The CORD EM Blog

Disclosure:  I am also an editor for the CORD EM blog, writing and editing posts by members of the CORD Student Advising Task Force (SATF).  

The Council of Emergency Medicine Residency Directors (CORD EM) recently started their own blog. This new Free Open Access Medical Education (FOAMed) resource is growing to include a variety of resources for those involved in emergency medicine (EM) education. One of the content areas (and the reason this is being mentioned here) is from the CORD EM Student Advising Task Force (SATF).

On the first Thursday of each month the SATF will publish a post with information crucial to students applying to EM, and all those that advise them.  Their first two posts should be of great interest:

• HireVue - The Pre-Interview Interview, where the video interviews that all EM applicants are being asked to conduct are explained.  This pilot program is being rolled out by the American Association of Medical Colleges (AAMC) just in EM this year.  
• Student Advising: A Comprehensive Guide and FAQ, where the most up-to-date versions of the CORD SATF Emergency Medicine Applying Guide and Applicant FAQ were shared. These resources contain the most current applicant advising recommendations available, based on Clerkship Director and Program Director consensus and the best available evidence.  

Future posts will highlight more invaluable resources for students including advising recommendations for applicants in Special Circumstances and highlighting of the most useful resources for students.  

Reflections on a balanced intern year

This post by Ashley Rider, a second year EM resident, is for the all the band new residents starting their internship.

Intern year is special. We finally have the responsibility that we have been yearning for, but it is appropriately coupled with layers of protective guidance from upper levels, fellows, and attendings. The hours can be long and grueling, but they tick away surrounded by people that understand your challenges, offer support when days are tough, and inspire you to be your best.

Striking a balance between your resident duties and life outside of the hospital can be one of the greatest sources of strain during intern year. Finding the time to keep in touch with friends and family in far away places is exceedingly difficult. You will probably miss some holidays. Your work schedule may be incompatible with many important events. Stressors may feel like they come from all directions—patient care, residency requirements, student loans, car issues, apartment fixes, and your relationships. Meanwhile, you are expected to work toward mastering the specialty of emergency medicine.

You will be functioning on limited bandwidth every day, week, and month this year. Time must be prioritized.

Once a month…

Get organized.

♦      Streamline your life. For all of those monthly bills, activate automatic recurring payments. You would be surprised how quickly the 1st of the month sneaks up on you. Ask your landlord about alternative payment methods or direct bank transfers. If you have roommates, brainstorm ways to consolidate payments. The fewer minor tasks you have to remember, the more your cognitive faculties can be applied to other areas of your life.

♦      Allow Google calendar to be your best friend, by helping you keep your best friends. Plug in event reminders and birthdays. Make a habit of checking your morning email of calendar events to avoid tardy birthday wishes or Mother’s day cards. Put your shift hours into a calendar, and then share it with family, friends, and significant others so that they know when you are available. With the beginning of each month, map out your upcoming events compared to your work schedule. On the eve before a new rotation, allow yourself 15 minutes of quality time with the GCal to plan ahead.

♦      Make time for your classmates. Believe it or not, your co-interns may be the people you see the least as you are carted off to the obligatory off-service intern rotations. Some of my most cherished moments of intern year were my class dinners. On the last day of every rotation one person would coordinate an outing that allowed us to catch up while visiting new areas of our city. Your co-interns understand everything you are going through. Revisiting your special bond every few weeks might be revitalizing enough to plunge into the next month’s “new job.”

Once a week…

Establish routines for learning and wellness.

♦      Attend conference. This is five hours a week dedicated to your education. Be engaged!  Take advantage of the protected time to learn from faculty, guest speakers, and peers. Bring ideas, bounce your thoughts, and ask questions. We only get this for 3 or 4 short years—don’t miss out! It is a tremendous component of our education with the unique flair of our residency program. That’s something CME will not offer in the decades to come.

♦      Keep in touch with family and friends. Vacations do not come often enough. Make a phone call to the parents, siblings, and friends that made you who you are. They want to hear how you’re doing! This may need to happen on the drive home, while folding laundry, or during an apartment clean. Put your emergency medicine multitasking capabilities to good use, and you will find the time.

♦      Reflect. Relax. Treat yo’self. GME requires approximately one day off a week. Set aside at least one hour on that day to do something that makes YOU happy. Take a walk, write, go to the gym, read, do Yoga, lounge in the park, hit the mall, or go for a hike. Whatever it takes to recharge and reset—you deserve a break!

Each day…

Aim to give 100%.

♦      Sleep. Time is always going to be limited but sleep is necessary. Every hour of sleep debt you accrue will chip away at your potential as a learner and as provider of patient care. On those days you have to wake up at 4am, go to bed earlier! Sleep hygiene is key: put away electronics, keep your room dark, and avoid food/exercise/alcohol/caffeine before going to bed. In emergency medicine we also have to tackle rotating schedules and night shifts. Invest in dark curtains and an eye mask to get your needed rest during the day. The routine you develop this year will set you up for a career of shift work, so make them good habits.

♦      Read about your patients. Pick at least one patient per shift and peruse a relevant up to date article, book chapter, or residency resource. At the peak of your exhaustion, a few minutes at the end of the day may seem unthinkable, so practice “learning on go.” Look up articles as clinical questions come up and scan them when you find free moments (e.g. waiting to present to the attending, walking to your mode of transportation at the end of a shift, or during the 5 minutes before sign-out). Furthermore, don’t let that time spent go to waste. Be sure to organize your learning, whether in a notes app, on old-fashioned pen and paper, or through Evernote. Screen time will be limited this year, so try to find ways to learn that don’t involve your computer.

♦      Stuff is going to happen. You are going to have bad days. You might get a flat tire on the way to work. You might make a medical error. You might feel overwhelmed and utterly useless—it happens to everyone. But remember that this too shall pass, every day comes to an end, and tomorrow is a new start (this goes back to the importance of sleep!)

Every Hour…

Brace yourself for the many challenges you will encounter.

♦      Prepare yourself for patients based on the differential for their chief complaint. Before you go to see him or her, have the top 5 most concerning diagnoses at the forefront of your mind. While interviewing the patient, collect all evidence that helps you to rule in or our these diagnoses, and formulate a plan from there. This active thought process will help you develop your practice style much more than a shotgun approach. Take a few minutes each day to follow up your patients. Did they come back to the ED after discharge? What became of them in the hospital? It will ultimately make you a better provider.

♦      Know your team. Nurses will save you and will frequently aid your decision-making. If you are worried about a patient, call rapid response and respiratory therapy. Social workers may be able to provide suggestions and resources that you didn’t even know existed. Call radiology to talk through an x-ray that you didn’t initially read correctly, because someday you may be the sole provider interpreting overnight films. Finally, remember all those dosages we never learned in medical school? Pharmacy will be your saving grace. If you are unsure about a medication interaction, dosing regimen, or the available of a drug, call your friendly pharmacist.

♦      Hypoglycemia is our Achilles Heel. For patients, always check a D-stick upon arrival. You can cure quite a few presumed altered mental statuses, or even CVAs. For yourself, recognize that glucose is the fuel for the brain. Keep a couple of granola bars (fun size snickers count, too) for that delayed meal or busy high acuity shift.

Each Moment…

Keep a positive attitude.

♦      Learn something from every case you see. It might be an agitated psychiatric patient, but they, like all your patients, are in the emergency room as a last resort. Give them your best doctoring. Investigate all organic possibilities. Hone your communication skills with difficult patients while you have the time. Learn what labs to order and what paperwork to fill out. Know where the snacks are kept. Your R2 self will be glad you took the time to learn the basics. Everything you tuck away this year will make the road ahead less bumpy.

♦      Be humble. You leaned a lot in medical school, but remember this is only the foundation. Always develop a differential, even if you are certain of the diagnosis. Consider the input of every member of your team. Recognize when you were wrong, and use your mistakes to improve care of the next patient. There is always more to learn!  

♦      May your every task be aimed toward taking good care of patients.  Just don’t forget about yourself along the way.

For additional pearls straight from the chiefs, see the ALiEM post on residency secrets to success:  https://www.aliem.com/2016/top-10-success-resident/

Welcome to emergency medicine. Best of luck with every month, week, day, hour, and moment this year!

Ashley Rider, PGY-2 Highland Emergency Medicine

CDEM Curriculum - EM Stud and SATF Resources

The Clerkship Directors in Emergency Medicine (CDEM) is the National Organization representing Undergraduate Medical Education in Emergency Medicine.  CDEM is comprised of medical student educators who are committed to enhancing medical student education.  They have recently revamped their web presence with the fantastic new CDEMCurriculum.com site.  Any student interested in EM should spend some time poring over this site as it is the single best resource available.  In this post we highlight the tip of that content iceberg. 

Curricula
Among the resources available are the Student Curricula that give the site its name.  Included are focussed reviews of the major adult and pediatric complaints with an emphasis on what the student needs to know.  A student familiar with all of this material would have a knowledge base that any supervisor would find impressive.  

EM Stud Podcast
There are an amazing number of podcasts out there, but don't you wish there was a podcast for the student interested in EM?  Well it turns out that the EM Stud podcast is what you are looking for.  Started independently by Dr. Nate Lewis (@ERDrN8), it is now the official CDEM podcast for students.  His co-host, Dr. J. Scott Wieters (@EMedCoach), recently recorded an incredibly insightful Match Analysis with Dr. Mike Van Meter.  Just packed with great insights that impact your application.  Previous episodes cover a variety of topics including the dreaded VSAS and How to Run Third Year Like a Boss, among many others. 

Student Advising Resources
The CDEM site also hosts the Advising Resources created by the Council of Residency Directors in EM (CORD-EM) Medical Student Advising Task Force.  This group of Program Directors, Clerkship Directors, Residents and Students collaborate to improve the quality of available student advising and increase the transparency in the EM application process.  Currently available resources you can download from the CDEM site include a comprehensive Guide to Applying to EM, a concise set of Frequently Asked Questions, a Student Planner, and a collection of the best Advising Resources currently available.  

This should keep you busy for a while.  Enjoy!

Adam Kellogg is an Associate Residency Director, former Medical Student Clerkship Director, and the immediate-past Chair of the aforementioned CORD-EM Student Advising Task Force. He wishes that the EM Stud podcast existed when he was a medical student.  Or any podcast for that matter.    

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.   

Application Resources from the CORD SATF

The CORD EM Student Advising Task Force has produced a set of application resources for medical students and those who advise them.  These were created with the input of all the groups who care about quality medical student advising (CORD, CDEM, EMRA, AAEM/RSA).  

You can find these resources on the CDEM Curriculum website, along with a whole bunch of other great resources: 
http://cdemcurriculum.com/2016/04/06/student-advising-task-force/ 

Included are a comprehensive guide to the application process, a more concise FAQ, a list of the best resources currently available, and a planner to help guide you through the process.  

Enjoy!

Adam Kellogg is an Associate Residency Director and a previous Emergency Medicine Clerkship Director.  He was Chair of the CORD EM Student Advising Task Force until very recently. Full disclosure - he served as an editor for these resources. 

A Guide to the "Perfect" Rank List

A Guide to the “Perfect” Rank List

This is a guide to help students in the Emergency Medicine (EM) match formulate the best possible Rank List to fit their needs. This guide was prepared on behalf of the Council of Residency Directors in Emergency Medicine (CORD-EM) Student Advising Task Force, a group that seeks to provide guidance to students applying to EM and to all those that advise them.

Introduction:

Congratulations on finishing your interviews; now here comes the hard part, compiling your rank list!

Making your personal rank list has been associated with common symptoms such as confusion, insomnia, aggression, depression, elation, and general malaise. The goals of this blog are to review tips and recommendations based on the National Resident Matching Program (NRMP) data from 2009 to 2015, as well as expert opinions from your fellow residents and attending in order to alleviate the psychosomatic stressors affiliated with the entire process. At the end of the day, it is still your personal preferences, interview experience, and family-social obligations that will drive you to create your “perfect” rank list.

Spoiler: There is NO spoon or the “Perfect” rank list. 

Background: 

According to the NRMP data from 2015, there were a total of 2352 applicants for 1821 nation-wide EM positions, with only 8 positions unfilled. The number of EM programs has been steadily increasing in the last decade, from 141 programs in 2009 to 171 programs in 2015 in order to meet the increased popularity of this amazing specialty, reflected by the 19% increase in total applicant since 2009 [Fig. 1]. Despite the rising number of programs, the NRMP dataset reveals a steady decline of unfilled position; in 2012, all programs were completely filled. Fortunately, 18 EM programs were added with 153 new available positions since 2012, allowing applicants to select from a larger pool of EM programs with less fear of scrambling.

Figure 1 – Application trends for EM Residency. Taken from NRMP dataset 2009-2015.

Questions to ponder:

What is the Matching Process?

The Matching Process is a time-honored (and feared) tradition where a mathematical algorism is used to place applicants into residency and fellow ship position (http://www.nrmp.org/match-process/match-algorithm/). The process begins by matching the applicant’s rank order list (ROL) to the respective programs. If the applicant cannot be matched to the first choice program, the computer algorithm will automatically attempt to place the applicant into the second, third, and so forth until he/she is matched. A tentative match occurs when a program also ranked the applicant “A” and either:

1. The program has an unfilled position, in which case there is room in the program to make a tentative match between the applicant “A” and program, or
2. The program does not have an unfilled position, but applicant “A” is more preferred by the program than another applicant “B” who already is tentatively matched to the program.  In that case, applicant “A” will be granted the position instead of “B.”

All matches are “tentative” because applicants who are matched to a program may be removed at any time from that program to make room for an applicant more preferred by the program (see example above).  When the applicant is removed from a tentative match, an attempt is made to re-match that applicant, starting from the top of the applicant’s ROL.  When the Match is complete, all tentative matches are considered “final.”

Will I get my first choice?

According to the 2014 NRMP data based on matched applicants to all specialties in relationship to their specific rank list, most students get their top 3 choices: 52%/16%/10%, as their 1^st/2^nd/3^rd choice [Fig 2]. This means that your top 3 rank list matter the most, so choose programs carefully! 

Figure 2 – Percent of Matches by Choice and Type of Applicants. Taken from NRMP 2014

Should I rank every program? 

This is a tricky question, but fortunately the answer is bluntly straight forward: YES!

When you leave a program out of the rank list, you will not be matched to that program, END OF STORY. If you were an EM applicant who failed to match in 2012, your only option to become an EM resident was to reapply for the following year as there were ZERO unfilled EM positions in the entire country. Fortunately by 2015, the number of unfilled programs rose to a total of 4, providing a small breathing room for the scramblers. 

My opinion, if you already invested your time and money for the interview, then just rank the program. It is okay to not rank a program, as long as you understand that the risk involves scrambling into a non-EM Program [Fig. 3].

  

“Scrubbing for EM in 2012 – Gonna need a bigger SOAP next year!”

Figure 3 – In 2012, NRMP reported zero unfilled EM positions across the country. Not matching meant scrambling to a Non-Emergency Medicine Program.  SOAP stands for Supplemental Offer and Acceptance Program®.

Which rank list reigns supreme? Applicants vs. the Residency 

Based on the NRMP Match Algorithm (as described above), the applicant rank list is reviewed before the program rank list, placing a higher priority to applicants’ preference over the residency’s. So, just like a game of blackjack, you, as the applicant are the “Dealer,” with just a slight advantage over the residency, aka “Player.”

Which program should I rank 1^st?

Unfortunately, this article will not be able to tackle the complexity of picking the “perfect rank list.” Your rank list will likely be affected by numerous factors, some of which you may have known, while others surface as you progress through the interview trail [Table 1]. In writing this article, we have collected numerous strategies to assist in making the ideal rank list, but at the end, the most common advice was to “follow your gut feeling.” Nevertheless, this article includes some general and useful suggestions for picking out your top 3 programs:

1. Ask your local EM program directors for advice – Program Directors are there to help and guide you through the application process. Their knowledgebase is formidable and they read thousands of applications annually. Sure, some may try to persuade you to join their program, but that is a good sign.
2. You will make new friends – This may sound silly, but many applicants are reluctant to leave their medical school institution, fearing they will lose touch with their friends due to the increased distance. Rest assured, however, you WILL make new friends, either intra- or extra-departmental (or even outside the hospital, GASP!)
3. Location, Location, Location! – This is true with the housing market, and it is equally pertinent in residency selection. If a particular EM Residency is your dream program, but it’s located in a region that you are unfamiliar with, or have limited access to your hobbies (i.e. an outdoorsman in NYC or a Californian surfer in Colorado), then you should strongly reconsider. After all, your wellness matters.
4. Don’t be distracted by gizmos and gadgets – What differentiates a strong EM Residency program is the cohesive nature of the residents, the supportive faculty, and the willingness to respond to feedback. Fancy technologies such as EMR, CT/MRI scanners, and even scribes can be enticing, but they are only as functional as the organization that utilizes them. Friendly consults, however, are always added bonuses.
5. Are the residents happy? – This is one of the most important things to assess during your interviews dinners. Most accredited residency program ensures that you will learn to be an effective and efficient healer, as a result, why not have a good time? If the residents at the dinner seem miserable and depressed, that is a big RED FLAG!

Table 1 - Common Factors Affecting Rank List Decision Making

What if I don’t even know myself?

When all else fails, there is a trick you can play on yourself to test your subconscious mind.

• Step 1 – Grab a friend
• Step 2 – Write all of your EM programs on pieces of paper, then fold and place them in a bag.
• Step 3 – Pretend it is Match Day! Have your friend pull a random piece of paper from the bag and tell you that you’ve matched to the program listed on the paper. 
• Step 4 – Make facial expression (very important step)
• Step 5 – Ask your friend for your reaction.

Conclusion:

Please remember, you have already chosen one of the most rewarding and exciting field of medicine, and you will have a great education and experience regardless of where you match. Just make the list, cross your fingers, and get ready for the next exciting chapter of your life!

- Tony

Xiao Chi (Tony) Zhang is an Emergency Medicine Resident at Brown-Alpert School of Medicine and a member 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.