Frequently Asked Questions from Medical Students about Emergency Medicine

Shadow: We have faculty and residents who are more than happy to have you tag along during a shift to see what this awesome specialty is all about. This is a great learning opportunity as well as chance to network and get a sneak peak of EM before fourth year. We have opportunities available at Eskenazi, Methodist and Riley (Indianpolis campus). All years are welcome! Medcal students interested in this specialty should also talk with a career advisor and get involved with a MD student interest group.

Emergency Medicine residencies are very competitive. There were only positions after the initial round of the 2018 NRMP Match. In 2016, the Match included 2693 total applicants (1597 US Seniors) for 2278 positions. The mean USMLE Step 1 was 233, Step 2 was 247.

We strongly encourage you to seek the EM residency that will force you out of your comfort zone to do your very best work. Consider this to be the foundation of a 30-35 year career. If you leave your residency with gaps in experience or knowledge, it is unlikely that you will ever become comfortable and confident in those areas.

The Emergency Medicine Residents’ Association (EMRA) has an interactive search for residency programs available at https://webapps.emra.org/utils/spa/match#/search/map.

In our estimation, medical students place too much emphasis on “location” in selecting their residency. Being tethered to Indiana because it is comfortable is just as risky as thinking that climate or mountains-ocean should drive your search. Emergency Medicine training requires access to a diverse patient population, which is available at IU School of Medicine.

There are 221 programs around the country. 167 are three-year programs and 54 are four years.

Every EM physician at IU School of Medicine is involved in teaching of some kind. This teaching includes patient education, mentoring colleagues, and/or working with new employees. Many emergency departments in the US host learners even if they aren’t part of a medical school. Students (medical, nursing, physician assistants) complete clinical rotations in and outside of academic settings. As such, teaching is a part of the regular life of most emergency doctors. Of course, those who elect to work at an academic medical center have increased teaching responsibilities because, in addition to students, faculty physicians regularly teach residents and fellows who are completing their training programs.

A good Emergency Medicine physician is decisive, thick-skinned, inquisitive, problem-solver, advocate, people-person. This is not the best specialty for those who are judgmental or indecisive.

In other words, if your own personal values system is so rigid that you use it to judge all other people, you will likely do so with your Emergency Department patients. Using this value yardstick, patients who make self-destructive life choices will invariably frustrate or fail to meet your personal standards. One cannot use their own personal values yardstick as the measure for our patients.

Emergency Medicine physicians treat all types of patients, of all ages, covering all acute – and many chronic – complaints. These physicians don’t have to “give up” any patient group forever. The career is known for undifferentiated patient complaints,, strong team work, high level of technical skills. Emergency Medicine physicians must handle multiple simultaneous patient care responsibilities.

Several areas of specialization are available in Emergency Medicine. The American Board of Emergency Medicine offers certification in Anesthesiology Critical Care Medicine, Emergency Medical Services, Hospice and Palliative Medicine, Internal Medicine-Critical Care Medicine, Medical Toxicology, Pain Medicine, Pediatric Emergency Medicine, Sports Medicine and Undersea and Hyperbaric Medicine. The Department of Emergency Medicine at IU School of Medicine offers fellowship programs in Clinical Informatics, Disaster Medicine, Emergency Ultrasound, Medical Toxicology, Out-of-Hospital Care (EMS), and Pediatric Emergency Medicine.

You should have two EM rotation experiences one at your home and one away (or two aways if your school does not offer EM).  Consider contrasting the types of programs you chose to rotate with: urban vs rural, small vs large, community vs county vs university center. Community Emergency Department rotations (not affiliated with an EM residency) are helpful for career affirmation, but they do not assist application credentials. If you are uncertain of career choice, consider a community Emergency Medicine elective in MS3 year.

When selecting away EM rotations, look for a high level of patient care responsibility. At IU School of Medicine, you have patient ownership and are responsible for charting and ordering meds and Dx tests.  Rotations in Ultrasound, Toxicology, Critical Care and Trauma can be helpful but you are likely to receive this training as part of residency as well.

Other elective rotations to consider include frequently seen complaints like Ophthalmology, Dermatology, Sports Medicine, etc. that you are unlikely to have dedicated rotations for in residency unless you use an elective.

A SLOE is a Standardized Letter of Evaluation required for residency applications in Emergency Medicine. SLOEs at IU School of Medicine are written by the EM Residency Program Directors. If you would like a SLOE, you will need to request a brief 20 minute meeting with a member of the Program Director’s Team between late June and mid-September. Contact the coordinators at emres@iu.edu or 317-962-3525 to schedule your meeting.

EM physicians can take advantage of many facets of their practice in order to maximize healthy work-life integration. After residency, most work between 12 and 14 shifts each month, with shift duration ranging from 6 to 12 hours (some lower volume EDs still have 24 hour shifts) for a total of around 1500 clinical hours per year. Because schedules are published weeks, months or sometimes even a year ahead of time, you know exactly when you are scheduled to work, and when you are off. No beepers. When you are off, you are off. However, as an EM physician you will work more evening, nights, week-ends and Holidays than almost any other specialty. Due to the disruption of your circadian schedule by late or overnight shifts, learning sound sleep hygiene skills is essential.

The Emergency Department is positioned as the gateway between society and the health care system. Most patients are feeling their worst ever, scared and in pain – not having a good day. You see many horrifying things, and will need a strong coping system. On the other hand, our patients never cease to amaze – and being able to interact with so many people with such a variable background is always intriguing and never gets old. Their stories will make you laugh, cry and everything in between.

Take advantage of “mock interview” opportunities, and interview as early as possible for your dream programs. The number of interviews you pursue should correlate with your performance. If you’re in the top quintile, you can shoot for 8-10 interviews. Fifth quintile performers should secure as many interviews as possible. Apply widely and consider a non-Emergency Medicine back-up. When scheduling keep in mind weather patterns (schedule Northern/Eastern programs early, Southern/Western programs later). Follow up in some fashion with every program that you visit. Email, written card or a polite brief phone call to the coordinator are acceptable.

• Step 1 over 255, MAY wait until November or December. Program Directors would prefer to see Step 2 scores in your application. However, if your scores are low, it can hurt. Some programs won’t rank you if Step 2 exam scores are not available.
• Step 1 225 – 255, July-Sept
• Step 1 under 225: June – Aug (Critical if <215!!)