EMRA and CORD Student Advising Guide

Supplemental Guidance for 2022 Match

Navigating Match 2022: Current Advice

Navigating the match is difficult in routine times - and the ongoing COVID-19 pandemic means 2022 will be another unusual year in medical education. This Q-and-A discussion addresses some of the most recent changes in the application cycle.

The most recent edition of the EMRA and CORD Student Advising Guide was printed and released in 2019 and the next major revision is not planned until 2023. While the majority of the guide's recommendations are still valid, there have been several major notable events since it was last printed, including:

• The elimination of the AAMC's Standardized Video Interview (this information is already removed from the electronic version of the book),
• The impact the COVID-19 pandemic has had upon away rotations and residency interviews
• The announcement by the National Board of Medical Examiners that the USMLE Step 1 will be moving toward a pass/fail scoring system 
• The recently released EM workforce projections for 2030

In March 2021, a multi-organization Consensus Statement on the 2021-2022 Emergency Medicine Residency Application Cycle was released, which students are encouraged to review to ensure they are up-to-date on the latest recommendations for this upcoming match cycle.

COVID/Travel Restrictions: Away Rotations/SLOEs

Q: I already completed two audition rotations but I got an invitation to do a third at a program where I really want to match. Can I go ahead and do it?

A: It has never been recommended to do more than 2 EM rotations (see Ch. 5 - Applying for Away Rotations). This advice continues to hold true during COVID and was re-iterated in the March 2021 Multi-Organization Consensus Statement on the 2021-2022 Emergency Medicine Residency Application Cycle. Your residency application should include a maximum of 2 eSLOEs.

DISCUSSION
A third rotation takes away opportunities from other students and doesn't necessarily improve your chances of matching. Per the consensus statement: "The two eSLOE limit is designed to promote equity [and consistency by] prohibiting unnecessary away rotations. Away rotations will be a highly limited resource this year, and should be distributed among the largest possible number of students. However, it should be recognized that in rare cases there may be valid reasons why students may have more than two eSLOEs. When this is the case, the reason for the anomaly should be clearly explained in the student's residency application."

We must work together as a community to assure that the majority of applicants have access to an away rotation, as they are a valuable but limited resource. This means that any student who has access to a "home" EM rotation should complete only one away rotation. Those students who do not have a home EM rotation should aim to complete two away rotations. In each case, the recommended goal is to have a maximum of two eSLOEs for your application. We are continuing to monitor the ever-changing application environment this year and recommendations will be updated as appropriate.

Q: I was able to get one eSLOE this year, but have not been able to obtain a second one. How will this affect my chances of matching?

A: We don't expect this to have a substantive impact on matching this year.

DISCUSSION
While we would like students to obtain two SLOEs, this isn't always possible. Program Directors recognize the unique challenges placed on medical students during the COVID-19 pandemic. There is always some variability in what PDs expect or desire, but on the whole, program directors only really expect to see one SLOE on an initial application review. Remember, students can obtain SLOEs past the initial ERAS application submission deadline, which would allow for an additional SLOE to be uploaded during interview season. This additional piece of information can then be used by PDs during the rank process, if they desire to do so. Even if you are planning on a late SLOE, we do recommend, however, that you have three letters of recommendation uploaded when ERAS opens to programs on Sept. 29 so that your application will be complete for review (and not held up by waiting on that late letter). 

Q: I am in the process of getting my letters of recommendation for my application. I remember that I was told I should attempt to obtain 2 eSLOEs for my application, but I think I did really well on my internal medicine rotation. Can I submit an oSLOE as one of these letters, instead?

A: There are several varieties of SLOEs, and it is important to understand the differences. An oSLOE is obtained from an off-service (or non-EM) rotation. It will not be considered with the same weight as an eSLOE. You want to aim to obtain 2 eSLOEs for your application. 

DISCUSSION
The language around the various types of SLOE (Standardized Letters of Evaluation) can be confusing. The bottom line is that you want to aim to obtain 2 eSLOEs for your application; the rest are extra. An eSLOE (electronic Standardized Letters of Evaluation) can be obtained after completing an in-person EM rotation at an institution that has a residency program, and it is written using a specific format. These letters are generally written by a group of EM faculty and the format is designed to promote fairness and transparency in evaluation. These letters hold the most weight for Program Directors when they review an application and are considered the gold standard of EM letters of recommendation.

Because ERAS allows you to upload a total of 4 letters of recommendation, you will want to add additional letters to the 2 eSLOEs you obtained. You can do this in several ways:

• If you completed an EM rotation at an institution that does not host an EM residency program, they can complete a "SLOE for non-EM faculty."
• If you completed a subspecialty rotation such as toxicology or ultrasound, you can ask for a "SLOE for subspecialty rotation."
• If you would like to obtain a letter of recommendation from faculty in a non-EM specialty you can ask for a traditional letter of recommendation or you can ask them to complete an oSLOE.

These letters can certainly add to your application and provide valuable information about you as a candidate, but they should not replace an eSLOE if you have one available. 

COVID/Travel Restrictions: Residency Applications/Interviews

Q: I've read the EMRA and CORD Student Advising Guide: An Evidence-Based Approach to Matching in EM, but my advisor said I should apply to many more programs than are recommended due to the impact of COVID on my education and application.  What should I do?

A: CORD and EMRA recommend that you stick to the guidelines which have been published (see Ch. 8 - Apply Smarter Not Harder: Understand Your Competitiveness), and that you seek counseling from an experienced EM-specific advisor. Applying to residency is about much more than the number of applications you submit - it has more to do with what you want, your competitiveness, and where you submit those applications. We recommend focusing on knowing yourself, and your programs, rather than arbitrarily increasing the number of applications.

Q: I learned that all interviews are supposed to be virtual this year, but got invited for an in-person interview.  What should I do?

A: CORD, EMRA, and other EM organizations recommend only virtual interviews this year. Take note of the current best practices for conducting interviews in the 2021-22 interview season (detailed here). 

DISCUSSION
CoPA and CORD have sent a clear message to training programs that interviews should be 100% virtual this year. There is no mechanism for enforcement, just an expectation that programs will adhere to the community standard. We recognize that receiving an invitation to interview in person puts students in a very difficult position. It is unlikely that programs would offer only in-person interviews, and we ask that all students opt for virtual interviews if given a choice. Students should familiarize themselves with their own institution's policies. If their medical school mandates virtual interviews, the student would be in jeopardy if they broke that rule. This allows them to gracefully decline an in-person invitation. 

Q: I got an invitation for a "second look" at a program, but already had a virtual interview at the program.  I'm afraid that if I don't go to the second look, the program won't rank me highly.

A: The Consensus Statement on the 2021-2022 Emergency Medicine Residency Application Cycle does not provide clear guidance regarding "second look" events.

DISCUSSION
This is another situation that puts a student in a difficult position. The only solution that prevents bias is for programs to have second look opportunities only after the program's match list is in but before the deadline for students' match list. It is currently unclear if any consensus statements will be made on this topic. Virtual interviews serve to level the playing field regarding the financial and time burdens related to interview travel necessary in the past.

Q: How do I know when programs are hosting virtual events?

A: Watch social media! Many programs are holding virtual meet-and-greet events. 

DISCUSSION
EMRA hosts a number of events and is a good first place to look. There also have been virtual events associated with the large national EM conferences:  AAEM, SAEM, ACEP.  Each residency should provide information about their program and locale on their website, social media posts, and will provide resources to students who apply. 

Research all residency programs on EMRA Match. Use the navigation tools in the upper left to search Residency Programs according to your own parameters. EMRA Match is free and open to everyone; EMRA members can log in to save and further customize their search results. 

Q: How can I determine the culture and feel of a program if I'm unable to visit them in person?

A: It can be very difficult to get a feel for a place without having the opportunity to experience it in person. One of the ways programs have tackled this challenge is by embracing social media and virtual platforms as venues for showcasing themselves, their training environment, and their culture. 

DISCUSSION
While many programs certainly had a social media presence prior to the COVID-19 pandemic, the number of programs creating social media content and the variety of platforms they are using has expanded significantly during the 2020-2021 application cycle. Following a program on Twitter or Instagram, for instance, can offer you a window into what a program chooses to highlight about itself. It is important to be mindful of your own social media presence; you may want to consider creating a professional account separate from your pre-existing personal account as a way of isolating any content on your own account that may cast you in an unfavorable light.  

Many programs have also begun to host virtual recruiting events where students can interact with faculty and residents. Some of these are informal "get-to-know-us" gatherings, while others are more structured and focused on a particular topic or subspecialty niche. Attending these virtual gatherings can be an effective way to express interest in a program while also learning about the program and the people in it. Recordings of some of these more structured events may also be made available if you are unable to attend during the scheduled time.

USMLE Pass/Fail

Q: The USMLE will soon become a pass/fail exam.  Am I better off taking the test now so that I can get a score? What if I can't take it now and have to take the pass/fail version; will that hurt me?

A: The best time to take the USMLE exam is when you are fully prepared to take the exam. 

DISCUSSION
Do not take an exam early to get a score. You don't want to sacrifice your potential to build and solidify your fund of knowledge or cut your study time short. 

When the exam converts to pass/fail on Jan. 26, 2022, there will be many other students in a similar position as you, and program leadership will likely adjust how they evaluate applicants, relying more heavily on the other factors mentioned in Figure 8.2 from Ch. 8 - Apply Smarter Not Harder: Understand Your Competitiveness.

For more information, you may read the most recent announcement from the USMLE: USMLE Step 1 updates on score reporting and standard setting (June 29, 2021)

EM Workforce

Q: What is the anticipated effect that the recently released Emergency Medicine Physician Workforce: Projections for 2030 will have on EM match this year?​

A: The projections set forth in the Emergency Medicine Physician Workforce report likely will have little substantive impact on the number of successful EM-matched applicants this year. Over the past several years, there has been steady growth in the number of EM residency programs and positions available, which means there are more opportunities than ever before for applicants to match into emergency medicine.

DISCUSSION
British statistician George E. P. Box is credited for his famous quote that "all models are wrong, but some are useful." A wide range of projections are described in the workforce report, including best case, worse case, and most likely scenarios. All of these projections are dependent upon a number of assumptions, including those regarding the growth of EM residency programs, the degree to which physician assistants and nurse practitioners are utilized in the future, the rate at which current emergency physicians retire or pivot into non-clinical roles, and the future demand for emergency care services. While the report does project a future surplus of emergency physicians, even the great Niehls Bohr, a Nobel laureate in physics and father of the atomic model is the first to admit that "prediction is very difficult, especially if it's about the future."

They say "the best way to predict the future is to create it," and as a result of the findings of the workforce report, numerous conversations are occurring within the emergency medicine community. These conversations are focused on multiple topics, including how to protect the unique role of emergency physicians, ensure comprehensive and consistent EM residency training, broaden emergency physician practice to meet evolving community needs, support emergency physicians and encourage rewarding practice in all communities, and ensuring that business interests do not supersede the needs of educating the workforce (ACEP Framework of Workforce Considerations, May 5, 2021). 

Given the uncertainty regarding the workforce report's projections, as well as the numerous solutions currently being explored, a career in EM still seems like a great idea to many physicians and students. As with all things in EM, our specialty is well-suited to adapt and overcome obstacles placed in our way. It is anticipated that a large number of students will continue to be interested in EM for the same reasons they always have (see Ch. 1 - Choosing Emergency Medicine).

For more information about the EM workforce, please visit ACEP's EM Physician Workforce of the Future page.