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Assessing Your Competitiveness as an Emergency Medicine Applicant. Chris A. Ghaemmaghami, MD Director, Emergency Medicine Residency Program University of Virginia. Introduction. Competitiveness of EM in general How program directors evaluate applications

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assessing your competitiveness as an emergency medicine applicant

Assessing Your Competitiveness as an Emergency Medicine Applicant

Chris A. Ghaemmaghami, MD

Director, Emergency Medicine Residency Program

University of Virginia

introduction
Introduction
  • Competitiveness of EM in general
  • How program directors evaluate applications
  • Specific elements of your application
who matched in em 2008
Who matched in EM 2008?

Total positions 1399

US seniors (MD) 1083 77.4%

DO’s 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%

the most competitive
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
the most competitive8
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
growth of em slots
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
what are pd s looking for14
What are PD’s looking for?
  • Honest
  • Intelligent
  • Works well with others
  • Good communication skills
  • Hardworking
how will pd know if you have these qualities
How will PD know if you have these qualities?
  • What is the data to prescreen for interviews offers?
    • Grades
    • Board Scores
    • Letters of recommendation
    • Dean’s letter
    • Personal statement
    • Other info in ERAS
selection criteria for emergency medicine residency applicants
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; 7:54-60

selection criteria for emergency medicine residency applicants17
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; 7:54-60

selection criteria for emergency medicine residency applicants18
Selection Criteria for Emergency Medicine Residency Applicants
  • Results
    • Moderate emphasis
      • Elective done at PD’s

institution 3.75

      • USMLE step 2 score 3.34
      • Interest expressed in PD’s

institution 3.30

      • USMLE step 1 score 3.28
      • Awards/achievements 3.16

Acad Emerg Med 2000; 7:54-60

selection criteria for emergency medicine residency applicants19
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; 7:54-60

how will pd know if you have these qualities20
How will PD know if you have these qualities?
  • What is the data to prescreen for interviews offers?
    • Grades
    • Board Scores
    • Letters of recommendation
    • Dean’s letter
    • Personal statement
    • Other info in ERAS
grades
Grades
  • Clinical > Preclinical
  • Basic Science failures are a problem
  • Core clinical rotations carry the most weight
    • Medicine
    • Surgery
    • Pediatrics
usmle scores
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
letters of recommendation
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
letters of recommendation24
Letters of recommendation
  • The PD’s view
    • Author reliability
      • Number of letters written
      • Accountability/reputation
    • Amount of exposure to the applicant
the slor
The SLOR
  • The Standardized Letter of Recommendation
  • Developed by CORD-EM
  • Unique to EM
  • Very streamlined
letters of recommendations
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?”
self assessment is difficult
Self assessment is difficult

Take advantage of mentors to give you honest assessments

recognizing red flags
Recognizing Red Flags
  • Felony convictions
  • Failure of med school courses
  • Failure of a part of the boards
  • Negative comments in Dean’s letter
  • Unexplained gaps in training/life
  • Jumping from school to school
  • Lack of EM letters – especially from home institution
nontraditional situations
Nontraditional situations
  • Changing specialties
  • Preliminary years
    • Must have program director letter
  • Transferring between residencies
      • Transfers hurt the team and the program
      • Don’t take these lightly
      • PD won’t tell you how much this hurts, but it does
addressing red flags
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 you’ve taken to rectify deficiencies
  • Honest and direct is always best
personal statement
Personal Statement
  • The PD’s 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
personal statement36
Personal Statement
  • The applicant’s opportunity:
    • First, do no harm
    • Explain weirdness
    • Promote yourself as a new team member and employee
competitiveness of programs
Competitiveness of Programs
  • US News report ratings:
competitiveness of programs38
Competitiveness of Programs
  • There are no formal ratings for competitiveness of EM residency programs by any organization.
  • It is all word of mouth.
program quality
Program Quality
  • ACGME reports programs on probation on their website:
    • http://www.acgme.org/adspublic/
  • Ask PD’s about:
    • accreditation status
    • board pass rates
conclusions
Conclusions
  • There are more EM spots available than ever
  • The balance is beginning to favor applicants
  • PD’s make interview offer decisions based on limited information
  • Even now, you do have control over much of your application content
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