Medical School

A fulfilling and exciting career in emergency medicine (EM) starts with proper planning and hard work as a medical student. Students interested in EM have a number of opportunities for early exposure to assess their interest in pursuing a career in the field. Additionally, EM has a number of unique requirements for upper level medical students that necessitate foresight and preparation.

Preclinical Years

USMLE Step One (allopathic students) and Level One (osteopathic students)

Step/Level One is one of the first milestones in your medical education. While there are many factors that determine your overall competitiveness for matching into an EM residency, passing Step/Level One is an essential component in this field, and one of the most important ways to set yourself up for success in both clinical rotations and for future formal testing. Step/Level One is a pass/fail exam, and any "failed" attempt is often considered a red flag in residency applications.

Extracurricular Opportunities

Consider joining national EM organizations such as the Society for Academic Emergency Medicine (SAEM), Emergency Medicine Residents' Association (EMRA), the American College of Emergency Physicians (ACEP) or the American Academy of Emergency Medicine Resident and Student Association (AAEM/RSA). Many of these groups have free or discounted membership rates for students, and offer a multitude of opportunities for scholarship, education, and mentorship. If you are seriously interested in a career in academic EM, participating in these organizations is one of the best moves. you can make for your professional development.

Getting involved with your school's emergency medicine interest group (EMIG) is also an easy way to get exposure into everything that EM has to offer. EMIGs will often arrange lectures on relevant EM topics and organize hands-on procedure workshops (e.g. splinting, intubation, suturing). These opportunities allow students to network with residents and faculty and gain an insider's look into what being an emergency physician is like. Becoming an EMIG member during your first and second year of medical school allows you to gain exposure to the field before starting your clerkships. Otherwise, aside from shadowing in the emergency department (ED), it can be difficult to gain any exposure to EM until your clinical years; additionally, many medical schools may not have students rotate in an EM clerkship until their fourth year of medical school. Consider applying for a leadership position on the school's EMIG executive board. This process will vary depending on your school's policies, so speak to the current EMIG chairs for more information. If you envision research as a significant part of your career, be sure to review SAEM's Research Career Roadmap for information about optimizing research opportunities early. Click here for more information and resources about EMIGs.

Clinical Years

Third Year

• Clinical Clerkships: A strong performance throughout your third year clerkships is a crucial component of future success. EM is all-encompassing; the broad scope of practice of an emergency physician includes elements from each of your core clerkships. During your third year, you will be transitioning from the classroom to the clinical setting, and the skills and habits you learn from each of your clerkships will be carried with you throughout your career as a physician. You should treat each clerkship as an immersion experience. Some medical schools will incorporate EM into the curriculum in the form of a clerkship, although this will vary.
• Electives: These are great opportunities to explore other specialties or areas in which you'd like to dive deeper. If your school does not make EM a mandatory clerkship, a third year elective is a good way to get some exposure to the ED environment and learn what thinking like an emergency physician entails. Depending on what is available at your school, there may be both an EM elective and an EM sub-internship. It is generally recommended that you do not complete your EM sub-internship until you have completed all or most of your third year clerkships so that you have a strong medical foundation prior to the elective. Of course, it isn’t necessary to take an EM elective; you should use the opportunity to explore any area of medicine in which you’re interested. As always, it is important to discuss your third year schedule with an advisor in order to maximize your chance of success. Other electives that bestow skills that directly translate to EM include anesthesia, ultrasound, critical care, emergency medical services (EMS), toxicology, pediatric EM, electrocardiogram (EKG), and urgent care.
  • Click here for SAEM's Clerkship Directors in Emergency Medicine (CDEM) M3 Curriculum Guide.
  • Click here for SAEM's guide on how to get the most out of your EM clerkship.
• Career Advising: Start thinking about connecting with an advisor in your field of interest. Most likely, your school will have a more formal advising system that will connect you with advisors who will serve to mentor you as you embark on the career decision-making process. A clerkship director, associate program director, or residency program director can serve as a great advisor. In addition to mentors through your school, there are a number of resources and workshops through SAEM that will connect students with mentors online. Click here for advice on developing a mentor relationship.

Fourth Year

• Elective Time: Some schools offer longitudinal teaching electives, allowing you to hone your clinical coaching skills with preclinical and clinical students. This is a great elective to take during fourth year, particularly if you are interested in academic medicine.
• USMLE Step Two CK and COMLEX-Level Two CE: In January of your third year, you should also consider when you would like to take Step Two CK or Level Two CE. Students from osteopathic programs may choose to take both Level Two CE and Step Two CK, the former as a requirement by their respective program, and the latter to stand as a competitive applicant with allopathic students. Most students will take Step Two CK and/or Level Two CE shortly after they finish their third year clerkships because it is likely when the material is the freshest in their minds. For example, if you finish your third year on a rotation such as internal medicine or family medicine (both of which cover much of the material on USMLE/COMLEX), it may be convenient to  begin your study time right after completing your rotation and shelf exam. While most programs will not require your Step Two/Level Two scores to grant you an interview, nearly every program will require your Step Two/Level Two scores prior to ranking. Furthermore, Step Two CK/Level Two CE is seen by many programs as more pertinent to EM than Step One/Level One since it is more clinically oriented. Because it is the only pre-graduation board exam with an actual score (as opposed to pass/fail), it will be weighted more heavily when programs send interview invitations. Ultimately, it is important to discuss with your advisor when it is best for you individually to take Step Two CK/Level Two CE based on your goals.
• Researching Programs: There are several online resources to help you research residency programs. Aside from programs' respective websites, several interactive databases of programs are available to students through SAEM, EMRA, and the American Medical Association (AMA). Your advisor will also be an invaluable resource in determining your priorities in a residency program and which programs might be right for you. Be wary of websites touting program rankings such as Doximity, as it is unclear how these rankings were generated.
  • EM residency programs may be located in an academic, community, or county setting. While residents will become proficient with foundations of EM in any setting, the style and culture of a program may differ between these settings. For example, students may choose a county program for its strong social mission to the underserved or an academic program for its strong research mentorship. These settings are also not mutually exclusive, as many hybrid programs straddle more than one realm. Of course, preference for program setting or length of training is a personal decision and no one type of program is necessarily better than all others. The focus should be on what is best for the individual student’s career goals and personality.
• Your Home EM Rotation (elective or sub-internship): This is your opportunity to learn the foundations of how to think like an emergency physicians. There are many online resources that detail how to succeed on your home EM rotation, including the CDEM Curriculum (particularly useful at this stage is the M4 Curriculum), the EM Clerkship Primer, EMRA's Skill Demonstration videos, and this Three-Minute EM Oral Presentation. Additionally, basic tenets of being a good medical student still apply: show up early, be enthusiastic, have a good attitude, show initiative by offering to help, work hard, and be thorough. If you've succeeded during your third year clerkships, you already know how to succeed on your EM rotation.
• Away Rotations and VSAS: To obtain the requisite number of departmental standardized letters of evaluation (SLOEs, see section below), it will be necessary to complete an away rotation. An away rotation (also called an "audition rotation") is a great opportunity to demonstrate to a program where you are interested in matching how you will perform as an intern. This can be really helpful if you are interested in matching at a particularly competitive program or have a strong geographic preference to a specific region. The process for applying to away rotations can be daunting and somewhat confusing as some programs use the Visiting Student Application Service (VSAS) while some use their own proprietary application process. The most important part of the away rotation application process is starting early. In January of your third year, you should begin researching programs that interest you and looking into their requirements. Some programs require letters of recommendation or personal statements that may take time to obtain or write. Additionally, all programs will require up-to-date immunizations and tuberculin testing with documentation, which may require that you set up multiple appointments over the course of weeks with your primary care provider or student health services. Finally, deadlines between programs often vary and may be as early as February. The number of away rotation positions you apply to will vary depending on how competitive a particular rotation is and which month you are applying for, but generally it is recommended to apply to approximately three-four away institutions for every one away rotation you wish to complete (note: you can often apply for multiple months at a single institution). Once you are accepted, you will need to alert your school and find temporary housing if applicable. One excellent resource is Rotating Room, which is a site specifically designed for medical students completing away rotations to sublet their apartments or rooms.
  • The away rotation is your chance to shine and demonstrate your clinical acumen and abilities. While these "audition rotations" may be daunting, the same rules for success apply: showing interest and enthusiasm will go a long way. Rotation directors will take into account how many EM rotations you had prior to this one when evaluating you (it is part of the SLOE). Remember to treat any interaction you have with any individual at that institution - patient, guest, or healthcare staff - as part of the away rotation. You should also try to set up a mid-rotation feedback session with someone from the program leadership for feedback on your performance. Additionally, ask for any advice they may have on how you can be better prepared for the upcoming application cycle.

The ResidencyCAS Application

While EM has become more and more competitive in recent years, it is still considered a medium-competitive specialty compared to some of the ultra-competitive specialties like dermatology, orthopedics, or plastic surgery. Charting Outcomes in the Match is a helpful document that reports vital statistics for each specialty (such as mean Step One score) and breaks down overall match success by a number of different application components. Based on the most recent NRMP Program Director Survey, the most important factors considered in granting an interview are the USMLE Step One Score (or COMLEX Level One score), letters of recommendation in chosen specialty, MSPE/Dean's Letter, USMLE Step Two CK score (or COMLEX Level Two CE score), and grades. The most important factors in creating a rank list include interactions with faculty during the interview, interpersonal skills, interactions with house staff during the interview, feedback from current residents, and the USMLE Step Two score (or COMLEX Level Two CE score). As always, it's important to discuss with your advisor where you fit into the EM applicant pool based on your cumulative medical school performance.

Letters of Recommendation and the SLOE

In EM, the most important letter you will need for your application is the Standardized Letter of Evaluation (SLOE). The SLOE is not a letter of recommendation in the traditional sense (i.e., it is not a “character letter” or “narrative letter”); rather, it is a standardized evaluation form that directly compares your performance to that of your peers and can only be completed by an emergency physician (although there are are offservice-SLOEs or (O)SLOEs that may be completed for non-EM rotations). Your SLOE is considered one of the most important, if not the most important, components of your application. For most programs, you will generally need at least two SLOEs, although the requirements of a given program may vary. One SLOE should come from your home institution and additional SLOEs should come from each institution at which you completed an away rotation. It is generally considered a red flag to have completed an away rotation at an institution and not have obtained a SLOE from that institution. While a SLOE can be written by a single emergency physician with whom you worked closely, SLOEs are often written  as “departmental” or “group” SLOEs, which represent your cumulative evaluation by everyone you worked with in the department. These are often signed by the program director and/or the department chair in addition to the SLOE writer and are often considered to have more weight than an individual SLOE. The policy on how SLOEs are written varies between programs so it is important to ask your rotation director at the beginning of your rotation what their process is for obtaining a SLOE. You can view additional information about the SLOE here.

Writing Your Personal Statement

Your personal statement is an opportunity to show a more personal perspective. It should concisely convey to programs why you are interested in EM and what path you took to get there. In short, it is your chance to tell your story and discuss the unique attributes you will bring to a residency program. In general, the personal statement is one of the less important components of your application and while it will rarely make or break your application, overall many would argue that it is better to err on the side of taking a more conservative approach. Rarely will interviewers remember how “great” a personal statement was, but they may remember one that was bizarre or had very little time invested with numerous grammatical errors, etc. Additionally, the personal statement is your opportunity to discuss any red flags you may have on your application, such as a course failure, a leave of absence, etc. It is a great opportunity to “tell your side of the story” and discuss how you’ve grown from your experience with hardship and how it has made you a more resilient candidate.

Filling Out ResidencyCAS

ResidencyCAS is the online common application for residency. Here, you will fill out all your identifying information, biographical information, and all your experiences throughout medical school which will ultimately be transmitted to programs electronically. An overview of the ResidencyCAS application (including timeline, pricing, and signals) is available here. Many students have questions about the use of "signals" in demonstrating interest in a particular program. General advice is not to signal your home institution or anywhere you completed a sub-internship. Additional details on the use of signals can be found here. In addition to the information you fill out on ResidencyCAS, you will need to transmit your USMLE scores and your school will need to submit a transcript and Dean's Letter or Medical School Performance Evaluation (MSPE) on your behalf.

While you can begin working on ResidencyCAS forms over the summer, you cannot officially submit your application until early September. While most students will attempt to submit on this first day, it is not an absolute requirement. However, you should submit your completed residency application before residency programs can begin reviewing applications at the beginning of October. Be sure to check the websites of each program to determine their absolute deadlines for a completed application.

Interview Season

Interview Invitations

Many programs do not begin sending interview invitations until several weeks after they are allowed to begin reviewing applications, although some may begin soon (i.e. days) after ResidencyCAS submission. Interview slots often fill up very quickly, so it is important to respond promptly to ensure you obtain your preferred date. Invites are sometimes granted directly through ResidencyCAS or via email, but the majority are managed through a third-party software such as Interview Broker or Thalamus. Because travel poses numerous logistical and financial constraints for applicants, most programs have transitioned to a virtual interview format.

Interview Preparation & Interviewing

Knowing your application inside and out is the most important component of preparing for your interviews. Be prepared to answer questions about anything you put on your application, including that one esoteric hobby or that poster you presented as a first year! You never know what might create a connection with your interviewer. In addition, if there are any "red flags" on your application (e.g. USMLE failure, leave of absence) you should be prepared to discuss why this occurred and how you have grown from the experience. Prior to your interviews, it's important to have read up on the programs at which you will be attending interviews. Program websites are a great first resource for information, particularly on curriculum, training sites, and ongoing research projects. Reviewing the website and their social media accounts are also a good way to formulate intelligent questions specific to an individual program. Many schools offer mock interviews and it is strongly recommended to take advantage of them. Even if you feel confident discussing your application, it is often a great opportunity to get a sense of any mannerisms or ticks you may have (e.g. the use of filler words) and to practice answering difficult questions.

Interviews are your chance to see if a program is a good fit for you and for a program to determine if you're a good fit for them. It's important to get a feel for how well you get along with the residents, faculty, and program leadership, and whether you see yourself in that environment for the next several years. While many factors go into what makes one residency or another better for a given person, your gut feeling and your overall perceived “fit” with the culture of a residency program are among the most important. Pre-interview dinners are often just as valuable as the interviews themselves, as they give you a chance to interact in a less formal setting with your potential future colleagues. While not an absolute requirement, many students will send thank you notes via email to the program directors or interviewers with whom they spoke. However, some programs prefer no post-interview communication, so it's important to check with the program coordinator on what that program's specific policy might be. Here is a helpful guide on the do's and don'ts of residency interviewing. 

The Match

The Match is designed to give priority to student preferences over program preferences. It is crucially important to rank programs in your preferred order, NOT the order in which you think you'd most likely match at a given program. In other words, you don't gain anything by ranking a program first that isn't your top choice simply because you think you're more likely to match there than at a "reach" program. Because you don't know where a program will rank you, you'll only miss out if you try to "game the system." Rank the programs at which you interviewed in the order you'd like to match!