EM PD - Ask Me Anything

[BehindBlueEyes]

I'm not @gamerEMdoc, but that situation is widely considered an exception to the "don't bug the PD/PC" rule. Of note, you will get WAY more traction in that if the PC or PD from the program at St. Elsewhere that offered your SO an interview can also contact the EM PD/PC on your/their behalf.

I think with regards to the couples match, its reasonable to reach out when the SO has an interview.

Thanks so much, I appreciate it! Also, just saw this was already asked a few pages back, sorry about that

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[RightTwix]

@gamerEMdoc I've been reading that you said it's too early for LOIs. I thought that too, and then asked my EM advisor and they said that it was definitely time. I sent one as a feeler to a program I really liked and got an II the same day. Now I'm wondering if I should send more or if it really is in fact too early. Do you think this was just an n of 1 fluke that it worked? I don't want to annoy my top programs, but feel like my interest may not be obvious because I'm trying to break into a new geographical region. Thanks!

 

[gamerEMdoc]

@gamerEMdoc I've been reading that you said it's too early for LOIs. I thought that too, and then asked my EM advisor and they said that it was definitely time. I sent one as a feeler to a program I really liked and got an II the same day. Now I'm wondering if I should send more or if it really is in fact too early. Do you think this was just an n of 1 fluke that it worked? I don't want to annoy my top programs, but feel like my interest may not be obvious because I'm trying to break into a new geographical region. Thanks!

yeah it can work, i know it will sometime. But i also know it will annoy some places if you do it too early and 3 weeks into interview season is just too early imo.

Look, I had people send LOI’s out the day eras opened. I’m sure they probably got a few invites by doing so. It doesn’t mean that that’s the right strategy to maximize the effectiveness of the LOI.

Personally i’ve always said that you should never email programs before mid November, but that’s back when ERAS opened up in mid September And invites typically came out in mid- October or so. I think with the late start, the appropriate date to start sending these out should be pushed back a little as well, which is why I think after December 1 makes a lot of sense. It also gives you time to see if you even need to do it or not. If you’re sitting at six interviews right now, chances are you’re gonna have more by December 1 and you probably won’t even need to send out LOI ‘s.

I realize there’s differing opinions on this, I could only speak for the strategy I recommend. If you were going to send out LOI‘s earlier, I would highly encourage you to wait at least until closer to the end of November to avoid running the risk of uour LOI being completely discounted by places that are still trying to get through their initial apps and find this stuff annoying during the app review cycle.

 

[RightTwix]

yeah it can work, i know it will sometime. But i also know it will annoy some places if you do it too early and 3 weeks into interview season is just too early imo.

Look, I had people send LOI’s out the day eras opened. I’m sure they probably got a few invites by doing so. It doesn’t mean that that’s the right strategy to maximize the effectiveness of the LOI.

Personally i’ve always said that you should never email programs before mid November, but that’s back when ERAS opened up in mid September And invites typically came out in mid- October or so. I think with the late start, the appropriate date to start sending these out should be pushed back a little as well, which is why I think after December 1 makes a lot of sense. It also gives you time to see if you even need to do it or not. If you’re sitting at six interviews right now, chances are you’re gonna have more by December 1 and you probably won’t even need to send out LOI ‘s.

I realize there’s differing opinions on this, I could only speak for the strategy I recommend. If you were going to send out LOI‘s earlier, I would highly encourage you to wait at least until closer to the end of November to avoid running the risk of uour LOI being completely discounted by places that are still trying to get through their initial apps and find this stuff annoying during the app review cycle.

Much appreciated. Totally get that. I feel like I almost didn't want the first one to work to backup me thinking it was too early, but that backfired in me feeling pressured to send out more. Just gotta wait for the system to work.

 

[attitudeofgratitude]

because some places flat out lie and tell every student they’re doing great. This is why the sloe exists in the first place. Non-sloe letters almost always say great things about people, even though they are still anonymous. No one wants to hurt a candidates chances. And when feedback isn’t blinded, evaluations are ridiculously skewed in the positive direction. The entire reason the SLOE hold so much value to program directors is because it’s blinded and PDs know that the author can be brutally honest and is told to be brutally honest.

I try to coach my residents and attending’s to give as honest of feedback as possible. I have had some really tough conversations that are legit uncomfortable over the years. But some people just are going to shy away from conflict, will never say anything bad to your face unfortunately.

...Idk how the system could be fixed bc obviously unblinding letters would make them pointless and they would carry zero weight.

Literally just giving honest feed back would be enough. saying "look you're a great person with a lot of qualities that will make a great doctor however you have some weakness that make me worry you'll have trouble matching EM" heck you could even follow up with "lets think of some ways you can address them so you'll do better on future rotations"

NGL this is personal for me Obviously I had poor SLOEs and let's talk about my summative feed back

"You're evals are average for us, and you rotated early so if anything we'll write you an above average SLOE"

No summative feedback but had said they'd take aside students who they thought might have trouble matching and have a "maybe EM isnt for you" conversation. Wrote good school eval

"I'm in a hurry, but you did fine don't worry about your SLOE"

LOL I've never met such a chicken **** group of people who would rather ruin someone like @Doctor_Strange 's career than have a mildly uncomfortable conversation.

 

[gamerEMdoc]

Literally just giving honest feed back would be enough. saying "look you're a great person with a lot of qualities that will make a great doctor however you have some weakness that make me worry you'll have trouble matching EM" heck you could even follow up with "lets think of some ways you can address them so you'll do better on future rotations"

NGL this is personal for me Obviously I had poor SLOEs and let's talk about my summative feed back

"You're evals are average for us, and you rotated early so if anything we'll write you an above average SLOE"

No summative feedback but had said they'd take aside students who they thought might have trouble matching and have a "maybe EM isnt for you" conversation. Wrote good school eval

"I'm in a hurry, but you did fine don't worry about your SLOE"

LOL I've never met such a chicken **** group of people who would rather ruin someone like @Doctor_Strange 's career than have a mildly uncomfortable conversation.

yeah i agree if you are going to write negative comments it shouldnt come as a surprise. Whether that is direct feedback or at least on the school evals that students can see.

I will say, the difficult thing is, sometimes the sloes get written three months after the student leaves. Well after the school eval’s are even done. So that makes it a little hard. Sloes are supposed to be written as group sloes, so most places wait until like sept, and then compare 3-4 months of students at once.

Well that being said, most of the time people who struggled, you were aware of that when they were there, but sometimes things do come to light that you weren’t aware about later. It does happen. So I can see some exceptions why feedback doesnt match the sloe, but usually its just bc people dont fee comfortable giving bad feedback.

Plus, it’s not always about bad feedback. You may just be an average student, and the sloe may say that. But if it’s at a more competitive place, average may mean you were on the low third part of their list. It doesn’t mean that you are a below average student, it just means you arent competitive enough for that place. So the sloe ranking isn’t necessarily bad feedback. You could be perfectly average, they could tell you your average, but that means you’re not competitive for them.

The sloe author instructions clearly discuss this. Low third candidates still match many times. There still considered appropriate for EM. Ive matched plenty of people who had a low 1/3 sloe on their app and then showed improvement.

But those sloes, without damning comments, still make people less competitive, which means interviews take time. Hell for even middle of the road groups, they dont get 12 interviews 3 weeks in.

 

[UreterIHardlyKnowHer]

@gamerEMdoc, in your opinion, should we be sending post-IV thank you notes?

 

[EMBoundHopeful]

So, speaking of LOIs, I’m currently sitting at 4 interviews: one from home, one from OOS, one after sending LOI, and one from heavy networking.

is this to mean that my application is good and considered acceptable at these programs? Or am I just getting because they’re offering as courtesy? And being a US MD with 4 so far, any ideas on whether more interviews are likely coming? Just worried about ranks and stuff...

 

[gamerEMdoc]

So, speaking of LOIs, I’m currently sitting at 4 interviews: one from home, one from OOS, one after sending LOI, and one from heavy networking.

is this to mean that my application is good and considered acceptable at these programs? Or am I just getting because they’re offering as courtesy? And being a US MD with 4 so far, any ideas on whether more interviews are likely coming? Just worried about ranks and stuff...

if the only invites you’ve gotten are at places you rotated and places you’ve had to network at, there is something wrong with your application, and its nearly 100% your slo(s). Once again, this doesnt mean its terrible or you wont match. It may just mean its subpar and it will take more time to get interviews. Most programs invite everyone that rotates and the other 2 are from networking and basically asking for an interview. Theres something there that is stopping programs from interviewing you.

 

[gamerEMdoc]

@gamerEMdoc, in your opinion, should we be sending post-IV thank you notes?

totally voluntary and wont change anything. Do it if you want. Dont do it if you want. Its not a big deal one way or the other.

 

[EMBoundHopeful]

if the only invites you’ve gotten are at places you rotated and places you’ve had to network at, there is something wrong with your application, and its nearly 100% your slo(s). Once again, this doesnt mean its terrible or you wont match. It may just mean its subpar and it will take more time to get interviews. Most programs invite everyone that rotates and the other 2 are from networking and basically asking for an interview. Theres something there that is stopping programs from interviewing you.

This is extremely unsettling and makes me worried about my chances to match

 

[gamerEMdoc]

This is extremely unsettling and makes me worried about my chances to match

I certainly hope Im wrong and more are on the way. I truly do.

 

[EMBoundHopeful]

I certainly hope Im wrong and more are on the way. I truly do.

A resident I spoke to said she is confident I got a good SLOE. Even if I got an interview by reaching out or emailing, doesn’t it mean that my application on paper is decent? Otherwise, why would they even offer the interview like that in the first place?

 

[Doctor_Strange]

Literally just giving honest feed back would be enough. saying "look you're a great person with a lot of qualities that will make a great doctor however you have some weakness that make me worry you'll have trouble matching EM" heck you could even follow up with "lets think of some ways you can address them so you'll do better on future rotations"

NGL this is personal for me Obviously I had poor SLOEs and let's talk about my summative feed back

"You're evals are average for us, and you rotated early so if anything we'll write you an above average SLOE"

No summative feedback but had said they'd take aside students who they thought might have trouble matching and have a "maybe EM isnt for you" conversation. Wrote good school eval

"I'm in a hurry, but you did fine don't worry about your SLOE"

LOL I've never met such a chicken **** group of people who would rather ruin someone like @Doctor_Strange 's career than have a mildly uncomfortable conversation.

It just puts me in a tough spot of being naturally defensive since I was given no indication whatsoever about possibly getting a low SLOE. And my mid rotation feedback was fairly generic and residents who did 90% of my evals said overwhelming positive comments to me. Now, it's entirely possible that when the program leadership sat down and wrote all the SLOEs, they were forced to put some as low 1/3 to save face with other EM programs ie "look at us we don't exaggerate, our program is legit" yada yada. Like if a program is known for giving everyone high SLOEs then it not only hurts those applicants, but also the reputation of the program itself. Finally, for most of the other students I rotated with, the program was their home site and their could have been some bias in terms of giving more favorable SLOEs to students that they were more familiar with. These reasons seem *more plausible* than the alternative of me having repeatedly poor performances on shift and getting a low SLOE at the end. Ultimately, it leaves students like me who have put a lot of time and effort into creating a decent EM app (not to mention studying my butt off for boards lol) -- and who are just normal, non-obnoxious, considerate individuals -- into a seemingly unfair situation of not being able to match EM based off a single SLOE. It's an unfortunate and extremely frustrating feeling. And I am extremely confident that if a regression analysis or chi-squared analysis were done to compare the board pass rates or whatever other marker of a program's success against top, middle, and low SLOEs, the difference would be low to moderate and maybe even statistically insignificant. If there is evidence to the contray I would actually want to read that.

This whole process becomes even more frustrating as for me since my sub-i was my first rotation after a 4-month COVID hiatus and all my internal medicine months were canceled. If more SLOEs were to be allowed, then I would say it would make the process more fair.

If it comes to pass that I am at-risk to match EM, I guess it is what it is -- I controlled and maximized all aspects of my app except for the one that I seemingly was out of my control. I'm not gonna hang my head in despair because I know I did everything I could for myself.

 

[gamerEMdoc]

A resident I spoke to said she is confident I got a good SLOE. Even if I got an interview by reaching out or emailing, doesn’t it mean that my application on paper is decent? Otherwise, why would they even offer the interview like that in the first place?

How would the resident know what your SLOE is? Also, most programs are going to interview everyone that rotated. We always interview low 1/3 candidates that rotate.

 

[gamerEMdoc]

It just puts me in a tough spot of being naturally defensive since I was given no indication whatsoever about possibly getting a low SLOE. And my mid rotation feedback was fairly generic and residents who did 90% of my evals said overwhelming positive comments to me. Now, it's entirely possible that when the program leadership sat down and wrote all the SLOEs, they were forced to put some as low 1/3 to save face with other EM programs ie "look at us we don't exaggerate, our program is legit" yada yada. Like if a program is known for giving everyone high SLOEs then it not only hurts those applicants, but also the reputation of the program itself. Finally, for most of the other students I rotated with, the program was their home site and their could have been some bias in terms of giving more favorable SLOEs to students that they were more familiar with. These reasons seem *more plausible* than the alternative of me having repeatedly poor performances on shift and getting a low SLOE at the end. Ultimately, it leaves students like me who have put a lot of time and effort into creating a decent EM app (not to mention studying my butt off for boards lol) -- and who are just normal, non-obnoxious, considerate individuals -- into a seemingly unfair situation of not being able to match EM based off a single SLOE. It's an unfortunate and extremely frustrating feeling. And I am extremely confident that if a regression analysis or chi-squared analysis were done to compare the board pass rates or whatever other marker of a program's success against top, middle, and low SLOEs, the difference would be low to moderate and maybe even statistically insignificant. If there is evidence to the contray I would actually want to read that.

This whole process becomes even more frustrating as for me since my sub-i was my first rotation after a 4-month COVID hiatus and all my internal medicine months were canceled. If more SLOEs were to be allowed, then I would say it would make the process more fair.

If it comes to pass that I am at-risk to match EM, I guess it is what it is -- I controlled and maximized all aspects of my app except for the one that I seemingly was out of my control. I'm not gonna hang my head in despair because I know I did everything I could for myself.

I don’t think it has anything to do with being more legitimate and everything to do with not everyone is equal or the same. If you have 30 students, a handful are going to be top tier and be right at the top of your list, the bulk of them are going to be somewhere in the middle, and a handful of them are going to be below that. Its a bell curve. Not everyone that rotates is going to be at the top of the list.

Its not programs trying to ”pretend to be legititimate” by not grading too skewed. Its just that’s how bell curves work.

No one said you had a poor performance. That’s not what a Low 1/3 sloe entails. What it entails is, your performance wasn’t as good as others. Those are too different things. You can be totally ok, with nothing negative about you. But at that place, for them, that may put you in the lower part of their list because you are ok, you aren’t excelling.

You can argue about the SLOE all you want, but you aren’t going to change it because programs actually find it valuable information. So its not going away. It’s like voters complaining about the electoral college. Like yeah, I get that it you may not like the electoral college, but the chance of getting enough states to change the constitution is nearly impossible.

For every student hurt by the SLOE process, there are far more that it has helped. Because without SLOEs, many people who were clinically excellent, far better than others, who just scored lower on their board exams (which were NEVER validated as a measure of clinical success), would basically be out of luck. The SLOE process allows people who are actually good at EM to show that they are really good at it.

Could you imagine if the NFL draft was based only on taking a test about football? No game tape. No combine? Sure, teams still get the draft wrong, but do you think teams would be more or less accurate drafting if they never saw anyone play and they just had everyone take a test? Can you show me the research studies that show that watching game tape as a scout is a better way to evaluate a football player than having them take a test about the rules of football?

Look its my job to find the best residents I can. I recognize that not every SLOE will be 100% accurate, good or bad. But in the end, that’s the best thing I have to predict who will be good to work with and not be a problem in training. You still have to take it in context and know its not perfect, but its the best thing you have to gauge it until someone comes up with something better. Because I can tell you, I’ve matched people whose sloes say things like “doesnt take direction well” or “takes feedback poorly” and guess what... they were right.

 

[Doctor_Strange]

I don’t think it has anything to do with being more legitimate and everything to do with not everyone is equal or the same. If you have 30 students, a handful are going to be top tier and be right at the top of your list, the bulk of them are going to be somewhere in the middle, and a handful of them are going to be below that. Its a bell curve. Not everyone that rotates is going to be at the top of the list.

Its not programs trying to ”pretend to be legititimate” by not grading too skewed. Its just that’s how bell curves work.

No one said you had a poor performance. That’s not what a Low 1/3 sloe entails. What it entails is, your performance wasn’t as good as others. Those are too different things. You can be totally ok, with nothing negative about you. But at that place, for them, that may put you in the lower part of their list because you are ok, you aren’t excelling.

You can argue about the SLOE all you want, but you aren’t going to change it because programs actually find it valuable information. So its not going away. It’s like voters complaining about the electoral college. Like yeah, I get that it you may not like the electoral college, but the chance of getting enough states to change the constitution is nearly impossible.

For every student hurt by the SLOE process, there are far more that it has helped. Because without SLOEs, many people who were clinically excellent, far better than others, who just scored lower on their board exams (which were NEVER validated as a measure of clinical success), would basically be out of luck. The SLOE process allows people who are actually good at EM to show that they are really good at it.

Could you imagine if the NFL draft was based only on taking a test about football? No game tape. No combine? Sure, teams still get the draft wrong, but do you think teams would be more or less accurate drafting if they never saw anyone play and they just had everyone take a test? Can you show me the research studies that show that watching game tape as a scout is a better way to evaluate a football player than having them take a test about the rules of football?

Look its my job to find the best residents I can. I recognize that not every SLOE will be 100% accurate, good or bad. But in the end, that’s the best thing I have to predict who will be good to work with and not be a problem in training. You still have to take it in context and know its not perfect, but its the best thing you have to gauge it until someone comes up with something better. Because I can tell you, I’ve matched people whose sloes say things like “doesnt take direction well” or “takes feedback poorly” and guess what... they were right.

I appreciate these clarifying points. I concede, most of what I've been told about SLOEs and what goes on behind the scenes is from residents and whose to say they actually have accurate info especially if they are not involved in such meetings.

 

[EMBoundHopeful]

How would the resident know what your SLOE is? Also, most programs are going to interview everyone that rotated. We always interview low 1/3 candidates that rotate.

Residents put in comments and so do faculty from what I know. there's a meeting the week after the sub I ends where they meet to talk about each of us. But the comments from online evaluations are used to build the SLOE first

 

[gamerEMdoc]

Residents put in comments and so do faculty from what I know. there's a meeting the week after the sub I ends where they meet to talk about each of us. But the comments from online evaluations are used to build the SLOE first

You have to be careful with generalizing, because every program is going to do this different. Some write individual sloes, some write group sloes. Some at the end of rotation, some wait until closer to ERAS opening and write them all as a cohort.

Here is what we do for insight, but again, I can only speak for how we do things, not for everybody else.

We evaluate students at the end of every shift with a comment scoring card that is written by the resident and attending that works with the student that shift. Its similar to a mini sloe. These, all get compiled into a database for all the students.

We wait until 2 to 3 weeks before eras opens to start writing sloes. We have a faculty only meeting then to compare all the students for the year so far and decide which students were top 10, top 1/3, and so on. Once we have each student slotted into their sloe rankings, then I write all the sloes based on the end of shift comments and the predetermined rankings. Then I get them uploaded uploaded, before Eras opens for the year.

 

[deleted645092]

Is there usually a good correlation between the grade a program gives you and where your SLOE ends up ranking? I got my evals from my two subIs last week and they didn’t use numerical grades, just a bunch of comments and Honors, High Pass, Low Pass, and Fail as the grading options for all categories and overall. My gut-instinct is to associate those with top 10%, Top 1/3rd, etc.

Also do programs usually atleast send you a courtesy interview if your SO is there in a different specialty? I’ve been ghosted by the EM program at my girlfriends hospital despite multiple people including her PD reaching out on my behalf as well as a LOI telling them I literally live in town lol. It’s a confusing situation because I’m otherwise doing well getting interviews and have a really strong application (don’t know specific about my SLOEs from interviews other than “they really liked me”). Others in my class have gotten interviews here even though in their words they have objectively bad applications and zero ties to the area.

 

[gamerEMdoc]

Is there usually a good correlation between the grade a program gives you and where your SLOE ends up ranking? I got my evals from my two subIs last week and they didn’t use numerical grades, just a bunch of comments and Honors, High Pass, Low Pass, and Fail as the grading options for all categories and overall. My gut-instinct is to associate those with top 10%, Top 1/3rd, etc.

Also do programs usually atleast send you a courtesy interview if your SO is there in a different specialty? I’ve been ghosted by the EM program at my girlfriends hospital despite multiple people including her PD reaching out on my behalf as well as a LOI telling them I literally live in town lol. It’s a confusing situation because I’m otherwise doing well getting interviews and have a really strong application (don’t know specific about my SLOEs from interviews other than “they really liked me”). Others in my class have gotten interviews here even though in their words they have objectively bad applications and zero ties to the area.

Thats really odd and outside the norm regarding not getting an interview where your GF is a resident. Most places are going to interview local students unless they are trainwrecks, because they are nearly sure things to rank the program highly.

The grades may give an estimate but dont always correlate. Ive seen academic places who’ve given over 90% of their student honors so some of those end up as mid 1/3.

In general, honors is probably a top 10 or top 1/3. High pass is probably top 1/3 or mid 1/3. Pass is probably mid 1/3 or low 1/3. But thats a big generalization. Some people with a pass may end up as a top 1/3. Some with a hp could end up low 1/3. Its partly about the grading distribution (some places skew ridiculously high with grades) but it is also about things outside of the purview of grades. Lets say someone does well clinically and aces the test, gets a good grade on the rotation based on the grading system but the residency is concerned bc they showed up late for several shifts. In that case for instance, you could see where a program could say Im not ranking this person highly even though they met all the criteria for a HP on the rotation for instance.

 

[deleted645092]

Thats really odd and outside the norm regarding not getting an interview where your GF is a resident. Most places are going to interview local students unless they are trainwrecks, because they are nearly sure things to rank the program highly.

The grades may give an estimate but dont always correlate. Ive seen academic places who’ve given over 90% of their student honors so some of those end up as mid 1/3.

In general, honors is probably a top 10 or top 1/3. High pass is probably top 1/3 or mid 1/3. Pass is probably mid 1/3 or low 1/3. But thats a big generalization. Some people with a pass may end up as a top 1/3. Some with a hp could end up low 1/3. Its partly about the grading distribution (some places skew ridiculously high with grades) but it is also about things outside of the purview of grades. Lets say someone does well clinically and aces the test, gets a good grade on the rotation based on the grading system but the residency is concerned bc they showed up late for several shifts. In that case for instance, you could see where a program could say Im not ranking this person highly even though they met all the criteria for a HP on the rotation for instance.

Awesome thanks!

 

[EMBoundHopeful]

You have to be careful with generalizing, because every program is going to do this different. Some write individual sloes, some write group sloes. Some at the end of rotation, some wait until closer to ERAS opening and write them all as a cohort.

Here is what we do for insight, but again, I can only speak for how we do things, not for everybody else.

We evaluate students at the end of every shift with a comment scoring card that is written by the resident and attending that works with the student that shift. Its similar to a mini sloe. These, all get compiled into a database for all the students.

We wait until 2 to 3 weeks before eras opens to start writing sloes. We have a faculty only meeting then to compare all the students for the year so far and decide which students were top 10, top 1/3, and so on. Once we have each student slotted into their sloe rankings, then I write all the sloes based on the end of shift comments and the predetermined rankings. Then I get them uploaded uploaded, before Eras opens for the year.

So for us, at the end of every shift, we have an electronic website that we use to assign the faculty we worked with for an evaluation. We can also choose to send this same form to residents we worked with. Over the course of the rotation, faculty + residents fill these forms out, and this is what begins to form the SLOE. The comments from these evals are part of what is built into our SLOE. I could see all these comments and never saw a negative thing.

After the rotation ends, the faculty and residents hold a meeting where they basically put up a photo of each of us and anyone can say whatever they wish to say about the student. These comments also make it into the SLOE. However, we don't hear any of this on our end. This meeting + online forms I mentioned above are the SLOE for us.

It sounds like my school and your school kind of have similar approaches but I like your program's use of the mini SLOE.

 

[Doctor_Strange]

@gamerEMdoc, if I waive my right to read a SLOE does that mean they will send me a PDF of it? How common is that even done?

I just finished an EM rotation that I am confident I performed well (or at least better than my first one), but I already submitted four LORs on ERAS. I messaged CORD and awaiting their reply. Any ideas on how to send this SLOE to programs? The only alternative I can think is to directly ask the letter writer to send me the SLOE and I email programs individually. I will have completed my interview at said program before the SLOE is completed anyways, but truthfully not sure what to do in this awkward situation.


Thanks!

Edit: Nevermind, CORD has no role in this.

 

[deleted645092]

@gamerEMdoc, if I waive my right to read a SLOE does that mean they will send me a PDF of it? How common is that even done?

I just finished an EM rotation that I am confident I performed well (or at least better than my first one), but I already submitted four LORs on ERAS. I messaged CORD and awaiting their reply. Any ideas on how to send this SLOE to programs? The only alternative I can think is to directly as the letter writer to send me the SLOE and I email individually. I will have completed my interview at said program before the SLOE is completed anyways, but truthfully not sure what to do in this situation.


Thanks!

Why didn’t you save a spot open and just submit 3 while you waited on the 4th, especially if it’s a SLOE?

 

[Doctor_Strange]

Why didn’t you save a spot open and just submit 3 while you waited on the 4th, especially if it’s a SLOE?

Franky, I didn’t think I would need to request an additional SLOE this late during interview season. I thought my first SLOE would carry me. I made a calculated assessment that four LORs at the outset of interview season would be more beneficial. But since I am sitting at 6 interviews at the moment, it’s safe to say my 1st SLOE may not be as solid as I thought. I also have an unfortunate score drop from 243 -> 237 on my Step exams (COVID, personal family tragedy). I did not envision I would be struggling this much to obtain interviews is basically the short of it.

 

[deleted645092]

Franky, I didn’t think I would need to request an additional SLOE this late during interview season. I thought my first SLOE would carry me. I made a calculated assessment that four LORs at the outset of interview season would be more beneficial. But since I am sitting at 6 interviews at the moment, it’s safe to say my 1st SLOE may not be as solid as I thought. I also have an unfortunate score drop from 243 -> 237 on my Step exams (COVID, personal family tragedy). I did not envision I would be struggling this much to obtain interviews is basically the short of it.

Dan that makes sense I’m sorry man.

 

[deleted645092]

Thats really odd and outside the norm regarding not getting an interview where your GF is a resident. Most places are going to interview local students unless they are trainwrecks, because they are nearly sure things to rank the program highly.

The grades may give an estimate but dont always correlate. Ive seen academic places who’ve given over 90% of their student honors so some of those end up as mid 1/3.

In general, honors is probably a top 10 or top 1/3. High pass is probably top 1/3 or mid 1/3. Pass is probably mid 1/3 or low 1/3. But thats a big generalization. Some people with a pass may end up as a top 1/3. Some with a hp could end up low 1/3. Its partly about the grading distribution (some places skew ridiculously high with grades) but it is also about things outside of the purview of grades. Lets say someone does well clinically and aces the test, gets a good grade on the rotation based on the grading system but the residency is concerned bc they showed up late for several shifts. In that case for instance, you could see where a program could say Im not ranking this person highly even though they met all the criteria for a HP on the rotation for instance.

I forgot to ask, regarding getting ghosted by my girlfriends program, I’ve already sent a LOI to the PC 2 weeks ago after they sent their first wave of invites (PDs email isn’t publicly available although I do have it and don’t want to bother them personally). Since her PD reached out to the EM PD after this happened would it be inappropriate to send another LOI in the near future? There hasn’t been movement according to the Reddit spreadsheet but I was considering emailing again either after more invites go out if I get passed up vs wait until December.

 

[gamerEMdoc]

@gamerEMdoc, if I waive my right to read a SLOE does that mean they will send me a PDF of it? How common is that even done?

I just finished an EM rotation that I am confident I performed well (or at least better than my first one), but I already submitted four LORs on ERAS. I messaged CORD and awaiting their reply. Any ideas on how to send this SLOE to programs? The only alternative I can think is to directly ask the letter writer to send me the SLOE and I email programs individually. I will have completed my interview at said program before the SLOE is completed anyways, but truthfully not sure what to do in this awkward situation.


Thanks!

Edit: Nevermind, CORD has no role in this.

After you've waived the right to see the letter, you can't ask for the letter. What you can do is, gather the emails of the program coordinators at the programs you want to have the SLOE sent to, and ask the SLOE author to email it to those programs directly.

 

[gamerEMdoc]

I forgot to ask, regarding getting ghosted by my girlfriends program, I’ve already sent a LOI to the PC 2 weeks ago after they sent their first wave of invites (PDs email isn’t publicly available although I do have it and don’t want to bother them personally). Since her PD reached out to the EM PD after this happened would it be inappropriate to send another LOI in the near future? There hasn’t been movement according to the Reddit spreadsheet but I was considering emailing again either after more invites go out if I get passed up vs wait until December.

It's very unlikely to help you. This is why I harp on sending LOIs too early. They don't help 2-3 weeks into application season in most cases. And it looks annoying like you can't take a hint, if you keep emailing the same program over and over.

Here's the thing. If a PD at that institution reached out to the EM program to ask them to interview you, and they haven't yet, I assure you, you emailing them a second LOI isn't likely to change your fate. They either have you on a list to email when spots open up or they don't. Your 2nd LOI isn't going to be more effective than a PD colleague asking them to interview you.

 

[The Knife & Gun Club]

After years of answering questions as an APD and now 49 pages of questions, I had to change the name of this thread. I will no longer be an APD starting in December so the thread title had to change.

Ayyyyyy congrats Gamer! I’m happy for you. You’ve been doing this forum a great service with this thread for years, and there’s lots of residents myself included who benefited from your advice.

Whats gonna change about your day to day roll as you take on the new job?

 

[Doctor_Strange]

Ayyyyyy congrats Gamer! I’m happy for you. You’ve been doing this forum a great service with this thread for years, and there’s lots of residents myself included who benefited from your advice.

Whats gonna change about your day to day roll as you take on the new job?

He'll demand students kiss his hand not unlike the Godfather.

 

[The Knife & Gun Club]

He'll demand students kiss his hand not unlike the Godfather.

I was thinking Iron Throne type chair, but made out of IV poles and Bed pans.

 

[gamerEMdoc]

Ayyyyyy congrats Gamer! I’m happy for you. You’ve been doing this forum a great service with this thread for years, and there’s lots of residents myself included who benefited from your advice.

Whats gonna change about your day to day roll as you take on the new job?

With less clinical time, I'll definitely be going in on my off days more and have more of a presence both formally at meetings but also informally in the residency suite to be around more for the residents. That'll be the biggest difference in terms of day to day life.

 

[boolin_1]

Is the PD listserv still talking about interview hoarding? Anything to be done about it?

 

[Doctor_Strange]

Is the PD listserv still talking about interview hoarding? Anything to be done about it?

I say we come up with a list of individuals who are hoarding interviews, go to their homes, and -- oh my God what have I become

 

[gamerEMdoc]

Is the PD listserv still talking about interview hoarding? Anything to be done about it?

Im not sure what they can do. CORD doesnt run the match. PDs are a participant in the match like students. Its like asking if students are doing anything about it?

At most, maybe you see a move to some programs try to use a third party software for that limits interviews but idk how you could enforce that globally. Unfortunately for this to change it has to come from the AAMC (limiting the number of interviews or programs you can apply to) or NRMP (limiting the numbers that you can rank). And I think it will in time, if virtual interviews become the new standard in the future.

 

[boolin_1]

Im not sure what they can do. CORD doesnt run the match. PDs are a participant in the match like students. Its like asking if students are doing anything about it?

At most, maybe you see a move to some programs try to use a third party software for that limits interviews but idk how you could enforce that globally. Unfortunately for this to change it has to come from the AAMC (limiting the number of interviews or programs you can apply to) or NRMP (limiting the numbers that you can rank). And I think it will in time, if virtual interviews become the new standard in the future.

understandable. just wondering if there was some chatter. I agree, there's not much that really can be done. it's just an unfortunate situation for anybody, but especially the applicants. I feel awful for all the applicants.

 

[EMBoundHopeful]

What is the current consensus on the likelihood of interviews that will be offered in December and January (and maybe even February)? Are all interview spots filled and done?

 

[gamerEMdoc]

What is the current consensus on the likelihood of interviews that will be offered in December and January (and maybe even February)? Are all interview spots filled and done?

In a normal year most people interview into January. So with the interview cycle being more compressed, I would imagine nearly everyone is interviewing the month. Some may even choose to interview into February.

Interview spots are not done. Even if the program has filled all of their spots initially, there will still be a good number of cancellations. How many cancellations, we don’t know. I can tell you that in a normal year, there’s 1-2 spots a week in Dec/Jan that are cancelled and we have to fill on short notice. With interviews being easier to make with no travel cost, the general assumption is, there will be less cancellations, however we don’t know that to be true, and even if it is, we don’t know to what degree.

I can tell you, we’ve already had two cancellations of interviews in November in our first few weeks of interviewing. People will cancel. I highly doubt there will be people who are in the end are doing 30 interviews. Its more the people in say the 15 range... will they choose to drop down to 12? Who knows.

 

[GrumpyKoala]

Hey @gamerEMdoc, thank you so much for all you've done to help students throughout the years! I was wondering whether you had any personal insight or thoughts about newer EM residency programs (who have yet to graduate a class/accept an intern class) and the quality of the training there? What are some red/green flags you would look for when considering these programs?

 

[attitudeofgratitude]

Im not sure what they can do. CORD doesnt run the match. PDs are a participant in the match like students. Its like asking if students are doing anything about it?

At most, maybe you see a move to some programs try to use a third party software for that limits interviews but idk how you could enforce that globally. Unfortunately for this to change it has to come from the AAMC (limiting the number of interviews or programs you can apply to) or NRMP (limiting the numbers that you can rank). And I think it will in time, if virtual interviews become the new standard in the future.

this might be really dumb but why aren't programs just interviewing the people who normally match there. If you're a community program that usually matches DOs with 2 middle thirds, A-MDs with 2 week middle thirds or one decent middle third and one lower third, and IMGs with one top third and one middle third why don't you just... interview those people? And it won't matter who's hoarding what then right?

 

[gamerEMdoc]

Hey @gamerEMdoc, thank you so much for all you've done to help students throughout the years! I was wondering whether you had any personal insight or thoughts about newer EM residency programs (who have yet to graduate a class/accept an intern class) and the quality of the training there? What are some red/green flags you would look for when considering these programs?

I think its generally accepted that new training programs that are opening up in like an HCA hospital, with faculty run by CMGs, in hospitals that are questionably robust enough to provide a good training environment, are probably not the best idea to go to. HOWEVER, I know absolutely nothing about these hospitals or their training environments, and I'm sure people could easily look at my location and say "you'll never see sick patients there" because its a small area, and they would have no clue what they are talking about. So I'm not going to pass judgement on programs/hospitals I've never been to.

I will say that, new programs aren't always bad. Sometimes they are in super busy places with years of GME experience in other fields. And being in the first class, you'll have all the procedures and cases you want with no other EM residents in the department. And there are people that want to be trail blazers out there who want to go somewhere unestablished and try to mold a program. So I see some benefit to new programs. But personally, that wouldn't have been my cup of tea as a graduating student years ago and I specifically left my med school and didn't go to their relatively new program because it hadn't graduated an EM class yet.

 

[gamerEMdoc]

this might be really dumb but why aren't programs just interviewing the people who normally match there. If you're a community program that usually matches DOs with 2 middle thirds, A-MDs with 2 week middle thirds or one decent middle third and one lower third, and IMGs with one top third and one middle third why don't you just... interview those people? And it won't matter who's hoarding what then right?

Some programs do. But it has less to do with the application strength, though that is a part of it, and more to do with geography. Geography is always the biggest predictor of where people go to train. For instance, med students who are from Philadelphia, and went to college in Philly, and med school in Philly almost NEVER match at my program (in western PA). It has happened, its just rare, because there are so many training programs in Philly, NJ, NY. But if someone is from the Western part of PA, I can almost certainly tell you the programs they are looking to match at based on their competitiveness. Same with central PA. Its all very predictable.

Geography doesn't always hold true though, and there are absolutely people that don't care at all about it. But it's the largest predictor. Which is why if you want to be really smart at only interviewing people that want to come to your program, you try and find geographic fits who are also in your competitive window to make a decent chunk of the "realistic" part of your list.

Are those all the interviews? Absolutely not. Just like applicants who take an application approach of 1/3 reach, 1/3 realistic, 1/3 safety applications, that's pretty much how I look at student applications. Take all the realistic (geographic ones) then split the rest of the spots between some reaches and some safety applicants. Sometimes those reaches actually match with you, just like sometimes candidates match at a place they think is a reach for them. And sometimes someone who you think is more of a safety choice has a phenomenal interview and moves up your list as someone you think may be a steal.

So I don't think it makes sense to go all-in on any one type of candidate, but rather have a more diversified group, as long as you are hitting on a significant pile of realistic candidates based on geography.

Hope that makes sense.

 

[kristysmiles]

Some programs do. But it has less to do with the application strength, though that is a part of it, and more to do with geography. Geography is always the biggest predictor of where people go to train. For instance, med students who are from Philadelphia, and went to college in Philly, and med school in Philly almost NEVER match at my program (in western PA). It has happened, its just rare, because there are so many training programs in Philly, NJ, NY. But if someone is from the Western part of PA, I can almost certainly tell you the programs they are looking to match at based on their competitiveness. Same with central PA. Its all very predictable.

Geography doesn't always hold true though, and there are absolutely people that don't care at all about it. But it's the largest predictor. Which is why if you want to be really smart at only interviewing people that want to come to your program, you try and find geographic fits who are also in your competitive window to make a decent chunk of the "realistic" part of your list.

Are those all the interviews? Absolutely not. Just like applicants who take an application approach of 1/3 reach, 1/3 realistic, 1/3 safety applications, that's pretty much how I look at student applications. Take all the realistic (geographic ones) then split the rest of the spots between some reaches and some safety applicants. Sometimes those reaches actually match with you, just like sometimes candidates match at a place they think is a reach for them. And sometimes someone who you think is more of a safety choice has a phenomenal interview and moves up your list as someone you think may be a steal.

So I don't think it makes sense to go all-in on any one type of candidate, but rather have a more diversified group, as long as you are hitting on a significant pile of realistic candidates based on geography.

Hope that makes sense.

Strangely, the only interviews I've been getting are places I have zero geographic ties. I'm very appreciate of these programs for finding value in my application and I'm optimistic that they actually holistically reviewed my application. I'd much rather go to a program where I'm wanted for my individual qualities. Whereas as for all the programs in my region, I attended the pre-interview information sessions and spoke with them directly at the numerous EM conferences I've attend over the past few years and have only gotten rejections or ghosted. None of it makes sense to me. As I've been listening to program directors from these programs for years say they want candidates like me and providing reassurance. I don't have any red flags that I know of nor that have come up at any of the interviews I've already completed. So I'm at a complete loss, and I think many other students feel the same right now. We'd just like transparency about the process. If your program doesn't like DOs or something else just tell us so we can save $$$ from applying and the feelings of rejection for some implicit bias that has nothing to do with who we are as people or how we'll train as residents.

 

[Oligodinero]

I have 4 interviews. Am i screwed? Why do others have 30+? And why do PDs say "numbers aren't everything" if they actually are?

I'd honestly don't want to match if I have to soap into a crap FM program.

I understand your frustration......but would you really rather not match? From what I've read if you don't match or SOAP your chances of matching the next year are abysmal at best. At least matching somewhere will make you eligible for board certification and thus financially able to pay off your student loans. And there are plenty of FM docs who practice EM and get paid well to do so.

 

[gamerEMdoc]

I have 4 interviews. Am i screwed? Why do others have 30+? And why do PDs say "numbers aren't everything" if they actually are?

I'd honestly don't want to match if I have to soap into a crap FM program.

Numbers arent everything. I know people with comlex scores in the 400's who get over 10 interviews. Clinical evaluations are everything. And if you have lower tier SLOE(s) AND low numbers, your going to struggle for interviews. Why do people have 30+? Because they are outstanding students with excellent letters and great numbers. They shouldn't go on that many, but that's why they get so many invites.

 

[gamerEMdoc]

Strangely, the only interviews I've been getting are places I have zero geographic ties. I'm very appreciate of these programs for finding value in my application and I'm optimistic that they actually holistically reviewed my application. I'd much rather go to a program where I'm wanted for my individual qualities. Whereas as for all the programs in my region, I attended the pre-interview information sessions and spoke with them directly at the numerous EM conferences I've attend over the past few years and have only gotten rejections or ghosted. None of it makes sense to me. As I've been listening to program directors from these programs for years say they want candidates like me and providing reassurance. I don't have any red flags that I know of nor that have come up at any of the interviews I've already completed. So I'm at a complete loss, and I think many other students feel the same right now. We'd just like transparency about the process. If your program doesn't like DOs or something else just tell us so we can save $$$ from applying and the feelings of rejection for some implicit bias that has nothing to do with who we are as people or how we'll train as residents.

I agree. However, its usually apparent if a program isn't real DO friendly because most have their resident lists on their websites. And if you have only 2-3 DOs in the entire program, or none... they aren't DO friendly. Unfortunately board cutoffs aren't always truthfully advertised and I wish they were. It is DEFINITELY odd that the places you have gotten interviews aren't geographically linked and are at places you didn't meet at residency fairs, meet and greets, etc while the places that you are being rejected are local places you previously met with. That is very atypical. The only explanation I could think of would be if the more local places were just way out of your league (ie you are a DO and they aren't DO friendly at all; or your boards are below some cutoff they have). Lack of interviews is more typically a SLOE issue, but that seems less likely if you are getting a bunch of interviews elsewhere but not regionally.

 

[deleted645092]

Because an "excellent student" with great numbers always translates to great physicians. Gotcha.

And both my SLOEs are good. At-least one is top 10%. I'm sure they are laying in your trash pile.

Bruh... I think I can see why you wouldn’t be getting interviews. Btw SLOEs are a lot more than numbers... they’re literally telling program directors and resident selection committees both your medical knowledge AND if they’d like to work with you.

 

[deleted645092]

Just incredibly frustrated by all the BS some EM PDs throw out.

Several people in my class, all top notch people, some are veterans, good people, good students, great clinically, people i'd love to work with - and who do PDs choose? Not them. They get a hard on for that 26 yo with no life experiences and 260s on the boards.

Sorry. I cant help but be mad.

Yes it’s frustrating but at the same time, and you’ll see this all over Reddit, here, and the specialty spreadsheets; numbers are absolutely less important this year. Just speaking anecdotally I’ve seen a lot of complaints online from high achievers who are sitting at 3-4. Maybe it’s a ****load of emphasis on the SLOE(s), I don’t know.

Who told you that you have a top 10% SLOE?

Edit: Also plz don’t knock people as being one-trick-ponies just because they have high board scores. You don’t know what else is in their apps and assuming someone is lacking in life experience just because they’re a high scorer doesn’t make sense. Same goes to thinking that just because someone has a cool life story means they’re more mature or prepared for residency. God bless our vets but the biggest pain in my classes ass is one of our marine vets who dismissed everyone else, including faculty, for the exact reasons I mentioned above.