsewhere in your application unless you feel that this was a particularly formative experience on your road to EM.

      I hope that helps.

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  8. Now that ERAS is upon us 2018ers I desperately need some advice. I'm a DO student who did well on my COMLEX but only got a 189 on my USMLE step 1. I passed the COMLEX Level 2 PE and I'm taking the Level 2 CE in August. Besides board scores I have decent grades/class rank, leadership positions in interest group school organizations, etc. I had hoped to be able to devote myself to just the AOA match but with the single accreditation there are fewer EM programs participating in AOA in 2018, and there are some ACGME programs I love with all my heart. Can I go with just my COMLEX score, or do I absolutely have to submit both scores if I do the ACGME match? Should I try to take the USMLE Step 2? What are my chances of matching in the ACGME match and what do you think I should do?

    Thank-you so much in advance for your thoughts!

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    Replies
    1. You should be able to go with just your COMLEX. Programs that give serious consideration to DO applicants, especially those that were recently AOA, will be find with a COMLEX. What you lose by not having a USMLE is the traditional ACGME programs with tepid interest in DO applicants. And most of them would likely be scared off by your USMLE score.

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