Assessing Your Competitiveness as an Emergency Medicine Applicant

1. Assessing Your Competitiveness as an Emergency Medicine Applicant Chris A. Ghaemmaghami, MD Director, Emergency Medicine Residency Program University of Virginia

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

4. Overall - Match RatesAll specialties

5. 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%

6. http://www.nrmp.org/data/resultsanddata2008.pdf

7. 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

8. 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

9. http://www.nrmp.org/data/resultsanddata2008.pdf

12. 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

13. What are PD’s looking for?

14. What are PD’s looking for? • Honest • Intelligent • Works well with others • Good communication skills • Hardworking

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. Grades • Clinical > Preclinical • Basic Science failures are a problem • Core clinical rotations carry the most weight • Medicine • Surgery • Pediatrics

22. 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

23. 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

24. Letters of recommendation • The PD’s view • Author reliability • Number of letters written • Accountability/reputation • Amount of exposure to the applicant

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

26. The SLOR

27. The SLOR

28. The SLOR

29. 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?”

30. Self assessment is difficult Take advantage of mentors to give you honest assessments

32. 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

33. 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

34. 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

35. 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

36. Personal Statement • The applicant’s opportunity: • First, do no harm • Explain weirdness • Promote yourself as a new team member and employee

37. Competitiveness of Programs • US News report ratings:

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

39. Program Quality • ACGME reports programs on probation on their website: • http://www.acgme.org/adspublic/ • Ask PD’s about: • accreditation status • board pass rates

40. 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

42. cg3n@virginia.edu