Everyone interested in the specialty has heard the same comment time and time again: Emergency Medicine (EM) is becoming more competitive every year. While this anxiety-provoking statement is certainly backed up by objective data reported by the National Residency Matching Program (NRMP), EM remains a very accessible specialty to medical students who understand the unique application process. One of the main ways to stand out in a crowded field is to do well on your away rotations. At this point in the year, third-year students should be applying through VSAS or the programs themselves for these rotations. These 2-3 months of audition are crucial for several reasons.
Earning a SLOE
Students that complete an audition rotation with an Accreditation Council of Graduation Medical Education (ACGME)- accredited EM residency program are eligible to request a Standardized Letter of Endorsement (SLOE). The SLOE is a special kind of recommendation letter that is the result of many years of dialogue between program directors about the most effective way to objectively compare EM applicants. The SLOE aims to be as objective as possible by adhering to a standardized rubric that directly compares the auditioning student to the total pool of auditioning students at that program during that audition cycle. While this structure does provide useful objective data, a significant degree of subjectivity remains in the evaluation process. While anyone can technically write a SLOE, they carry the most weight if they are generated collectively from an accredited residency program and not from an individual. SLOEs are an absolutely vital part of the application, and many programs will screen out applications that do not have at least two. Having great SLOEs can compensate for weaker parts of the application, such as low board scores. In fact, programs tend to weigh the SLOE more heavily than any other factor, and there really is no close second.
Getting to Know the Program
Many consider audition rotations to be a month-long interview. The residents and attendings can really get to know an auditioning student over the course of the month. Compared to a handful of 20-minute residency interviews, this provides a distinct advantage for rotators. Students who do very well on an audition rotation will rank higher on a program's rank list. Although it is easy to forget, programs also take some risk when selecting candidates based solely on an application and interview. By focusing on students who rotate with them, they can mitigate this risk after working directly with the people they will be training. The audition also gives students the opportunity to get a feel for the program itself. It's much easier to learn about the facilities, patient population, residents, and faculty through spending a month there rather than attending a tour during the interview day. Rotating at different programs can help determine individual preference for community, academic, or county programs. All types of programs have their strengths and weaknesses, and spending a month in different settings will certainly help students determine what's right for them.
Although not always the case, many audition rotations will either offer an interview at the end of the month or ensure that rotators are included in the first round of interview invites. It's nice to have a few “guaranteed” interviews when interview season arrives, and these interviews are often great practice as they occur early in the season and there's already familiarity between the interviewee and the interviewers. If a student is really interested in a particular program, doing well on an away rotation can significantly increase the chance of receiving an interview and ultimately matching there. It is important to note that not all programs will extend an interview to all rotators, so it is still critically important to work hard and make a good impression at all times.
Away rotations can help get secure interviews in parts of the country that students would otherwise not be competitive. For example, if a student goes to school in the Midwest, doing away rotations in the Northeast or South demonstrates to programs in those regions that the student has a real interest in the area. In addition, SLOEs from within the same geographic region are often weighed more heavily because of program familiarity and faculty relationships. These factors will likely increase the amount of interviews the student receives from those regions. Program directors have often remarked that since the number of applications has increased dramatically in the past few years, students without a significant tie to the program's geographic region will often take a back seat to those with roots in the area. In short, programs may be unsure whether the student has a true interest in them or is just applying to meet a minimum number of applications. Completing an audition rotation nearby or in that region shows the program that the student does have a true interest in that area, and can be a major factor in the application process.