Balance how well the letter writer knows you with how well they are known to the EM residency directors' community. A stellar letter from a community family practice preceptor will carry less impact than a solid letter from an EM program director that I know and trust. My concerns about that community practitioner is that they may be comparing you to a different group (or with a different yardstick) tehn the EM applicant pool. Likewise, they may not understand attributes that make an excellent EM resident. They can provide information about your work ethic and interpersonal skills. Therefore, you need to have at least one letter from an EM program director. Most directors also want to see a letter from every EM program that you did a rotation with (the absence raises questions about how well you did). EM directors will use a SLOR (Standard Letter of Recommendation) that can be found on the CORD home page.

There's no consensus on this issue. Unlike what is advocated in Iserson's book, many of us feel that the last week of interview season is a bad choice…the program directors are tired, you are tired, and spontaneity is lost. There is also no bad weather buffer. There is a "learning curve" over 2 to 3 interviews, so perhaps target your "front runner" programs after you complete several. I particularly enjoy the time in December before the holiday season…and likewise would avoid the week after New Years.

This depends on the number of variables; how academically competitive you are as a student, how competitive are the programs you are applying to, how many programs accept you for an interview, and how much exposure you've had to EM. I would advocate interviewing at a minimum of 6 and a maximum of 12 to 15 programs depending on the variables listed. This may require an application to 20 or more programs to secure the necessary number if interviews. For example, as a student in the top third of your graduating class of a 220 on the USMLE Steps I & II you may be a competitive candidate to many programs. If you apply to ten programs and accept interviews at three of the most competitive programs, there is a distinct possibility that you may not match to any program. See enough programs to be certain that you are an informed consumer, regardless of your exposure to EM. Utilize web sites to explore programs in depth, past the paper brochures. Time and money are issues, although securing the best-fit program is critical, and the extra spent now will be water under the bridge 10 years from now. Don't skimp!

Early bird concept rules with accepting invites. Accept an invitation as soon as you are able to arrange travel plans. Advantage and ease of scheduling goes to the best prepared. Your options will be limited the longer you wait to respond. Some programs offer invitations and hold posts for a limited time only 2-3 weeks, some over a month, others indefinitely. If programs have not heard a response after that time frame, a second wave of invitations is sent out to other applicants. Be courteous to yo9ur peers.

If you are having difficulty with scheduling days and times let the program coordinators know that you are working on a way to make it, or that you may need to postpone for the time being. Good communication skills will secure you a spot in the future when you uncover hidden funds. When declining an invitation, first make sure that you have secured enough interviews to suit your needs. To decline appropriately, do so early and be polite. Most program directors are understanding and sensitive to student's time and financial constraints.

Do accept invites to stay with residents in the program if….You are will informed and comfortable with the situation. For example, if you have shared interests or background with the resident. This can be a hit or miss situation and personalities play a large role. If you decline, ask for the resident to escort you through the hospital, didactic session, or to observe change of shift in the ED. This will increase your exposure to residents and faculty while preventing hurt feelings.

Do accept invites for second looks. Not offered by all programs, you might ask. It is a very positive move to communicate interest in a program and allows a student to meet with different residents and faculty that were not present during the interview day. Again, try to arrange a time with plenty of residents or faculty such as change of shift and didactic experiences. Financially, this can be taxing, but well worth it for your top choices.

Do write thank you notes. A must; consider writing notes to all those that interviewed student or program directors only. It is fair to ask how applicants are selected to help determine how many letters should be sent. Do not write identical thank you notes to all members of the selection committee; we compare notes. Try to mention something particular that we discussed during the interview, but it does not need to be novelesque in length. Try to include the program coordinator among your list of thank yous and do not underestimate their contributions to this process.

Do make follow up contacts. For those programs that you are particularly interested in a brief letter at the conclusion of the interview season is appropriate. It might reaffirm your interest after all interviews and include an update on board scores, rotation grades, or publications.

Don't be a "NO-SHOW"! Most programs have waiting lists, and several people to review your file before you arrive. Please do not waste their time, and likewise be courteous to your peers on the waiting list (and perhaps eliminate a competitor from the applicant pool!). Call ahead as soon as you decide you will not be going to an interview. You won't hurt our feelings. A "same-day" cancellations is almost as bad, unless of course there has been a personal emergency or travel problems. However, EM is a small community and if you are a no-show at a program there is a good chance that word of this will spread around… and could affect your ranking. Do not underestimate how damaging this can be!
Don't be late or fall asleep during the process
Don't over or under dress
Don't be artificial. Be yourself!
Don't dominate the interview - let the interviewer set the tone and pace.

These may be encountered, and your response should be tailored to the situation. We try to find out as much as we can about you as a person, but for some this may feel like prying. If you are uncomfortable answering a questions, say so. One technique is to turn the question back on the person, or say something like "I'm curious why that information would be of interest to you?" Also keep in mind who is asking the question. If a faculty member or resident is asking, it usually is out of ignorance of the "rules" or simply genuine curiosity (an extension of our "history taking" skills). Few of these questions represent true malice, although I would have serious concerns if they are coming from a program director or chair.

I strongly recommend a follow-up visit if feasible. Three or four years of your life are on the line, so make certain that those favorable first impressions hold. Get a better idea about the city. I also recommend a follow-up letter at the conclusion of interviews to the 3 or 4 programs that you like the most. Don't tell someone that you are ranking them first unless you really are (again we compare notes). Ask the program two pointed questions; "How would an applicant know if the program was really interested in them?", and "If an applicant is very interested in your program how should they communicate this?". The answers are variable and ranges widely from program to program. The only "illegal" activity would be for a program to promise you a position, or to request that you drop out of the match and they will guarantee you a position.

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