Applying Residency Programs Emergency Medicine: TO IN

APPLYING TO RESIDENCY PROGRAMS IN EMERGENCY MEDICINE
by: James Kimo Takayesu, MD, MS
Introduction
Applying to residency programs in Emergency Medicine (EM) can be difficult given the
competitive nature of the application process. This guide is intended to provide you with some
basic direction for structuring the application process. You should use this guide to help
organize your clinical time and discussion with the EM faculty who are advising you at your
rotation site(s).
Choosing an EM Advisor – Your Trail Guide

By late in your third year, identify potential advisors by asking around. Other students in the
class ahead of you, your dean’s office or local emergency medicine interest groups can be a
great source of information. You do not have to wait until your EM clerkship to talk with a
faculty member about a career in EM.
Talking with one or more EM faculty will allow you to sample different perspectives and choose
an advisor with career interests that are similar to your own. Junior faculty are a great resource
to discuss the application process, job satisfaction, research opportunities and lifestyle in EM.
Ideally, the faculty advisor should be someone in touch with the residency application process.
Consider talking with a local residency program director, assistant program director or clerkship
director to help you identify faculty who might serve as good advisors.
Once you are in your EM clerkship, it is worth seeking out a faculty member who knows your
strengths and weaknesses from working with you clinically. Usually, this is the clerkship director
or assistant director, but it may be another faculty member with whom you have a good
rapport. (Fourth year medical students and the dean’s office can also provide you with good
advice on who to seek out.) Ask them for feedback on your clinical performance, points for
improvement and help in the application process. Beware of physicians overloaded with other
students or who are out of touch with the current residency environment.
With this advisor, you should begin brainstorming a list of about 15-20 residency programs to
apply to in the coming fall through ERAS. You will need to decide whether you are going to
apply to academic EM residencies, community EM residencies or both. While geography may
be the most common factor, other characteristics such as institutional quality and residency
length may be more important to you. Many students apply to over 20 programs, so keep the
list long in the initial stages. (For a complete listing of available programs, go to
www.saem.org/rescat/contents.htm)
Getting Your Letters of Recommendation

Every emergency medicine applicant should have at least one letter from an EM physician.
Other good letters may come from faculty in internal medicine, cardiology, critical care or
surgery. Beware that certain residency programs require a specific recommendation form
(Standard Letter of Recommendation -- or S.L.O.R.) to be filled out and included with their
letter, so check the websites of your desired programs to clarify their requirements.
Although it is nice to have a letter from an EM chairman or residency program director, it is
more important to choose an EM physician who knows you well. Remember that the letter
should give the residencies a picture not only of who you are academically, but also of who you
are as a clinician and team member who will work in that emergency department (ED) for the
next 3-4 years. An enthusiastic and descriptive essay from a rising professor is always better
than a form letter from a department chief.
Scheduling Fourth Year Rotations

Obviously you should have at least one month of an EM clerkship completed before applying for
a residency position in the specialty. Start by finding out what is the last rotation month that
will be included in your dean's letter (usually September). Work with your registrar or contacts
at away institutions to schedule your EM clerkship(s) before this deadline. Some students prefer
to have a “warm-up” rotation prior to their EM clerkship while others prefer to jump right in. At
the beginning of the rotation, make sure to tell the clerkship director that you will be applying in
EM and that you will need a letter of recommendation. You should have at least one letter from
an EM faculty member, preferably the clerkship director or assistant director or a well-published
EM faculty member on staff.
There is no “right” recipe for which rotations you should have when applying in EM. However,
trauma surgery, cardiology, MICU, SICU and radiology will expose you to clinical matters that
you will see in the ED and will be reinforced by your future residency. Other related electives
include dermatology, psychiatry crisis center and/or toxicology. Most schools require a sub-
internship in internal medicine or surgery. Depending on your ability to excel in these intensive
rotations, there are advantages and disadvantages to completing them before your Dean's
Letter goes out.
Make sure that you schedule some well-deserved time off or alternative experiences to expand
your horizons (international travel, etc.) during the latter part of the fourth year.
Best wishes for a happy and successful fourth year!
“Audition” Rotations
Each year many students do away or “audition” rotations at other EDs to find out more about
the institution or try to get their foot in the door. This can be very important in some of the
more competitive programs and/or for students trying to dramatically change location (e.g.
moving from one coast to another). Some programs will automatically interview any students
who rotated through their department, so this can help you get noticed.
A word of caution, however, must be given. Audition rotations can just as easily kill your
chances for matching as improve them, sometimes on a seemingly insignificant interaction.
Therefore, an audition requires absolute commitment to making the best possible impression
and to demonstrate both your hard work and friendly personality. Do not plan on getting to
know the surrounding area. Rather plan on spending as much time in the ED as possible,
working hard, staying late and prepping your knowledge base as much as possible for each
shift.
These rotations usually must be scheduled at least 3-6 months in advance. Often the home
students get first priority, but most programs reserve at least a few spots for visiting students
or will add them onto a given month. Contact the department as soon as possible to learn
2
about their enrollment process. A listing of all emergency medicine electives is available on
the SAEM website at www.saem.org/rotation/contents.htm
Scheduling Interviews
Work hard to stay on top of the application process, gently reminding your recommendation
letter writers about due dates on their letters for ERAS. Approach each program you visit with
an open mind and remember that everyone likes students who smile. You will be contacted
starting in late September or early October for planning interview dates. Emergency medicine
interviews begin in November, although there are programs that start earlier. You should plan
to take a month’s vacation (or light rotation) in either December or January to permit you to
block schedule your interviews, especially if you need to travel for them.
Some students feel interviewers are in a better mood before the December holidays. Others say
later is better because the interviewers will remember more about them in making their rank
lists. Another important factor is weather, as Northeast schools are at the mercy of January
snowstorms. In the end, no recipe really exists, so schedule them as your plans and rotations
allow, letting programs that are far away know your travel plans so they can accommodate your
schedule. Remember, if they are calling you, they want to see you as much as you want to see
them.
After the interview, don’t forget to send a brief thank you note to your interviewers. Although it
does not affect your ranking, it will make you that much more memorable and can permit you
to solidify your image/direction to the interviewers.

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APPLYING TO RESIDENCY PROGRAMS IN EMERGENCY MEDICINE

by: James Kimo Takayesu, MD, MS

Choosing an EM Advisor – Your Trail Guide

Getting Your Letters of Recommendation

Scheduling Fourth Year Rotations

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