Planning your fourth year final

Planning Your Fourth Year
Nicholas E. Kman, MD FACEP
Associate Professor
The Ohio State University
Department of Emergency Medicine
Past President-Clerkship Directors in Emergency Medicine (CDEM)
@drnickkman

Objectives
 Map out 4th year for EM Applicants citing important
dates and deadlines.
 Discuss AAMC Standardized Video Interview and
important dates associated with it’s completion.
2

Emergency Medicine Student Planner
3
Year 1 Summer Fall Winter Spring
Academics Basic Sciences – aim to be in top ½ of class
Research CITI, Click IRB and COI Training Mentor and Project Selection Literature Search Submit IRB Application
Volunteer Aim for consistent, longitudinal experiences (at least 3): national societies, student run clinics, community organizations such as Healthcare for the Homeless, international projects,
coaching for middle/high school/undergraduate/medical students, EMS, etc.
EM Career
Experience
Join EMIG
Join EMRA
1. EM Based Continuity Clinic or shadowing
2. Find an EM mentor
Misc. Keep track of volunteer experiences and
honors for CV
ACEP/AAEM Conference SAEM conference
Research Await IRB determination (likely resubmit
with changes)
Data Collection
Volunteer Take leadership positions in volunteer organizations and complete a volunteer project
EM Career
Experience
Take a leadership position in EMIG EM or Peds EM Based Continuity Clinic 2 1. Study and take Step 1 (aim for score > 220)
2. Meet with EM mentor to discuss strategies
for success in clerkships
honors for CV
Academics Clinical Clerkships – focus on consistent performance across all clerkships, balance shelf exam with clinical performance
Research Data Analysis
Volunteer Complete another volunteer project (if possible) or small EM quality project
EM Career
Experience
Take a leadership position in EMRA 1. EM, Peds EM or EM Critical Care Based Continuity Clinic
2. Meet with EM mentor to discuss EM electives and 4
th
year schedule
honors for CV
ACEP Conference - EMRA medical student
symposium
SAEM conference – residency fair
ACEP regional conference
Academics Electives – front load EM rotation, EM electives and critical care rotations
Research Write abstract and submit for presentation at national or regional EM meeting (ACEP,
SAEM, CORD, Critical Care, Wilderness, Ultrasound, EMS)
1. Present at EM meeting
2. Compose manuscript and submit for
publication
EM Career
Experience
1. EM rotation at home
2. Study and take Step 2 (aim for higher
than Step 1)
3. Meet with EM mentor to discuss
interviews and ERAS application
1. EM rotation at outside institution
2. EM elective rotation (pediatrics,
ultrasound, toxicology, international,
sports med, EMS, etc.)
1. Interview
2. Create Match list
Fun
Misc. 1. Update CV for ERAS Application
2. Start writing personal statement for
ERAS Application
1. Submit ERAS Application
2. ACEP/AAEM Conference
SAEM conference

Emergency Medicine Student Planner
4
Research CITI, Click IRB and COI Training Mentor and Project Selection Literature Search Submit IRB Application
Volunteer Aim for consistent, longitudinal experiences (at least 3): national societies, student run clinics, community organizations such as Healthcare for the Homeless, international projects,
coaching for middle/high school/undergraduate/medical students, EMS, etc.
EM Career
Experience
Join EMIG
Join EMRA
1. EM Based Continuity Clinic or shadowing
2. Find an EM mentor
honors for CV
Research Await IRB determination (likely resubmit
with changes)
Data Collection
Volunteer Take leadership positions in volunteer organizations and complete a volunteer project
EM Career
Experience
Take a leadership position in EMIG EM or Peds EM Based Continuity Clinic 2 1. Study and take Step 1 (aim for score > 220)
2. Meet with EM mentor to discuss strategies
for success in clerkships
honors for CV
Academics Clinical Clerkships – focus on consistent performance across all clerkships, balance shelf exam with clinical performance
Research Data Analysis
EM Career
Experience
Take a leadership position in EMRA 1. EM, Peds EM or EM Critical Care Based Continuity Clinic
2. Meet with EM mentor to discuss EM electives and 4
th
year schedule
honors for CV
ACEP Conference - EMRA medical student
symposium
SAEM conference – residency fair
ACEP regional conference
Academics Electives – front load EM rotation, EM electives and critical care rotations
Research Write abstract and submit for presentation at national or regional EM meeting (ACEP,
SAEM, CORD, Critical Care, Wilderness, Ultrasound, EMS)
1. Present at EM meeting
2. Compose manuscript and submit for
publication
EM Career
Experience
1. EM rotation at home
2. Study and take Step 2 (aim for higher
than Step 1)
3. Meet with EM mentor to discuss
interviews and ERAS application
1. EM rotation at outside institution
2. EM elective rotation (pediatrics,
ultrasound, toxicology, international,
sports med, EMS, etc.)
1. Interview
2. Create Match list
Fun
Misc. 1. Update CV for ERAS Application
2. Start writing personal statement for
ERAS Application
1. Submit ERAS Application
2. ACEP/AAEM Conference
SAEM conference

https://www.aliem.com/2017/05/users-
guide-em-match-advice-series/

Med 3 into Med 4: Select an Advisor
 Should be an emergency physician familiar with
residency application process.
 Know your strengths/weaknesses & willing to provide
personal and candid advice.
 Begin brainstorming a list of residency programs to
which to apply to in the fall.
 They need to know your Step 1 Score, Med 3
Grades, Geographic Area of Interest and any
potential red flags.
 Send them your CV.
7

Scheduling Key Rotations
 Most programs like to see two months of EM
clerkship time (Home and 1 Away).
 Start by finding out the last rotation month that will
be included in your Dean's letter (usually
September). Work with your registrar or contacts at
away institutions to schedule rotations before this
deadline.
 Make sure to ask for a SLOE as most residency
programs want at least SLOE from each rotation.
8

Scheduling Key Rotations
 Other recommended electives include trauma
surgery, ICU, anesthesia and radiology.
 Other related electives include cardiology,
dermatology, neurology, psychiatric emergency,
gynecology, Wilderness Medicine, EMS or
toxicology.
 Bootcamp courses
 Additionally, most schools require a sub-internship in
internal medicine or surgery. Depending on your
ability to excel in these intensive rotations, there are
advantages and disadvantages to completing them
before your MSPE (i.e. Dean's Letter) goes out.
9

When should you do an EM rotation?
 The easy answer is, "as early as possible". If your
school allows electives in the third year it can be
really helpful for career exploration. Try to do home
rotation first, if possible.
 In 4th year, or late in your third year, you will do
audition rotations.
 You should plan to do at least two EM rotations by
October of your fourth year.
10

Where should you do EM rotations?
 Most students do one home rotation, at an ED
affiliated with their medical school, and at least one
away rotation at another ED where they would be
interested in matching for residency.
 If you do not have an EM residency at your
institution, you will need to do two away rotations.
 Away rotations are not mandatory but are strongly
recommended to allow you to see how another ED
functions.
 To get into some geographic areas, an away rotation
in that area may be essential to demonstrate
interest.
11

Where should you do EM rotations?
 EM rotations should be completed at departments
that have a residency program.
 The most useful letters of recommendations you can
receive are Standardized Letter's of Evaluation
(SLOE's) from an EM Residency Program Director,
Department Letter, or Medical Student Clerkship
Director.
12

How do I find EM rotations?
 Many rotations in EM are available on VSLO
or VSAS (Visiting Student Application Service)
network.
 In addition to going on the VSAS
network SAEM.org and the EMRA Match Student
Directory provide interactive maps of the United
States that links to information on EM rotations in the
country, including those that do not participate in the
VSAS.
13

Home Rotation
 AMHBC-EM here May, June, or July (August
acceptable if necessary).
 In EM, the USMLE step 1 and 2 and the SLOE’s are
essentially how programs decide who to invite.
 https://lifeinthefastlane.com/wp-
content/uploads/2012/04/EM-Clerkship-Primer.pdf

VSAS and Away Rotations
 How many away rotations should I do?
 In most cases, one away rotation to obtain a SLOE
 Away rotation can be at a site where you would like
to end up (“audition rotation”) or in a reputable
program to gain experience.
 You need to apply to about 3-5 places for each
block/month you are trying to fill.

SLOE’s
 At minimum: 2 SLOE’s & 1 additional EM letter.
Ideally 3 EM SLOE’s.
 SLOEs can be written as a “Group SLOE” (Clerkship
Director, Program Director, etc) or as a non-
combined letter (from one individual).
 Usually you have a Group SLOE from your home
school and one combined SLOE from your Away EM
rotation, then a third SLOE from another EM faculty
member with whom you have worked closely (could
be EM rotation or Toxicology, EMS, U/S, etc).

USMLE Stuff
 Based on the 2014 NRMP Program
Director Survey Results, a USMLE Step
1 & 2CK score above 230 is very good.
 Many programs will not interview
applicants with failed Step 1 or Step 2
score.
 Step 2 may be more important to your
application than Step 1! A good Step 2
score can make a PD forget about a
mediocre Step 1 score. Take it early if
your Step 1 was <220.

ERAS Application Dates
 July 1
 Site opens and you can start uploading documents
 DO applicants can send applications to Osteopathic
AOA programs
 July 15
 Deadline to complete AAMC SVI
 Sept 15
 Applicants can apply to ACGME programs!
 Oct 1
 Deans letter’s sent to residency programs
 Get your application complete as soon as you can.

Preparing for the SVI
Joshua Wallenstein, MD
Cynthia Leung, MD PhD
Mike Barrie, MD
Nicholas Kman, MD

What do I need
• Computer with a camera
• Reliable and stable internet connection
• Quiet location in which you will not be disturbed
• Non-distracting background

Mechanics
• 6 Text-based questions
• Audio/video response
• 30 sec to read each question
• 3 min to respond each question
• 21 minutes of interview time
• “Behaviorally-anchored scoring rubrics” on a 1-5
scale per questions for a total of 30 possible points

What is being assessed?
• Interpersonal and communication skills
• Knowledge of professional behaviors

Interpersonal and communication skills
• How have you handled dealing with some of your
more challenging patients? What specific actions did
you take? What was the outcome?
• Give an example of a time when you were
successful in communicating a difficult message.
What was the message? How did you communicate
it? What was the outcome?
• Imagine you are leading a multidisciplinary team
composed of professionals with different areas of
expertise. How would you make sure everyone
works together effectively?
(sample questions from the AAMC-SVI website)

Knowledge of Professional Behaviors
• One of your patients refuses treatment because it is
incompatible with the patient’s religious beliefs. How
would you handle the situation?
• Tell me about a time when you noticed a mistake or
an error that had been made. How did you identify
this mistake or error, and what action did you take?
• You have just received the test results for your
patient that indicate the patient’s disease has
progressed beyond any available treatment. How
would you deliver the news?
(sample questions from the AAMC-SVI website)

Types of questions you may be asked
• Tell me something about yourself (strength,
weakness, etc.)
• Tell me about a situation in which you had to….
• Here is a (challenging) situation, how would you
manage it?

Guiding principles
• The patient always comes first
• Conflict resolution/management
• Professional and personal values
• Leadership

Hot topics
• Patient-centered care
• Patient safety
• Cost-conscious care
• Team-based care
• Shared-decision making
• Medical error
• The medical apology
• Delivering bad news
 Cultural
competency/humility
 Implicit bias
 Depersonalization
 Work-life
balance/integration
• Substance abuse
• Mental illness
• Physician wellness
• Physician suicide

Other tips
• Read and ponder question carefully- 30 seconds is a
lot of time.
• Try as best you can to develop a mental outline of
your response before you begin
• Only answer the question being asked
• By going off topic you take risks and have nothing to
gain
• If asked for one example don’t give two
• This is not your opportunity to sell yourself
• That’s what the real interview is for
• Remember this is a part of your ”paper” application

Rehearse and Dress the Part
• Test your technology and, if possible, rehearse with a
friend. At minimum, record yourself and listen or
watch. Get to a point where you feel comfortable in
front of the camera.
• Sit up tall. Look lively. Smile. Avoid overhead lighting.
Maintain eye contact with the webcam. Speak
naturally as if the interviewer were sitting across the
table from you.
• Wardrobe note: Choose an outfit that projects
confidence. During your video interview trial run,
make sure clothing patterns aren’t distracting from
your presentation.

Do your homework
 Practice video interview questions during your
“audition” with a friend.
 Be prepared with brief stories to illustrate how you
would handle difficult situations.
 If you happen to make a gaffe, compose yourself,
and proceed with the task at hand. To err is human.
The manner in which you recover will matter more
than dwelling on your mistake.

32
Buckeye Timeline to Match/Class of 2019
February 2018 MSPE Questionnaire opened in Vitals.
April 4, 2018 Match Information Meeting
April 5, 2018 ERAS tokens will be distributed. Students can register and will
have access to LOR portal for letter-writers.
April-May 2018 Identify/contact faculty to request LORs/Create entries in ERAS for
LORs
April 30, 2018 Deadline to complete MSPE Questionnaire in Vitals.
May-June-July 2018 Follow up with letter-writers to make sure letters are submitted.
Late May 2018 MSPE Meetings with Deans/Faculty Advisors Begin
June 1, 2018 Registration begins for San Francisco Match (Ophthalmology)
June 2018 ERAS opens for completion of application and document
submission.
June-August 2018 Obtain a professional portrait and upload to ERAS
September 1, 2018
Plan to have your ERAS application ready to submit, documents
uploaded, and programs saved for which you plan to apply. Last
year, ERAS opened for early submission (with applications being
released on September 15)
September 5, 2018 Deadline for CAS Application (San Francisco
Match/Ophthalmology)
September 8, 2018 Deadline for all students to take USMLE Step 2 CS
September 15, 2018
Deadline for ALL students to complete and apply to programs in
MyERAS.
Registration for NRMP opens.
Deadline for Military Match to submit documents. Some branches
required completion of Step 2 by this date.
Interview Season: Check email daily (including spam filter).

October 1, 2018
MSPEs are released to programs.
Plan to have all LORs uploaded by letter-writers. Some
department letters will be uploaded after this date.
November 30, 2018
Standard registration deadline for NRMP. $50 late free is
assessed after this date.
November 30, 2018 Deadline for all students to take USMLE Step 2 CK
November-December 2018 Begin thinking about rank list.
December 2018 Military Match results announced.
January 3, 2019
Rank order lists due at noon PST for Ophthalmology
(CAS)
January 11, 2019 San Francisco Match/Ophthalmology results released to
students.
Early January 2019 Rank order lists due for Urology (NRMP)
Mid-January 2019
NRMP R3 system opens for ranking.
Urology Match results released.
February 20, 2019 NRMP Rank order list deadline.
March 8, 2019
SOAP-eligible participants receive notification (all
students received this notification; this does not indicate
match status)
March 11, 2019
Match Week Begins
Unmatched and partially matched applicant lists are
released to OSUCOM at 10:30 a.m. and those
applicants are notified at 11:00 a.m.; Programs notified
of unfilled positions at 11:00 a.m.
March 12-14, 2019 SOAP applications and offers made in 3 rounds.33

Crush Your Clerkship: EM Fundamentals by
Ohio ACEP
 PowerPoint with synched audio.
 Take notes.
 The review is divided into 21 lectures presented by Ohio ACEP
Faculty. The topics covered include:
 Approach to Emergent Patient Presentations
 1.Abdominal pain
 2.Altered mental status
 3.Cardiac arrest
 4.Chest pain
 5.Gastrointestinal bleeding
 6.Headache
 7.Poisoning
 8.Respiratory distress
 9.Shock
 10.Trauma
34

Crush Your Clerkship: EM Fundamentals by
Ohio ACEP
 $49 dollars for students.
 Specific Disease Entities
 1.Cardiovascular – Abdominal aortic aneurysm; Acute coronary
syndrome; Acute heart failure; Aortic dissection; DVT/pulmonary
embolism
 2.Endocrine/Electrolyte – Hyperglycemia; Hyperkalemia; Hypoglycemia;
Thyroid storm
 3.Environmental – Burns/smoke inhalation; Envenomation; Heat illness;
Hypothermia; Drowning
 4.Gastrointestinal – Appendicitis; Biliary disease; Bowel obstruction;
Massive GI bleed; Mesenteric ischemia; Perforated viscous
 5.Genito-urinary – Ectopic pregnancy; PID/TOA; Testicular/ovarian
torsion
 6.Neurologic – Acute stroke; Intracranial hemorrhage; Meningitis; Status
epilepticus
 7.Pulmonary – Asthma; COPD; Pneumonia; Pneumothorax
 8.Psychiatric – Agitated patient; Suicidal thought/ideation
 9.Sepsis
 10.Pediatric Emergencies
35

2018 SAEM Medical Student Symposium
 https://www.saem.org/annual-
meeting/education/forums/medical-student-
symposium-(mss)
 8:00 am – 8:15 am: Introduction and Welcome – Kman and Davenport
 8:15 am – 8:35 am: Options in Emergency Medicine – Kathy Hiller, MD
 8:35 am – 8:55 am: How to Find a Mentor – Matthew Stull, MD
 8:55 am – 9:15 am: Intro to EM Research – Aaron Brody, MD
 9:15 am – 9:35 am: Long Term Career Options – Moira Davenport
 9:35 am – 9:45 am: Break
 9:45 am - 10:05 am: Away Rotations – David Story, MD
 10:05 am – 10:25 am: SLOE Basics – Shawn London, MD
 10:25 am – 10:45 am: Clerkship Basics – David Wald, DO
 10:45 am – 11:05 am: How to Master the Application and Personal Statement –
Amy Pound, MD
36

2018 SAEM Medical Student Symposium
 https://www.saem.org/annual-
meeting/education/forums/medical-student-
symposium-(mss)
 11:05 am – 11:15 am: Break
 11:15 – 11:35 am: Interviews 101 – Doug Franzen, MD
 11:35am - 11:55 am: Interview Etiquette – Cynthia Price, MD
 11:55 am – 12:15 pm: Taming ERAS - Tom Morrissey, MD
 12:15 pm – 1:15 pm: Lunch with themed CDs and PDs
 o – Table 1: Doctor of Osteopathic Medicine (D.O.) –Einstein (Merle Carter and
Debra Pierce)
 o –Table 2: Couples Matching-Laura Hopson
 o –Table 3: Schools without Emergency Medicine Residency Programs –Henderson
McGinnis
 o –Table 4: Applying as an IMG
 1:15 pm – 2:30 pm: SVI Overview – Nicholas Kman and Renee Overton
(AAMC)
 3:00 pm - 5:00 pm: SAEM18 Residency/Fellowship Fair37

Resources
• http://emadvisor.blogspot.com/p/finding-em-rotations.html
• https://www.emra.org/globalassets/emra/publications/boo
ks/emra-mssgonline-final.pdf
• AAMC SVI website
• https://students-residents.aamc.org/attending-medical-
school/article/aamc-standardized-video-interview-research-study/
• AAMC tips for applicants
• https://aamc-
orange.global.ssl.fastly.net/production/media/filer_public/d8/db/d
8db1eca-a5af-4c88-b379-a693f6565bed/svi-tips-applicants.pdf
• HireVue website (interview platform)
• https://www.youtube.com/watch?v=x093DPCCWls

Resources
 https://cordemblog.wordpress.com/2017/06/01/the-
standardized-video-interview/
42

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