[2019-2020] Emergency Medicine Application Thread

[manyleavesonetree]

Not sure they were destroyed in their SLOEs but more than likely got a low 1/3 in at least one of them that shied many places away.

But yeah, its almost certainly the sloes. Its always the sloes.

Have you ever interviewed such candidates and let them know somehow that they have a not so great SLOE in their application? If we are getting ghosted by programs because of a likely unimpressive/bad SLOE but still have gotten some interviews, I would just appreciate it if someone along the way made some mention of it.

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[gamerEMdoc]

Have you ever interviewed such candidates and let them know somehow that they have a not so great SLOE in their application? If we are getting ghosted by programs because of a likely unimpressive/bad SLOE but still have gotten some interviews, I would just appreciate it if someone along the way made some mention of it.

I usually dont discuss the SLOEs in the interview. First candidates waived the right to see them. Second, Im interviewing someone, its not the time or the place to be their advisor. I have 20 minutes to get their insight into EM, get to know them as a person, and potential colleague.

This is more the role of a good advisor not during the interview. Ill review sloes of people that are rotating with me in app season and give them some feedback of how competitive they are if they ask. I still dont disclose the exact content of the sloes, but I can give them a better idea of how competitive they are as a candidate.

 

[burner29380]

@gamerEMdoc what are your opinions about how there seem to be many applicants holding onto 20-30+ interviews, many on overlapping days, and are just hoarding them? Are there any discussion with the greater CORD community at large regarding this?

I know as an applicant who hasn't been deemed terrible enough to be rejected but isn't awesome enough for an initial invite (one malignant sloe) hearing about this hoarding irks the crud out of me. Many have conjectured more spots will be in the SOAP, but I feel like holding onto an invite to a place you're ranking at greater than 12 where you would never want to go to is just rude to the programs and to your fellow (hopefully) future colleagues. I also understand the neuroticism. I know my med school class in general has been labeled one of the more neurotic classes by our admin. I can extrapolate that to the greater general applicant community and can see where it isn't too surprising.

I know I am on a burner account here as I have been ID'd by some of my classmates on my real one. I can say you have helped me immensely, and I hope to be able to call you a fellow EM colleague come March 20.

 

[Listen2Savage]

this seems like people hyperventilating over anecdotes.

I would be willing to bet this is brought up every year and complained about.

What has changed in the last year that has made people hoard interviews?

Not sure if anyone can point to an answer.

Feels like people reaching due to low IV invites, maybe you're just a non competitive applicant? Has nothing to do with other people?

 

[gamerEMdoc]

I also think that there is this expectation that you must get 12 interviews and that most people that match get at least 12. Tons of people that match go on 10 or less interviews. But the anxiety you see of “not being at 12 yet” is really excessive in my opinion, but I understand where it comes from. Everyone wants a guarantee.

But to the original question, I think interview hoarding is absurd. I wouldnt waste my time interviewing at any place over 10 that I wasnt seriously considering tbh. If you have 15 and you seriously are considering all 15, then sure go on all of them. But hoarding places you dont even intend to actually consider once you have 10-12 interviews is selfish IMO.

 

[burner29380]

this seems like people hyperventilating over anecdotes.

I would be willing to bet this is brought up every year and complained about.

What has changed in the last year that has made people hoard interviews?

Not sure if anyone can point to an answer.

Feels like people reaching due to low IV invites, maybe you're just a non competitive applicant? Has nothing to do with other people?

I know for me personally, I had one malignant SLOE and looking back on it, some of the more chill residents said some stuff that I should have questioned more. One resident said that no matter what he would give a good eval because he is tired of this sloe tanking apps. Program leadership even said they didn't expect most of us to rank them. Bad feelings. Interview day there was weird. Am I bitter because outside of that SLOE I was an extremely competitive applicant? Heck yes. Shotgunned 25 more apps without that SLOE and had 2 invites and a waitlist the following Monday. Legit had an advisor tell me "What the actual f**k?" when I told him what was happening. Other advisor told me this should not have happened to me. According to the EMRA guide, I should be competitive. I followed their advice and found out too late it shouldn't apply to me.

Then I have been talking to people on rotations and have heard of many admitting to holding onto 20-30 invites and just not deciding. Some have admitted to not intending on ranking programs but they weren't ready to drop them just yet. Other friends said they have heard similar from multiple people on rotations. I get it. It must be great to feel wanted. I have talked to a few people at the interviews I have attended and they are also sitting on less than 7 interviews and are just like "What is happening?" It is very frustrating when 3 years of hard work in medical school plus hard work when I had a life before medical school have been reduced to 5 invites, 1 waitlist, and a whole lot of silence. I am hopeful I will match at my favorite rotation as I will be ranking them number 1. I just hope they liked me as much as some of the residents said they did.

 

[Listen2Savage]

I know for me personally, I had one malignant SLOE and looking back on it, some of the more chill residents said some stuff that I should have questioned more. One resident said that no matter what he would give a good eval because he is tired of this sloe tanking apps. Program leadership even said they didn't expect most of us to rank them. Bad feelings. Interview day there was weird. Am I bitter because outside of that SLOE I was an extremely competitive applicant? Heck yes. Shotgunned 25 more apps without that SLOE and had 2 invites and a waitlist the following Monday. Legit had an advisor tell me "What the actual f**k?" when I told him what was happening. Other advisor told me this should not have happened to me. According to the EMRA guide, I should be competitive. I followed their advice and found out too late it shouldn't apply to me.

Then I have been talking to people on rotations and have heard of many admitting to holding onto 20-30 invites and just not deciding. Some have admitted to not intending on ranking programs but they weren't ready to drop them just yet. Other friends said they have heard similar from multiple people on rotations. I get it. It must be great to feel wanted. I have talked to a few people at the interviews I have attended and they are also sitting on less than 7 interviews and are just like "What is happening?" It is very frustrating when 3 years of hard work in medical school plus hard work when I had a life before medical school have been reduced to 5 invites, 1 waitlist, and a whole lot of silence. I am hopeful I will match at my favorite rotation as I will be ranking them number 1. I just hope they liked me as much as some of the residents said they did.

I hear you man it sucks

I had a program lose my SLOE eval forms then refuse to write it for me, then not offer me an IV

Apparently this programs screwed over other students too in the same way, been meeting them during IVs lol

Explaining why I don't have a SLOE to a person interviewing me is super annoying

You would think people that are accepting money to train students would have some shred of professionalism.

But yeah I'm just not buying the 1%er argument about people hoarding IVs

 

[burner29380]

I hear you man it sucks

I had a program lose my SLOE eval forms then refuse to write it for me, then not offer me an IV

Apparently this programs screwed over other students too in the same way, been meeting them during IVs lol

Explaining why I don't have a SLOE to a person interviewing me is super annoying

You would think people that are accepting money to train students would have some shred of professionalism.

But yeah I'm just not buying the 1%er argument about people hoarding IVs

Will you be name and shaming them come March? I think that program should be called out. I am ready to go with mine. Haha

 

[Listen2Savage]

Will you be name and shaming them come March? I think that program should be called out. I am ready to go with mine. Haha

definitely

after the match lol

 

[gamerEMdoc]

Will you be name and shaming them come March? I think that program should be called out. I am ready to go with mine. Haha

While I think its fair for programs to give low 1/3 sloes when justified, but some of the stuff people mention on here really surprises me. I just cant believe some of these programs keep getting people applying to rotate/interview there. I think its more than appropriate to warn people if a places process for handling rotations, sloes, interviews, etc was clearly unprofessional.

 

[Listen2Savage]

While I think its fair for programs to give low 1/3 sloes when justified, but some of the stuff people mention on here really surprises me. I just cant believe some of these programs keep getting people applying to rotate/interview there. I think its more than appropriate to warn people if a places process for handling rotations, sloes, interviews, etc was clearly unprofessional.

my school only has affiliation with 3 EM programs that write SLOEs

As an IMG i'm persona non grata when it comes to VSAS

 

[gamerEMdoc]

my school only has affiliation with 3 EM programs that write SLOEs

As an IMG i'm persona non grata when it comes to VSAS

Well yeah, thats a bit harder of a situation.

 

[ED_hopeful]

As a DO with a large number of interviews at University programs, is the “12 is enough” phrase still true as compared to MD candidates? I will not interview at more than 15, and I have been given the opportunity to interview at all programs that I would love to train at. I just don’t know if there is still a need to fear not matching because of DO status at a big program despite very competitive scores.

 

[Sterling_Archer]

Anyone else being asked where else they've interviewed at or where they are interviewing next? I've been asked at almost every interview and I don't really know how to answer. I don't particularly care if they know, but I'm wondering if this is just conversation fodder or if there is something more to it.

 

[Sterling_Archer]

As a DO with a large number of interviews at University programs, is the “12 is enough” phrase still true as compared to MD candidates? I will not interview at more than 15, and I have been given the opportunity to interview at all programs that I would love to train at. I just don’t know if there is still a need to fear not matching because of DO status at a big program despite very competitive scores.

According to the Interactive Charting Outcomes, both US MD and DO seniors have a 99% chance of matching with 11-15 contiguous ranks.

Charting Outcomes™: Characteristics of Applicants who Match to Their Preferred Specialty

Interactive Charting Outcomes in the Match has been built using data visualization software and draws from the same data sources as the NRMP’s publication Charting Outcomes in the Match.

www.nrmp.org

 

[Torsion]

Anyone else being asked where else they've interviewed at or where they are interviewing next? I've been asked at almost every interview and I don't really know how to answer. I don't particularly care if they know, but I'm wondering if this is just conversation fodder or if there is something more to it.

My understanding is that this is actually an illegal question to ask. I'd also like advice on how to handle this. I've had this happen a few times and just gave the answer.

 

[notANOTHERPREMED!]

If a candidate had one bad sloe which tanked them.. would they still be getting interviews at all? i'm at 6 interviews (3 from AI). Can I at least assume that the first SLOE isn't completely horrible and that i still have hope for 3-4 more in end of Nov. or Dec.?

Also, hypothetically if the first rotation a student gets a bottom 3rd but then rotates at your institution and gets a top 10% and honors the course. Would you look past the first horrible SLOE? Thanks!!

 

[southerndoc]

I find it very hard to believe you're getting any type of accurate representation of number of procedures done. This question was almost always asked by someone at all my interviews and unanimously programs said "Oh we get tons", "you'll get your numbers really early", "interns are already checked off", etc. The reality is the RRC procedure requriement is ridiculously low and nearly every program will get several times the needed amount. It can even hugely vary between residents within the same program. You don't pick what comes into the emergency department. Also, for me, I could do two months extra of critical care if I wanted to at my program, which would add ton of CVLs and tubes, etc. I disagree with Gamer on this. I don't think you should put much weight on how many "reported" procedures a program has. You also don't even know what it means. What is a lot to you? What if a resident tells you he "only" has 32 LPs? What about at the other program where one had 64?

Most of our interns have >50 intubations already (including OR time). We are a very high acuity busy ER (150,000/year) who do a ton of procedures. No subspecialists to come reduce your ankle fracture (it's all you), you do the PTA's, you do the lines, etc. I'm sure we aren't the only procedure heavy program.

 

[gamerEMdoc]

As a DO with a large number of interviews at University programs, is the “12 is enough” phrase still true as compared to MD candidates? I will not interview at more than 15, and I have been given the opportunity to interview at all programs that I would love to train at. I just don’t know if there is still a need to fear not matching because of DO status at a big program despite very competitive scores.

12 is enough, but you have the right to go on as many as you want. If you are truly interested in 15 and undecided, you earned the right to go on 15.

 

[gamerEMdoc]

Anyone else being asked where else they've interviewed at or where they are interviewing next? I've been asked at almost every interview and I don't really know how to answer. I don't particularly care if they know, but I'm wondering if this is just conversation fodder or if there is something more to it.

Yeah thats an match violation question. I think its ok to ask where are you rotating now, or where did you do your EM rotations, but specifically asking what programs an applicant applied to or interviewed at is an explicit match violation.

 

[gamerEMdoc]

If a candidate had one bad sloe which tanked them.. would they still be getting interviews at all? i'm at 6 interviews (3 from AI). Can I at least assume that the first SLOE isn't completely horrible and that i still have hope for 3-4 more in end of Nov. or Dec.?

Also, hypothetically if the first rotation a student gets a bottom 3rd but then rotates at your institution and gets a top 10% and honors the course. Would you look past the first horrible SLOE? Thanks!!

Absolutely. Ultimately Im always going to trust my own gut over someone elses. We dont give out many top 10 sloes, so if someone gets one, they pretty much impressed everyone they worked with across the board.

 

[Rekt]

Most of our interns have >50 intubations already (including OR time). We are a very high acuity busy ER (150,000/year) who do a ton of procedures. No subspecialists to come reduce your ankle fracture (it's all you), you do the PTA's, you do the lines, etc. I'm sure we aren't the only procedure heavy program.

Word on the trail when questions about trauma role and trauma procedures come up at your shop and things get a little quiet . No need to always try and sell your program. You'll always have people to fill seats. I just hit ~40s last week and don't think it's a big deal. Monkeys can do procedures aka mid-levels. It's more important to know when it's appropriate or not. Dumping someone on a vent or tossing in a CVL isn't a benign process.

 

[ED_hopeful]

12 is enough, but you have the right to go on as many as you want. If you are truly interested in 15 and undecided, you earned the right to go on 15.

Thank you so much! All the advice you give is very much appreciated. This process is terrifying to say the least.

 

[notANOTHERPREMED!]

Absolutely. Ultimately Im always going to trust my own gut over someone elses. We dont give out many top 10 sloes, so if someone gets one, they pretty much impressed everyone they worked with across the board.

Given that some people might get unlucky with SLOES, wouldn't it be in everyone's best interest to do 3-4 auditions instead of 1-2? I know most AOA programs don't even use standardized forms to evaluate each shift. My first one (AOA) was based on verbal feedback and I definitely feel like I was not given a fair chance. To know that 3 years of hard work has gone down to one SLOE is heart breaking.

 

[attitudeofgratitude]

I mean… students can game the system to some extent now right? If you do a home and 2-3 aways and have an advisor who’s willing to tell you what your SLOEs say… you can choose which ones you send out. Also you could just do 4 rotations , apply to a bunch of programs and send two to each and odds are you’d make out pretty well. But you’d need the money to do four aways and send out 100+ apps.


I think a lot of people in this thread are hurt by bad surprise SLOEs. And I don’t just mean professionally. Reading this thread there are many people who only got positive feed backand now aren’t getting interviews, I'm sure it's hard not to take that personally. The truth is I don’t know how to fix it, but given what I’ve read in this thread I think I might tell the MS3s interested in EM why I support the four rotation strategy.

Yes and these concerns are known by CORD. Its just that no one wants to unblind LORs, bc thats why grades at many places arent trustworthy in the first place. If you unblind sloes, the places that give 90% Honors bc they are afraid to give negative feedback will suddenly give 90% top 10% sloes. Then Sloes become as meaningless as general LORs that just all say everyone is the greatest candidate ever. Then letters dont matter.

Not only that, but even if places are honest and give a good distribution, students would be able to manipulate the system and only submit the SLOEs that are positive.

I dont have an answer, but I dont believe unblinding SLOEs is the answer.

And even if it was, and there was some middle ground, it would take integration with eras. You’d have to require any sloe written to be submitted no matter what. And how would that work for people applying to two specialties?

I honestly cant think of a great way to do this. Im aware the blinded nature means over application. I just dont know how unblinding it doesnt just completely devalue the clinical evaluations to the point we’ll just do what every other field does and just base rank of board scores (which is a terrible idea imo).

 

[gamerEMdoc]

I mean… students can game the system to some extent now right? If you do a home and 2-3 aways and have an advisor who’s willing to tell you what your SLOEs say… you can choose which ones you send out. Also you could just do 4 rotations , apply to a bunch of programs and send two to each and odds are you’d make out pretty well. But you’d need the money to do four aways and send out 100+ apps.


I think a lot of people in this thread are hurt by bad surprise SLOEs. And I don’t just mean professionally. Reading this thread there are many people who only got positive feed backand now aren’t getting interviews, I'm sure it's hard not to take that personally. The truth is I don’t know how to fix it, but given what I’ve read in this thread I think I might tell the MS3s interested in EM why I support the four rotation strategy.

I definitely get the concern but I think those that get a surprise sloe they never saw coming that really hurts them are a small minority of candidates.

As for not submitting SLOEs, most people submit all the SLOEs they get now. Few withhold them. If students suddenly knew exactly what each sloe said, they would all do more rotations, get 5 sloes, and submit the best 2-3. No one would submit a bad SLOE.

 

[gamerEMdoc]

Given that some people might get unlucky with SLOES, wouldn't it be in everyone's best interest to do 3-4 auditions instead of 1-2? I know most AOA programs don't even use standardized forms to evaluate each shift. My first one (AOA) was based on verbal feedback and I definitely feel like I was not given a fair chance. To know that 3 years of hard work has gone down to one SLOE is heart breaking.

Well there are no AOA programs now, they are all ACGME, so Im not sure if you mean former AOA. Some of the former AOA programs STILL aren't writing SLOEs which is incredible. I have a handful of students every year in an interview that I ask if they are getting a second sloe and they tell me they got one from some program, then I have to tell them the program submitted a generic LOR, not a SLOE. Its a shame, I wish these programs would at least be honest and tell students up front “we don't write sloes”.

As for rotation number, I think many candidates are already doing 3 rotations at a minimum. Certainly most DOs are. I mean I see students doing 5-7 every year. I think its insane and have no clue how their schools let that happen. I see little benefit of doing more than 3 (other than securing interviews).

 

[southerndoc]

Word on the trail when questions about trauma role and trauma procedures come up at your shop and things get a little quiet . No need to always try and sell your program. You'll always have people to fill seats. I just hit ~40s last week and don't think it's a big deal. Monkeys can do procedures aka mid-levels. It's more important to know when it's appropriate or not. Dumping someone on a vent or tossing in a CVL isn't a benign process.

Not sure why it gets quiet. Trauma is unopposed at my shop. We do not have surgery residents. The EM residents intubate the traumas and run them.

Will always try to sell our program because I'm proud of it. Don't need to though. We receive a ton of applications every year and don't go far down our rank list to match.

 

[Torsion]

I'm sure this has probably been mentioned but didn't turn up much when trying to search: what is the prevailing viewpoint on writing thank you notes? A class mate of mine just mentioned a document that was emailed to the entire class that stated that an applicant should write thank you notes, preferably hand-written notes, to every interviewer at every school they interviewed at. I found this sounded extremely excessive and time consuming. I can see value in following up via email with particular interviewers that you had a good conversation with at programs that are at the top of your list to express interest and thank them for their time, but I don't know where I'd find the time during this busy interview season to hand write and mail ~5 notes per interview and I don't know how the faculty would have time to read all of that.

 

[WildcatS11]

I'm sure this has probably been mentioned but didn't turn up much when trying to search: what is the prevailing viewpoint on writing thank you notes? A class mate of mine just mentioned a document that was emailed to the entire class that stated that an applicant should write thank you notes, preferably hand-written notes, to every interviewer at every school they interviewed at. I found this sounded extremely excessive and time consuming. I can see value in following up via email with particular interviewers that you had a good conversation with at programs that are at the top of your list to express interest and thank them for their time, but I don't know where I'd find the time during this busy interview season to hand write and mail ~5 notes per interview and I don't know how the faculty would have time to read all of that.

Whether you write thank you notes or not, totally up to you, and definitely not necessary. Nobody is “keeping notes” on who writes thank you notes. I personally would rather you be polite to everyone you meet at interview day, including the admin assistants and coordinators.

If you feel you want to write thank you notes - email is totally fine (and for the majority of faculty I have to assume) much preferred.

 

[gamerEMdoc]

Whether you write thank you notes or not, totally up to you, and definitely not necessary. Nobody is “keeping notes” on who writes thank you notes. I personally would rather you be polite to everyone you meet at interview day, including the admin assistants and coordinators.

If you feel you want to write thank you notes - email is totally fine (and for the majority of faculty I have to assume) much preferred.

100% this. Thank you notes are nice, but they won't increase your match chances, or hurt you if you don't send them. Personally, I prefer email.

 

[southerndoc]

I've never heard anything mentioned at a rank list meeting about who did or didn't write a thank you note.

If someone emails one to me, I will usually send a standard reply thanking them for interviewing. If they hand write one, I read it, but don't reply.

 

[PersistentDoc21]

I Finally just got my third sloe uploaded and I am wondering if to assign them to programs at this point or if it is too late. I have some interviews but not as much as I hoped

 

[gamerEMdoc]

Unless you thought it was a terrible SLOE, I don't know why you wouldn't add it. May not help a ton, but at the programs you still have interviews with, another positive SLOE will only help you.

 

[Emhopeful_123]

I know it was said that residency SLOES are much better than non-residency SLOES, but I only have one more spot to upload a SLOE. I have one from a non-residency program that is extremely positive, but then another from a residency program, but it as submitted months late and have no idea regarding its contents but received a decent grade on the rotation. Should I still chose to upload the uncertain residency SLOE instead? Thank you for all of your help!

 

[gamerEMdoc]

I know it was said that residency SLOES are much better than non-residency SLOES, but I only have one more spot to upload a SLOE. I have one from a non-residency program that is extremely positive, but then another from a residency program, but it as submitted months late and have no idea regarding its contents but received a decent grade on the rotation. Should I still chose to upload the uncertain residency SLOE instead? Thank you for all of your help!

Residency SLOE, all the way.

 

[Phoebe Buffet]

@gamerEMdoc how much can a top 1/3/middle 1/3 rating from an EM sub-I affect your interview chances? I didn’t know combos of the top/middle/bottom ranking were allowed.

 

[gamerEMdoc]

@gamerEMdoc how much can a top 1/3/middle 1/3 rating from an EM sub-I affect your interview chances? I didn’t know combos of the top/middle/bottom ranking were allowed.

So its not a mixed ranking, its that there are two separate questions that ask you to rank:

Compared to other EM residency candidates you have recommended in the last academic year, this candidate is in the (this is the question that shows previous years statistics of what you percent you gave each category):
Top 10%
Top 1/3
Mid 1/3
Low 1/3


How highly would you estimate the candidate will reside on your rank list?
Top 10%
Top 1/3
Mid 1/3
Low 1/3
Do not intend to rank

So while these questions are kind of similar, and often the two categories are in agreement, you can imagine why sometimes the answer would be different. Let say one year you have a typically very competitive group of students, better than the previous year. Everyone is great this year. So maybe an individual is great compared to the year previous, and so they are Top 1/3, but on the rank list they are mid 1/3 because this years group was so competitive.

Or another scenario. Lets say every year the students you get are SUPER competitive and great candidates. And your rank list is biased because you take the people that rotate and do well and weigh that heavily on your list. And someone rotates and is excellent, but everyone is excellent. So maybe they are middle 1/3 in terms of rotators, but will be in the top 1/3 of your rank list.

Or another one. Lets say an IMG student rotates at a place that just doesn't rank IMGs. Does well, and is a middle 1/3 student compared to past rotators. But they still don't rank IMGs. So they write a SLOE saying the person was mid 1/3 compared to past students, but do not intend to rank, then explain why they do not intend to rank in their comments.

Just several examples of how the questions can subtly be different, though most of the time SLOE authors just make the two agree. Personally I wish the questions were just combined in some way. There was a study on SLOE writing by CORD that I was interviewed about awhile back, and they were asking a lot about these two questions and how authors perceive them, and if they should just be one to avoid confusion.

 

[Phoebe Buffet]

So its not a mixed ranking, its that there are two separate questions that ask you to rank:

Compared to other EM residency candidates you have recommended in the last academic year, this candidate is in the (this is the question that shows previous years statistics of what you percent you gave each category):
Top 10%
Top 1/3
Mid 1/3
Low 1/3


How highly would you estimate the candidate will reside on your rank list?
Top 10%
Top 1/3
Mid 1/3
Low 1/3
Do not intend to rank

So while these questions are kind of similar, and often the two categories are in agreement, you can imagine why sometimes the answer would be different. Let say one year you have a typically very competitive group of students, better than the previous year. Everyone is great this year. So maybe an individual is great compared to the year previous, and so they are Top 1/3, but on the rank list they are mid 1/3 because this years group was so competitive.

Or another scenario. Lets say every year the students you get are SUPER competitive and great candidates. And your rank list is biased because you take the people that rotate and do well and weigh that heavily on your list. And someone rotates and is excellent, but everyone is excellent. So maybe they are middle 1/3 in terms of rotators, but will be in the top 1/3 of your rank list.

Or another one. Lets say an IMG student rotates at a place that just doesn't rank IMGs. Does well, and is a middle 1/3 student compared to past rotators. But they still don't rank IMGs. So they write a SLOE saying the person was mid 1/3 compared to past students, but do not intend to rank, then explain why they do not intend to rank in their comments.

Just several examples of how the questions can subtly be different, though most of the time SLOE authors just make the two agree. Personally I wish the questions were just combined in some way. There was a study on SLOE writing by CORD that I was interviewed about awhile back, and they were asking a lot about these two questions and how authors perceive them, and if they should just be one to avoid confusion.

much clearer! thank you for taking the time to respond.

 

[manyleavesonetree]

So its not a mixed ranking, its that there are two separate questions that ask you to rank:

Compared to other EM residency candidates you have recommended in the last academic year, this candidate is in the (this is the question that shows previous years statistics of what you percent you gave each category):
Top 10%
Top 1/3
Mid 1/3
Low 1/3


How highly would you estimate the candidate will reside on your rank list?
Top 10%
Top 1/3
Mid 1/3
Low 1/3
Do not intend to rank

So while these questions are kind of similar, and often the two categories are in agreement, you can imagine why sometimes the answer would be different. Let say one year you have a typically very competitive group of students, better than the previous year. Everyone is great this year. So maybe an individual is great compared to the year previous, and so they are Top 1/3, but on the rank list they are mid 1/3 because this years group was so competitive.

Or another scenario. Lets say every year the students you get are SUPER competitive and great candidates. And your rank list is biased because you take the people that rotate and do well and weigh that heavily on your list. And someone rotates and is excellent, but everyone is excellent. So maybe they are middle 1/3 in terms of rotators, but will be in the top 1/3 of your rank list.

Or another one. Lets say an IMG student rotates at a place that just doesn't rank IMGs. Does well, and is a middle 1/3 student compared to past rotators. But they still don't rank IMGs. So they write a SLOE saying the person was mid 1/3 compared to past students, but do not intend to rank, then explain why they do not intend to rank in their comments.

Just several examples of how the questions can subtly be different, though most of the time SLOE authors just make the two agree. Personally I wish the questions were just combined in some way. There was a study on SLOE writing by CORD that I was interviewed about awhile back, and they were asking a lot about these two questions and how authors perceive them, and if they should just be one to avoid confusion.

Is it possible, if you had all your letters from a specific geographic location and they mostly had programs saying top 1/3 for ranking a candidate, that programs in other geographic areas would then ignore this candidate because they are more likely to match in that location? Or I guess what Im asking is can being ranked top 1/3 or above for the rank list question deter programs from giving you an interview because that may think the candidate will not seriously consider them etc

 

[gamerEMdoc]

Is it possible, if you had all your letters from a specific geographic location and they mostly had programs saying top 1/3 for ranking a candidate, that programs in other geographic areas would then ignore this candidate because they are more likely to match in that location? Or I guess what Im asking is can being ranked top 1/3 or above for the rank list question deter programs from giving you an interview because that may think the candidate will not seriously consider them etc

Sure. But it will depend on a program. If you are a big name program and people are lining up to try to come to your program, then it probably matters less to you. But as a small town community program, why in the world would you interview someone from NYC who went to school in NYC and who did 3 rotations all in NYC? You'd have to assume that person fully intends on staying in that city.

Interview spots are limited for programs. You can't interview everyone. You have to try and maximize interviewing the best people, but also the people who actually intend on ranking your program high enough that they could actually match there. Its a guessing game for sure, but as a program, you have to find candidates that fit a profile for your location and program type. If someone never applied to rotate at your place, never rotated anywhere near your place, never rotated in a geographic place similar to yours, and has personal interests that don't align with what your area offers, it's a waste of time as a program to interview that person. As a program you can only interview 10% or so of the people that applied. You have to try to figure out which people are BOTH the best qualified to interview while ALSO being the most likely to take the interview / not cancel, and actually be interested in your program.

It's a hit or miss process. Obviously everyone you choose to interview you isn't ranking you #1, or even #1-3 for that matter. It takes a good bit of profiling based on peoples hometowns, med school location, personal interests, rotation sites, etc combined with looking at their data and SLOEs to get a sense of whether they will be a good fit for your program. I spend an extraordinary amount of time looking at apps trying to find the right people, and I can tell you, I'm sure I miss out on a lot of good candidates with genuine interest and still grant interviews to a lot of people that aren't that interested in the end. But I think it's still better than just saying "I'll interview the 10% with the best sloes / boards". Ultimately you want your match class to be happy they matched there. You want them to be happy for the 3 years they are there. That's important for having a good cohesive team that all gets along.

So just like applicants applying and knowing their competitive window, I think programs have to know the types of candidates the excel at in matching.

 

[SauseBause]

Sure. But it will depend on a program. If you are a big name program and people are lining up to try to come to your program, then it probably matters less to you. But as a small town community program, why in the world would you interview someone from NYC who went to school in NYC and who did 3 rotations all in NYC? You'd have to assume that person fully intends on staying in that city.

Interview spots are limited for programs. You can't interview everyone. You have to try and maximize interviewing the best people, but also the people who actually intend on ranking your program high enough that they could actually match there. Its a guessing game for sure, but as a program, you have to find candidates that fit a profile for your location and program type. If someone never applied to rotate at your place, never rotated anywhere near your place, never rotated in a geographic place similar to yours, and has personal interests that don't align with what your area offers, it's a waste of time as a program to interview that person. As a program you can only interview 10% or so of the people that applied. You have to try to figure out which people are BOTH the best qualified to interview while ALSO being the most likely to take the interview / not cancel, and actually be interested in your program.

It's a hit or miss process. Obviously everyone you choose to interview you isn't ranking you #1, or even #1-3 for that matter. It takes a good bit of profiling based on peoples hometowns, med school location, personal interests, rotation sites, etc combined with looking at their data and SLOEs to get a sense of whether they will be a good fit for your program. I spend an extraordinary amount of time looking at apps trying to find the right people, and I can tell you, I'm sure I miss out on a lot of good candidates with genuine interest and still grant interviews to a lot of people that aren't that interested in the end. But I think it's still better than just saying "I'll interview the 10% with the best sloes / boards". Ultimately you want your match class to be happy they matched there. You want them to be happy for the 3 years they are there. That's important for having a good cohesive team that all gets along.

So just like applicants applying and knowing their competitive window, I think programs have to know the types of candidates the excel at in matching.

Hey @gamerEMdoc thanks for all the help you've offered us applicants this season! We credit a lot of our interview/application successes to you. Coming back to that question, so if one was to submit a SLOE (top 1/3) from a region in the NorthEast to somewhere in the Midwest, would that actually hurt their chances of matching in the Midwest (even if they're from that area originally)? Or is that dependent on how that highly that SLOE prefers to retain that student in the Northeast area (IE, rank in the top 1/3, top 10% on their match list)? I really want to go to the Midwest school but Idk if that sloe from the Cali rotation is actually gonna help or HURT my chances of matching in the NE.

Thanks!

 

[gamerEMdoc]

Hey @gamerEMdoc thanks for all the help you've offered us applicants this season! We credit a lot of our interview/application successes to you. Coming back to that question, so if one was to submit a SLOE (top 1/3) from a region in the NorthEast to somewhere in the Midwest, would that actually hurt their chances of matching in the Midwest (even if they're from that area originally)? Or is that dependent on how that highly that SLOE prefers to retain that student in the Northeast area (IE, rank in the top 1/3, top 10% on their match list)? I really want to go to the Midwest school but Idk if that sloe from the Cali rotation is actually gonna help or HURT my chances of matching in the NE.

Thanks!

No, not at all. I was referring more to if you are from an area and did all your rotations in that area, then its expected you are only trying to match in that area.

Its very common to do rotations in more than one location. Programs arent going to care if your rotations are in more than one place.

 

[The Knife & Gun Club]

What does it mean to “Kill the interview”? Feels like I hear people say that all the time on SDN, but I’ve yet to have an interview where I feel like I “killed it”

I almost always chat for 15 minutes about my hobbies, career goals, make a joke or two, at best get the interviewer to smile and laugh a little.

 

[Rekt]

What does it mean to “Kill the interview”? Feels like I hear people say that all the time on SDN, but I’ve yet to have an interview where I feel like I “killed it”

I almost always chat for 15 minutes about my hobbies, career goals, make a joke or two, at best get the interviewer to smile and laugh a little.

Usually some form of lethal weaponry. I'd personally give style points for a sword of some type or toxins. Both would be difficult to pull off. You'll likely be limited to what's in the interview room. So paper weights or letter openers might be your go to. Although a chair could work. Your bare hands would be impressive and certainly move you up the rank list.

 

[Forever_Blessed]

LOIs emails definitely work this late in the season. Just netted 3 IVs this week from sending a handful out on Monday. Worth a shot, you really don’t have much to lose at this point. (I also had an update with my SLOE just recently being uploaded).

 

[gamerEMdoc]

Nothing to lose, yes. Definitely work? Depends. They definitely work when cancellations happen and the waitlist isn't really taking the interviews.

 

[Torsion]

How much of a difference does ED volume affect training? For programs with similar acuity and # of residents, I'd like to know if 130,000 vs 70,000 actually results in a real difference in the quality of training.

 

[Rekt]

How much of a difference does ED volume affect training? For programs with similar acuity and # of residents, I'd like to know if 130,000 vs 70,000 actually results in a real difference in the quality of training.

This is a really diversive topic for whatever reason. I personally believe that more volume = increased % chance at higher acuity patients, procedures, rarer pathology. solidifying the bread and butter of EM, etc. It was a factor in my rank list. I think the opposition comes from prestigious named programs (Usually prestigious for other specialties like IM) that have very low volumes like 40-50k that attract applicants that like names. Usually people say well they just have more residents at higher volume places and this just isn't the case a lot of time, including my program. There's also those academic places with that 40-50k volume with like 10-14 residents per class even. Just my two cents.

 

[gamerEMdoc]

I have searched for this quite a bit in the past (and just did again) and as far as I know, there isn't anything that the ACGME openly publishes about the ratio of ED visits to # of accredited spots. They collect a ton of data about visits, procedures, types of patients, admissions, ICU admits, etc during accreditation. But how they arrive at the number they accredit a program for is unknown.

Give or take some, I'd guess ED volume > 2000 x (number of residents in the program) would be a reasonable low starting point to hit.

Obviously you have to take the total volume of the ED AND the number of residents into account. A program that sees 60k with 18 total residents will provide far more resident volume than an ED that sees 120k but has 54 total residents.