Assessing Your Competitiveness as an Emergency Medicine Applicant

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Assessing Your Competitiveness as an Emergency
Medicine Applicant

• Chris A. Ghaemmaghami, MD
• Director, Emergency Medicine Residency Program
• University of Virginia

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Introduction

• Competitiveness of EM in general
• How program directors evaluate applications
• Specific elements of your application

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Overall - Match RatesAll specialties
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Who matched in EM 2008?

• Total positions 1399
• US seniors (MD) 1083 77.4
• DOs 133 9.5
• US grads (MD) 70 5.0
• US IMG 55 3.9
• Unfilled 29 2.1
• Non-US IMG 20 1.4
• Canadian 2 0.1
• 5th pathway 7 0.5
• Overall fill rate 1370 of 1399 97.9

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http//www.nrmp.org/data/resultsanddata2008.pdf
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The most competitive

• Specialties and specialty tracks with 10
  positions in the Match and 100 percent fill
  rates
• Dermatology PGY-1
• Dermatology PGY-2
• Pediatrics (primary care) PGY-1
• Plastic Surgery PGY-1
• Radiation Oncology PGY-1

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The most competitive

• Specialties with 10 positions in the Match and
  more than 90 percent filled by U.S. seniors
• Orthopaedic Surgery PGY-1
• Otolaryngology PGY-1
• Plastic Surgery PGY-1
• Psychiatry-Family Medicine PGY-1

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http//www.nrmp.org/data/resultsanddata2008.pdf
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Growth of EM slots

• 2007/8 - Emergency Medicine put 90 more positions
  in the Match this year (combining PGY-1 and
  PGY-2) and filled 87 more positions.
• 2008 - Three new EM programs approved by the RRC
  with an additional 23 spots

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What are PDs looking for?
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What are PDs looking for?

• Honest
• Intelligent
• Works well with others
• Good communication skills
• Hardworking

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How will PD know if you have these qualities?

• What is the data to prescreen for interviews
  offers?
• Grades
• Board Scores
• Letters of recommendation
• Deans letter
• Personal statement
• Other info in ERAS

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Selection Criteria for Emergency Medicine
Residency Applicants

• Survey of 94 residency directors ratings of
  variables in applicant information
• Items ranked from 1 (least important) to 5 (most
  important)

Acad Emerg Med 2000 754-60
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Selection Criteria for Emergency Medicine
Residency Applicants

• Results
• Most emphasis
• EM rotation grade 4.79
• Interview 4.62
• Clinical grades 4.36
• Recommendations 4.11

Acad Emerg Med 2000 754-60
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Selection Criteria for Emergency Medicine
Residency Applicants

• Results
• Moderate emphasis
• Elective done at PDs
• institution 3.75
• USMLE step 2 score 3.34
• Interest expressed in PDs
• institution 3.30
• USMLE step 1 score 3.28
• Awards/achievements 3.16

Acad Emerg Med 2000 754-60
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Selection Criteria for Emergency Medicine
Residency Applicants

• Results
• Less emphasis
• AOA status 3.01
• Medical school attended 3.00
• Extracurricular activities 2.99
• Basic science grades 2.88
• Publications 2.87
• Personal statement 2.75

Acad Emerg Med 2000 754-60
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How will PD know if you have these qualities?

• What is the data to prescreen for interviews
  offers?
• Grades
• Board Scores
• Letters of recommendation
• Deans letter
• Personal statement
• Other info in ERAS

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Grades

• Clinical gt Preclinical
• Basic Science failures are a problem
• Core clinical rotations carry the most weight
• Medicine
• Surgery
• Pediatrics

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USMLE Scores

• Most programs do not have published minimum
  scores
• Passage of Part 1 is essential
• Part 2 seems to predict success in residency
  better than Part 1

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Letters of recommendation

• Most programs require a minimum of 3 letters
• Get at least 2 EM letters
• One letter from a core clinical rotation
• No more than 5 letters total
• Letters from visiting elective can establish
  external validity

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Letters of recommendation

• The PDs view
• Author reliability
• Number of letters written
• Accountability/reputation
• Amount of exposure to the applicant

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The SLOR

• The Standardized Letter of Recommendation
• Developed by CORD-EM
• Unique to EM
• Very streamlined

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The SLOR
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The SLOR
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The SLOR
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Letters of Recommendations

• Fair questions to ask of letter writers
• Would you have time to write a positive letter
  of recommendation on my behalf?
• If you are planning on using the SLOR, can you
  please type it?

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Self assessment is difficult
Take advantage of mentors to give you honest
assessments
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Recognizing Red Flags

• Felony convictions
• Failure of med school courses
• Failure of a part of the boards
• Negative comments in Deans letter
• Unexplained gaps in training/life
• Jumping from school to school
• Lack of EM letters especially from home
  institution

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Nontraditional situations

• Changing specialties
• Preliminary years
• Must have program director letter
• Transferring between residencies
• Transfers hurt the team and the program
• Dont take these lightly
• PD wont tell you how much this hurts, but it does

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Addressing Red Flags

• Directly explain in ERAS fields
• Weak grades, retesting, and remediation on ERAS
  form
• Medical issues, family emergencies, growth
  experiences
• Use the personal statement to expand on
• Complex reasons for difficulty
• Steps youve taken to rectify deficiencies
• Honest and direct is always best

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Personal Statement

• The PDs assessment
• Why should interview this person?
• What does this person bring to the table?
• Will this person be a good employee?
• IS the applicant prepared for EM residency?
• Have red flags been addressed?
• Not interested in
• Personal medical anecdotes
• Self-discovery
• Poetry

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Personal Statement

• The applicants opportunity
• First, do no harm
• Explain weirdness
• Promote yourself as a new team member and employee

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Competitiveness of Programs

• US News report ratings

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Competitiveness of Programs

• There are no formal ratings for competitiveness
  of EM residency programs by any organization.
• It is all word of mouth.

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Program Quality

• ACGME reports programs on probation on their
  website
• http//www.acgme.org/adspublic/
• Ask PDs about
• accreditation status
• board pass rates

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Conclusions

• There are more EM spots available than ever
• The balance is beginning to favor applicants
• PDs make interview offer decisions based on
  limited information
• Even now, you do have control over much of your
  application content

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cg3n_at_virginia.edu