This lecture was given at the 2024 Society for Academic Emergency Medicine Medical Student Track. It discusses match strategy and competitiveness of programs and students.

1. Emergency Medicine
Match Axioms 2024:
Strategy, Statistics, and
Competitiveness
Michael A. Gisondi, MD
Professor and Vice Chair of Education
Assistant Dean for Academic Advising

2. Gisondi’s Three Rules
I want you to
match at the very
best place that
you can and
want to match.
There is no #1 or
“best” program.
There is no
guarantee that
you will match.

3. Learning Goals:
STRATEGY: The Art of War
MATCH STATISTICS: What Do They Mean?
MIRROR, MIRROR on the WALL: ‘Am I Competitive?’

4. STRATEGY: The Art of War
MATCH STATISTICS: What Do They Mean?
MIRROR, MIRROR on the WALL: ‘Am I Competitive?’

5. “A plan of action or policy designed to
achieve a major aim.”
Synonyms: Master Plan, Game Plan
“The art of planning and directing military
operations in battle.”
Synonyms: Tactics, The Art of War
STRATEGY

6. Case Study

7. The Art of War: A Case Study
BATTLEFIELD:
2014 Chicago
Easter
Eggstravaganza
OBJECTIVE:
Obtain Eggs
SOLDIER:
Abby

8. Avoid the
Cornucopia!

9. Why did Abby get
so many eggs?
Because she had an advisor!
The advisor:
Understood how the game was played
Knew Abby’s strengths relative to peers
Discussed her goals ahead of time
Set realistic expectations for her
Was someone she trusted
Helped her develop a strategy

10. Biggest Potential
Strategic Mistakes
TRYING TO DO THIS BY YOURSELF
Not seeking an advisor
Not seeking multiple sources of advice
Not meeting with your advisor
Not being prepared
Not listening the advice of senior advisors
LISTENING TO THE WRONG PEOPLE

11. 1
2
3
Warnings
Be Wary of Advice from Non-EM Physicians
The same rules don’t apply to all specialties!
Be Wary of the Interview Trail Rumor Mill
Be careful what you hear from other students!
Be Wary of Social Media: Don’t Trust Blog Sites
Never log on! Just say no!

12. Get Good Advice:
WHO CAN YOU TRUST?
1. RESIDENCY LEADERSHIP
Seek out faculty members who regularly advise
students and help run the program
2. RESIDENTS
Pay attention to their impressions of programs
Do not rely on resident
assessments of your “competitiveness”

13. STRATEGY: The Art of War
MATCH STATISTICS: What Do They Mean?
MIRROR, MIRROR on the WALL: ‘Am I Competitive?’

14. How competitive is
emergency medicine?

15. Emergency Medicine Match Outcomes: 2019-2024
Year # Programs # Programs
Unfilled
# Positions # Positions Filled # Positions
Unfilled
# Filled by
LCME Seniors
% Filled by
LCME Seniors
2024 292 54 3026 2890 136 1286 42.5%
2023 287 129 3010 2456 554 1274 42.3%
2022 277 69 2921 2709 291 1593 54.5%
2021 273 ~ < 10 2840 2826 14 1765 62.1%
2020 256 ~ < 10 2665 2652 13 1713 64.3%
2019 238 ~ < 10 2488 2458 30 1617 65.8%
Source: NRMP Main Residency Match Advance Data Tables

16. Thoracic surgery 93.8%
Plastic surgery 88.3%
Orthopedic surgery 79.3%
Vascular surgery 77%
Obstetrics-gynecology 71.7%
Surgery 62.3%
Radiology 54.5%
Pediatrics 47.6%
Emergency Medicine 42.5%
Internal Medicine 35%
Family Medicine 29.2%
Best % LCME for EM 84.1%
2022 54.5%
2023 42.3%
Fill Rates by LCME Grads by Specialty in 2024

17. Total Positions Filled, 2024
Historical Performance:
• Emergency Medicine was a ‘100% filled specialty’ in 2012.
• Emergency Medicine previously filled > 98% annually.
Total % Positions Filled:
• Emergency Medicine dropped to 92% in 2022
• Emergency Medicine dropped to 81.5% in 2023.
• Emergency Medicine rose to 95.5% in 2024

18. KEY TAKE-AWAY:
Emergency Medicine is no longer
a competitive specialty.

19. STRATEGY: The Art of War
MATCH STATISTICS: What do They Mean?
MIRROR, MIRROR on the WALL: ‘Am I Competitive?’

20. Why do students not match?
(1) Didn’t apply to ‘enough’ or a ‘mix of programs’
(2) Had severe geographic limitations
(3) Didn’t listen to their advisors
(4) Bad fit for emergency medicine

21. What kind of applicant am I?
You need to talk to a trusted advisor
who can and will
give you a realistic assessment
of your candidacy.
Are there issues in your academic record that will come up?
How were they addressed in your ERAS application?
What was your performance during the EM clerkship?
What is your class rank? Will MSPE be supportive?
Do you have limited geographic or program preferences?

22. Assessing Your
Competitiveness
It depends what you are competing for!
You need your advisors to
give you a sense of which programs are
likely to be the most selective
You already know if your file is
‘average’ or ‘above average’
The ‘average LCME medical student’
can successfully match in EM!

23. USMLE Step 2
When should I take it?
Red Flags: Take Step 2 early
Gisondi’s Deadline: January 1
Programs require it to rank you
Indicators of clinical knowledge

24. How Many
Applications?
Dependent on:
1. Where you want to live
2. Programs that interest you
3. Overall strength of your application
General rule for average students:
Apply to 30 maximum
Take 12 interviews
Most students will be turning down interviews

26. What did we
learn in
30 minutes?

27. SUMMARY:
Be strategic. Get an advisor!
EM isn’t all that competitive anymore.
Average applicants match.

28. Thank You!
Slides:
@MikeGisondi