How competitive am I for an EM match?

Emergency Medicine is one of 8 specialities that had 100% fill in the 2012 match. Of the 1,668 positions available, all of them filled. This means you couldn’t scramble into a position if you didn’t match. This doesn’t mean it’s impossible to get a position in an EM residency, but you got to play it smart. Let’s look at the numbers.

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Of US Seniors ranking only Emergency Medicine in their rank list, 5% didn’t match. Of those that had a backup specialty, 12.6% didn’t match.

Summary statistics

summary_statisticsThis table summarizes a lot of the data we are about to look at. The average Step I score for someone matching in EM is 223. For step II it is 234. The average number of programs someone ranked is 10.8.

How many places should I rank?

continguous_ranks_2The way to look at this chart is the bottom shows how many places a student ranked, the blue line represents US Seniors (ignore the green one). The more places you rank, the more likely you are to match (obviously) People ranking 16 or more programs all matched.

How good do my Step I scores have to be?

usmle_step_1This graph shows probability of matching against USMLE Step I scores. So you can see, that even with a score of 200, you have an 80% chance of matching SOMEWHERE. Maybe not where you want, but somewhere.

How good do my Step II scores have to be?

usmle_step_2For Step II, they don’t have a similar probability graph but a chart. Still you can see the same information here. If your Step II score is between 181-190, you have more of a chance of not matching than matching. Between 191-200, you have a 66% chance of matching. Obviously the higher your score, the more likely you will match.

If you want the full data, you can look at the Emergency Medicine relevant data at this link.

What do residency directors look for in their applicants?

Hello prospective Emergency Physicians. Dr. Casey and I have created this note to help maneuver through some of the documents that the NRMP (National Residency Matching Program) put out, specifically in regards to matching in Emergency Medicine. Our hope is that this can answer some of your questions before we meet, so we can spend our time together answering questions pertinent to your specific situation. In this first post, we’ll look at the Results of the NRMP Program Directors Survey 2012.

The way I would interpret this data is to understand what program directors are thinking. You can adjust your approach accordingly. If they don’t value your personal statement so much, now you have permission not to obsess about it. Focus on what does matter.

What do program directors look at to grant interviews?

looking_for_in_interviewees_1looking_for_in_interviees_2The first two charts (you’ll have to click on them to see bigger versions) reflect what program directors think are important in deciding whether to grant an interview. By far the thing most PD’s (program directors) value are letters of recommendation from someone in Emergency Medicine. Also important are your clerkship grades, your EM grade (especially if that’s an honors) and an audition elective. It’s also important to note what’s not as highly valued: second languages, post-interview contact and membership in the Gold Society (hmm, what does that say about our humanism?).

What goes into ranking applicants?

factors_in_ranking_em_applicantsIn determining who to put at the top of their rank lists, an audition rotation at that institution has the greatest weight. Similarly, an away rotation at another institution is also prized. A second-visit after the interview, your personal statement, interest in an academic career and the Humanism society (man, we’re heartless) are at the bottom of the list.

How important are board scores?

step_one_scoresstep_two_scoresI don’t think it’s a surprise that board scores are important. All places require a Step I score and most require Step II. If you fail either of these tests on the first pass, a large number of these programs will not consider you (or only rarely do so). The other way to spin this is that there are a few programs that will.

What board score do I need?

step_scores_and_interviewsThese next two charts show two important pieces of data. At what score will I not get an interview and at what score am I almost guaranteed an interview. The box plots represent interquartile ranges, meaning the top line is the 75th percentile and the bottom line is the 25th percentile. So for Step I, with a score of around 200, seventy-five percent of the program may not consider you for an interview. If you rock a 250 on Step II, 75% of programs would very likely give you an interview.

How many interviews do they grant?

applicants_interviewedOn average, a program will get 719 applicants, interview 132 of them, rank 117 and match only 11. This corresponds to 39% of applicants being rejected for an interview and 57% being granted an interview.

So take this for what it’s worth. It’s at least a starting point for discussion. Feel free to ask any questions or contact me or Dr. Casey. Here’s a PDF of these charts if you’d like.

Radiolab: End of Life Care

radiolab_logoThere was an amazing piece on the Radiolab podcast this week (Jan 15, 2013) on perceptions of end-of-life care. This is an issue that we face in the Emergency Department as we see many patients who present in their last minutes. This may be an acute exacerbation of a chronically ill person or an acutely injured patient.

Our instinct and training is to “do something,” so it is hard to sit on the sidelines and do nothing. Sometimes the family or patient can give us an indication of what their wishes are. Sometimes we are faced with the decision of discontinuing a resuscitation which may be pointless.

Listen to the podcast and feel free to comment below. There are no right or wrong answers, just a discussion. Let me know what you feel about it.;containerClass=radiolab

Article: End of Life Issues in the Acute and Critically Ill Patient
Blog post from doctor mentioned in podcast: How doctors die

What is your learning style?

In medicine, we are presented with information to learn in many different ways.

  • Reams of journal articles and text book chapters
  • Flowcharts and anatomical atlases (atli?)
  • Managing a complicated patient on the first day of your rotation
  • Paper cases allowing you time to reflect and digest information

Regardless of how you learn best, you’re going to get information in ways that work for you and many ways that don’t. You’re going to need to adapt. It pays to know how you learn so you can engage in strategies that help you deal with situations that don’t match your style.

There’s a great 40-question test by Felder and Silverman to determine one’s learning styles. Here are my results after taking the test. Apparently, I’m quite unbalanced.

Results for: Rahul Patwari
ACTIVE     11  9  7  5  3  1  1  3  5 [7] 9  11 REFLECTIVE
SENSING    11  9  7  5  3  1  1 [3] 5  7  9  11 INTUITIVE
VISUAL     11 [9] 7  5  3  1  1  3  5  7  9  11 VERBAL
SEQUENTIAL 11  9  7 [5] 3  1  1  3  5  7  9  11 GLOBAL

I like to sit back and think about things, then make colorful diagrams, sketching out connections and sequential steps. Apparently I can’t learn by listening (my mom could have told you that). Yet there are tactics I can use to learn well in a lecture.

I recommend taking the 5 minutes to figure out your learning style then look here to see how to adapt to other styles. What styles are you? How have you adapted to succeed in medicine? Put your comments below.

Index of Learning Styles

Felder and Silverman came up with a test to determine one’s learning styles. Here are my results after taking the test. Apparently, I’m quite unbalanced.

Results for: Rahul Patwari
ACT 11 9 7 5 3 1 1 3 5 [7] 9 11 REF
SEN 11 9 7 5 3 1 1 [3] 5 7 9 11 INT
VIS 11 [9] 7 5 3 1 1 3 5 7 9 11 VRB
SEQ 11 9 7 [5] 3 1 1 3 5 7 9 11 GLO
  • If your score on a scale is 1-3, you are fairly well balanced on the two dimensions of that scale.
  • If your score on a scale is 5-7, you have a moderate preference for one dimension of the scale and will learn more easily in a teaching environment which favors that dimension.
  • If your score on a scale is 9-11, you have a very strong preference for one dimension of the scale. You may have real difficulty learning in an environment which does not support that preference.

Here are descriptions of what these mean and how to best improve your learning based on your type.

Active learners should look for opportunities to use what they have learned, even if that means just explaining it to other students. Reflective learners need time to study the material by themselves.

Sensing learners like to see how information connects to the real world, so they should look for examples of the information being used, such as case presentations. Intuitive learners look for connections and relationships between ideas. Make these connections obvious to students.

Visual learners obviously like to see diagrams and charts. Concept maps and color coding work well. Verbal learners like to hear the material to understand it.

Sequential learners like material that is laid out in steps whereas global learners need to see the big picture first.

Is it possible to design instruction that caters to all of these? My videos should be a good mix of both. So you should be able to just listen to the video and get the gist of the information. Would that even be effective? Another good study idea, first need to design it though.

Ask students to make predictions

how_learning_worksA student’s previous knowledge helps them establish new learning. By creating connections to this old material, they are able to build off it and solidify the new content in their minds.

While teaching in the emergency department, this can be done by asking them to use their prior knowledge to make a prediction. They then test this prediction by seeing if it comes true or not. Whether they predicted correctly or not, it can be used as a teaching point later.

  • “Do you think this patient will be admitted or discharged? Why? Let’s see what happens and talk about it later.”
  • “Do you think this troponin on will be positive or negative? Let’s see and talk about use of troponins when it comes back.”

Try it out during a shift and let me know how it worked.

Post Intubation Checklist

Quick Checklist

  • Analgesia & Sedation
  • Secure the tube well (use a commercial device)
  • Raise head of bed to 30-45°
  • Confirm Lung Protective Vent Settings
  • Humidify the air (Heat Moisture Exchanger)
  • Place Inline Suction (q1h or more)
  • End Tidal CO2 Monitor (Pt -> suction -> humidifer -> ETCO2 -> vent)
  • Check cuff pressure (20-30 mmH20, use a cuffalator, ask resp Tx)
  • Gastric Tube (NG/OG)
  • Nebulizers (if any h/o asthma)
  • Get an ABG (VBG? only if sat = 90-95% or FiO2 = 30%)
  • Check tube depth (CXR)
  • Put a BVM at the Bedside ± PEEP Valve
  • Run to bed if Vent Alarms

Continue reading “Post Intubation Checklist”