Hello all,

As a confused medical student attempting to make some of the most
stressful decisions of his life, I found the 400 shekel Emergency
Medicine conference well worth it. I would encourage anyone to
attend any conference in whatever specialty where american
physicians are present and just chat it up and introduce yourself;
particulary if it is a field you are possibly considering. Doctors
love to talk about themselves and their fields and it is this wealth
of information about life as an american doctor that is most
particularly lacking as a student here at Sackler.
The advisement I received is invaluable and hopefully you too will
find something useful from the next conference you attend.

Sincerely, Darren Lucas

-I typed up what I discussed and hope that it helps you.

March 11, 2008
Emergency Medicine conference

Advisement from Professor Holliman: American EM physician and
student advisor for 20 years at Penn. State Univ. Previously on York-
Hershey EM admissions. Currently building healthcare system in
Aghanistan.

In general:
The profession is looking for physicians with excellent clinical and
people skills. Need to work with all different kinds of people and
all different kinds of colleagues within the hospital. See many
kinds of people who walk in that door and each patient is a
challenge. Will diagnose many patients. Patients are in more
critical need of care. Need to know the entire breadth of medicine.
The need is increasing and more positions are being offered. As in
any specialty, you need to be comfortable with dealing with the
downsides of the profession as they will occur on a daily basis.

The upsides:
Great hours and flexibility of schedule with great reimbursement and
the ability to leave your work at the hospital following your shift.
Lifestyle is great and happy physicians.

The downsides:
Ability to deal with a non-existent schedule and not being able to
know what patient will be seen next. In addition, an ability to deal
with the drug addicts and lowlifes of society that will walk through
the door on a daily basis. The non-continuity of care that is
usually noted of EM but is not particularly specific to EM anymore.
Other specialties also rarely follow their patients and pass them
around with more often with the group setup and you will see certain
CHF and asthma patients more than once for example.

Application:
Very competitive. Everything is assigned a point value and then
added up to grant interviews. Most important are third year rotation
grades, EM elective letters, letters, but step1 score is about
seventh on the list and step2 is held in a higher regard as it is
more clinically based.
Other things to consider to gain points are volunteer service,
research, knowledge of another language even if basic, membership in
the respective professional organization such as SAEM (saem.org) or
EMRA (emra.org) in order to show commitment to the profession.
Complete the application early, by early October. You should have
everything in except the letters from the first elective you do and
you should follow up on these letters and get them in asap as most
programs will only look at completed files.
Apply to 20-25 places. Many programs simply throw away every fifth
application without even looking at it due to the sheer volume they
receive (800 for 10 spots). They know they are throwing away great
applicants.

Recommendations:
You need 3 letters from EM specifically, most preferably all 3 from
a faculty physician that can say, "I worked with him/her and they
did a good job". So someone you work with. You will get 2 letters
from your first elective, and the other from the second elective.
Try to get your letters from the guys at the top who will be
naturally recognized in the field due to their research (most
likely). EM in general feels that other fields do not understand
them, so even a great letter from another specialty is not quite as
good as a letter from EM in general, perhaps an outstanding letter.

The personal statement:
It needs to demonstrate 3 things specific to EM. First, a
demonstration that you understand what EM is all about. Second, find
a way to describe yourself as an empathetic / people person. Third,
write about the things that make you stand out from other
applicants, perhaps the international schooling experience.

Electives: the order.
First-EM (2 letters)
Second-an intensive field such as surgery, medicine ICU, any ICU, or
anaesthesia. Something to build your clinical skills.
Third-EM (1 letter)
Fourth-The fourth in any of these helpful areas, EM applicants are
usually most weak in peds. Outpatient peds, outpatient ortho,
dermatology, sports med, any surgical subspecialty.
Do an elective at places where you think you have a shot at being
accepted. They give you an interview if you do an elective there, so
try not to waste this chance.

Programs: 3 types
-three year programs are the large majority
-1-2-3-4 years continuous program
-2-3-4 years program with a required previous transitional year that
is usually at the same institution.
The four year programs are generally geared towards more
administrative experience. It has repercussions following residency
regarding academics and is more favorable to gain a faculty position
( I was not totally clear on this).

-If you do NOT get accepted: simultaneously apply for a transitional
year. Transitional year programs usually have 1 month of EM
included, request an extra month and do them both early in the year.
When you reapply, focus on the 2-3-4 programs so you can just enter
as second year resident, but also apply to the others or where you
want to go as well. It will strengthen your application regardless.
Some programs require international grads to do 1 year in the usa
before considering the application. It will place you on the same
level as an American graduate.

Websites:
www.saem.org
www.emra.org
www.acep.org