Emergency Medicine

What are some important statistics around the specialty? 

Program directors were asked what were the top factors in 1. Offering an interview and 2. Ranking candidates. Results as follows: Interview - 1. Letter of Recommendation / Audition Rotation 2. Step 1/Step 2 scores 3. Red flags (IE failed exam attempts) Ranking - 1. Interpersonal Skills 2. Interactions with faculty/staff 3. Letter of recommendation/audition rotation https://www.emra.org/books/msadvisingguide/apply-smarter-not-harder

What general advice do you have for someone choosing this specialty?

More generally, I received two great pieces of advice I carry with me. Pursue the specialty you 1. Don't mind reading the literature about and 2. Least hate the negative aspects of. For Emergency Medicine, I feel the happiest EM docs I work with enjoy the primary care/urgent care aspects of the job just as much as the critical care aspects. For applications - prioritize your away/audition rotation. Get it scheduled as early as possible and study/prepare as much as you can

What are the top three areas that students can focus on to help prepare themselves for a successful residency application and a successful transition to residency? (i.e. grades/academics, professionalism, any of the categories listed above, etc.)?

1. Prioritize your audition rotation 2. As cliche as it may be - don't neglect your grades. STEP scores and Clerkship evaluations matter 3. Arriving early, eager, and with a positive attitude gets you far both in clerkships/clinicals and in interviews

What resources would you share with a student who is just starting to research their interest in this specialty and/or wants to learn more specifics of this specialty (anything from what a typical day may look like to specifics on rotations, specialty specific residency info, fellowships)?

I always recommend getting into an ED or two and working with an EM physician to get the feel of what the day to day is like is very important - whether that’s shadowing or as a rotation. EMRA also has a great resource for all things EM and EM application related to get you started - https://www.emra.org/books/msadvisingguide/choosing-emergency-medicine

What subspecialties exist with this specialty?

There are a great number of fellowships / subspecialties that range from toxicologic consultants to sports medicine clinicians. Please check out this resource for the exhaustive list: https://www.emra.org/books/fellowship-guide-book/i-title

What does a typical workday or work week look like (hours/schedule/shifts, work setting, team based environment, acuity, etc.)?

I work on average 3-4 shifts a week, ten hour shifts. They are team based environments where I'm constantly communicating/working with APPs, nurses, technicians, respiratory therapists, consultants etc. My shifts range from all critical care patients to all primary/urgent care patient and every combination in between. I don't have call, though I do work weekends/nights/holidays but I can easily get time off and flex my schedule to accommodate for more vacation time.

What are the important traits, qualities, and/or considerations recommended for physicians in this specialty?

The paradoxical combination of having the patience and empathy to care for someone's toe pain after running a long and emotional code while simultaneously being able to think and act quickly, with little to no information. A tolerance for night shifts/switching schedules.

How does the specialty work differ in various settings (e.g. a private vs community vs an academic environment)?

Private/community environments tend to be metric focused and pay better for it. It is generally described as a "grind," is less collegial/conversational as a stereotype but not a rule. Academic environments tend to avoid this almost entirely and nurture more collegiality especially in training, but in exchange you are working with trainees along all aspects of the medical system and things can be slower, and you take a pay cut to do so.

What does training for this specialty look like (how many years, is a separate prelim year needed, etc.)?

3-4 years of residency (this may be changing to be 4 years across the board very soon, in deliberation by the ACGME). Optional fellowship.

What types of experiences might strengthen my future residency application, especially in areas of service, leadership, and research? 

In general, extracurriculars of any type are helpful and flush out your application/interview - (the more you can chat about the better) - but aren't hard requirements. Prioritize your away/audition rotation - it carries a disproportionate amount of weight in EM.

Is there a specialty interest group?  If not, what other networking options would you recommend?  Are there any specific national organizations or committees I should join?

Yes, I am currently the liaison for the Emergency Medicine Special Interest Group at UofA – Phoenix. We work on hosting lunch talks, procedure / simulation days, and other experiences related to emergency medicine. There are also several national groups you can get involved in – the most well-known being Emergency Medicine Residency Association (EMRA). While joining/participating in committees is not a requirement, it can open doors and allow you to meet people in the field who may have an influence in your application process.

What advice would you offer MS1s and MS2s who are interested in this specialty?

Focus on your studies/exams but try to get into an ED as a rotation or to shadow to help make your decision.

How and where can I find other mentors for this specialty?

I am always happy to chat. If you have a specific location you would be interested I always encourage reaching out to the ED director there - especially if they host trainees/students regularly. If you are interested in a subspecialty I would attempt to reach out to physicians in that subspecialty - again I can do my best to help.

Is there anything else in addition to the suggestions above that could aid my future application, now that Step 1 is P/F?

At risk of sounding obvious, do your best to pass Step 1 on your first attempt

Which group and association memberships might strengthen my future residency application (e.g., AOA, GHHS, MSG, Specialty specific groups, etc.)? 

Any would help your application, none are required

How important are Step 2 scores to this specialty?

Scores are very important.

Are publications important to this specialty? Is there a general number of publications or presentations I should be aiming for?  How important is it for these to be within the specialty I am pursuing?

Publications are helpful but not a necessity in EM. Quality is better than quantity here - having a project related to the specialty you can talk about in an interview will outweigh a large number of publications you aren’t as involved in.

Are there any special considerations when applying for residency?

Prioritize Audition Rotations/SLOEs (I cannot emphasize this enough)

What is a general recommendation for how many programs to apply to (recognizing that this may vary based on student situation)?

A general number is 10-12 interviews which is usually obtained by 20-30 applications, but this can vary based on application strength and which programs you are applying to.

What letters of recommendation are recommended for this specialty (e.g. from research, physicians within this specialty, academic, etc.)

Emergency Medicine has a large focus on Standardized Letters of Evaluation – they are one of the most important parts of your application. Historically a “SLOE” only described letters obtained from audition rotations, now referred to as eSLOEs. The Council of Emergency Medicine Residency Directors has updated this to reflect where other letters may come from. Specifically, there are non-residency based SLOEs meant for EM attendings who do not belong to an academic residency program faculty, Sub-specialty SLOEs for rotations in emergency medicine that aren’t an audition rotation (ultrasound, toxicology, etc), and off service SLOEs (oSLOEs) for rotations not in emergency medicine.

Program Directors value these letter types differently. In general eSLOEs with an audition rotation with a known academic emergency medicine program is going to greatly outweigh any other type of SLOE or letter. However, they also consider what program the SLOE comes from, who is writing the SLOE, and what information is provided in the SLOE, as well as other circumstantial information. A subspecialty sloe from a strong program a program director knows may outweigh an audition rotation letter from a lesser known program, for instance.

Therefore, my general recommendation is to prioritize eSLOEs as much as possible. Additional positive letters or types of SLOEs will not hurt your application and are better than no letters.

Generally speaking, you should have at least 1 home rotation eSLOE and 1 away eSLOE. There has been some debate regarding an additional away eSLOE. To ensure all applicants can receive at least 1 away eSLOE, the official recommendation is to limit yourself to one away eSLOE. In my experience at 4 different programs, additional eSLOEs have never been construed as a negative and may help your application if you have an eSLOE that is less than ideal. 

If other disciplines are appropriate for letter of recommendation writers, are there specific specialties you would strongly recommend?

No preference. 

How competitive are the residency programs in this specialty?

Recently this has varied by year and location. EM averages in the moderate competitive range. Plan on popular locations and programs to be fairly competitive

When do programs typically offer interviews?

You will typically hear back about receiving interview invitations in October, no later than early November. Interviews usually occur in November – January (rarely extending into the first weeks of February).

Are away rotations required for this specialty and if so, when should I plan to do them?

Yes - you need a home rotation and an away rotation for SLOEs. An additional away rotation will not hurt your application but is not required. Try to get this done as early in your 4th year as possible.