Updated July 2022
Navigating the residency application process used to be significantly more difficult for osteopathic students when there were two matches: AOA (DO) and ACGME (MD). The transition to a single match with all EM residencies now certified by the ACGME is now complete. However, though there is just one pathway, DO applicants still face unique challenges in the application process.
What are the obstacles in applying?
The biggest obstacle to a DO student’s application
to a traditionally allopathic program is perceived competitiveness. Fourth year US
seniors are selected preferentially by programs that were traditionally allopathic, and there are more of those than there are traditionally osteopathic programs that preferentially select DO students.
The issue of bias against DO students remains real, though it has improved in recent years. Only some allopathic affiliated programs will interview and
rank DO students, therefore there are less programs available to apply to.
One way to maximize your application is to look at the composition of a residency's recent classes. If they have no DO's, your application is less likely to be seriously considered. If they have DO's, especially from your school, they are much more likely to consider your application. The EMRA Match program database can help you find programs that are training DO's.
One way to maximize your application is to look at the composition of a residency's recent classes. If they have no DO's, your application is less likely to be seriously considered. If they have DO's, especially from your school, they are much more likely to consider your application. The EMRA Match program database can help you find programs that are training DO's.
Be warned that some programs who give consideration to both types
of students, will rank academically equal MD's above DO's.
So how do you match?
You need to level the playing field as much as possible. The
easiest way to do this is to make yourself as competitive as possible. You can
not change how your school is viewed, but you can effect how you are perceived. Your goal is to
allow the programs to compare you "apples to apples" with the MD students.
First: you MUST take the USMLE to get fair consideration. This allows your knowledge to
be compared directly to your MD peers. USMLE Step 1 scores >230 will help you get interviews. Scores <210 will make it more difficult for you to get interviews. As the transition to pass/fail Step 1 happens, the attention will go to Step 2 instead.
Many allopathic residency directors, even those open to taking DO's, will be unwilling to
translate a COMLEX score to an equivalent USMLE score. Do not give them an excuse to discard your application.
Second: you need to rotate at traditionally allopathic EM
residencies during your fourth year if you want to match at those type of residencies. This again puts you head
to head with the MD students in a single rotation. This also shows your
performance in an academic setting similar to the residencies you will be
applying for. Ideally you will want two clerkships between May and September.
While community EM months can be great learning experiences
they will not assist your application to an EM residency. If your
school requires them you will have to do extra clerkships in EM, and in some
instances even forgo credit to gain the opportunity to advance your
application. These community clerkships do not count towards the 2 - 3 EM rotations that are recommended as the max for a student.
Lastly: the letters that carry the most weight are going
to come from residency program administrators. You are looking for SLOE's written by the education leadership (Program Directors and Clerkship Directors). Sometimes these types of letters are missing from the
osteopathic students application, making it difficult to accurately compare them
to the rest of the applicant pool. Having these letters sets you ahead of much of your competition.
Summary
You can match to a traditionally allopathic EM residency without doing all of the things recommended - this is the playbook to let you take control of this process and proceed as an equally competitive applicant:
1. Take the
USMLE and score >230 on Step 1 or 2
2. Rotate at 2 allopathic EM residencies, that take
DO's
3. Get group
SLOE's from the Clerkship Director and Program Director
4. Be ready
to apply broadly and strategically, if your application is not above average
For more information targeted at "non-LCME applicants":
- The EMRA Newsletter article on Applying to EM as a DO Student
- The EMRA and CORD Student Advising Guide has advice for DO students integrated througout
Hello,
ReplyDeleteI'm an osteopathic student. I have a great step 1 score (255+), and anticipate a step 2 score that will be pretty good as well (I'm a good test taker). My concern is that by september 15th I will have only completed 1 Allopathic EM audition rotation. I'll be about midway through my 2nd block of Allopathic EM which ends about 10 days after September 15th. My question is really two questions I guess.
1. Is it worth waiting until the end of the second EM block for a SLOE from that institution, or is it better to submit everything on time on Sept 15th? Also if I do submit on the earliest date possible, is it at all beneficial to submit subsequent letters/SLOEs later?
2. My second Question is in regards to #3 on your above list. Is it acceptable to get two SLOEs from one institution and have it count as 2 letters?
Hope this makes sense! Thanks a lot for your blog, it is very informative and helpful.
Jon,
DeleteYou find yourself if a common situation where a 2nd rotation will delay your application. With a rotation ending in late september you will still have a letter from that rotation arriving to ERAS by early October. That is early enough to hold a spot for that letter. You should still try to have everything you control submitted between Sept 15 and October 1st. Have a back-up letter you can designate in place of that 2nd SLOE just in case it gets delayed past the middle of October.
You can get 2 SLOE's from one program. That is better than having non-EM letters. However, that does not get you the benefit of 2 SLOE's from different programs. The advantage of having 2 SLOE's is that the information will seem more reliable, assuming they say similar things. When programs require multiple SLOE's what they are really requiring is multiple rotations. Few programs will not look at a candidate with only one EM rotation, but there are some.
how important do you think research or other extracurrics are for DO students applying ACGME? I did decent on step 1/level 1: 248/619, but i have no extracurrics outside of a few shifts at the student run clinic. the big problem is that i have to do all my core rotations at a small community hospital and the nearby residency is dominated by carribean students rotating there. the nearest residencies/research opportunities outside of that are over 1.5hrs away. should i try and volunteer somewhere i like?
ReplyDeletemy current plan is to hopefully get 2 ACGME SLOEs, a couple honors on my core rotations, do well on step 2, and then hope for the best.
-NW
I think you should separate research from other extra-curricular activities as you consider putting together your application.
ReplyDeleteResearch is important for all students interested in training at a program that emphasizes resident research. All programs will have some kind of research going on and varying opportunities for residents. Programs that require residents to do a research project (instead of just the "scholarly project" the ACGME mandates) are likely to be looking for trainees with research experience so they don't have to start from scratch with someone who has not previously been interested in research. So it depends on what you are looking for. Research done just for the sake of a med school requirement or to "check the box" (the most common type of student research) generally does not impress most program directors enough to affect your application.
Opinions vary greatly on the value of other extracurriculars. The personal likes/biases of individual application reviewers can give enough weight to some activities to be the difference between an interview and no interview. For example: a faculty member with an interest in global health is going to be predisposed to like the application of someone with global health experience. Same for public health interventions, community service, teaching, specialty interest groups, etc. So do activities that you are interested in and apply to programs that have those activities as features.
Dr. Kellogg,
ReplyDeleteI wanted to thank you for your post! I am an OMS-1 and have been drawn towards EM after scribing for close to three years in an emergency department. As an osteopathic medical student I have been feeling more anxious and honestly scared of the match process and attempting to match at a solid EM residency. I read your recommendations above, but what else do you think can make someone standout as an applicant at an osteopathic medical school? Thank you!
Some of the current advice will be outdated by the time you match, as we find out what impact the single accreditation system has on DO students being accepted into traditionally ACGME residencies.
DeleteFor a more comprehensive look (and broader opinion base) have a look at this guide created specifically for the DO student applying to EM: https://www.cordem.org/files/DOCUMENTLIBRARY/SATF%20Special%20Popn%20OSTEOPATH.pdf
Thank you for the quick response! I saw you had answered another students question concerning research. Their are a view mentors at my school whose research I am interested in, however, they are not relevant to EM, nor do I plan on pursuing research later on in residency. However, since I do not wish to pursue research later on in my career, do you think it would still be worth it to do? I would most likely have a fantastic LOR and get to do something I enjoy.
DeleteIf you enjoy research you should do it. Certainly will not hurt your application and could help. Only caution would be to get involved with something that would hurt your ability to adequately prepare for boards and be involved with EM based opportunities and projects. As a general rule: do what you enjoy!
DeleteDear Dr. Kellogg,
ReplyDeleteI am an OMS III and have a COMLEX score of 597. At the time of preparing for boards I did not realize just how important it was to have a Step 1 score, especially for EM. Outside of not having a Step I score, I would consider myself a well-rounded and strong applicant. I have three questions:
1. Are there ACGME accredited programs that tend interview students with only COMLEX scores? Or is the fact that I did not take Step 1 an instant rejection at most ACGME accredited programs?
2. If I took Step 2 and performed well, would this help negate the fact that I did not take Step 1?
3. What do you advise that I do now that I am in this difficult situation?
Thanks!!
Many ACGME programs will interview students without a step 1, if they are a program that typically considers DO students. No instant rejection at most.
DeleteThere are some programs where you will be screened out. Those are mostly going to be programs that were not going to look at a DO applicant.
Taking step 2 and doing well certainly could help.
You also want to make sure the rest of your application is strong. Do not give programs a reason to not interview you. Try to do a couple ACGME EM rotations and get SLOE's.
Hi Dr. Kellogg,
ReplyDeleteFirst, I'd like to say thank you very much for your time and help you provide through this blog. As a DO student without an EM advisor, your site has been a great resource for me throughout this process!
I am an OMS IV and am in a predicament regarding Step 2. I scored 575 and 589 on COMLEX 1 & 2, but only scored a 205 on Step 1. I had planned on taking Step 2 after an extra month of studying, in August, but received a last minute offer to do an MD away (I already had 2 DO aways set up but no MD). With the rotation completed, I recently took a CCSSA practice test and scored just above passing. I'm very uncertain as to how to proceed...
I feel that the rest of my application is fairly competitive, without any other red flags (based what I have heard from a few EM student symposiums I have attended, and other info provided on sites like yours).
My question ultimately is:
Will it be better for me to not take Step 2 if I can't show improvement? Would it be better to amp up my studying again, push it back and take it late, as many programs don't require Step 2 to apply? Or would it be better to take it in the upcoming weeks and do comparable to how I did on Step 1?
Thank you very much for any thoughts and guidance you have!!
Sorry for the delayed response - issue with comment moderation.
ReplyDeleteI don't think Step 2 is going to help you much at this point. Step 1 is used by some programs to screen applicants but once passed that filtering your application will get a holistic look. As a DO you won't take USMLE step 3 and your COMLEX scores are quite solid. Adding a step 2 score that is not above average (>240), is unlikely to change a lot of minds and is thus likely a poor return on time invested.