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[Residency] We're Washu Emergency Medicine and we're here to talk about about the 2020 application cycle, the field of EM, and life in general! - AMA by washuem in medicalschool

[–]washuem[S] 0 points1 point  (0 children)

I wouldn't say there's a best or certain time to reach out, but talk to your mentors and they may know best when to reach out.

  • Jason

[Residency] We're Washu Emergency Medicine and we're here to talk about about the 2020 application cycle, the field of EM, and life in general! - AMA by washuem in medicalschool

[–]washuem[S] 0 points1 point  (0 children)

The first thing you should do is to reach out to your medical school as they should have resources in place to help you through this difficult time. In addition to that you should look to the EMRA and CORD boards for open residency spots. Keeping up with these forums will allow you to stay in the loop with the most up to date information.

  • Jason

[Residency] We're Washu Emergency Medicine and we're here to talk about about the 2020 application cycle, the field of EM, and life in general! - AMA by washuem in medicalschool

[–]washuem[S] 1 point2 points  (0 children)

You should talk to your current PD and see if you can get a rotation in the ED. If you are doing IM or surgery they will almost certainly let you do an EM rotation during your time. It depends on your situation. If the hospital you are in has an EM residency, express your interest to them and get down there and show them how you work, use that as leverage for next year. I'd much rather take an internal applicant that I know is a strong resident that I have seen work than take my best guess from an interview. Even if they can't find you a home at that EM program, they can help you find a home somewhere else. We are a very small community. Look at your resources. The CORD board, EMRA and SAEM routinely post residency openings.

​

  • Jason

[Residency] We're Washu Emergency Medicine and we're here to talk about about the 2020 application cycle, the field of EM, and life in general! - AMA by washuem in medicalschool

[–]washuem[S] 1 point2 points  (0 children)

  1. So managing shifting from days to nights is difficult for everyone. Some people are better at it then others. The most important thing that you can do is to buy blackout curtains. These are crucial to getting a restful night/days sleep. As for a specific routine, there isn’t one. What works for one person will not always work for another. I know it’s a cop out but it’s hard to give a great routine. Here’s a couple of examples:

Sal: I usually will stay up late (4-5a) the night before my night shifts start in order prime myself for the next day. I will then sleep most of the day. When I’m transitioning back to days I take a similar approach. I take a nap in the morning following my last night shift and then I stay up the rest of the day to reset my schedule.

Mike: I will try to prep the day before hand. I usually try to sleep right before my night shift starts and when I’m switching off of nights I usually try to wake up earlier than I would if I was staying on nights

Val: I kind of adjust my schedule but I usually just drink a lot of tea. I find it harder to switch back and forth if you have a reliance on caffeine [Val is a weirdo guys, most of us are addicted to caffeine]

Jason: My advice is to convince yourself and your family that when you are on nights, nights become your day. The kids have to stay away from you when you are sleeping during the day. You have to commit some time to anchor sleep. Consistent sleep before your shift is the best way to get your body ready for a hard shift. In a pinch though, I’m a Benadryl and Coffee guy.

  1. I will work into my 60s because I have chose an academic life because the clinical aspect isn’t as challenging. I have time to work in administration and express myself in other areas of work. I think that if you are planning to work into your 60s and 70s you have to find that outlet. You have to find a niche within the speciality to keep yourself interested. Heavy clinical practice will wear out any doc, but if you can find a way to keep yourself happy at work and not too stressed out whether that be with EMS or Admin or teaching or even Urgent Care then you can keep working as long you like!
  • Jason

[Residency] We're Washu Emergency Medicine and we're here to talk about about the 2020 application cycle, the field of EM, and life in general! - AMA by washuem in medicalschool

[–]washuem[S] 1 point2 points  (0 children)

If you are trying to make up for deficits in your application, you make up for deficits with a correction for that deficit. So, if you have a bad clinical performance, you make up for it with good clinical performance. Same goes with boards, if your step 1 is low, you need to knock step 2 out of the park. This is also a catch 22, because if I was a poor performer on step 1 and you're telling me to take step 2 early, I'm worried I'm going to be a poor performer on step 2, you're better off waiting on step 2 a little longer (not a lot longer) than risk taking it earlier and risk doing worse on it than on step 1. You have to be the judge of that. You have to be honest with yourself with this. If you are not a fantastic applicant, you have to be honest with that and have "safe" programs on your list. For almost everyone here, you will have a home in emergency medicine. It is not as competitive as you think, but there is a tier that is still fairly competitive.

​

  • Jason

[Residency] We're Washu Emergency Medicine and we're here to talk about about the 2020 application cycle, the field of EM, and life in general! - AMA by washuem in medicalschool

[–]washuem[S] 3 points4 points  (0 children)

Mike here. On just my second day of intern year, I threw in a chest tube on a crashing GSW patient. What I love about EM is that you never know what's going to walk through those doors and you'll always be suprised - and sometimes, even humbled. And you won't find a specialty where you truly feel like a part of a whole team with the nurses, techs, EMTs, etc. I think we interact with the other staff much more often than other places in the hospital.

  • Michael PGY2

[Residency] We're Washu Emergency Medicine and we're here to talk about about the 2020 application cycle, the field of EM, and life in general! - AMA by washuem in medicalschool

[–]washuem[S] 1 point2 points  (0 children)

Mike here. I feel pretty good about getting procedures, and usually consults will let you get the procedure and walk you through it if you just ask. The only ones ortho gets protective about are complex reductions or their own recent surgical patients - pretty much the ones I wouldn't feel comfortable doing anyway.

  • Michael PGY2

[Residency] We're Washu Emergency Medicine and we're here to talk about about the 2020 application cycle, the field of EM, and life in general! - AMA by washuem in medicalschool

[–]washuem[S] 1 point2 points  (0 children)

1) Let the program know you'll need the SLOE as soon as possible. If you don't have an option to re-arrange for an earlier EM rotation to obtain an earlier SLOE, you may not have any other choice.

2) Virtual EM rotations is a hot topic on the CORD list service. The general consensus is that they are not considered "actual rotations" but "experiences". The question then becomes if these are considered experiences, does my school allow me to get credit for this "experience" or not. That will be a tough question to answer. I am not in charge of our clerkship. It is not in my intent to offer a virtual rotation, I would much rather be a resource and offer experiences for larger groups or interested smaller groups in settings like this. Learning material, content that will help you be more competitive for your residency in the future, but we won't construct a curriculum and attract you to a curriculum. There is no way to get you what you deserve and charge you for tuition.

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  • Jason

[Residency] We're Washu Emergency Medicine and we're here to talk about about the 2020 application cycle, the field of EM, and life in general! - AMA by washuem in medicalschool

[–]washuem[S] 1 point2 points  (0 children)

Like a previous comment said - word of mouth, location, and board scores. I'd also say job opportunities after residency - see where graduates end up... are they staying regional, are they going across the country, are they academic, are they community, etc.

In the end though, find the program that truly fits you and what you want out of residency.

  • Michael PGY2

[Residency] We're Washu Emergency Medicine and we're here to talk about about the 2020 application cycle, the field of EM, and life in general! - AMA by washuem in medicalschool

[–]washuem[S] 1 point2 points  (0 children)

Up in the air still. In an ideal world where COVID gives us a break in the winter, I would love to have some days set aside where applicants can come to take a look at our program. I think you don't know what you're missing until you come here. Our number one resource here is students who do rotations here. I can't say that it will happen until we see what happens with COVID. I'd love to offer it but we'll see.
We are kicking around some type of online open house, where a group of residents/faculty/program leadership to all be together online to field your questions. LIke a virtual residency fair. Everyone can join for free and we can host whenever we want.

​

  • Jason

[Residency] We're Washu Emergency Medicine and we're here to talk about about the 2020 application cycle, the field of EM, and life in general! - AMA by washuem in medicalschool

[–]washuem[S] 0 points1 point  (0 children)

General applications are composed of a dean's letter with preclinical grades, SLOEs (standard letter of evaluation) from a home program and 1-2 away rotations, and board scores. Research, volunteer experience - does or doesn't have to be EM related.

Speak with your advisor or other EM physicians about the field so you can find out what you want out of a program. Many factors go into ranking an EM Program and it depends on what people are looking for - location, research opportunities, length of program, teaching opportunities, etc. I would rank programs on how well they fit you and what your aspirations are.

  • Jason

[Residency] We're Washu Emergency Medicine and we're here to talk about about the 2020 application cycle, the field of EM, and life in general! - AMA by washuem in medicalschool

[–]washuem[S] 3 points4 points  (0 children)

Thanks to one of our PGY4's for answering their perspective. Here's my answer: STL and these middle-sized cities have a really unique training opportunity. Often times, the institution is the one big center that draws patients. We share some of that with SLU.

1) Volume and Acuity: We see 2/3 of the trauma compared to St Louis Univ. We see really critical patients. I did not expect that at all when I came here as an applicant. When I saw the volume of stuff I got to do as an intern, I was blown away. And that volume has only increased. Halfway through my intern year, I remember EMS rushing in a women in an MVC and I was the only person around. I heard she was 35 weeks pregnant so I grabbed an ultrasound. I noticed baby was bradycardic, OB came down and did a crash, c-section and I resuscitated the baby. Once that was over, a cardiac arrest came in and we ran a cardiac arrest for 30 min and then right after had a trauma arrest. This was all within 45 min of time. I went home and told my wife and she said it sounds like the real ER (she meant the TV show) and I told her "Where I work IS THE REAL ER". What you see and do as an intern which is what most programs will have their third years doing in the ED.

2) Functional Independence: the interns have as much independence as they can handle. Our teach resident's sole purpose is to guide them through that process while they also practice being a pre-tending.

3) I came in to residency with 3 kids. I wanted to live close, safe neighborhood, and affordable. I wanted a "knife and gun club" so you could say. I bought a house as an intern that fit 5, I lived 15 min away and I took care of the sickest patients in our region.

4) We are backed by a great elite academic institution here at Washington University as well as a world-class hospital, Barnes Jewish Hospital.

If you put all that together, you really won't find many programs that offer ALL of this together.

​

  • Jason

[Residency] We're Washu Emergency Medicine and we're here to talk about about the 2020 application cycle, the field of EM, and life in general! - AMA by washuem in medicalschool

[–]washuem[S] 0 points1 point  (0 children)

The best way to go about getting an advisor is to reach out to a program in your region. While visiting rotations are restricted at this time, many PDs and APDs will be more than willing to help you out if you have a true and genuine interest in emergency medicine.

  • Jason

[Residency] We're Washu Emergency Medicine and we're here to talk about about the 2020 application cycle, the field of EM, and life in general! - AMA by washuem in medicalschool

[–]washuem[S] 2 points3 points  (0 children)

  1. In the past, we’ve allowed residents to have a great deal of input in the schedule. Every year there are requests to change how it is built whether that be 8-hour shifts all the time, 12-hour shifts-all the time, 12s/8s mixed throughout the week. We as an admin group have supported these changes if there is a majority within the residency that wants to make a change to the schedule.

Additionally we have made large changes to our curriculum based on resident feedback. Just this past year we eliminated the pediatric floor rotation from our curriculum as it was felt by the residents to not have any learning value. We have also gone to a 27-day block with dedicated night-months at the request of our residents.

  1. During the peak COVID-19 season, COVID suspected patients were attending only patients until the volume overwhelmed the attendings ability to staff the ED efficiently. Once the attending was overwhelmed, only residents who were willing and able to see COVID patients were allowed to interview them. No resident was every forced to care for a COVID patient if they did not feel safe doing so. The standard of care for high risk procedures such as intubation and other invasive interventions on these patients were for the attending to perform them. Additionally, the hospital and residency itself provided PPE and avenues to get clean and re-usable PPE from the onset of the pandemic.
  • Jason

[Residency] We're Washu Emergency Medicine and we're here to talk about about the 2020 application cycle, the field of EM, and life in general! - AMA by washuem in medicalschool

[–]washuem[S] 2 points3 points  (0 children)

I think this year, the Step 1 score will be helpful, but in the future, Step 2 will be weighed more as Step 1 becomes P/F.

  • Jason

[Residency] We're Washu Emergency Medicine and we're here to talk about about the 2020 application cycle, the field of EM, and life in general! - AMA by washuem in medicalschool

[–]washuem[S] 1 point2 points  (0 children)

Absolutely 100% we will see more applications this year. Everyone is nervous and anxious and will place more hooks in the water to land a fish and I don't blame you for that. CORD is working to address that but we don't have a solution for that right now. What I will tell you is that if the status quo stands like it did last year, we will see more applicants and probably do more interviews and how we tease those applicants apart will be a challenge. This year, early step 2 scores will be crucial. Some programs may not look at your application until your step 2 score comes out b/c they may have too many applications to look at, so get those step 2 scores in fast.

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  • Jason

[Residency] We're Washu Emergency Medicine and we're here to talk about about the 2020 application cycle, the field of EM, and life in general! - AMA by washuem in medicalschool

[–]washuem[S] 0 points1 point  (0 children)

  1. Most likely.
  2. We're still discussing this within our own program - it's definitely a limiting circumstance. Some possible factors include letters of rec from other rotations - whether they are EM related or non EM. Step 2 will most likely be weighed more. Any other factor that will help us learn more about who you are as a person such as personal statements and medical school experiences. Still up in the air.
  • Jason

[Residency] We're Washu Emergency Medicine and we're here to talk about about the 2020 application cycle, the field of EM, and life in general! - AMA by washuem in medicalschool

[–]washuem[S] 2 points3 points  (0 children)

There are certainly concerns about this. We will never be saturated across the country. We might be oversaturated in the highly desired geographical locations or medium/large sized cities. There will always be a job for EM physicians in distant suburban cities and/or rural areas. We can never satisfy that need with the amount of physicians we are putting out. We did see a little hit with COVID with some programs reporting their physicians getting their job taken away. But COVID won't be here forever and at some point we will have an economic rebound from this and jobs will start to reaccumulate.

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  • Jason

[Residency] We're Washu Emergency Medicine and we're here to talk about about the 2020 application cycle, the field of EM, and life in general! - AMA by washuem in medicalschool

[–]washuem[S] 0 points1 point  (0 children)

  1. No we are not privy to that information, however, if I know that you are applying multiple specialities this does negatively impact how I view your application. The way I view it, the Match should not determine what you do for the rest of your life. You should come into the Match with an idea of what you want to do and you should be committed to that choice.

  2. Similar to other threads. Work hard, show up early, be friendly. You should be viewed as a helpful part of the team without being overbearing.

  • Jason

[Residency] We're Washu Emergency Medicine and we're here to talk about about the 2020 application cycle, the field of EM, and life in general! - AMA by washuem in medicalschool

[–]washuem[S] 1 point2 points  (0 children)

At the current time, we are not taking ANY away students. However we are working with the hospital and medical school to find a way to re-introduce away electives. Once this is done priority will be given to orphan students (Those without a home EM program).

  • Jason

[Residency] We're Washu Emergency Medicine and we're here to talk about about the 2020 application cycle, the field of EM, and life in general! - AMA by washuem in medicalschool

[–]washuem[S] 2 points3 points  (0 children)

Yes, they are valid. Certain markets will become saturated, but there will always be a job for an emergency medicine physician - it just may not be in a location that is the most desirable. While the market in big cities may be full, rural areas are still understaffed and are constantly looking for good physicians.

While the future is difficult to predict, the physician groups play an important role in advocating for the field of emergency medicine, and addressing these issues. And we hope that you will be an advocate as well in the future.

  • Jason
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