This presentation, "Strategy, Competitiveness, and the Interview", was given at the 2015 Annual Meeting of the Society for Academic Emergency Medicine - Medical Student Symposium. San Diego, CA. May 15, 2015. #SAEM15 Intended target audience includes senior medical students preparing for the NRMP Match.

1. Strategy,
Competitiveness,
& The Interview
Michael A. Gisondi, MD, FACEP, FAAEM
Residency Program Director
Northwestern University
@mikegisondi
SAEM Medical Student Symposium - 2015

2. Topics to Discuss:
1. Strategy
2. Competitiveness
3. The Interview

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

4. Effective Advising Programs = Strategic Success!
The best advisors:
 Understand how the game is played
 Know your strengths relative to peers
 Discuss your goals ahead of time
 Set realistic expectations
 Are someone that can be trusted
 Help develop a strategy

5. 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

6. Getting Good Advice – Who can you trust???
Residency Leadership
Seek out faculty members who regularly advise
students and help run the program
Residents
Pay attention to their impressions of programs
Do not rely on their assessment of your
“competitiveness”

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

8. ALiEM EM Match Advice www.aliem.com

9. Topics to Discuss:
1. Strategy
2. Competitiveness
3. The Interview

10. How competitive is the EM Match?
NRMP©DataforEmergencyMedicine,2007-2014*
MikeGisondi,JillCraig–NorthwesternUniversity
# EM
Residency
Programs
(allopathic)
# EM
Positions
Offered
(allopathic)
# EM Positions
Filled in the
NRMP© Match
(allopathic)
# EM Positions
Filled by LCME
US Seniors
(allopathic)
% EM
Positions
Filled by
LCME US
Seniors
# EM
Positions
Available**
for SOAP©
# EM-bound
unmatched
LCME
US Seniors†
# EM-bound
unmatched
Independent
Applicants†
2014 170 1786 1772 1388 77.7 12 44 114
2013 165 1743 1740 1428 81.9 1 90 188
2012 153 1668 1668 1335 80.0 0 65 149
2011 150 1607 1602 1268 78.9 5 94 196
2010 147 1556 1540 1182 76.0 16 68 151
2009 141 1472 1459 1146 77.9 13 69 182
2008 133 1399 1370 1083 77.4 29 36 117
2007 127 1288 1282 1027 79.7 6 78 150
* Data from National Resident Matching Program, Results and Data Main Residency Match® reports 2007-
2014. Available at http://www.nrmp.org/match-data/main-residency-match-data/ .
Any discrepancies between the above numbers and cited NRMP ® source reflect typographicalordataentry
errorsforwhichtheaboveauthorsassumeresponsibility.
**SOAPdatawasavailableforthefirsttimein2013.Numbersfor2007-2012,beforetheSOAPexisted,reflectpositions
listedas“Unfilled.”
†Reflectsapplicantsthatrankedonlyonespecialty

11. Specialties with 100% Fill Rates in 2014
• EM / IM
• Pediatrics / Primary
• Dermatology (PGY-1)
• Physical Medicine & Rehabilitation (categorical and advanced)
• Plastic Surgery (integrated)
• Psychiatry / Family Medicine
• Radiation Oncology (PGY-1)
• Thoracic Surgery
• Neurological Surgery
• Otolaryngology
• Emergency Medicine was a ‘100% filled specialty’ in 2012.
• Emergency Medicine fills > 98% of available positions annually.

12. Specialties > 90% Filled by LCME Grads in 2014
• Radiation Oncology (PGY-1): 100%
• Radiation Oncology (PGY-2): 93.8%
• Otolaryngology: 94.6%
• Dermatology (PGY-1): 100%
• Plastic Surgery (PGY-2): 92.3%
• Orthopedic Surgery: 93.4%
• Neurological Surgery: 91.7%
• Emergency Medicine has not yet made this list.

13. Old paradigm:
Many students underestimate their ability to
match in emergency medicine.
New reality:
Some students overestimate their ability to
match in emergency medicine.

14. Why do students not match?
Many LCME seniors who don’t match in EM, or match
low on their list, didn’t listen to the advice they were
given or they weren’t really suited to the specialty.
• Didn’t apply to ‘enough’ or a ‘mix of programs’
• Had severe geographic limitations
• Wanted it to fit, but EM really wasn’t the best
choice for their interests, personality and
strengths in the first place

15. 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
should or will come up? How were they
addressed in your ERAS application?
 Performance during the EM clerkship
 Other rotations/Dean’s Letter
 Geographic or Program preferences

16. 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 highly selective
•You already know if your file is ‘average’ or ‘above
average’ ... Though it is getting more competitive, the
‘average LCME medical student’ can match!

17. Comparing ‘Average’ to ‘Above Average’ in a
World of Over-Achievers
CLASS RANK
TOP QUINTILE
2nd QUINTILE
MIDDLE QUINTILE
4th QUINTILE
BOTTOM QUINTILE
Your class rank is above average.
(Congratulations. Don’t be cocky.)
Interview at 10 programs, max.
Apply to 20 or so, max.
Your class rank is average.
(You will very likely match!)
Interview at 15 programs.
Apply to approximately 30 programs.
Your class rank is below average.
EM is not a guarantee.

18. Comparing ‘Average’ to ‘Above Average’ in a
World of Over-Achievers
STEP 1: a criterion-referenced exam…
> 271
250 - 271
228 - 249
207 - 227
< 206
Mean: 228
SD: 21
> 1 SD above the mean. Very competitive.
Statistically speaking,
your Step 1 score is average.
< 1 SD below the mean is below average.
> 2 SD above the mean. WOW.

19. How many programs should I apply to?
•The magic numbers (how many programs to apply to
and how many interviews to take) are dependent on:
(a) where you want to live
(b) the types of programs that interest you
(c) the overall strength of your application
•Need to talk to an advisor and also get several opinions
•Most students will be turning down interviews

20. Topics to Discuss:
1. Strategy
2. Competitiveness
3. The Interview

21. Interviewers Are NOT Looking for Reasons to Reject You!

22. Interviewing = A Talent Search

23. This is a job interview!
PLAY THE PART!
Dress Appropriately
Firm Handshake
Be Mature
Say Thank You
Don’t be overly familiar!

24. What are we looking for?
Professionals
Goal-oriented
Self-starters
Evidence of achievement
Learners who can pass the tests
Employees who won’t complain

25. What is the 3am Test?

26. Who is interviewing you?
•The program coordinator when you call to schedule
(and re-schedule) your interview.
•The receptionist who sits in the lobby with you during
your interview day.
•The resident who is giving you a tour of the ED.
•The nurses on your ‘second look’ day.
•Everyone.

27. The ‘optional’ pre-interview social is
not truly optional.

28. The ‘Pre-Interview Social’: What to expect
•Occurs the night before or the night of your interview
•Some residents will be there (not all of them!)
•Faculty or alumni may be there
•There may or may not be food and alcohol
•You will learn a lot about the program

29. Before your interview…
•Read the website
•Read the information sent to you about the interview day
•Know who runs the program (PD, APDs, Chair)
•Ask your advisor what they know about the program
•This is a job interview…do your homework!

30. There are lots of
stupid questions.
True Story.

31. Some general rules….
•Do not ask the program director about shift length,
vacation requests, days off, etc.
•Do not ask the residents questions exclusively about shift
length, vacation requests, days off, etc.
•Do not waste your interview with the program director by
asking questions that you could have answered by
carefully reading the program website.
•Have good reasons for your questions.

32. Always ask a question!
•No Questions = Disinterested
•Some back-up questions:
1. What do you like best about this program?
2. Why did you come here/why do you stay here?

33. The illegal and inappropriate questions to anticipate
• Arrest history
• Ethnicity
• Religious preference
• Rank Number
• Marital Status
• Dependents
• Sexual Orientation
• Personal Health

34. Methods of Post-interview Communication
•‘Thank You’ notes
• The Second Look
•“I plan on ranking you highly….”
•“I am ranking your program #1….”
• Phone calls from program staff

35. Never ‘no-show.’
(Late cancellations are
unprofessional too!)

36. A lot of effort goes into your interview day….
What to anticipate:
5-8 hour interview day
Pre-interview social the night before
Continental breakfast and lunch
Tour of facilities
Conference
Numerous interviews
Time with the residents

37. DO NOT:
Cancel less than 2 weeks ahead.
Cancel via the ERAS website only.
No show.

38. Topics to Discuss:
1. Strategy
Find an advisor!
2. Competitiveness
Set realistic goals!
3. The Interview
Prepare for a job interview!