PATIENT, PHYSICIAN, AND SOCIETY                                                  ANTHONY D. LE

ELECTIVE PROJECT                                                                                NIRAV SHAH

MARCH 2002

 

EMERGENCY MEDICINE:

A STUDENT PERSPECTIVE ON GETTING INTO RESIDENCY

 

The process of applying and interviewing for residency can be fun and exciting, but it can also be stressful. Having just completed the process not too long ago, we would like to take the opportunity to provide important information and key points on applying to an emergency medicine residency so that the journey will be less stressful and more successful.

 

Entailed are key points listed in chronological order.

 

Year 1 and 2

If you are fortunate enough to know already that emergency medicine is the specialty that you would like to pursue, then you can prepare early. If you haven’t decided, that’s okay, too. You are not at a lost or significant disadvantage. But for those who have already seen the light, you can look into research in the specialty of emergency medicine to beef up your future application. If you want to be highly competitive, research can set you apart from other applicants during the interview season.

 

Research opportunities in emergency medicine at SLU are few and far between, from our experience, but you may be able to ask the faculty for suggestions. Our advice to you, if you would like to do research, is to get in touch with the Washington University Emergency Medicine Department and ask some of their faculty if there are any on-going research projects that you may participate in during medical school. In comparison to SLU, Wash U has a residency program in emergency medicine and there is PLENTY of funding for research at that institution. Dr. Douglas Char is the residency director at Wash U and he may be able to arrange for a research project within the department.  Dr. Larry Lewis, department chair, is very nice and very interested in getting people involved in research. Nirav contacted Dr. Lewis and it was a great experience for him.

 

Another piece of advice during the early years is to get to know the emergency medicine department at SLU. The faculty at SLU is a great asset, especially Dr. Brooks and Dr. Weston. Try to set up a brief meeting with Dr. Brooks, the head of the department, and express your interest in the field of EM. He will set you in the right direction and you will build a strong rapport with him (strong rapport = strong letter of recommendation).

 

Another opportunity to become more familiar with the field of emergency medicine during the first two years of medical school is to be a member of the Emergency Medicine Interest Group at SLU. The group is very informal, but helpful in providing the chance to ride in the ARCH helicopter (for those interested in flying, EMS, and the aeromedical side to EM). Also, the addition of the group to your CV will show residency programs your genuine and early interest in the field of EM.

 

Finally, and most importantly, at the end of your second year, there will be a little quiz called the USMLE Step I exam. We can not stress enough the importance of this exam. Performing well on Step I can make life a lot easier down the road. Take the time to study hard and long for Step I. Whether it may be two or four months, however long you need, make sure to prepare for the exam and rock it when you do. The number of residency program doors that swings open, during the application process, due to an outstanding Step I score is high. Make Step I a highlight to your application.

 

Other important aspects to consider during Year I and II include setting up your third year rotations and pursuing other things outside the realm of medicine. In regards to the third year rotations, we do not believe that the order of the rotations matters, so long as you do well, learn as much as you can, and have fun while doing the rotations. One piece of advice when scheduling though – try to set-up an elective month in emergency medicine at SLU Hospital during the second half of your third year (preferably after you have done internal medicine and surgery). Bypass either your neurology or family medicine month to do emergency medicine so that you can prepare for upcoming away rotations in EM, you can get to know and work with the EM faculty earlier on, and it will also help you on Step II. You will also have to pick an advisor for the last two years of medical school. We would suggest Dr. Brooks because of his title as head of the department, his friendliness toward and support for students, and his availability.

 

Going back to interests outside of medicine, it is very important to show EM programs that you are not this one-sided, robot, gunner student. Explore and pursue other things in life. Whether it may be marathons and sports or acting and the arts, go do those things to make life fun and to keep your sanity in hand. EM residency programs want people who are fun to be with, in and out of the hospital setting. Don’t get us wrong, they want residents who work hard, but they also want people who play hard when they get the time.

 

Year 3

As you go into your third-year clerkships, life will hopefully be much more fulfilling and fun. You have completed your core academics and you are now finally applying what you have learned all those hours of studying the books. Try to do the best you can in every rotation, yet focus on your months of surgery and internal medicine (the two fields that are the basis of emergency medicine). Also, try your best to honor your emergency medicine rotation whenever you take it at SLU.

 

In order to prepare you for a rotation in emergency medicine, there is a short paper on the topic located on the Internet. The following is the website:

 

http://www.saem.org/inform/advicefo.htm

 

Also, there is an article in the journal, Academic Emergency Medicine, April 2001, Volume 8, Number 4, pp. 402-403, entitled The Outstanding Medical Student In Emergency Medicine, that is very helpful, too. It points out qualities in a successful medical student in EM rotations [e.g. learning how to approach common EM complaints (chest pain, SOB, abdominal pain), staying on top of patients without having to be reminded, etc.].

 

Don’t forget to keep in touch with your advisor and make a mental note of the faculty whom you would like to get a letter of recommendation from when it comes down to the application. It would be wise to ask s/he if they would be able to write you a strong letter of recommendation, and if so, what they will need to write the letter. Know that the letter writing process does not occur until the summer of your fourth year or maybe even later, depending on your writer. Don’t sweat it unless the letter isn’t in by November 1st of your applying year, but we’ll discuss this more later.

 

Besides studying, the later half of your third year should also be dedicated to researching emergency medicine residency programs. Talk with Dr. Brooks and the rest of the faculty on what EM programs should definitely be on your list. Also, do your own investigating on the Internet. There are a great number of websites on the topic of EM, yet we will only suggest a few.

 

http://www.saem.org/

http://www.ama-assn.org/ama/pub/category/2997.html

http://emra.org/

 

The SAEM website is especially useful to view articles dedicated to medical students interested in the field of EM, to review residency programs that have externship electives available, and to become familiar with the residency programs that you are interested in applying to next year. The website also has links to the EM residency program website addresses, too. The AMA website also has many statistics on the numerous EM residency programs and contact numbers.

 

Arranging for away rotations should begin around the months of March to June. Residency programs are very busy with the Match process up to the middle of February and would probably like not to be bothered until it is over. Starting in March is great. You will have time to contact the programs, get application material for the rotation (either by the Internet or snail-mail), and prepare to have all the medical/legal/academic clearance for the externship. Get your immunizations, antibody titers, chest X-ray/PPD done by the end of your third year so that all documents are handy when they need to be sent with the applications. Also, some programs may request a letter of recommendation from a faculty member- this letter is NOT the same as a letter of recommendation for residency- it should be short and sweet, stating that you’re a hard-worker, team-player, blah-blah-blah, not schizophrenic, et cetera. This is when it is nice to have the EM faculty at SLU on your side, or an attending in internal medicine or surgery that you feel can write you a brief letter quickly. EM away rotations are popular and it is wise to get a jumpstart on the application before lists get filled up. Rotations are very popular during the months of July through November (the prime “audition months” of the year), especially the highly sought after and competitive programs in the nation. It’s First Come, First Serve!!!

 

When selecting which programs to apply to for externships, go for programs that you are REALLY interested in going to and will have the opportunity to show your stuff everyday on rotation. Many programs will grant interviews on the spot after your month there, to forgo travel expenses later and get you interviewed while you’re still fresh in their minds (these interviews are done during the months of October/November and after). Tony went to Highland Hospital in Oakland, Ca., during the month of November and December and it was very easy to set-up the rotation. Nirav went to UCLA and USC for his externships. Contact the person in charge of academic affairs via the SAEM website (listed under Undergraduate Rotations, divided into states) and get the application in as soon as possible. Location is a big factor, considering you will be at the program for a month and you will need some sort of housing and transportation (friends and family are very helpful at this time). One other piece of advice is to do away rotations at institutions that you have a decent shot a getting into. In other words, don't go to a top-notch, hard-core program if you know you don't have the Board score or grades to get an interview.

 

During the latter half of your third year, you will also begin scheduling your last and final year in medical school (it sounds great and it is!). Hopefully, you will know which away rotations you have set-up and those months can be set aside already. We would suggest scheduling for the USMLE Step II exam fairly soon after the end of your third year. Why? Well, all the information you have accumulated during your third year is still fresh in your mind and you will be able to recall the facts much easier. Also, you don’t want Step II to be something looming over your head for the rest of the year, especially after your interviews and Match time when everyone else is going out, having fun, and enjoying their last moments of irresponsibility. We took it in March and we wish ww had taken so much earlier!!! Another advantage to taking Step II earlier is to redeem any shortcomings on your previous Step I exam score or academic history. Take two to four weeks to study for the exam intensely and then ace it. You may feel some burn-out at the end of the third year, but trust us, get Step II out of the way. We suggest that you take two weeks completely off prior to the exam to study hardcore and, if you can, prior to the two weeks off, schedule a very easy elective for two weeks so that you can ease into your studying. Some examples of low-intensity electives are as follows:

 

The Role of Teaching and Feedback (ED 402)

Cardiac Auscultation – An Advanced Course (IM 431)

Interpretation of the Electrocardiogram (IM 427)

Computer Assisted Instruction in Internal Medicine (IM 430)

Reading Elective with a Faculty Member of Choice

Cross Sectional Anatomy (A 406)

 

All of the above are two-week electives that do not require much time and will allow you the ability to study for Step II while still getting your elective completed. Knowing this about the electives, they are extremely popular in the class and difficult to schedule at times.

 

A few tips on studying for Step II, get used to thinking for a long period of time. Step II is at least more interesting than Step I, but it is also longer by one hour (extra 50 questions). Get some endurance and stamina! What to use to study? Well, that all varies with how you study, but some of the more popular books include the following:

 

NMS Question Book for Step II (lots of Q’s and great answers to review)

Advanced Life Support for Step II (short and sweet)

Secrets for Step II

Prescriptions for the Boards (long, but comprehensive)

Kaplan Questions on CD-ROM (lengthy Q’s, more difficult than Step II)

First Aid for USMLE Step II (bombarded with facts)

 

Ask other senior medical students what they used and go from there. Also, remember to take time to enjoy yourself when you can- in other words, don’t get burnt out studying and peak too early.

 

After Step II, the beginning of your fourth year should revolve around doing the EM elective at SLU if you have not already done so in the third year and the rest of the EM rotations you have scheduled elsewhere. We would suggest that you do no more than three EM externships and at least one. Why? The SLU EM rotation is great in the sense that you work intimately with the attendings and do some procedures here and there. However, SLU does not have a residency program in EM and that is important. EM residency programs want to see that you completed a month at an institution with an EM residency program so that they know what you will be getting into for the coming year. They also want to see evaluations and letters from faculty who have come across EM residents and medical students interested in EM (better comparison and perspective of future star residents). By doing an EM externship early enough, you may be able to get one of the faculty members to write you strong letter quickly enough to get into the application. Don’t do too many EM rotations, though. It is best to spread out your time wisely and smell some other flowers while you can. Plus, you don’t want to look too gung-ho. If you would like to meet the EM faculty of another institution, yet you have already done three EM electives, try a toxicology month if they offer it.

 

Other great electives to take during your fourth year that will help you to prepare for a residency in EM include anesthesiology, unit months (CCU, ICU, MICU, SICU, burn unit), radiology, orthopedics, and pediatric EM. A final word or two on scheduling the last year: plan to take off a month in December or January for residency interviews, or schedule a rotation that will allow you to miss days here and there with short notice during those months; and in the last half of the year, schedule FUN MONTHS!!! Take advantage of those last few days of freedom, prior to the internship hell. Go to a foreign country, do a month of wilderness medicine at a National Park, sign-up for cruise ship medicine, or just maximize your away rotation time by going back home, Florida for spring break, or whatever. Just don’t let that time go to waste.

 

Year 4

The year you have been waiting for has finally arrived and let the games begin. If you have scheduled the year wisely, then the fourth-year should run smoothly. Glitches in the master plan will happen inevitably, but don’t sweat it. Take Step II and get it out of the way. Then, do the best you can on those away rotations in EM. Get to know the faculty, especially those on the admission committee, and the residents well. Ask a lot of questions about the program and take advantage of your time there to make an informed decision later on about the program. See if you get along with the people, ask the residents what life is like working there, and take notes on all the logistics to the program. First and foremost, though, when you are there, work hard and be friendly. Go out with the EM crew when you have the opportunity, do that rectal on every chest pain patient, get those lab results/scans read so you can report them to the attending or resident, treat the ancillary staff with respect, do serial checks on your rock patients that are in the ED for a long time, and take the initiative to help out wherever you can. It is also important not to be that annoying fourth-year student who is trying way too hard. Be yourself and go with the groove. Remember: the program is definitely checking you out as much as you are checking them out. Leave them with a stellar impression of you when you end your rotation and they’ll want you when it comes to Match time. Remember to get contacts in the program before you leave and keep in touch later on, especially if it is a program high on your list. Try to do your interview while you’re there, especially if it’s the month of November and December. It'll save you money and time.

 

During the early months of fourth-year, you will also need to ask faculty for letters of recommendation. I would suggest Dr. Brooks and Dr. Weston if you have built a strong relationship with the both of them. The letters of recommendation from EM faculty is written on a form letter which may be found at the following website:

 

http://www.cordem.org/slor.htm

 

You may elect to have another faculty member at SLU EM to write you a letter and that is fine. Again, it is to your advantage if you have completed an EM externship elsewhere to have a faculty member from the EM residency program write you a letter of recommendation. The reason, again, is because the letter will be more credible and worthwhile in the eyes of the residency committee members. Get at least two letters of recommendation from EM faculty, and the third may come from someone who can write you a great letter. Most programs request three letters of recommendation, but a limited few want four. You can check each program’s website for details. On ERAS, the electronic application service you will use, a total of four letters can be sent to each individual institution you apply to. We both had four letters (2 EM, 1 IM, 1 PEDS) that we sent to each school because they were all very strong letters. In any case, provide each letter writer with whatever material they need- CV, photo, personal statement.

Since the writers of you letters of recommendation will need a CV and personal statement, it is necessary for you to buckle down and get these documents on paper by around August. It is courteous to give letter writers approximately a month to write a letter of recommendation. So, getting the CV and personal statement finished early will be to your advantage. In order to get a better feel on how to go about writing a CV and personal statement, please read Iserson’s Getting Into A Residency and First Aid for the Match, to become more familiar with samples. The two books are also a great way to prepare for interviews and the rest of the application process. One suggestion we have about the personal statement is to express a hobby or interest outside the realm of EM in the document. EM programs want well-rounded people. Also, don't get too bogged down on completing the personal statement- there are other, more important factors to the application than the personal statement. The following article in Academic Emergency Medicine, January 2000, Volume 7, Number 1, pp. 54-60, entitled Selection Criteria for Emergency Medicine Residency Applicants, discusses what EM residency committees look for in applicants and how much each aspect is weighted in their decision to select the applicant for a residency position. Also, remember to have your personal statement reviewed by Dr. Brooks and others for feedback and grammar correction.

 

Back to the application process, complete the ERAS application by the first week of October as a deadline. This means that you must know where you want to go and how many programs you want to apply to. Again, familiarize yourself with all the different residency programs on the FREIDA and SAEM websites, along with the individual residency program websites. What we suggest is narrowing the field of 124 residency programs by LOCATION, LOCATION, LOCATION. Think about where you will be happy living for the next 3-4 years. Whether it be close to home and family, or one of the coasts, try to decide on which states you can say, "Yeah, I can live there," with a smile. For us, we were both looking into heading back to California and being with family and friends again. So we applied to all the programs in California (except for one). If we weren't going to make it back to California, we were determined to live in a big city, in a nice state. So, we chose places like Arizona, Illinois (Chicago), New York (NYC), Massachusetts (Boston), and staying here in Saint Louis. An advantage to the big city is that there are generally more programs within the vicinity and it makes life easier come interview time grouping your interviews. We would suggest applying to 30 programs if you're an "average student." Of course this is dependent on the caliber of the applicant, but EM is a relatively competitive field these days, especially with lifestyle playing more of a factor in choosing a specialty. What you're shooting for when you're selecting the number of programs to apply to is getting around 10 interviews at good programs. If you receive more invitations, then the better because you'll have the choice of canceling some programs. Also, by applying to 30 programs, you'll make the cut-off before the price per program increases.

 

Another thing to consider when looking at programs is the type of program you want to train at. Do you want a small program of 5 residents per year or the large-scale one of 18 residents per year? There is also the consideration of a county versus a non-county facility to train at. Many county residency programs like Alameda Highland Hospital (Oakland, CA), USC, Cook County (Chicago, IL), and Kings County (Brooklyn, NY) are very high volume with a predominately indigent, poor patient population, and a lack of nice perks you'll find in other programs. You'll work hard in the county setting and you'll see the major traumas. Is it worth the pain of dealing with an understaffed facility and the hectic atmosphere? That is for you to decide. Some love that setting- being able to learn with a lot of patients, relatively more independence and less guidance, and handling more trauma cases. There are definitely pros and cons with either setting. Here are a few things to consider:

 

County Program

Pros-   High volume, many procedures to perform, always busy with a rare dull moment in the shift.

Cons- Working with the poor and indigent population, usually not the best facility/ancillary staff/surrounding environment.

 

At the end of this paper, there will be a list of several programs that we and other EM applicants this year applied to and interviewed at, and a brief description of the program. Hopefully, this will give you more insight on the program, in addition to the information on the Internet.

 

As for those of you deciding to apply to EM programs that require an internship year (2-4 programs), you will need to open you pockets once again and select preliminary medicine and/or transitional year programs to apply to, also. There are not as many transitional programs as preliminary medicine programs in the nation. That being said, if you are looking to live somewhere specific, you may be better off applying to a preliminary medicine program. However, we particularly like the transitional program curriculum because they tend to have more elective months and you will be exposed to a number of different specialties that are important in EM (e.g. surgery, anesthesia, critical care). On the downside, you will be shifted from one service to the next, as opposed to medicine where you will have more continuity and familiarity with the system of the program. We played it safe and applied to 10 preliminary medicine and 10 transitional programs. If you are lucky, some of the 2-4 EM programs will have their own internship year program and your interview with EM program will usually be taken as an interview for the internship. Many will push your name ahead of their internship list if they know you will be ranked highly on the EM program rank list.

 

By your application deadline, you will need your CV, personal statement, list of programs to apply to, and your letters of recommendation. Regarding the letters of recommendation, make sure to touch base with your letter writers to make sure they make your deadline date. The letters should be at least in by November 1st, but the earlier the better. One other piece of advice is to deny the opportunity to see these letters- it is just the decision that everyone chooses. You will also need your Dean's Letter for the application. Try to schedule your meeting time in August or September with the Dean. The meeting will be brief and will consist of the Dean reviewing your grades and evaluations, and discussing with you what will be taken from the evaluations to be put in your letter. Beware of reviewing the Dean's letter to make sure that the content is appropriate and grammatically correct.

 

When all the necessary material is in hand, you can send off the application via ERAS and check the ADTS website to see when the programs have received the material. Depending on the program, you will begin to receive e-mails/phone calls inviting you for an interview or denying you an interview. Most interviews are conducted from November to the end of January. Make sure to keep up to date with your e-mail as it is the main course of communication between you and the program. As soon as you receive an invite to interview, schedule it ASAP. You want to have the advantage of choosing your date and securing your spot. Some programs will invite more applicants than they have spots to interview and that means it's first come, first serve to those interview spots (don't be wait-listed!). When to schedule? It is best to schedule your top priority programs in January because you will be fresh in their mind when they must make their rank order list of applicants in February. Also, by collecting your receipts in January, you can make tax deductions on that calendar year for employment travel expenses. However, don't make the mistake of setting up several back-to-back interviews that will leave you in a whirlwind and present yourself poorly during the interview. Keep in mind, though, you will also want to set aside some time at the end of January or beginning of February to do second-looks at the programs you are dying to go to for residency. Do the second-looks at the top three programs you're interested in. It can mean a lot when the program makes their rank order list of residents when they know you went out of your way to see them again. One other piece of advice, we would suggest trying to group you interviews by location, of course, to cut down on costs and time. The bottom-line is to try to interview in January, but December is just as good.

 

When you are preparing for the interview, get as much information on the program and read up on it. Have a set of questions you want to ask program directors/attendings/residents during the interview (don't be left mute when they ask you the "Do you have any questions for us" for the billionth time- at least ask the same question you asked someone else before). Make sure to ask the questions appropriate to the person you are asking (i.e. the direction of the program to the program director, most difficult off-service rotation to the residents). Also, ask about highlights to their program (for example, EMS, international EM, pediatric EM exposure). By doing so, they can tout about their strengths and it will show that you have read about the program and you are interested in them.

 

This goes without saying, but always look your best and be on your best behavior. You never know who is evaluating you. Ancillary staff, residents, attendings, program secretary, or anyone else you may meet during the interview may have a say in the selection process- a resident you meet during lunch and had a great connection with could push you further through the door of getting accepted to the program.

 

Travel and accommodation suggestions when interviewing, we have only a few. Look into the Internet travel companies (e.g. Priceline, Orbitz, etc.) if you have the leisure of when you can arrive and depart. Take advantage of residents offering to house you for the night. You can find out more about the program while saving costs. Also, ask the program secretary if they have anyone willing to house you or if they have hotels at a discounted rate for interviewees. Finally, Priceline hotels and rental cars when you can. We were amazed at the prices we received for one-night stays in 3-4 star hotels. Remember, save those receipts for any expenses that you have January 1st and after- IT'S TAX DEDUCTIBLE.

 

The typical interview day begins with a brief introduction by the program director and a slide-show entailing information and logistics to the program. Following, interviews will be conducted by as many as five faculty members (program director/chair, attendings, residents, ancillary staff managers) but will usually be around 2-3 total interviews. Be ready for anything, but most interviews are relatively pleasant and friendly. Questions on why you want to come to this program, what you want in a program, why you chose EM as a specialty will always come up. More fancy questions that we've come across include, "What is the latest book you have finished reading?", "Tell me about a patient you learned the most from?", "If you were stuck on the rooftop of a building, how would you get down?" After the interview marathon, lunch will be served and you will be able to talk with other residents in the program at this time. Finally, a tour of the ED and facilities will usually conclude the day.

 

If you have time, we would suggest that you shadow a resident or observe the ED in action after your interview or possibly the day before your interview (if you get in early). Most will welcome the idea and hand you some scrubs. Check out how things work, how everyone works together, what types of patients come through the day, and whatever else is important to you. Note how much teaching goes on during a shift, how much supervision and autonomy do the residents have by the attendings, and what role does the ancillary staff have in the scheme of the ED. All in all, by spending some time during your interview in the ED, you will come across as being very interested in the program and its staff, and you will have your own point of view of the program when it comes to making your rank list later.

 

Again, before you leave, have some contact people you can talk with later on during the interview season. The people you stay in contact with can also be people who can speak for you at the time when the admissions committee makes their list of residents. Depending on the program, residents may have an equal say as an attending on who and who does not get into the program.

 

After an interview, it is a good idea to send the program a thank you letter for inviting you to interview and for the entire day. Who to send the letter(s) to? We made a point to send each person we interviewed with a letter, along with anyone else we spoke to whom we felt we made a connection with during the day. This made for A LOT of letters to write, sign, and send, but we believe it's worth it. Most letters will be put in your applicant file that the committee will review during the day(s) of making their decision. This being said, it is wise to personalize the letters to their respective recipients. Use notes that you have taken after each interview and mention something specific that was talked about during your conversation. With respect to thank you letter format and content, refer to the sample letters in First Aid for the Match and Iserson's handbook. If you are honestly going to rank a program very high on your list (top three), it may be worth mentioning in your letter. Try to get these letters in the mail 2-3 days after your interview with the program so that you are fresh in the interviewers' mind when they read them.

 

When you have hit the end of the interview trail and the last program has been visited, the last second-look has been completed, and the last thank you letter is in the mail, you can take a moment and sigh . . . for a moment. It will be the beginning of February and the EM programs will be making their list and hopefully checking it twice to see that you name is high on it. To make sure of this, give a call to your top three programs and, again, express your desire to come to their program. You can also just e-mail the program to re-iterate your intent to put the program high on your rank list. Just don't be pushy when you make the call or write the e-mail. Keep it short and brief- just a little reminder before they make their list incoming residents.

 

Now, it is time to make your rank order list (middle of February). First and foremost when making your rank order list, go with your gut and rank how you feel. Even if a program may not be the best in reputation according to some article, if you felt during your interview that it is the place you will be most happy at and where you felt that you belong, then rank it at the top of your list. On the flip side, if there is a program where you feel that you would be miserable working at for the next 3-4 years, whether it is due to location, a particular person in the program, or whatever, don't rank it!!! It is not worth going through the training feeling upset and depressed about being where you are. There are options when you don't match, yet going unmatched is another can of worms that needs to be discussed, too. Do not over-analyze the match process, how you think the programs will rank you, or come up with a scheme/formula to the rank order list. Go with your heart and rank accordingly. Choose the program where you will ultimately be happy and where you will be trained well. All accredited EM programs in the US should train you well in EM (beware of programs that do not fill or programs that are on probation- find out why and then make your decision about the program), some better than others.

 

As the rank order list deadline comes, try not to make any last minute or hasty decisions (unless you absolutely have good reasons to do so). Leave the list alone. Go ahead and count the seconds as they pass, but realize you have set your best foot forward and made the most informed decision in your rank order list.

 

Congratulations! Your destiny is out of your hands and it is now put into the Match computer. Approximately in one month, around mid-March, the term "March Madness" will not only apply to NCAA basketball but also many graduating senior medical students awaiting the results of the Match. Enjoy the rest of your year, make that spring break trip, go back home and relax with family and friends. Match Day will come soon enough.

 

Match Day is usually a Thursday in mid-March. The Monday prior, you will know first of all if you match, just not where. A notification via e-mail will tell you if you have matched or the registrar's office will contact you with the bad news. If you go unmatched, you will need to find out which programs in the nation have unfilled spots and make contact with those you are interested in applying to in the Scramble. We can not give you suggestions or hints on this process since we did not go through it, but you will receive more on this topic in a meeting conducted by the medical school administration.

 

Once you know you have matched on Monday, you must wait until Thursday to find out where you will be going for residency. Match Day is definitely exciting. You will be handed an envelope with the program enclosed. Hopefully, you will be happy with the results, but no matter what go out and have fun with everyone because the culmination of four years and an arduous interview season is over.

 

When the smoke has cleared and you have awaken from your stupor of celebration, it is courteous to contact all those who have helped you with applying to residency (advisors, mentors, letter of recommendation writers) and let them know about the results. It is also a good idea to contact the residency program and let them know how excited you are about coming to the program. Additional information regarding the program, ACLS/BLS/ATLS/PALS training, health verification, and the one-year contract will eventually come in the mail. Keep on top of these things so that you won't fall being and look unprofessional before you even start on the floors.

 

As for the rest of the year, ENJOY, ENJOY, ENJOY. Savor the time you have before internship year and when you actually have a job. Graduation is in May and we’re looking forward to it, along with the rest of our class of 2002. This year has been a successful one for those going into EM: UT Southwestern-Dallas (2), Brigham Women's Hospital (Harvard) (1), Ohio State -Columbus (1), USC (1), Howard University (1), and Barnes-Jewish (Washington University) (1).

 

We wish you all luck in your journey through medical school and beyond, whether you choose emergency medicine or another field of medicine, and we hope that this information will help guide you.

 

List of EM Programs Interviewed

1.      Highland Hospital-Alameda County (Oakland, CA):

4-year program. Excellent county program.  Good relationship between attending and residents.  Good teaching. 25% of time spent at UCSF. One of the better and more competitive programs. Tony did a month out there and it was easy to get, if you apply for the externship early enough. There are a lot of students rotating through. Very indigent patient population. Lots of trauma. New ED opening by the time you get there. EM department is the highlight to this facility, so they call the shots. Oakland is a great place to live in the Bay Area which is another reason why this program is high on a lot of applicants’ lists. You rotate through the Children’s Hospital of Oakland for pediatrics EM and it is a phenomenal hospital to get trained for the little ones. Residents at the program LOVE IT! Most residents appear to be from UCSF and other California schools, but program has high caliber residents from elsewhere. Highly regarded program nationwide.

 

2.      University of California, Davis (Davis, CA):

3-year program. Large ER with good mix of indigent and private patients. Good teaching. Not as busy at county programs. Trauma is run by surgery- a negative (you run it on your trauma month). Time mostly divided between the University Hospital (more county) and Kaiser Hospital ED (brand new, very nice, small). Tony liked this program because of the University and Kaiser (HMO) mix. Also, the program is known for its high volume of trauma (they serve all above and east of the Bay Area in California, parts of Nevada and Oregon, too. Residents are happy there. Downside is the location- Sacramento is a relatively big city, capital of California, not much of a nightlife compared to San Francisco, but you’re only a couple of hours away from the SF and Lake Tahoe along with the rest of the prime ski spots/lakes for vacation fun. UC Davis is the local University located 30 minutes away with a lot of young people. Residents mostly from California schools. Program getting more and more popular.

 

3.      Loma Linda University (Loma Linda, CA):

3-year program. Good program. Great pediatric training and international EM is a highlight to the program as well as event medicine (doing concerts, award shows, auto racing and other sporting events). Good EMS training as well. Very nice and committed faculty.  Great ancillary staff. Not as busy as county. Faculty and director are very friendly and helpful. Located in the southern California called the Inland Empire. Ski slopes, Las Vegas, LA and the beaches are all very close (1-2 hours away) for fun. Seven-Day Adventist institution (no meat, no caffeine) and you must a certain distance from the hospital. Nice weather all-year, but smog can be a problem. A significant proportion of residents from Loma Linda School of Medicine. Residents are happy, yet just content about living in Loma Linda.

 

4.      Cook County Hospital (Chicago, IL):

2-4 program. One of the better programs in the nation. One of the largest with respect to how many residents they take each year. Good off service rotations. Very structured program. Very busy, less time for teaching but great place to learn by doing. In our opinion great combination of county population, supervision, and teaching. New ED in the works and will most likely be available by the time you get there. Patient population is indigent with lots of new immigrants and phenomenal pathology. Don’t bother with applying to the preliminary internal medicine year there, though- it’s not well-received even by the EM residents. Chicago is a fantastic big city to live in with a lot of universities (young people), great cuisine and nightlife, beautiful next to the lake, but horrible winters. Residents appear very happy there but know they work hard. 8-hour shifts are great though.

 

5.      Boston University (Boston, MA):

2-4 year program. One of our favorite programs. BU runs the county hospital and the university hospital which makes a great patient population. Good faculty and great training. Dr. Brooks is a graduate from the EM program and he is happy to talk to you about the program. Very nice curriculum and residents are happy there. Boston is of course a great east coast city with all the benefits of being a big city. Great exposure to cardiac care.

 

6.      Metrohealth-Cleveland Clinic (Cleveland, OH):

3-year program. Excellent place to train if you want to stay in the Midwest. Very county at the Metrohealth site, yet your small amount of training at the Cleveland Clinic (a premier medical center) is great with the private patients and the phenomenal facilities. Phenomenal EMS training with a boast of the aeromedical exposure. You will see the sick and the poor at the Metrohealth. Good amount of trauma to add to the patient population. Cleveland is VERY similar to Saint Louis, yet it has a nice body of water nearby. Interview there has a specific set of questions they ask everyone. Be ready to answer why you want to go there (it’s Cleveland and they know that it may be a drawback for some). Most residents from the Midwest.

 

7.      Kings County Hospital (Brooklyn, NY):

4-year program. Another very county setting. Diverse patient population and tremendous variety of pathology. Residents are working VERY hard in the program. High volume, not as much trauma as expected for NYC. Big drawback is the ancillary staff- pretty much non-existent in the ED. You push the patients to radiology, you push the medications, you get the vitals. Very understaffed. If you get done there, you will be stronger. Besides the hard work you put in and putting up with the ancillary staff, it is a very good program.

 

8.      New York Methodist Hospital (Brooklyn, NY):

3-year program.  Middle of the road program. Nice people. Nice community program. Nice place to live in Park Slope. Tony used to live there and he had a great time. Housing is provided next to the hospital as subsidized housing. Medium size volume per year. You do get shipped around to other hospital ED’s during your training. There is a SLU alum training there now. Low trauma status, so you go elsewhere for trauma training.

 

9.      Mt. Sinai Hospital (New York, NY):

2-4 program. Relatively new and with a young housestaff. Tony was not very impressed after the interview. You train at two sites- the University Hospital and a higher level trauma and indigent population location in Queens which makes for a bad commute. Program is in the heart of Manhatten which is great when you’re not working though. This was low on Tony’s list.

 

10. Barnes-Jewish Hospital, Washington University (St. Louis, MO):

4-year program. Good strong program.  Amazing facilities with a brand new ED. Strong commitment to being one of the premier programs in ER and the faculty are dedicated in making it so soon. New program with young faculty. Great patient population and nice attendings. You may have some disputes with IM for admissions yet the faculty will support you. Lots of research time and money to support this endeavor. Residents appear happy. Don’t have to move!

 

11, University of Southern California (LA, CA)

2-4 program. Large county program. Learn by doing.  Very little supervision. You see everything and have to do everything. Crazy place to work but you can deal with most things when in the real world.  Excellent program.

 

12. UCLA - Olive View (UCLA Medical Center/Olive View)

2-4 program. Excellent teaching. Excellent ancillary staff. Most patients are private patients. Very little trauma. Excellent program.

 

13. UCSF-Frenso (Fresno, CA)

4-year program. Excellent patient population and teaching. One of the best programs Nirav has seen. Everything you want in a program. Nice faculty, great population, and great teaching. Biggest down fall of program is LOCATION. Nothing to do in Fresno.

 

14. Kern Medical (Bakersfield, CA)

2-4 program. Small community program. Not very impressive. Since it is a small community program when off-service rotations like ortho, you are the only ortho resident so you do everything. Location less than desirable with nothing to do in Bakersfield.

 

15. University of Pittsburgh (Pittsburgh, PN)

3-year program. Excellent program. Private patients. One of best EMS training during residency Nirav has seen. If interested in EMS check this program out. Nirav would have ranked this program in top three if location was not an issue. Great teaching and nice people. SLU alum training there now.

 

16. University of Missouri Kansas City (Kansas City, MO)

3-year program. Middle of road. Nothing special.  Trauma training was weak.

 

17. Long Island Jewish (Long Island, New York)

4-year program. Nirav talked to resident as UCSF-Fresno who transferred out of the program. He said very slow program without enough procedures. Would not recommend this program.

 

List of Transitional Programs Interviewed

1.      SLU (Saint Louis, MO)

Offered by the anesthesiology residency program so most spots dedicated to that specialty. However, a good number of spots left for other residencies requiring an internship year.

 

2.      Forest Park (Saint Louis, MO)

You will not learn anything during the year, don't waste your time.

 

3.      Santa Clara Valley Medical Center (San Jose, CA)

A fantastic place for the internship year. Very competitive and sought after by applicants. Great location. Director is very nice.

 

4.      St. Vincent’s Hospital (New York, NY)

Phenomenal program for the transitional year. Good training. Residents are happy. Located in the heart of Greenwich Village in Mahatten which makes for fun times when you’re not a work. Highly sough after by applicants for the internship year.

 

List of Preliminary Medicine Programs Interviewed

1.      SLU (Saint Louis, MO)

Dr. Schmidts of the renal module during the 2nd year is the head of the department is very dedicated to making the internship year the best experience for the residents. Good amount of electives.

 

2.      UCLA-San Fernando Valley (CA)

Nice mix of outpatient and inpatient. Very nice people. Great program.

 

3.      UC Irvine (Irvine, CA)

Majority of your time spent on VA wards. Good location.

 

4.      Santa Clara Valley Medical Center (San Jose, CA)

Same as above.

 

5.      Mt. Sinai (New York, NY)

EM interview counted as preliminary medicine interview.

 

6.      Cook County (Chicago, IL)

Don’t bother applying. Poor training. Not advised by faculty and residents.

 

Great EM Programs We Wished We Were Granted An Interview

1.      UCLA-Harbor

2.      Carolinas

3.      Bellville, New York

4.      Jacobi, New York

5.      Maricopa, Arizona

6.      UC Irvine

7.      UC San Diego

 

*DISCLAIMOR:

THE CONTENT OF THIS PAPER IS THE OPINION OF NIRAV SHAH AND ANTHONY LE ONLY. WE ARE ONLY STATING OUR THOUGHTS AND IDEAS. WE WERE OF SOUND MIND WHEN WRITING THIS PAPER (AT LEAST MOST OF THE TIME).