New Program: Southside Hospital on Long Island, NY

Here is a message to the CORD-EM mailing list from the APD of a new EM Program in the 2018-19 Match:

We are very excited to announce that we are recruiting for our inaugural class for the new EM Residency at Southside Hospital in Bayshore, New York. Southside is part of Northwell Health and is a rapidly expanding tertiary care facility in Suffolk County, NY. Our first class will comprise of 6 residents, and the program will be for three years. We are currently ACGME certified and listed on ERAS for application purposes. Our state of the art ED just finished construction last year, and we are eager to begin educating the next generation of EM physicians!

Southside Hospital is the tertiary referral center for Northwell Health's eastern Long Island region and receives transfers of patients from community hospitals throughout the area. The Department is an American College of Surgeons level 2 trauma center, with in-house trauma surgeons 24 hours a day. Our hospital is recognized by the American Heart Association as Gold awarded STEMI institution, with 24-hour cardiac catheterization lab availability. We are also recognized by the American Heart Association as a Gold-Plus Quality Achievement, Stroke Elite-Plus Honor Roll Award for our Stroke care. Our hospital has comprehensive Cardiology and Cardiothoracic services, Orthopedics, Women's Health, Neurosurgical services, receives patients from the Northwell Imbert Cancer Center, and transfers from community hospitals throughout Long Island.

Twitter: EMSouthside
Website: BayshoreEM.com

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Andrew Mastanduono
Associate Program Director
Southside Hospital

Great Question! - Cancelling excess interviews?

A fortunate student who received a lot of early interview offers asked...

I’m thankfully in a position where I have gotten a lot of interviews offers, including many of my top choices.

I’m starting to make a more concise top choice list of programs and want to begin releasing interviews that I am less interested in to make room for other applicants. 

I’ve read varying things about releasing interviews, with some suggesting you just cancel on interview broker and some suggesting you should email programs explaining as well. 

• Do you know which programs prefer? 
• Should I preemptively withdraw from any programs I have not heard from that are lower on my list than my current interviews?

These are great questions and I am glad you are thinking about purging your interview list.  

You can withdraw from programs lower down your list that you have not heard from, or simply wait to decline until they offer you a spot.  Waiting does not interfere with others getting interviews. 

You can just release/cancel interviews in ERAS or interview broker.  I would only email them if they handle all their scheduling themselves.  Nobody needs more email or phone calls this time of year.  Programs appreciate you giving us as much notice as possible to find someone else to fill that interview spot.  

- Adam

Interviews: the good the bad and the ugly

Interviews are very shortly about to begin. You already overcame the greatest hurdle - you got the interview, now make it count. This is your opportunity to really get to know programs and in turn let them get to know you. While you may find in the end that you love the spot you always thought you'd go, most applicants are surprised along the trail and fall in love with an unlikely program that captures their heart. Be open to the change that is likely to occur during this process. The interview trail is designed to do just this - let  you slowly gain exposure and with it find what you truly need and want.

Ways to succeed:

• Make the pre-night events - almost all EM programs will have a pre-interview social gathering the night before you interview. Residents will be there to answer your questions and get to know you. This is your chance to really get the feel for a program. You can see how the residents interact with one another, with interviewees, and with faculty if they attend. This is the most honest exposure you will have - take the time to go and discover if you fit with the group already at the program.
• Try your suit on now and get a friend to give you input on your appearance. How you present yourself counts - an ill fitting suit reads as ill prepared.
• Compose questions before you arrive. This makes you appear genuinely interested - if you have no questions you seem disinterested. You are spending time and money to be there, set yourself up for success. If you have the names of the faculty you will be interviewing with, go ahead and look them up so you can explore interests you share. Ask what matters to you - consider asking:
• What keeps you at this program?(gets at strengths)
• What issues have arisen over the past year and how did they get handled?(gets at weaknesses)
• What changes do you foresee over the next few years?(gets at vision) 
• Lean in(literally) - lean forward in your chair and make eye contact. Body language counts. If you slouch or fail to look at your interviewer you look disinterested, overconfident, or worst awkward. You only have a few minutes to stand out, so lean in make eye contact and have a conversation.
• Finish with a thank you note (electronic is fine but I remember the hand written) - it certainly won't hurt.

Classic Blunders:

• Don't check your luggage - carry just what you need and have it with you so you are not the applicant this year in jeans and a teeshirt.
• Don't be late - early is on time - on time is late - and late is unacceptable.
• Plan for weather - it snows in many spots you will be traveling to - expect it and have appropriate clothes and extra time.
• Don't over schedule - you can do two interviews per week no more. When you try to squeeze more, you can't make the pre-night, you end up tired and don't present your best self. 
• The sherpa applicant - there will be a safe spot for your luggage and carry on - you don't need anything but yourself in the interview. If you want to carry a CV or card with you go ahead but programs have this information and don't need it from you.
• Needy and nervous are not positives. If you want to make contact with your top choices once after you interview, go ahead but do not call or write repeatedly.

Lastly the rules of the game:

Conduct for interviews:

• Most programs will offer interviews after your Dean’s letter is released on October 1st on a rolling basis(sending a group out at a time, waiting for answers then sending more)
• You may hear an answer quickly or have to wait to hear - breathe
• Many programs purposefully send invitations after 5pm to avoid you having to check email during your rotations(try and be respectful of your rotation and patients)
• Once you receive an invitation answer it quickly
• Do not double book - it is unfair to programs, your fellow applicants, and against policy. Programs will be notified after 72 hours if you hold two interviews for the same date - they may choose to cancel your invitation.
• If you need to cancel, do so as soon as you realize you need to. Give programs enough time to allow another applicant to fill the spot, at least two weeks.

Lucienne Lutfy-Clayton is an Associate Program Director at UMASS Baystate Health, Chair of the CORD Application Process Improvement Committee and former Clerkship Director. She has the attention span of a nat and needs shiny sincere applicants to draw her attention. She is also really short and some believe this is where the real problem begins.

New Program: Eisenhower Medical Center in Rancho Mirage California

From Matthias Barden: 

"Eisenhower Medical Center has just received ACGME initial accreditation. We are now applying to be listed on ERAS/NRMP, which may take 7-10 days. Please pass on the word to look for our program on ERAS If anyone advises student's who may be interested in applying.

EMC is in Rancho Mirage California. We have 55 licensed ED beds and see about 85k patients per year. We have in house STEMI and Stroke centers. Residents will rotate away at a level 1 trauma center, pediatric center, and facility with OB-GYN services.

We will be recruiting 6 residents per year for a 3 year program.

More information is here: Emergency Medicine - EisenhowerHealth.org - formerly Eisenhower Medical Center"

Getting your ERAS Application Together - Personal Statement: Time to put your thoughts down

At this point most of you have finished your CV details together and it is time to stop avoiding that personal statement(PS). The PS is a point of high anxiety for most applicants, so lets dissuade it right now. Program Directors complete a survey with NMRP each year, on it only 62% report the PS as a factor in selecting applicants for interview with a mean importance of 3.2 on a scale from 1 (not at all important) to 5 (very important). 

At the top 97% report SLOE as factor in selecting applicants for interview with a mean importance of 4.8 and at the bottom 11% report Honors in basic sciences as factor in selecting applicants for interview with a mean importance of 2.4. 

The list of factors more important than the PS include: 
USMLE Step 1/COMLEX Level 1 score 
Letters of recommendation in the specialty

Medical Student Performance Evaluation (MSPE/Dean's Letter) 
USMLE Step 2 CK/COMLEX Level 2 CE score
Grades in required clerkships
Any failed attempt in USMLE/COMLEX 
Class ranking/quartile 
Perceived commitment to specialty
Personal prior knowledge of the applicant 
Grades in clerkship in desired specialty
Audition elective/rotation within your department 
Evidence of professionalism and ethics 
Leadership qualities 
Alpha Omega Alpha (AOA) membership
Perceived interest in program 
Other life experience
Passing USMLE Step 2 CS/COMLEX Level 2 PE 
Volunteer/extracurricular experiences
Consistency of grades

If your goal is to get interviews and match you can relax about your personal statement, and get it done.

What you should do:

• Write a personal statement that gives the reader a window into who you are, what is special about you, why you want EM, and what you will bring to EM. It does not need to be an epic novel and it does not have to be worthy of the Moth Radio Hour. Be authentic and as with all of EM succinct and on target.

• Keep it under one page single spaced. Longer will definitely hurt your chance at an interview - so keep one page as an ABSOLUTE limit. 

• Have someone who loves you read it to ensure it reflects you.

• Have someone who is involved in an EM residency program leadership read it to ensure it will not hurt you.

• Have someone who is good at grammar and spelling proofread it.

• Last if you have a "red flag" this is the spot to address it. Don't make excuses, own it, and tell us how you have learned from it and how you will avoid repeating it. Remember if you write about it in your PS, you should be ready to talk about it on interviews. 

Next up you need to finish up choosing where to apply to.

Lucienne Lutfy-Clayton MD is an Associate Residency Director and a previous Emergency Medicine Clerkship Director. She is the current chair of the CORD Application Process Improvement Committee and past-chair of the CORD Advising Student Committee. Her eyes cross reading applications each fall.

Another New EM Program - Brandon Regional Hospital

Another new program recruiting for the 2019 Match in Emergency Medicine:

Brandon Regional Hospital in Brandon, FL (outside Tampa):

Here is their website with a message from the Program Director: 
https://brandonhospital.com/gme/emergency-medicine-residency/

Acing your EM rotations

So you want to know the secrets to success on your rotation...

While there is no magic bullet that will earn you honors, the essential keys to success are easy to follow.

• Work hard
• Be kind
• Be honest  

Sounds easy, right. Well amazingly many rotators can't follow these 3 simple rules.

Work Hard:
EM is not easy and there will be little down time. Be prepared to go straight through without breaks to eat or go to the bathroom. Carry snacks with you and have a covered drink to stay hydrated.
Make it obvious you will be willing to do anything and want to see and experience everything. No case is too small or too challenging for you.

Be Kind:
Imagine everyone you see and work with is someone you love - treat them as you want your loved ones treated. This applies to staff colleagues and patients. It doesn't matter how they smell, how they act, or what they are asking. Absolutely kill them with kindness at all times.

Be Honest:
While you always plan to be honest there will be a moment when you are embarrassed and the devil on your shoulder will push you to lie or omit. Imagine you didn't check the pupils of a patient with a head injury. Do you tell the truth and admit it didn't occur to you? Couldn't you just say they were fine - what's the harm.
The harm is if someone catches the lie - they will never trust you again. All the hundreds of times you were being honest will be called into question.
It just isn't worth it - be honest at all times - we will respect your admissions. And then you correct the error. Go check the pupils and you are set.


Once you have the rules set it is time to take on the greatest challenge and best opportunity to succeed - the presentation. Here is a video from EMRA and CDEM that says this better than any post can.

EM presentations are entirely different from those on your other rotations.

1. Don't bury the lead - if they are sick (go get someone) or might be sick say it up front
2. Focus on the chief complaint - what is happening right now
3. Be brief - less is always more
4. Think of the differential diagnosis - anything you say should help weight the differential bringing some up high on the list and others down low
5. Sum it up - we weren't listening (squirrel) summarize the important details before giving your plan so your listener pays attention 

While nothing can guarantee you honors acing the presentation and avoiding pitfalls will have you doing your best.

Lucienne Lutfy-Clayton is an Associate Program Director at UMASS Baystate Health, Co-Chair of the Application Process Improvement Committee and former Clerkship Director. She has the attention span of a nat and needs shiny presentations to draw her attention. 

New EM Program for 2019 - University of Vermont Medical Center

Another new EM program will be recruiting their first class in the 2019 NRMP Match.  Here are details from their Program Director:

With great enthusiasm, I would like to announce the initial accreditation of our new Emergency Medicine Residency Program at the University of Vermont Medical Center in Burlington. Our 3-year program will start in July 2019 with the inaugural class, and we are excited to start interviewing candidates this fall. We are currently accepting visiting students as well, so please spread the word amongst any EM-bound students interested in an away rotation where they will be working one-on-one with academic faculty (and no EM residents yet).

Please visit our website (still under construction) for more information:

www.med.uvm.edu/emergencymedicine/...

  

Richard Bounds, MD, FACEP, FAAEM

Program Director, Emergency Medicine

Associate Professor, Department of Surgery

University of Vermont Medical Center

Burlington, VT

New EM Program - Opening in July 2018

Just published to the CORD Community:

​I am incredibly pleased to announce that we just received accreditation for our new emergency medicine residency at St Joseph's Medical Center in Stockton, California, and are hoping to fill our 9 resident positions this July. We will be reviewing applications and conducting WebEx and in person interviews over the next few weeks. We are located just about a hour south of Sacramento. 
Interested individuals can contact me (jennifer.oakes@dignityhealth.org) or my coordinator at lacy.quijalvo@dignityhealth.org. 
Thanks! :)​

------------------------------
Jennifer Oakes MDProgram Director
St. Joseph's Medical Center

This program is going to fill their first class outside the match.  Applicants without a settled landing spot for 2018-19 should consider applying to the folks listed above. 

So it's time to find the right Emergency Medicine rotations to set you up for success in the match

The skinny on where, when and how to get your sub-internships, rotations, and letters...


Throughout this post you find links to useful pages within this blog and outside resources to help you better understand  the process of applying to EM

Where?

• Home - if your school has an EM residency, you should start with a home rotation
• This gets you a letter called a Standardized Letter of Evaluation (SLOE)
• You will be in familiar surroundings and a system you know, so you can focus on learning EM as you are starting out 
• Away - even if you have multiple options at your school you should do an away
• This gets you a second SLOE
• This throws you into the deep end - you won't be familiar with your surroundings, you will have to learn a new system, and you will do it all while progressing forward from your first rotation

*For students who don't have a residency at their school two Aways should be scheduled

When?

• As soon as you can get them, between May and October is ideal
• Schools and rotations have different requirements, so start looking now
• Earlier is better so your SLOEs are written and in your application, ready to be reviewed for interview offers
• Many programs will review your application and consider you for interviews with one SLOE. EMRA match lists how many SLOE are required at each program for an application to be reviewed
• Dates for electives may not match with your schools blocks
• Review the dates carefully 

How?

• Visiting Student Application Service(VSAS) allows you to apply to most rotations 
• SAEM.org has a student directory that can help with planning
• EMRA Match Student Directory provide interactive maps of the United States that links to information on EM rotations in the country, including those that do not participate in the VSAS

Ways to succeed:

• Many rotations ask for a letter of recommendation
• Decide who will do this for you, and ask them ahead of time. This will allow your application to go smoothly
• Generally the rotation wants someone to vouch for you as a student in good standing, interested in applying to EM
• Start early 
• Try to envision where you want to be for residency and rotate some place similar in location, structure, or culture
• A bird in the hand is worth two in the bush
• Take what is offered to ensure you have the two early rotations you need, rather than waiting for the perfect one
• Variety is the spice of life
• This is a great time to try out someplace new
• If you already have a 3 year program rotation, see what a 4 year program is like
• If you rotate in community for one try a county or hybrid program for the other
• EMRA Match Residency Directory has information on the programs associated with rotations and lists many of these characteristics

Lucienne Lutfy-Clayton is an Associate Residency Director, former Medical Student Clerkship Director, a past Chair of the CORD-EM Student Advising Task Force, current co-Chair of the CORD-EM Application Process Improvement Task Force and lead author on the SATF Applying Guide and Frequently Asked Questions. 

Match Day 2018 - Contingency Planning for the Unmatched

Match Day 2018 is friday, March 16.  That day is anxiety provoking for every student in the match as they find out where they are going to continue their training.  Even more stressful is monday the 12th, sometimes called "No-Match Day".  At 12 pm all programs and applicants find out if they matched or if they are going to have to scramble for a position in the SOAP.  Most applicants will get good new on monday and their worries will quickly shift from "if I match" to "where will I match?".  

This post is for applicants who get bad news on monday.  We will outline the big decision points and connect you with additional resources.

The first thing you need to do if you are notified that you did not match is to take a little time to grieve.  Even if you knew you were at risk to not match and this news is disappointing, but not a surprise, take a little time to wrap your head around it.  

Then you need to make a plan, or put into action the plan you already made.  

The big decision:  Do you still want to match into EM?

Using the SOAP process to get into EM, or finding a spot post-match, are not viable routes to get an EM training spot.  A very few lucky folks may make this happen but there are not enough spots for this to be something you plan for.  

The most commonly recommended path to pursue in setting up a re-application to EM next year is to get clinical training in a one year internship (surgical, medical, transitional, etc.).  Other options include matching to a categorical program (full course of training, like categorical IM or FP), extending medical school graduation to improve your application, or pursuing additional experience like a research project or masters degree after graduating on time.  Which option(s) is best for you depends on a variety of factors including why you did not match, how likely are you to be successful in reapplying, and which are available.  

Resources to help you make an informed decision:

• This previous EM Advisor post takes you through deciding what route to pursue in much more detail.
• This post: The Re-Applicant Playbook, takes you through self-assessing your situation and making plans to reapply.  It served as the foundation for an Advising Guideline written by the Council of Emergency Medicine Residency Directors (CORD-EM) Student Advising Task Force:  The Emergency Medicine Re-Applicant Applying Guide.  This guide adds national consensus and evidence based recommendations for those facing a second time through the application cycle.  All of the guides written by the Task Force live on their web-page.  
• There is a paucity of expert advice available for students who do not match, and even less literature.  However, a recent article published in Academic Medicine provided some insights for students who did not match.  The implications for the applicant to EM were discussed in this post on the CORD EM Blog.  

If you know of additional quality resources for the unmatched applicant to EM please share them in comments below and we will incorporate them into future resources.  

Adam Kellogg is an Associate Residency Director, former Medical Student Clerkship Director, a past Chair of the CORD-EM Student Advising Task Force, and an author on far too many of the resources for re-applicants.  Seriously, if you have some other good resources, share them!