Guide to Applying for EM Residencies

(written by former M4, Kristin Herbert)

EM Residency

Besides knowing that EM is a wonderful career choice, there are a few things you need to know up front. EM residencies are overseen by a Residency Review Committee or RRC which is specific for EM and separate from other specialties. The RRC dictates what a program/hospital must have, ie. trauma, burn, peds, as well as what procedures etc. residents must perform for a residency to be accredited (and its very strict!). This is important for you to know because you won't have to worry about whether or not you will get a "good education" or get enough of this or that procedure. If a program is accredited, you can rest assured that you will get a "good" education there. This makes choosing a program somewhat easier in that you don't have to wonder if you'd be a better doctor if you went to Vanderbilt or Cincinnati. What you will be worrying about is where you want to live and which program you feel comfortable enough to be in for 3 or 4 years, and whether you care about 3 vs. 4 years.

EM residencies can be 3- 4 years long with some being 2thru4 programs, which means that you do a transitional or prelim year before starting your residency. The debate on whether 3 or 4 years is better continues and it basically comes down to personal preference. Most 4 year programs offer more electives, but a 3 year program is one less year of residency and a year sooner of making money. Also some prefer a 3 year program because they plan to do a fellowship after residency. There is also a trend for those planning a career in academics to do 4 year programs over 3 years. Personally, I didn't have a preference in regards to length of residency. My #1 program is a 4 year, #2-#4 are 3 year, and #5 is a 4 year program. I basically choose my rank list based on where I felt most comfortable and where I felt like I would be most happy.

Grades

From what I can tell the first two years aren't really important...unless you failed something, and honestly that might not be that big of a deal. I had very average first two years. I definitely wasn't the top of the class and I am not anywhere close to being AOA :) But anyway, what does matter is your clinical grades, particularly Medicine, Surgery, and then Pediatrics. MOST IMPORTANT are your EM clerkship grades. So the point is, don't be a slacker, but if you didn't get that "A" in OB/GYN or didn't really care for MBOD or whatever they are calling Cell Biology now, don't lose hope.

Personally, I had "A's" in Medicine and Surgery and a "B" in Peds. My grade from my EM rotation at Vanderbilt was a "B" (but they have this weird bell curve thing they have to do...needless to say I don't think it hurt) and then I got an "A" from my EM rotation at LSU, New Orleans.

EM Clerkships

First, DO AWAY ROTATIONS!!!!!!!! If you are interested in a particular program, try to rotate there if possible. Doing an away rotation is good for many reasons. Away rotations get you exposed to a program, its residents, and faculty; giving you a view of the program you will NEVER get on a one or two day interview. Also, it is invaluable to have a program know you and that you are a hard worker and that you get along with not only the residents and faculty, but also the nurses, techs, and paramedics. (As an aside, NEVER be rude or disrespectful to nurses or ancillary staff. They talk to program directors too!)

Most people who rotate at a program are pretty much offered an interview. However, I know of only one exception. A person who rotated at The Carolinas this past summer didn't get offered an interview. But the MOST BENEFICIAL aspect of away EM rotations is letters of recommendation!

Letters of Recommendation

Most programs require you to have at least 2 letters from EM faculty and sometimes 3, but you need at least 3 letters to complete your ERAS application. EM is a pretty close knit family. Most everyone knows each other...either they went to residency together, met at conferences and stayed friends, or maybe they are trout fishing buddies as I found out in one interview. Point is, if you get a good letter from a well respected program director it can make your application.

I got letters from Dr. Peter DeBlieux, Program Director at LSU, Dr. Micelle Haydell, Assistant Program Director at LSU, and Dr. Keith Wrenn, Program Director at Vanderbilt. And from what I've been told at interviews, they were all "excellent" recommendations. GET LETTERS FROM EM PROGRAM DIRECTORS!

Board Scores

Boards scores....Unfortunately they do matter, but how much is the question. If you rocked out a 240 on Step 1, more power to you :) But if you are like me and didn't do as well.....passed but that's about it, then it's time to buckle down. You do need respectable board scores in general for EM, I'd say above 200 at least. But, great comebacks can occur. I did horribly on Step 1 (extenuating circumstances I'd be happy to elaborate if you are interested) so to redeem myself I decided to take Step 2 early and do much better.

I took off July, studied, and made a 221 on Step 2. Some programs commented or asked about my Step 1 score during my interview, but they would then mention how well I did on Step 2. Point is, do your best, but if Step 1 isn't your best then know that programs DO look at Step 2 scores. And if you rocked Step 1, don't worry about taking Step 2 till later in the year, but don't do like some and wait till April and have such a hard time studying that you don't pass, that's BAD.

Applying for Residency

I applied to about 40 programs and got 13 interviews. I did 11 interviews and ranked 9 programs. I actually had 12 interviews scheduled but had to cancel one due to weather.

I was offered interviews at:

  • Vanderbilt, Nashville, TN
    LSU, New Orleans, LA
    Resurrection, Chicago, IL
    Washington University, St. Louis, MO
    Allegheny, Pittsburgh, PA
    Case Western/Metro Health, Cleveland, OH
    Indiana University, Indianapolis, IN
    Palmetto-Richland, Columbia, SC
    East Carolina, Greenville, NC
    East Virginia, Norfolk, VA
    University of Michigan, Ann Arbor, MI
    University of Louisville, Louisville, KY
    George Washington University, Washington, D.C.

I didn't make it to my interview at East Virginia because of snow and couldn't work out my schedule to be able to drive to Ann Arbor, but I interviewed everywhere else. So, if you have questions about a particular program, I'd be happy to tell you what I know.

MAKE SURE YOU SCHEDULE INTERVIEWS AS SOON AS YOU GET INVITED! I cannot stress this point enough. Programs have a limited number of interview slots and offer more interviews than they have spots available. Translation...if you wait a day to schedule, you may end up on a waiting list or worse without an interview all together! So even if you are driving everywhere like I did, best bet is to get a calendar and a map and try to schedule interviews based on what days they offer and how close you may be to that location from another interview. It is usually easier to reschedule an interview than to wait and risk not getting one at all.

Overall, interviewing is a good experience. It is definitely exhausting. You don't realize how much effort it takes to not only smile all day, but to also be on your best behavior. I suggest you make an effort to spend time with the residents at your respective programs. Definitely attend dinners if offered the night before an interview. You really need to know if the residents are truly happy as well as if they are the kind of people you could work well with. And if there is someone else in your class doing EM interviews, try and stay in touch while interviewing. I found it very helpful to have someone to compare notes with. Finally, have fun on your interviews, be yourself, and answer questions honestly. If they don't like you for who you are, you definitely don't want to end up at that program.

Ranking

Ranking is a tough task and you simply have to do it based on what feels right to you. DO NOT rank a school that you would be unhappy to match with or where you think you'd be miserable. "Murphy's Law" is that if you rank a program and don't want to go there, you'll probably match there. Also, if you like a program over all others, but don't think you have that good of a chance, rank it #1 anyway. The way the match works is in favor of the applicant and I have heard several stories of students who ranked there favorite as #1, but didn't expect to get in and they did. RANK THE PROGRAMS IN ORDER OF WHERE YOU WANT TO BE, NOT WHERE YOU THINK YOU CAN GET IN.

And if you care, here's my final list…

  1. LSU, New Orleans
  2. Palmetto Richland, Columbia, SC
  3. Indiana University, Indianapolis
  4. Resurrection Medical, Chicago, IL
  5. Washington University, St. Louis, MO
  6. Allegheny General Hospital, Pittsburgh, PA
  7. East Carolina, Greenville, SC
  8. Vanderbilt University, Nashville, TN
  9. George Washington University, Washington, DC

Check out theses helpful websites. I used them all frequently.

www.scutwork.com

www.studentdoctor.net (go to forums, then Emergency Medicine, then pick a thread that looks interesting)

www.saem.org