Happy New Year!... and on to the 2018 Match...

The 2017 Match is just a couple months away.  This post is for those planning to apply for Emergency Medicine in the 2018 Match. 

Like everything else in EM, advanced planning is the key to success in the Match. This post is the updated guide to the resources on this blog.

Throughout the year various authors contribute "Posts" that appear in reverse chronological order on the landing page.  Standard blog set-up.  

Down the right hand side of the web-page you will find a "Featured Post", a topic that we want to keep at the top even as other posts come up.  

Below that is a collection of static "Pages". These cover a variety of topics pertinent to the different stages of your application and contain general advice.  These are updated periodically to reflect changes in the Application and Match process. 
The most frequently viewed are:

• Applying - Letters of Recommendation
• EM Rotations - Where, When, and How?
• Applying- the Boards

Below the "Pages" are the collection of "Labels" - all the Posts on the site sorted by topic.  The most useful are linked across the top of the web-page, just below the header. These can help you find more on a specific topic.

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The advice you find on this blog is not one-size-fits-all. We try to reflect the consensus opinions of the membership of Clerkship Directors in Emergency Medicine (CDEM) and the Council of Residency Directors (CORD), but we do not speak for them. Nor does their membership always agree. When something is controversial, we try to address that controversy. We believe we are a source of sound, balanced, and accurate advice on becoming an emergency physician in the United States. We also have no doubt that you will find different opinions elsewhere. 

To help you sort through all of the differing opinions you may find, you need the guidance of a local EM advisor, in addition to your Dean. You need someone who knows the EM application process and can help you navigate issues specific to students from your school and region. If you cannot find anyone, or you need advice from a different region you can find help from residents who just went through this process provided by the EMRA mentorship program. 

Adam Kellogg is an Associate Residency Director and a previous Emergency Medicine Clerkship Director.  He is the past-chair of the CORD EM Student Advising Task Force and a member of the SAEM Resident and Student Advisory Committee. He has written for EM Resident about Diagnosing the Match. 

The Re-Applicant Playbook

The Emergency Medicine match has become more competitive than ever. In 2016 there was 1 spot unfilled in the match. Programs are getting more applications than ever before and students are doing more interviews. The audition, application and interview cycle is compressed over just a few months. If just one thing goes wrong with their application a qualified candidate can find themselves without an EM residency on match day.

In the So You Didn't Match post we explored the options available to those still dedicated to pursuing training in EM.  Now we are going to look at the next step: becoming a successful re-applicant.

Unfortunately there is no standardized "playbook" that you can follow in re-applying to EM.  The causes for struggling in the match are too varied and the solutions are too personal.  You need to design your own playbook. The information below will hopefully get you started. As always, there is no substitute for discussing your individual situation with an experienced advisor.

Diagnosis

The first step is an honest self assessment.  Analyze where your application went wrong. What were the weaknesses of your application? Were there potential concerns (Red Flags) that did not get addressed in your Personal Statement? Here are some of the most common issues that can lead to application reviewers not offering an interview:  

• Late or incomplete application
• Failure or low score on USMLE or COMLEX
• Lack of SLOE's or late arriving
• Below average SLOE's that do not show improvement
• Extension of medical school for academic reasons
• Professionalism issues 
• Non-U.S. allopathic med school

Most students who do not match had limited interview opportunities (less than 10 interviews).  Those who completed double-digit interviews and yet still did not match likely had issues within the interview day.  

Get some feedback. Self assessment can be difficult especially if self-criticism is involved. Get some outside help from your advisors and the programs where you rotated and interviewed. You may feel as though your advisors let you down when you did not match. However, they may have based their advice on faulty or incomplete information. Did they have a complete picture of your application when you talked? Looking at everything retrospectively, they may be able to give you useful advice now. The programs where you interviewed should have a complete picture of you as an applicant, including letters your advisor was not privy to. Reach out to them and politely request honest feedback on where your application fell short.  You will get some answers like, "We don't do that" or "It was just a really competitive year".  Though if you make it clear that you are seeking honest feedback to guide your future decisions you may find some willing to give you objective analysis of where things went wrong.

Treatment

You think you have identified the problems. Are they fixable?  

Late Application
Some issues are easy to mitigate.  If your application went in late or was not complete until late in the review process (late November) you are going to make sure that does not happen again. Everything you have control over will be submitted to ERAS by October 1st. And if you did not have SLOE's in your application, or if they came in late, you will correct that too. 

Bad Strategy
Application strategy is also an easier fix if you applied to a limited collection of programs for geographic reasons or if you only targeted the biggest "names" in the best locations. This time you are going to apply to a diverse group of programs with a focus on those that are realistic. You will likely apply to a lot of programs but the key is not just in quantity. Well chosen programs that will see you as a reasonable candidate are your priority. 

Med School Misadventures
Preclinical or clerkship failures that required remediation, or other academic or professionalism issues, will always be in your MSPE (Dean's Letter).  You can't make them go away but you can better address them in your application. Application reviewers will go right to your Personal Statement when they find something concerning in your application.  Failure to address a "red flag" can lead to your application ending up on the discard pile without further review. Own your mistakes. Learn from your failures. Those are skills all Emergency Physicians need to possess so you may as well demonstrate them now.

Board Problems

Having failed a step of the boards will always be on your transcript. If you had not retaken and passed the exam by the time rank list decisions were made in February you would have been considered "unrankable". The compensation for a low score is to improve on a subsequent step of the boards AND to show that the rest of your skills outweighs a poor showing on a multiple choice test. If you are doing an internship this year, demolish step 3. Leave no doubt that you will pass your EM boards (which is all that your USMLE/COMLEX can be expected to predict). 

Interview Issues

Did you do a number of interviews associated with a high probability of matching (10+) but were unsuccessful?  There could be issues in how you interview.  It might be hard to get someone to tell you that you make a bad first impression in interview situations.  Seek some help with interview prep from someone you can trust to be honest about your conversation style and body language.

Rough Rotation

The hardest thing to decipher can be whether you had a harmful letter. You should certainly suspect this if you received a grade below what most EM applicants receive on that rotation (Pass on a rotation where most EM applicants get at least a High Pass, or a High Pass on rotations that give lots of Honors).  Even if grade distribution information is not publicly available (check your MSPE) you may be able to get a sense of what EM bound students typically got from your fellow rotators and classmates. 

Torpedo Letter
You can also receive a harmful letter without a notably concerning grade. Academic performance may have been good but questions were raised about your fit at a particular type of program. There could have been interpersonal or communication concerns raised that did not affect your grade but they felt the need to share.  

Why you got a bad SLOE really comes down to a couple possibilities. The first is what the defensive parts of our brains wants to believe: it was all a misunderstanding or an unfair evaluation process. And that does occasionally happen. Making this assumption can only harm your chances as a re-applicant. The more frequent cause was an inability to meet expectations or a genuine lapse in professionalism. This is a hard job and it puts a lot of stress on those who do it. The clinical approach does not come naturally to most and takes work to adopt. And we all have moments where we are not our best self. Any one of those under the bright lights of an audition can spoil a letter.   

If you suspect a letter to be harmful do not use it in your re-application. Do not ignore that it happened. Try to take ownership and learn from this experience. Try to identify if there were valid concerns that you need to address. If you fail to do this then your next performance on an EM rotation will be no better.  Those subsequent EM experiences are what will ultimately determine the success of your re-application. You need to upgrade your application with very supportive SLOE's that make it clear you have developed the skills to succeed.

That is the ultimate goal for your re-application. To present a clear picture of someone who is going to succeed in the difficult environment of residency training. Show that you can learn and that you have grown. Leave no doubt that this humbling experience has left you more dedicated and better prepared to succeed.  

Adam Kellogg is an Associate Residency Director, former Medical Student Clerkship Director, the immediate-past Chair of the CORD-EM Student Advising Task Force.   

Happy New Year!... and time to think about Match 2017

For students planning to apply for Emergency Medicine in the 2017 Match, the application cycle is already starting. 

Like everything else in EM, advanced planning is the secret to success in the moment. This post is to get you started on the application process and to serve as a guide to some of the resources on this blog.

Your first task is to decide if EM is right for you as a career (be sure to follow the links to ERcast and St.Emlyn's at the bottom of the page - they offer very helpful perspectives).

Some folks already have years of experience in emergency care and know that this is the specialty for them. For most a final decision on EM as a career cannot be made until you complete your first rotation. At most schools this will be early in your fourth year so you will need to lay the groundwork for your application in advance. As you are planning your fourth year schedule, these are some of the biggest questions to consider (linked to what we have to say about them):

• When and where are you going to do EM rotations?
• Away rotation?
• What kind of letters will you need?
• What should you be collecting for the ERAS application?
• When should you take step 2?
• How do you know if you are a competitive applicant?
• How do you know which programs are competitive?
• How do you choose which programs to apply to?

The advice you find on this blog is not one-size-fits-all. We try to reflect the consensus opinions of the membership of Clerkship Directors in Emergency Medicine (CDEM) and the Council of Residency Directors (CORD), but we do not speak for them. Nor does their membership always agree. When something is controversial, we try to address that controversy. We believe we are a source of sound, balanced, and accurate advice on becoming an emergency physician in the United States. We also have no doubt that you will find different opinions elsewhere. 

To help you sort through all of the differing opinions you may find, you need the guidance of a local EM advisor, in addition to your Dean. You need someone who knows the EM application process and can help you navigate issues specific to students from your school and region. If you cannot find anyone, or you need advice from a different region you can find help from residents who just went through this process provided by the EMRA mentorship program. 

Adam Kellogg is an Associate Residency Director and a previous Emergency Medicine Clerkship Director.  He is the current chair of the CORD EM Student Advising Task Force and a member of the SAEM Resident and Student Advisory Committee. He has written for EM Resident about Diagnosing the Match. 

Why Emergency Medicine?

Kara Barker is a third year medical student who is embarking on the year-long journey to match to an EM residency. This is how she made that decision.    

Prior to starting medical school, my experience with Emergency Medicine (EM) was limited to an ER visit with my nephew following an unfortunate run-in with a homemade arrow and a few late night TV episodes of Bizarre ER. During medical school one of my instructors - a retired EM doc - piqued my interest in this field with her wild stories about her time “on the front line of medicine”.  When I had to pick my third year elective rotation, I decided to see for myself what all the excitement was about. After just one day in the Emergency Department I was done searching for my future specialty.  I was done trying to figure out what I want to be when I grow up. I was hooked.  

There were several aspects of this experience that helped me end my search for a specialty:  

Variety.  We saw a tremendous variety of patients each and every shift.  We treated babies, elderly and everyone in between. We treated psychiatric patients, pregnant women, the critically ill, prison inmates, college students, the addicted, veterans, and many more.  We had the opportunity to meet and help people from every walk of life. There was never a dull moment.

Multifaceted Challenge.  Every shift offered interesting and diverse challenges.  The EM physicians had to possess the tools to address the most critical issues in all other specialties. These tools included both medical knowledge and the skills needed to perform a multitude of procedures. During my first twelve hour shift we reduced a shoulder, placed a central line, treated an anaphylactic reaction, evaluated a suicidal patient, treated a miscarriage, placed a chest tube, and sutured multiple lacerations.

And the challenge did not end with just having medical knowledge and procedural skills.  The EM physicians also had to have exceptional interpersonal skills – they had to be mind-reader, therapist and trusted confidant all wrapped in one.  In a matter of minutes, they had to be able to enter a room, read the patient and their situation and then establish that patient’s trust to solicit critical information in order to initiate appropriate care.    

Teamwork.  Every day, the EM physicians worked closely with a large group of individuals including Emergency Nurses, Physicians Assistants, Medical Assistants, Interpreters, and many other members of the healthcare system. The team I was fortunate enough to briefly be a part of worked together like a well-oiled machine. The staff looked out for one another, anticipated each other’s needs, and collectively worked hard to deliver the best patient care possible.  The losses were mourned together and the successes and triumphs were celebrated together.  There were tense moments, there was a lot of laughter and, importantly, there was never a lonely moment.

Impact.  On many days we were with patients during some of their most vulnerable moments.  This meant that we had the opportunity to make a huge impact on their lives - whether by initiating a lifesaving treatment, easing someone’s pain, or simply taking the time to sooth a worried family member.  I was inspired every day by what a privilege and responsibility this area of medicine carries with it.  

In my opinion, EM physicians have one of the most interesting and challenging jobs out there.  As a third year medical student, I feel fortunate to have found a specialty that inspires me.  Now, I look forward to moving on to the next step in my journey – ending up in the emergency department . . . as one of these inspiring healthcare providers.

I hope reading this helps you decide if EM is right for you.

- Kara

A New Year and a New Application Cycle

For students interested in Applying to Emergency Medicine for the 2016 Match, the application cycle starts now. Really. 

This post is to get you started on the process and to serve as a guide to some of the resources on this blog.

Your first task is to decide if EM is right for you as a career (be sure to follow the links to ERcast and St.Emlyn's at the bottom of the page - they offer very helpful perspectives).

You may not be able to make a final decision on EM until you complete your first rotation but you will need to lay the groundwork for your application in advance. As you are planning your fourth year schedule, these are some of the biggest questions to consider (linked to what we have to say about them):

• When and where are you going to do EM rotations?
• Away rotation?
• What kind of letters will you need?
• What should you be collecting for the ERAS application?
• When should you take step 2?
• How do you know if you are a competitive applicant?
• How do you know which programs are competitive?
• How do you choose which programs to apply to?

The advice you find on this blog is not one-size-fits-all. We try to reflect the consensus opinions of the membership of Clerkship Directors in Emergency Medicine (CDEM) and the Council of Residency Directors (CORD), but we do not speak for them. Nor does their membership always agree. When something is controversial, we try to address that controversy. We believe we are a source of sound, balanced, and accurate advice on becoming an emergency physician in the United States. We also have no doubt that you will find different opinions elsewhere. 

To help you sort through all of the differing opinions you may find, you need the guidance of a local EM advisor, in addition to your Dean. You need someone who knows the EM application process and can help you navigate issues specific to students from your school and region. If you cannot find anyone, or you need advice from a different region you can often find help from SAEM's e-advisors program or the EMRA mentorship program. 

Adam Kellogg is an Associate Residency Director and formerly an Emergency Medicine Clerkship Director.  He is a member of the CORD EM Student Advising Task Force and of the SAEM Resident and Student Advisory Committee. He has written for EMRA about the EM Match. 

The EMStud Podcast

I recently became aware of a new resource that every medical student interested in Emergency Medicine should check out: the EMStud podcast.

Started this fall by Dr. N8 (@emstudpodcast), they are hitting on key topics of importance to students applying to EM. They have covered The 7 P's of RSI (Really Stellar Interviewing), had a 2 part Q&A on Interviewing (part 1 and part 2), and most recently got the rank list discussion started with 100 Days to Match Day.

These short (well under 20 minutes!) podcasts hit the key points that students need to know. He also provides links to longer form advice for those seeking more. EMStud is a welcome addition to the growing collection of resources for students interested in EM.

Enjoy!

Choose EM?

Most people reading this have probably already made their choice of specialty and have chosen EM.   But if you are undecided, having "buyer's remorse", or someone recently disappointed in not matching into what has become a very competitive specialty in the U.S., have a look at this recent post from Life in the Fast Lane on "Choose EM".

The first picture is as good a summary as I have found of what makes this specialty wonderful and unique.  

The second picture is a reminder that even the best job in the world has it's drawbacks.  If this was easy, everyone would do it.   

Congratulations to everyone who successfully matched in 2014!