Advice From an Emergency Medicine Residency Director

Session 107

Emergency medicine residency training requires lots of interpersonal skills. Dr. David Snow has been out of training for 6 years now. Today, he tells us more about the acuity, variety, and steep learning curve in EM.

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Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[01:15] Interest in Emergency Medicine

Coming to the end of the third year in medical school, David was choosing between surgery, psychiatry, and emergency medicine. Ultimately, there were things about EM that appealed to him.

[Related episode: What is Emergency Medicine?]

[04:22] Traits that Lead to Become a Good EM Physician

When you get to a shift, it can get as busy as any other time during any other shifts in their life. They sometimes work at 5 am and 11 pm and it doesn't matter what comes before that. They just have to be ready as they walk in the door. This is not unique to EM at all, but it is unique across all the fields of EM. As an EM doctor, you have to understand the unpredictable nature of the specialty. 

Additionally, interpersonal skills are important as you could be speaking to patients from all walks of life.

Alongside, you'd also be networking with clerks, nurses, medical students, and division chairmen. You have to be able to work with the challenges of that environment and do so with a smile on your face.

David has been evaluating residency applications for 7 years now. A few years ago, they added a new piece to the application for emergency medicine called the Standardized Letter of Evaluation. In any of the rotations you do, you will have one of these letters written for you.

This is a movement away from the Letter of Recommendation that students ask from an EM physician. It compares you to applicants from the current cycle and the previous year. The letter also lists a set of attributes that talk about your success within those attributes as well as your work ethic, professionalism, etc.

There are also specific pretext parts to the document where people speak very candidly about the applicant. Emergency physicians are looking for the same things. They somewhat know what to write. 

[Related episode: Looking at Emergency Medicine Match Data and Surveys]

[10:50] Pass-Fail System Evaluating Students

David thinks there are so many facets to a pass-fail system. He believes it could be hard from the student's standpoint as a sub-average USMLE Step 1 score can be very detrimental to an applicant.

Programs can use filters based on USMLE or COMLEX scores and that one score can be very hard for them to move past to ensure the reviewer doesn't get stuck on that. There's no recommendation an applicant needs to have taken Step 2. But if the Step 1 score is below the mean, it's encouraged that they take Step 2 so they can work past that. This being said, it adds a lot of pressure to all of it.

[Related episode: What Step 1 Score or Level 1 Score Should I Try to Get?]

[13:40] How to Stand Out in Rotations

David recommends getting in touch with EM faculty and to start interacting with them as early as possible so they can start asking questions. Most medical schools that have EM departments have some way to get shadow shifts with EM faculty.

Nevertheless, he doesn't think there should be