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.

How to rock your ER rotation

Hello M4’s, at this point in the year, most of you are taking away “audition” rotations. The goal here is to make a good impression, such that when your application comes across the residency selection committee’s desk, they remember you fondly.

You want to do well here. So how can you do that?

  • Be professional: don’t be late, be respectful. There’s a lot of emphasis on punctuality in EM – the last thing you want to do after a tiring shift is have your replacement show up late. So, show up 10 minutes early and get the lay of the land.
  • Respect the nurses: not only have they been doing this longer than you, they know more than you. Get them on your side. I suggest you take the time to learn their names… and use their names. Keep them informed of the plan. Help them out. If a patient needs a pillow, you get it. Put a patient on a bed pan.
  • Respect the patients: same applies here. Ask their names (Mr. and Mrs. So-and-so unless they insist you use their first names) and give them yours. And most importantly keep them informed of what’s going on. Rather than getting the patient on your side, you want to get on the side of the patients.
  • Ask questions: Don’t make up questions to seem inquisitive. Instead, make an effort to find out the answer first. With Up-To-Date, Smart Phone apps, websites (CDEM) you have a lot of information at your fingertips already. If you still can’t find the answer, now ask intelligent, informed questions.
  • Make decisions: this is the time where you get to flex your decision making muscles. So don’t wait for the attending to spoon feed you the plan – get all your information, take some time to synthesize it, and then make an educated guess at a plan. You’re not going to be right every time, but it’s better to commit yourself to creating a plan and show you’ve put some thought into this than to passively accept what’s given to you.
  • Have a DDx: have this ready before you present to the resident or attending. You don’t want to be stumbling guessing when asked “what could kill this patient presenting with X?” Think this out ahead of time.
  • Do the stuff you’re supposed to do: finish your charts, complete any shift cards, go to all lectures, complete all assignments, and look up whatever anyone asks you to look up. Check on all results. Don’t leave stuff half done so you can leave your shift the minute it ends. Most of your attendings and residents will be staying late to get their work done… if they are, if you have stuff left undone, maybe you should, too. Along these lines, don’t pick up a complicated patient 10 minutes before you’re supposed to leave – you won’t be able to finish. You’ll be there for hours.
  • Set expectations early: if you’re going to be asking an attending for a letter of recommendation, ask them at the beginning of the shift. “Dr. X, I’d like to get a great letter of recommendation from my time here. I was hoping you could help me excel here. I’m open to any feedback, positive or constructive.” Now Dr. X will be paying attention to you, and looking for ways to help you. If you want till the end, Dr. X likely won’t have paid 2ยข of thought to you and will make up generic advice in the heat of the moment. If you want to learn something, bring that up at the beginning of the shift. “Dr. Y, I’ve been having trouble presenting concisely. I’d like to work on that today. I’d appreciate any feedback that can help me do that.
  • Enjoy it: I know I made it sound pretty tough, but if you are considering this as a career, it should also be fun. It is fun! Sure there will be good days and bad days, but on average you should be enjoying yourself.

I’ll add more here if I think of it.

Is Emergency Medicine right for me?

I always found this to be a very difficult question. It’s just like having to guess if being a physician is right for you. There’s really no way to know until you’re already a doctor, living the doctor’s life. And by this point… it’s too late! You can never really know until you’re living the EM life, but you stil have to make the choice. So…
Continue reading “Is Emergency Medicine right for me?”