Overview

Congratulations, this is one of the easier years… after you are done trying to be impressive during your EM months.  You will enjoy externships and electives since you get to choose rotations and places you like.  There are different required courses for the various medical schools, but most will allow you to do an away rotation and decent number of electives.  Therefore, you may get to do lots of traveling in addition to your interviews. 

 

Keys to your success

1. You will probably participate less in the extracurricular activities since you will be either focused on performing in rotations where you will request letters of recommendation, taking the time to apply and set up interviews, travel to the interviews, or relax after matching, but don’t forget to help out those following in your footsteps!

2. See below regarding away rotations.

3. Try to make sure that you have everything ready for your ERAS application and submit it as early as possible.  This puts you on the top of the stack and gives programs more time to review your application.  Programs may wait until November 1 (release of dean’s letter and AAMC suggested date) to offer interviews.  You will receive your “electronic token” from your dean’s office for access to your online account.  You will then enter personal information, personal statement, extracurricular activities, listing your possible letter of recommendations, indicating whether you wish to release board scores, etc. 

4. Check your email (and phone messages) as often as possible.  (Also check your “bulk mail” and filtered spam mail because rarely the interview offers may slip into those folders.)  It may seem neurotic, but the quicker you discover an interview offer, the quicker you can reserve a spot on your preferred date.  The vast majority of programs will email you with a list of dates to interview on.  Have a calendar that you record your interviews on so that you can cluster them geographically in order to save time and money.  If they fill up, then you are forced to choose another day (or worse, none at all and be put on a waiting list). 

5. For your interview, know a little about their program (by reading their website), show up early, be yourself, have good questions to ask faculty and residents (you will get tired of them asking you, “Do you have any questions?”) and get as good of a feel of the program as you can.  Write everything down that night before you mix up which place was which.  Send a thank you card to the program director, your interviewers, residents that you have significant contact with, program coordinators and secretaries (they can help you out a lot), and anyone else you feel that is appropriate.

6. Keep in touch with the programs and program directors prior to the rank order list (ROL) deadline.  A letter or email letting them know that you are still interested or will be ranking them highly is an option that some applicants take.  You may feel compelled to do this to keep you fresh on their mind.

7. Rank programs in the order you liked them.  Do not account for whether you think a program will rank you highly or low.  Do not rank a program if you absolutely do not want to go there and would rather scramble because the match is a binding contract.  When you submit your ROL on NRMP and each time you change your ROL, be very sure to certify your list and have it in certification status by the ROL deadline.  You do not want to have the deadline pass with your ROL without certification or you will not match anywhere, have wasted lots of money on applying and traveling for interviews, and have to scramble!

 

My experiences (rotation by rotation, please also see my MS4 page)

(I did all of my rotations with my wife, Amy, so if I say “we,” then that is who I am usually also referring to.)

 

UT Southwestern (UTSW) EM Core

I began the fourth year by doing my first away rotation in Dallas.  I learned a lot from the residents and faculty and made sure to tell each of them that I met how much I wanted to come to Dallas for EM.  I let them know I was interested in helping, learning, or performing any procedures available during the shift.  I showed up at least 15 minutes early for every shift.  I was able to get to know many of them and had good rapport with the patients, attendings, residents, nurses, and other students.  I set up appointments to speak with faculty who I asked SLORs (Standard Letter of Recommendation) from and the program director.  I did an extra shift so that I could have another shift with the program director.  I studied the material they provided us with as much as I could for the final exam.  I felt more comfortable with LPs (I did 10 during my rotation there).  I did only one paracentesis and unfortunately only got to assist on central lines (thread the wire, sew it in place, etc.), but residents (EM and medicine) would come and invite me for these experiences even though many were not on my patients because I always let them know at the beginning of the shift that I was interested.  I jumped into the rooms for traumas and other critical patients.  Sometimes you have to find a way to be involved, especially if there are lots of other people already surrounding the bed.  With EM at the airway, and trauma surgery and nurses at the sides, I would try and put in the Foley so that I could be useful and close up to the action.  You learn a lot from being as close as possible by seeing what each person is doing.  I asked to do chest compressions (several in the trauma bays and once at the CT scanner).  Just go up and tell the person doing compressions that you can relieve him or her when she gets tired (and be sure to remove the stethoscope from around your neck because it will swing around and get in the way.  Don’t get frightened if you feel the ribs crack (especially on older ladies) because that will happen.  I asked to use the external defibrillators and it is kind of scary (mainly because I did not want to shock a nurse or respiratory therapist who may still be in contact with the patient, and I always looked down to make sure I was “clear” also).  Another way to get involved with those patients is to do the ABG.  I did them on my non-critical patients (when indicated) also.  By doing more, you also learn the details involved (patient needs to be on room air, get patient temperature, place the sample in a cup of ice) and become more useful when the nurses and doctors are busy.  Hopefully then you make a good impression and don’t get asked to leave the crowded room as much.  Of course, you will get to suture to your heart’s content at any ED because this saves the residents lots of time.  You learn what sutures to use, where all your equipment is located (sutures in the cabinet, suture kit and lidocaine in the omnicell, needles and syringe, the shucks, and irrigation), and how to write the procedure note.  The same goes for I&D’s (which I got to do with some autonomy at times).  I asked for the chance to intubate a couple of times, but the first lady was dying from and MI while the other was not quite ready for intubation yet.  Still, I think the residents realize how eager you are and that helps with future opportunities. 

 

The faculty and residents were all great.  I learned a lot from all of them.  Dr. Martinez and Roppolo were in charge of the student rotation.  They provided us with a great folder of info (which we were tested over at the end), introduction of the course, tour of the ED, and great lectures from residents and faculty.  They were kind enough to meet with us regarding SLORs and advice on the applications process.  We also met with Dr. Wainscott, the program director.  He also gave great advice concerning EM and various residencies.  I worked a few shifts with him (including an extra one in which I just showed up so that I could have more time with him).  I worked a good number of shifts with Dr. Kleinschmidt who also met with me after I requested a SLOR from him.  I worked a few shifts with Dr. Fowler and met with him after one shift to discuss a SLOR also.  I had the good fortune of presenting a patient to Dr. Delaney on camera when a local PBS station was filming for a documentary on the Parkland ED.  She said I did a good job and was kind enough to write me a SLOR also.  We decided to go to Toxicology Grand Rounds because we saw that the flyers said they would be doing “Toxicology Jeopardy.”  I ended up being the only person that knew a part of the Final Jeopardy question.  (One of the toxicology faculty, an assistant program director, remembered this and mentioned it during my interview there!)  I also asked her if I could attend Toxicology rounds with her which was for residents and students on the EM Toxicology rotation.  I learned a lot and got to email back an answer for something she had mentioned for us to look up.  Various residents were happy to teach and help with procedures.  There was a new “teaching resident” rotation for the R3s in which they were there solely for the students to check out to.  This is nice because you do not have to wait around waiting for someone to present to and the resident is not busy with other responsibilities and instead can help you with your patients.  I asked all of them about advice and heard lots of helpful tips for getting into an EM program.

 

Students were scheduled to do 12 shifts that were 12 hours each.  They were separated into 3 day shifts on the west side (traditionally medicine), 3 night shifts on the west side, 3 day shifts on the east side (traditionally surgery), and 3 night shifts on the east side.  (I did an extra west side shift with Dr. Wainscott.)  UTSW was very flexible with us.  I finished on the Tuesday of the last week so that I could take my ICEE exam at UTMB on that Thursday.  You could switch shifts and ask the chief resident who scheduled us which days you preferred to work or be off. 

 

Pediatric Diabetes Camp Elective 

This a fun experience at Texas Lions Camp in Kerrville, TX.  I got to stay in the cabins with the campers.  Dr. Ponder from Corpus Christi ran the medical staff and is a great guy.  We checked the kids’ sugars 4 times a day (and more if we were on call to do midnight checks).  We got to titrate their insulin (especially the ones with pumps).  We participated in activities with them during the day and checked them whenever they “felt low,” and provided snacks and sugar cubes.  We encouraged fluids and check for urine ketones when they were high.  I especially enjoyed the teaching session we had with them each day.  Overall, I feel better about my knowledge and understanding of diabetes.  I got to help the kids with their finger sticks and mixing insulin.  The kids actually taught me most of what I learned.  The ones that had been diabetic for a long time were self sufficient and could count their carbs and choose the doses of their shots or pumps.  The camp was 1 week long for 2 sets of campers.  We went to San Antonio during our day off in between the sets.  It was nice to get four weeks credit for a two week course.   I was able to visit family and attend a wedding in Lubbock as well as return to Galveston to take my ACLS course since I did all my EM rotations at other institutions during the two free weeks after camp. 

 

University of Louisville (U of L) EM Elective

We went here because Amy’s cousin goes to med school there and we had free housing with Amy’s aunt and uncle.  They provided me with “Manual of Emergency Medicine,” 4^th edition by Jenkins and Braen.  I however preferred to use “Just the Facts in EM” by Cline, Ma, Tintinalli, Kelen, and Stapczynski.  After reading chapters out of “Just the Facts in EM” that were mentioned on the U of L EM syllabus, I did the corresponding chapter of questions in “EM: Pretest Self-Assessment and Review” by Koenig.  I loved these books and I felt I learned a lot by doing the books in this manner.  The final exam was difficult, but I did okay.  They emphasized the point that the exam was very difficult and that they would not fail us because a poor test result.  Dr. Price was the student rotation director.  He was friendly as was most of the faculty.  Dr. Vicario, the program director, offered to write me a SLOR and let us do our interviews while we rotated there.  Dr. Danzl was the chair, and he was kind enough to sit down and go over various EM programs with me.

 

I saw lots of trauma, period.  U of L received lots of MVAs, ATV accidents, and other traumas from Western Kentucky.  I felt comfortable helping because they allowed the students to play an active role in caring for the critical patients.  Trauma surgery was not called in until the EM residents felt they needed to be called.  I did lots of fem sticks after asking the nurses for the opportunity.  This is where I started to try and do a few FAST scans.  I was also fortunate enough to get a central line (subclavian) on one dying patient.  I was surprised the resident let me given the critical nature of the situation (so always ask).  Another resident let me do an intubation since there was no EM intern on that day.  This patient had a nasotracheal tube put in by EMS and needed a more definitive airway.  I had met this R3 during journal club which was at Dr. Smock’s home.  Overall, I thought that attending the journal club was great not just because of the articles were covered, but because of the relaxed atmosphere and duration of time with residents and faculty we were able to talk with that evening.  The weekly lectures and conferences were good.  As usual, there was plenty of suturing to be done in the ED.  I only did one LP during this rotation, but I did see a patient with a ruptured ectopic.

 

During this rotation, I did 12 rotations that were 8 hours each on weekdays and nights.  I also did 4 rotations that were 12 hour shifts on the weekend days and nights.  I also had a few days off in a row where I was able to go and visit my SAEM virtual advisor, Dr. Rodgers, at Indianapolis.  I got to see the ED and went out to a ballgame with some of the residents.

 

UC-Davis EM Acting Internship

I initially chose this program because I needed an acting internship (AI) for my 4^th year.  Of course, I wanted to do my AI in EM, but that was not an option at UTMB.  I searched for an AI in EM and this rotation in Sacramento popped up.  (In the end, it really does not matter if it is labeled an “AI.”  You just choose any EM core rotation and have it called an “AI.”)  The program provided me with a list of people who were renting out a room in their house.  I found a nice nurse who lived two blocks from the hospital.  Rent for the month was $350, she was cool about letting us use her fridge and washer/dryer, and let me watch most of the MLB playoffs on her TV during the evenings.  They had a few lectures (mostly on orientation day) and gave a good tour of the ED.  Dr. Erik Laurin was the student rotation director.  He was a great guy.  Dr. Laurin gave us his cell phone and let us contact him whenever we wanted to switch shifts with another student.  During this rotation, I did plenty of suturing, an I&D under procedural anesthesia (with ketamine!), and an LP.  The ED was separated into 4 sections.  (Acute, subacute, and fast track were 12 hour shifts while pediatrics was 8 hour shifts.)  Of note, UTSW and U of L has separate children’s hospitals with their own pediatric ED’s so I guess I should have requested the chance to rotate through the children’s hospitals at those places.  I received some good peds exposure at UC-Davis including traumas and presentations that are found only with kids.  Overall, I saw a good variety of patients and the residents and faculty were all great to work with.  Unfortunately, I was working a shift the night they had a journal club at a faculty’s home.

 

On free weekends, we toured the Bay Area and redwood trees in Northern California so these away rotations were a good way to get to explore other parts of the country.  I enjoyed exploring Sacramento and seeing what that part of the state was like.

 

UC-Irvine EM Ultrasound Elective

When I was searching the Internet for an EM related elective, I was excited to find one involving ultrasound (u/s).  Dr. Mileski at UTMB had mentioned that u/s was an emerging modality in trauma care during his surgery lectures so I felt the EM Ultrasound elective might be helpful or a step into the future of EM.  After rotating, I learned that u/s is already used in EDs, but has much progress ahead also.  For any students wanting to do an away rotation besides the usual EM course, this was a good one.  What made this rotation so great was that Dr. Fox was not only a good teacher, but he was fun to be around.  He was laid back, funny, and very committed to the field of EM Ultrasound.  He allowed us plenty of autonomy to go and scan whoever we wanted in the ED.  If he or the fellow was working the ED while we were scanning, they would come and see the scan at the bedside and do some teaching.  Every Friday, we would have QA (quality assurance) and review all the scans (which were recorded).  During QAs, we would listen to music, take breaks to get drinks, or talk about other things besides medicine.  Dr. Fox made the rotation fun and was easy to joke around with. We had journal club at his house and watched the Monday Night Football game on his HDTV (nice!).  We also went to Dr. Langdorf’s (the chair) house for the monthly EM journal club.  I learned so much during that month that I feel very confident about my ultrasound skills/knowledge going into residency. Obviously I still have plenty to learn but that was an awesome opportunity for a med student. We scanned lots of people who really did not need a scan just so that we could work on our technique and experience with FASTs, RUQ, etc.  There were also plenty of traumas and other patients who needed a scan where we did find abnormalities.  Just running through the list, we did and saw the following: (ICP evidenced by widened optic sheath when scanning the eye, u/s guided IJ's/paracentesis/thoracocentesis, positive FAST, VSD! (showed up on Color flow Doppler as you scanned through the septum), abscesses (one in the jaw – we used the vaginal probe, with a condom of course!), gallstones, massively dilated bile duct, appy (non-compressible tubular structure), IUPs at various gestational ages, and a subchorionic hemorrhage that looked like a separate possible second gestational sac (which Dr. Langdorf and Dr. Fox helped us write up as a case report).  I scanned for but did not find any DVTs, torsion, ectopic pregnancies, or AAAs (although one Aortic root was a little dilated on the parasternal long axis view of the heart).  I logged in 125 scans for the month and feel more comfortable with u/s now.

 

I would highly recommend the rotation because Dr. Fox was a great teacher and a fun guy to be around. He reiterated the proper way to capture images, important things to look for, and normal anatomy. The fellow was cool and he taught us a lot also. They had a CD-ROM with good instructions on how to use/apply the u/s machine (but don’t worry, they are great about answering any questions you have) and there were great u/s videos showing interesting pathology. He also provided a notebook full of articles, handouts, and other great u/s background info.  If you go at the right time, you might get to go with him to Mexico to help with the free clinic he works at and surf the waves with him there. The only problem with the rotation is housing. They provide you with a list of people that are renting out a room but they were expensive (over $900 for the month!).  I found a cousin (in-law) that I had never met but was cool enough to let me stay with him.  He lives in West Covina so it was at least 30 minutes away, but Dr. Fox was flexible with the shifts and QA times.  We got to explore the LA and go to San Diego for a day.  It was great that we got to go to a couple of the largest churches in the country at Saddleback Church and Calvary Chapel in the LA area.  We also did our MLK and UCLA-Harbor interviews while we were there so that saved us a plane ticket. 

 

(End of) November, December, and January

I scheduled these months off so that I would have flexibility for interviews.  Now that I have spoken with other students, it might have been nice to schedule a rotation that was lax about absences because then you can get credit, miss a few days for interviews, and have your open months at the end of the year.  The risk is that you might need more days for traveling and interviews than the rotation will allow.  I guess my schedule was pretty good so I can’t complain.  We drove home to Galveston from UC-Irvine and had an interview at UT-Houston a few days afterwards.  A few days later, we flew to Philadelphia… (see “Interviews” below)

Neurology

I studied the tPA protocols closely during this required senior rotation (but now they let MS3’s at UTMB take this course also).  Learning about seizures, headaches, and other ED presentations was good for me.  I did the neuro exam repeatedly so that was also useful for EM. 

 

Senior Surgery

The MS4’s on surgery saw the SICU patients so that was good for me.  I also tried to get some suturing in at the end of an OR case, but did not get the opportunity to intubate (although I definitely asked).  I’ll let you know what else happens in these last 2 weeks…

 

Dermatology/Radiology

Next (and last) month!

 

Away rotations

Some things will be different when you are visiting rotation, but most things will be pretty easy to figure out after a few shifts.  The key is to do your best.

 

1. Before they make your shift schedule, you might ask the program coordinators if they can put you on with the program director or chair as much as possible so that you can get a SLOR. 
2. Take your interviewing outfit on away rotations just in case they let you interview while you are there even if it is not interview season.
3. Do your best.  Your chances of matching are okay if you have decent grades and board scores, but if you are a weaker applicant, doing well on an externship can be the key to overcoming your deficiencies.  Remember, programs must choose from a ton of applications.  The few hours they see you on interview day is no guarantee that you won’t quit and mess up the shift schedule if you match there.  If they feel that you are a hard worker based on your externship performance, then you have done yourself a favor and the away rotation was a success.  Also, if they have an exam at the end, study for it so that they remember you as the high scorer, not as the only person that failed.
4. Get along with the people there.  They would rather not have an applicant that looks great on paper if he or she never gets along with faculty and nurses.  This month rotating with a program makes them more comfortable with you than a stranger that they interview for one day.  Also, you get to see if you would enjoy three or four years there.  When the residents have time, try to get to know them and what they like (and dislike) about the program/city.  Chat with and build your rapport with everyone from secretaries, coordinators, faculty, techs, residents, nurses, janitors… 
5. Let them know your interest in EM/their program.  Ask each resident, “Who is a good person to ask for SLOR from?” and “What advice do you have for me to get into your program?”  Ask faculty, “Do you have advice for me since I would like to go into Emergency Medicine?”  You may already know the answers, but asking will show your interest.
6. Keep a few notes of which residents and faculty you worked with.  At the end or after the rotation, you can write a thank you card with a reference to something they taught you or an interesting case you discussed with them.
7. Keep informed about department events.  Most will require that you attend weekly conferences, EM grand rounds, and lectures.  Do your best to go to all of them, even if you are getting off a night shift.  Try to attend other activities of the EM subspecialties (toxicology rounds/grand rounds, etc.) or the journal clubs (EM, tox, etc.) which great for getting to interact with lots of faculty and residents.
8. Have fun exploring the city and region!  You might want to live there for the next three or more years so see if it is safe and fits for you.

 

Interviews (including my experiences)

So after rehashing the adventures I had, I would sum it up with this…

1. Check your email and phone messages as often as possible so that you can secure your preferred dates in order to save money and time by clustering programs by location.  If you wait too long, you may have to be waitlisted or denied an interview because some programs invite more applicants than they have spots for.

2. Look for discounts on flights, rental cars, hotels, etc. related to interviews.  (For my year, the AAMC renewed an agreement with American Airlines to offer discounts for senior medical students traveling to interviews for residency programs.  The contact info was: “call American Airline's Meeting Services Desk, or have your travel professional call, 1-800-433-1790 seven days a week from 7:00am to 12:00 midnight (CST) and reference the STAR file number 16762.  If you have any questions, contact Denine Hales ([email protected]) at 202/828-0681.”  You may also make friends from away rotations or on the interview trail that may live in the city of your interview.  I have also heard of hostels and other cheap alternatives for students, but you don’t want to get your nice suit stolen the night before interviewing.

3. Read up on the program (website) before you travel.  You may not have Internet access while on the road.  This will save you from asking questions that could easily be answered by reading their webpages.  Scutwork.com and StudentDoctor.Net are great resources as are your buddies on the interviewing circuit.  (See UTMB Connections page.)  Then have questions ready because you will get tired of hearing, “Do you have any questions?”

4. Beware of bad weather (especially in the cold North) and schedule your travel plans wisely.

5. Stay as close (and safe) to the program as possible to minimize travel time. 

6. Don’t stay at one hotel if you have a second interview in the same city the next day that is a far away.  I think it is worth packing up and moving so that you have extra time in the morning.

7. Take anything you might need (gum, handy wipes for those tough stains, mace, etc.)

8. Get to your interview early.  This means planning for big city traffic, getting lost on the way, not being able to find parking (so ask the program in advance!), not being able to find the meeting place, and going to the wrong place (so please make sure you know exactly where you are supposed to go – room number, floor, building, and campus!)

9. Turn your phone/pager off or put it on vibrate.  I think the vibrating phone could still be a distraction in a quiet room with your interviewer.

10. Smile, be yourself, and enjoy your time there.

11. Get info on where to send your thank you cards.

12. Learn as much about the program as possible from residents. 

13. If you have time, see if you like the area/city.

14. Keep in touch… (see below) and write a thank you card to the program director, interviewers, and anyone else you feel appropriate.

 

Be sure to check out the links page for other resources (EMRA, SAEM, etc.) to learn more about this topic.

 

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Last updated on 4/14/04

 

Questions, comments, suggestions?  Feel free to contact me at [email protected] (I will reply as soon as possible.)

 

(EM=Emergency Medicine, ED=Emergency Department, EP=Emergency Physician)