Jacob Schwab, OMS-II

Timothy Bikman, OMS-IV

I recently interviewed National Student Past-President, Tim Bikman. Emergency medicine has become a highly competitive specialty, but there are things you can do each year to set yourself up for success on Match Day. Tim’s answers to the following questions provide great insight and will benefit anyone interested in emergency medicine.

What are some basics things that anyone interested in EM should do?

Get involved with your local EM club and try to find ways to get experiences in and around emergency medicine. Things like shadowing an emergency physician or attending a lecture by an emergency physician or resident can be extremely valuable. Become a member of the national organization, which for us as osteopathic students would be the American College of Osteopathic Emergency Physicians (ACOEP), and also register as an EMRA member. Both organizations provide really unique, basic things that are helpful for students interested in emergency medicine.

For those who may not be familiar with it, can you explain what EMRA is?

EMRA is the Emergency Medicine Residents’ Association and it’s basically the MD’s version of our National Student ACOEP Chapter. It’s something for residents and students alike.

First Year

What made you want to go into EM?

As a first year student I had an upper classman who encouraged me to look into EM. At that point, I really felt like I wanted to do pediatrics. Finally, he convinced me to attend an ACOEP student event. At that event I just found myself surrounded by people whom I really meshed well with, and it was the type of culture that I wanted to be involved in. I realized these were the kind of people I want to be like later on in life. I was really inspired by that experience, going to a conference and being around those types of people.

As a first-year medical student, how do we know whether or not EM would be a good fit?

The only way you can know is to start having experiences. Attend your local EM club events, especially if they have a doctor coming to talk, and just ask yourself, “Is that the type of environment that I want to work in?” “Are those the types of experiences that I want to have?” “Do I feel like I would excel in that type of environment?” Look around the room and ask, “Do I see myself fitting in with these types of people?” I would also highly encourage students to attend an ACOEP or EMRA-sponsored “Regional Symposium.” These are one day events on a Saturday, so you don’t have to miss class, where they have lecturers, labs and some sort of residency-networking experience. Going to one of these as a first-year student would be really valuable in helping you understand, “Is this really a specialty that I should pursue?”

Did you attend any other conferences outside of emergency medicine?

I did, actually. For two years, I went to OMED, which is basically the osteopathic world’s major conference that brings together a number of different specialties, where I presented research. Also as a first year student, I attended the American College of Osteopathic Pediatrics spring conference. These conferences were fine, but lacked student-focused lectures and events. At that point, I assumed that’s just how it goes as a student. Then I attended an ACOEP conference as a second-year student and found myself engaged in lectures, labs, and social events specifically for students like myself. I felt like, “This is a college that cares about me as a student and where I’m going,” and that was one of the things that really inspired me to do emergency medicine.

How important are clubs?

I think being involved in a club shows dedication to a specialty and it’s a valuable opportunity to help you find out if you are really interested in that specialty. Emergency medicine has become very competitive, so the earlier on you know it’s the specialty you want to go into, the better prepared you can be for matching into a good residency.

What if you don’t have any ED shadowing experience? What are the first steps that you would recommend to get ideas about whether this is the path that I should go down?

I think this question really goes along with some of the other things that we’ve talked about, such as getting involved in your local club, attending their events, trying to find out if there are any regional symposiums or conferences that you can attend and just getting experiences within that environment and among those people that practice in that environment. I think that’s the best thing that you can do. If you have the opportunity to spend some time in the emergency department, that’s great, but I know that’s not a possibility for all students and I don’t think it’s completely necessary. I think there are other ways that you can get those experiences and rub shoulders with people who are in those environments and will help you better know if emergency medicine is right for you. So just being involved in your local club and trying to find an emergency conference to go to would be very beneficial. If you don’t make it to an ACOEP conference, SMACC puts on a conference, SAEM puts on a conference, and EMRA has their conferences with ACEP. There are lots of conferences out there. Find one that’s doable for you and attend it.

Second Year

How important is club leadership during our first two years?

I think having leadership experience is very valuable. There is so much personal growth in taking on the challenge of a leadership position. Those types of positions also, inevitably, lead to networking and other opportunities that you wouldn’t have been exposed to otherwise. Also, as a second-year student, it’s not wrong to look at national leadership opportunities as well. The ACOEP students have elections every fall for their national leadership and we always encourage second-year students to run for positions.

What advice do you have about taking USMLE along with your COMLEX, and what kind of implications does it have in emergency medicine specifically?

This is a question I’ve thought a lot about. Within the next 2-3 years, I imagine the single accreditation will create an environment where there is virtually one match and all students, DO or MD, are competing directly for all positions. I know a lot of students have concerns like, “What if I don’t do well on the USMLE?” I get that. It’s scary. It’s another exam you’ve got to prepare for, but you really prepare for it the same way. Let’s say you don’t do well–I don’t think that closes any more doors than would already be closed if you don’t take the exam. Just taking the USMLE will give all programs the opportunity to consider you as an applicant, regardless of your score. Also, it’s been my experience that students who plan to take both exams are more diligent, disciplined and serious about the exams.

When is a good time to do an ED rotation as a third-year student?

At most schools, you have limited control of how your schedule’s set up as a third-year student, and I get that, but there’s no better way to find out if emergency medicine is right for you than to do a rotation as a medical student. Whether it’s a required rotation or an elective, I would try my best to get into the emergency department early in your third year, especially before January when you really have to hit the ground running while preparing for fourth year.

What are important dates to keep in mind as a third-year student, as you’re preparing for fourth year?

Third year, academically, is much easier than your first and second year, so you’re not spending so much time worrying about the next exam. Third year is really a time to prepare for fourth year. July through December is a great time to do a lot of general investigation of many different programs. Try to find out what you want from your future training. Are you looking for a community-based training, a large academic center, a major trauma center, or is geographic location important? By December you need to have a small list of your top 5-8 programs. These will be the programs where you would like to do a visiting/audition rotation. In January and February, find out exactly how to go about applying for an audition rotation at these programs. You’ll need to find out if they have their own application or if they go through VSAS (Visiting Student Application Service). Every program has different deadlines and requirements. You want to be on the ball because even audition rotations are competitive and you need to have all of your paperwork ready and submitted the day their application opens up. Then, as third year is wrapping up, you’ve got to be serious about being ready to fill out your ERAS (Electronic Residency Application Service). That means you have an up-to-date CV put together, you’re working on your personal statement and you’re thinking about your letters of recommendation. Most medical schools allow you to start filling out your ERAS in March. You can also go to ERAS, at any time, and download a PDF template to know what information you will need to input into ERAS. Lastly, you will want to sign up early for board exams. Take your exams early, like in July, so that programs have your scores back when they are considering whom to invite for interviews.

How important is Step II?

Step II, in general, is not as important as Step I when programs are considering which applicants to interview. I think programs make a lot of their decisions and set their minimum board scores for accepting interviewees and auditioning students based on Step I; however, I feel like Step II is definitely an important opportunity. It’s your chance to show the program a consistent pattern of success, or if you didn’t do so well on Step I, it’s an opportunity to show improvement.

Fourth Year

What months are best for audition rotations?

I think the prime months to do audition rotations are August, September and October. In July, programs are trying to get their new interns oriented. Interview season is primarily the end of October through early January. It’s best to avoid being on auditions in the middle of interview season.

What are SLOEs and why do I need one? 

SLOE is a Standard Letter of Evaluation. It’s a letter of recommendation that standardizes you, as a rotating student in emergency medicine, compared to other students each specific program has seen. It’s extremely valuable. This is arguably the most powerful tool a program director has that shows how you function in an emergency room, through the eyes of the faculty members that work in residency programs.

If you’d like to learn more about SLOEs, you can find more information at this website: http://www.cordem.org/i4a/pages/index.cfm?pageID=3743

You can also see an example of the SLOE template at this website: https://www.cordem.org/files/DOCUMENTLIBRARY/SLOR/SLOE%20Standard%20Letter%20of%20Evaluation%202015.pdf

How and when do I get them?

When you’re doing an audition at an emergency medicine program make sure to let them know at the very beginning of your rotation that you would like to receive a SLOE at the end of the rotation. This is also a great time to ask them about their process in writing SLOEs and about their criteria to achieve “honors” vs. “high pass” vs. “pass,” etc.

Who gives them?

It depends on the program. Each program has their own process. Some programs have a committee that gets together to develop their SLOEs and others might have the program director or a specific faculty member assigned to create their SLOEs.

Do you see your SLOEs?

This is like any other letter of recommendation and so you probably won’t see what it says. It is also important to know that the process of uploading a SLOE is the same process used to upload any letter of recommendation. In addition, remember that you can only submit four letters of recommendation to any residency program. I would recommend that two of those four letters of recommendation submitted to each of your programs be SLOEs.

Do you have any advice for preparing and submitting your ERAS application?

There are two big things I would like to mention. First, be early on everything when it comes to residency, especially your ERAS application. Find out when you can start filling out your ERAS and then find out what dates DO and MD programs accept applications (these are all different dates that change each year). Be ready to submit your application the first day that ERAS allows. Secondly, you don’t have to have a complete application to submit it to programs. For example, most of you won’t have your board scores back and your SLOEs will not have been uploaded by the time you can submit your application. For example, if you don’t get your COMLEX PE set up early enough and you don’t have that score back yet, you should still submit your application. This shows them that you are organized and serious about their program.

How do you maintain balance and wellness through this crazy process?

If we don’t have health, in all of its aspects, we have very little. Be conscious of what you eat/drink, and exercise regularly. Finally, for most of us the clinical years of medical education is the first time we have been exposed to real tragedy on a regular basis. You will see and be part of some patients’ most devastating moments. These moments take their toll. Find ways to maintain balance in your life. These will be different for everyone. Family, socializing, religion or exercise are just a few of the things that can contribute to a long and healthy career.

Here are some pearls of advice from some program directors:

  1. Personal Statement: Make it believable. Tell what motivates you, drives you, and makes you want to excel in EM. Let them know about you and what they would be getting out of you as a resident, for example, leadership qualities, experiences, research, personality, etc. Tell what you are looking for in a program. Tell what you need from a program to help you be successful.
  2. Doing an audition at an institution that is not familiar with or doesn’t complete SLOEs is not as advantageous as those that do.
  3. Taking both USMLE and COMLEX should be viewed as mandatory.
  4. Most students do 3-5 auditions which takes a significant amount of early planning and a lot of time.
  5. As a fourth-year student it is important to follow up with programs you liked in order to express your interest in that program before rank lists are submitted.