The Trail Ends and The Ranking Begins

Today we had our last interview of the season, and I expect each of you are winding down as well. Congratulations on all you have accomplished and getting it all done. Your well-worn interview suit can go to the cleaners, trash or bonfire. You can start planning that amazing trip you have earmarked for spring. And it is also time to step back and look objectively at the programs you interviewed with.  

Your last major residency application task is your rank list.  You have until  9pm on February 25th to finalize your Rank List.  And if you are anything like me, you are on the third iteration of your complex spreadsheet desperately trying to sort through them all. 

"How to make your Rank List" was one of the first topics we tackled here, and very little has changed about this part of the process. Our Rank List Tips still hold true, and you ultimately should still Go with your gut, in defiance of what your giant spreadsheet is telling you. 

There are some differences between this year and last, however overall competitiveness has not changed significantly. The ratio of available spots to total applicants is the same. Both numbers have been gradually and proportionally increasing for years. This does NOT appear to be what Medical School Dean's have been claiming, as the major change this year is in the number of applications each person has sent out AND in the number of interviews they have done. I do not blame the Dean's for giving this advice, their job is to ensure that all of their students match. They will do what they think is necessary to accomplish that goal.

The difference this year is that there are fewer applicants with a number of programs to rank (8 - 10) who should feel comfortable about matching. Instead, there appears to be an unusually large divide between the "haves" (>10 programs, AKA: the over-interviewers) and the "have nots" (<8 programs to rank). This has introduced added uncertainty into an already stressful situation.  Programs fear that they have interviewed the same candidates as EVERYONE else and won't match enough of them.  Applicants with low numbers of interviews fear that they are only padding the back-end of rank lists at programs that interviewed extra or played it safe in offering interviews. Most of the concern is likely unfounded, given the steady growth in BOTH spots and applicants, though we will not know how this plays out until after the match.  

The advice that follows has held true in past years and is likely to still be relevant:   

1. Rank any program that you would consider to be better than scrambling (SOAPing) to a surgical pre-lim. year or to family medicine. There is effectively no scramble within EM.  If you don't match, your next shot at EM is next year.  
2. Rank programs in the order you like them.  The match algorithm favors the students. You will match to the program you rank highest that gets to your spot on its Rank List.  There is no advantage to you in ranking a more "realistic" program ahead of a "reach".  
3. Once you settle on your #1 program, you need to let them know.  Programs want to be liked, just like everyone else. Just don't tell more than one program they are your #1.  The world of Residency Program Directors is a relatively small one and you don't want to get caught in a lie. 

For more on making your rank list see these posts from Academic Life in Emergency Medicine's EM match advise: Making Your Rank List and Top 10 Tips When Making Your Rank List, as well as our post on Going with your gut that includes a more detailed explanation of the Match Algorithm in case you do not believe the whole "student weighted" thing.

Best of luck!  You are almost there.  

Lucienne Lutfy-Clayton is a Clerkship Director and Associate Residency Director. She believes in this whole "student-weighted match algorithm" business and thinks that you should too.  

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!

Interview Etiquette: The No Show

A comprehensive collection of Interview Resources is coming soon, just in time for phase 2 of the interview season (the time when interview spots really start to open up). There is one topic, not previously covered in detail, that I wanted to give more attention to: the Interview Day No Show.

The short version... This is a terrible idea and reflects badly on you, your advisors, and your school. 

The longer version... First a qualifier: a true Interview Day No Show is when an applicant who has scheduled an interview does not show up without notifying the program in a meaningful way. Programs understand weather-related travel delays and family emergencies. They don't mind you canceling your interview - there are plenty of other applicants who actually are interested in the program to take that spot. The program director will actually appreciate you giving someone else the opportunity. That reflects well on you.

However, you create an entirely different perception of your character if you cancel with so little notice that finding a replacement is impossible. Or, even worse, if you just do not show up at all with no attempt to contact the program and explain your circumstances.

Many reading this are horrified that anyone would have such an egregious lapse in professionalism. Though there are likely a few who are thinking, "well, I did not want to train at the program anyway, so what is the big deal?"

Here is a list of who the aggrieved program director will likely be notify of your No Show:

1. Your dean
2. The residency director at your home institution
3. Anyone who wrote a SLOE or a LOR
4. Your mom (okay, probably not your mom... unless she wrote one of your letters)

You may not care about the program you just No Showed. However, your home program director, and those at any away rotation that provided you with a letter, are going to care. Inferences will be made about your sense of responsibility, duty to your patients, and overall professionalism. This is a huge professionalism Red Flag. All it takes is one Red Flag to sink your chances.

Adam Kellogg is an Associate Residency Director and former Emergency Medicine Clerkship Director.  He has never personally hunted down a "No Show" to give them a piece of his mind. Yet.

Diagnosing the Match

We are in the heart of EM residency interview season here in the United States. This has been an anxiety provoking year for all involved.

Applicants and their advisors are worried because they do not have as many interviews as they expected.

Residency programs have unprecedented numbers of applications this year and are worried they are not interviewing enough candidates.

The Council of Residency Directors (CORD) Student Advising Task Force and the Emergency Medicine Residency Association (EMRA) worked together to try to shed some light on these events. The result of this collaboration, written by Zach Jarou (@zachjarou), a resident at the Denver Health EM Residency, and myself, was just published on EM Resident. We looked at recent match data and a survey of residency program directors to figure out how we got here and what we can do going forward.

This is a long article, with a lot of data, but after reading it you should have a better idea of where you stand in the application process AND what you can do now to improve your chances.

http://www.emresident.org/emergency-medicine-match/

As the Trail Begins

As you get ready to go out on the interview trail, you need to know what will allow you to shine to maximize your match. 

Scheduling
Realistically you can only do two interviews each week. If you try to make swings into areas, doing back-to-back interview days, you are going to miss out on getting to know the places you visit. Instead of hopping about the country a la Planes Trains and Automobiles, leave yourself extra time. Plan to get in for your interview at least mid-day, the day before. This will allow you to fully participate in the whole interview experience. This means you need to be judicious in choosing interviews if you have been offered more than 10-12. You simply can’t fit more in and do them justice. 

The Night Before
The evening prior to your interview the program will host a social event, usually a dinner or cocktails with residents, interviewees, and possibly some attendings. This is a great opportunity for you to see how the program is from the resident perspective, and observe the groups interactions. You can get many questions answered from different viewpoints, and this is a great time to see how you fit with each group. On reflection, many applicants find this to be the most useful part of the interview when making their decision about a program. Do not miss it just so you can pack another interview in.  

Look Professional

Avoid checking baggage when you fly to an interview.  It will get lost and you will show up to interview day in jeans. While this happens to a few folks every year, it is easily avoidable by sticking to a carry on.

On interview day, arrive early so that you guarantee not to be late. You should be wearing a well fit suit. Men should wear suits with a tie, and women should wear either a dress, skirt, or pants with a matching jacket. Try your suit on now and have it altered or get another, if it no longer fits you well. While it may seem superficial you never want to loose favor because of perceived lack of preparation. The shabbily dressed student might end up being the ill prepared resident. You have a limited amount of time to make an impression, make it a good one.

Have Questions

At the interview you will want to have a list of questions. Everyone is going to ask what questions you have, if you have none - you look disinterested. Don’t fall into this trap. It is easy to have questions. First, have some basic questions you ask at all programs. These should be what matters to you and what is helping you stratify programs. Next, look at the residency website and come up with 3-5 specific question for each program. If you know ahead of time who you will interview with, look them up and have questions about their interests or role within the program. Everyone, absolutely everyone, enjoys talking about themselves. If you don’t know ahead of time, ask what your interviewer’s role is, then ask some follow ups specific to that role. 

Engage

Keep up your energy and interest level throughout the interview. Lean forward, listen, and smile. Avoid slouching, leaning backward, and swearing at all cost. If you do any of these things you will be perceived to be disinterested, and unprofessional. As interviews go on this will get harder than it sounds. Despite your current fervor, after a few months of interviews you will be tired, bored, and ready for a break. You will begin to show disinterest just from the monotony of it all. This is one of the reasons you should focus on 10-12 interviews at a variety of programs you are interested in. 

If you go on more you will have a quickly diminishing return on your investment of time and money. Your chance of matching with eight programs on your rank list is >90%. Your chance of matching passes 99% with twelve programs on your rank list. More programs will not increase your chance of matching: you already maxed it. Remember, you have more control than you think: more than 50% of you will get your first choice and 80% of you will get within your top three. As you move forward think about both the time, effort, and money going into each interview, and compare this with the likely outcome. If you have 10-12 interviews at places you want, you have no need to do more. 

Cancelling

Canceling interviews with enough time for the program to get another applicant in, is courteous to the program, and generous to your fellow applicant. If you realize that you have enough interviews for your rank list, you can begin canceling those that would go to your bottom. The key is canceling early enough, that the program can get another applicant in for that day. Generally the longer lead time, the better. A few days and even a week is difficult to re-arrange, so ideally cancel more than two weeks ahead of time. If you are worried the programs will be insulted, remember they want to maximize their match list as well. Give them enough notice and there will be no hard feelings. If you are one of the many great candidates that doesn’t have enough interviews, you should consider freeing up January. There will be more cancelations as the interview process continues and you will need flexibility to accept on shorter notice.  

Quantity and Quality

Interviews are your opportunity to try out a variety of programs and see how they will fit you. With a reasonable plan you can schedule, travel, and arrive at 10-12 spots ready to shine, and succeed in the match. Remember to maximize this opportunity by focusing your energy on a selection of interviews, with questions and observations that matter to you and your learning.

Lucienne Lutfy-Clayton is a Clerkship Director and Associate Residency Director, and has had her luggage lost too many times.  

#ACEP14 is upon us... "Should I go?"

The American College of Emergency Physicians (ACEP) is the largest EM organization in the United States.  Their largest annual meeting, the Academic Assembly (#ACEP14), starts this weekend.  Thousands of Emergency Physicians, and other acute care providers, from all over the world will be descending on the McCormick Place convention center in Chicago.

As part of this event the Emergency Medicine Resident Association will be hosting a week of events as well.  For students pursuing a career in EM the highlights are the Student Symposium and the Residency Fair, both happening on Sunday, October 26.

If you are in the 2015 match, you can make an argument that there is little value in going to this now as most of the interview offers are out already.  That is a good point.  Many of the Program Director's have already made up their minds about their interview offers and wait lists.

Another viewpoint would be that this is the MOST important Residency Fair to go to for someone in this years match.  Especially if you do not have the 10-12 interviews that correlate with a 99% match rate.  With the increased number of applications that each program is receiving (without an increase in the overall number of applicants), most program directors are expecting to make more use of their "wait list" than ever before.

A nice introduction and conversation with the program leadership staffing the Residency Fair may very well impact your spot on that wait list.

Adam Kellogg is an Associate Residency Director and former Emergency Medicine Clerkship Director.  He is currently training residents he met at the EMRA Residency Fair.