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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 l.jpg

Assessing Your Competitiveness as an Emergency Medicine Applicant

Chris A. Ghaemmaghami, MD

Director, Emergency Medicine Residency Program

University of Virginia


Introduction l.jpg
Introduction Applicant

  • Competitiveness of EM in general

  • How program directors evaluate applications

  • Specific elements of your application


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Overall - Match Rates ApplicantAll specialties


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Who matched in EM 2008? Applicant

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%



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The most competitive Applicant

  • 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 Applicant

  • 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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Growth of EM slots Applicant

  • 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 PD’s looking for? Applicant

  • Honest

  • Intelligent

  • Works well with others

  • Good communication skills

  • Hardworking


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How will PD know if you have these qualities? Applicant

  • What is the data to prescreen for interviews offers?

    • Grades

    • Board Scores

    • Letters of recommendation

    • Dean’s 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; 7:54-60


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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; 7:54-60


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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


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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; 7:54-60


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How will PD know if you have these qualities? Applicants

  • 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 l.jpg
Grades Applicants

  • Clinical > Preclinical

  • Basic Science failures are a problem

  • Core clinical rotations carry the most weight

    • Medicine

    • Surgery

    • Pediatrics


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USMLE Scores Applicants

  • 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 Applicants

  • 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 Applicants

  • The PD’s view

    • Author reliability

      • Number of letters written

      • Accountability/reputation

    • Amount of exposure to the applicant


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The SLOR Applicants

  • The Standardized Letter of Recommendation

  • Developed by CORD-EM

  • Unique to EM

  • Very streamlined


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The SLOR Applicants


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The SLOR Applicants


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The SLOR Applicants


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Letters of Recommendations Applicants

  • 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 Applicants

Take advantage of mentors to give you honest assessments


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Recognizing Red Flags Applicants

  • 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


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Nontraditional situations Applicants

  • 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


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Addressing Red Flags Applicants

  • 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


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Personal Statement Applicants

  • 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


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Personal Statement Applicants

  • The applicant’s opportunity:

    • First, do no harm

    • Explain weirdness

    • Promote yourself as a new team member and employee


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Competitiveness of Programs Applicants

  • US News report ratings:


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Competitiveness of Programs Applicants

  • 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 Applicants

  • ACGME reports programs on probation on their website:

    • http://www.acgme.org/adspublic/

  • Ask PD’s about:

    • accreditation status

    • board pass rates


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Conclusions Applicants

  • 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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