Choosing a Medical Specialty: Emergency Medicine

Highlights from AUC's recent webinar all about the medical specialty of Emergency Medicine.


According to the AAMC, there are more than 120 specialties and medical subspecialties that students can explore during and after medical school—from sleep to sports medicine, from pulmonary disease to psychiatry. With that many specialties to choose from, it’s never too early to start exploring different areas of medicine to get a feel for which fits you best.

AUC has teamed up with our alumni to bring you the insider’s perspective on different physician careers through a series of webinars. On March 29, three alumni hosted a webinar to explore the specialty of Emergency Medicine—discussing residency life, speaking about why they chose AUC over a US school, and answering specialty-specific questions like:

  • What’s a typical day like for an emergency medicine physician?
  • Can you become board certified in emergency medicine?
  • Are there opportunities to sub-specialize?

Missed it? Watch the recording or read the webinar recap below, including the presentation slideshow and Q&A with our alumni speakers.

Speakers

  • Gino Etta, MD '18

    Matched into Emergency Medicine


    St. John Macomb Oakland Hospital | Warren, MI

Slideshow: About Emergency Medicine

An overview of the specialty, including factors for success, residency outlook, compensation and more


Alumni Q&A

Featuring the AUC experience, clinical rotations, boosting your EM application, and residency life


Attending Medical School at AUC

Why did you choose an international med school vs. a U.S. school? 

Pavel Antonov: When I was in undergrad I wasn’t the best academic student. One of my biggest problems was I didn’t know how to study properly, particularly for the MCAT. I applied to U.S. medical schools, and I didn’t get in. I didn’t feel that waiting around to reapply was the right choice for me, and I had friends who were students at AUC and everything was going well for them. I thought I’d give it a shot. When you go to AUC, you have no other choice but to learn how to study, and that’s how I got where I am today. 

Gino Etta: I didn’t apply to any U.S. schools myself; I went straight to the Caribbean. I knew if I worked hard I would do well. AUC gave me everything I needed, as far as resources, opportunities, and Step 1 preparation. Of course there’s ups and downs, but you have to walk in there knowing that your success is your own responsibility. 

How did AUC support you with academics?

Adam Johnson: One of my favorite things at AUC is the peer-to-peer tutoring for specific classes such as anatomy or pharmacology. There were some classes that I needed extra help in and I got tutored in those, and years down the line I signed up to be a tutor myself. AUC also had a fantastic open door policy with the professors if you were struggling in class or just needed clarification on a topic.

I remember after I got a poor grade on an immunology exam, I showed up at my professor’s office every single day after class and I ended up getting a 99% on the next exam. The professors are there to support you, just like everyone else. You’re at an international school, everyone has left friends and family behind, and you build a new family to support each other. 

PA: I felt very prepared for the USMLEs -- I scored very high on Step 1 and 2, I passed all of my exams on the first try, I was able to match into emergency medicine. When I started residency, the question I had was, ‘Will there be a bias because I went to an international medical school?’ In my program, it’s mostly U.S. grads, and a few international. It’s not a problem. It doesn’t matter. No one asks where you went to med school, no one asks what you scored on your USMLEs; as long as you do the work and put in the effort you’ll get where you want to be. I was chosen as one of the chief residents of my class. You can do it, and AUC will definitely help you get there. 

Were you involved in any extracurricular activities at AUC that helped prepare you for residency?

PA: I was part of Phi Chi medical fraternity on campus. It's a service organization, where we did a lot of community service, fundraisers, etc. It’s a great way to make friends and meet upper semesters. A lot of those connections carry out to the clinical years, which translates to helping you get rotations, tips on getting into residency, etc. That was probably one of the biggest things that helped me. 

AJ: I think it’s also important to not forget about your passions or pastimes. Residencies want to see that you have hobbies and you’re a regular person. Myself, I was really into long distance running. So in addition to doing extracurriculars on campus, when I was doing clinicals in New York I would volunteer in the medical tent for local races, working as a volunteer paramedic and EMT. If you can find a way to combine your passions with medicine, or just stay involved with something you’re really into, I think that looks good as well. 

Today, I’m really involved in the Emergency Medicine Residents’ Association. Medical students able to take part in that as well, and it’s affiliated with the American College of Emergency Physicians, ACEP. They have a lot of great resources and mentors—I actually wish I had gone to some of the conferences and gotten involved earlier, because you can make a lot of connections through these conferences. 

Boosting Your Residency Application

What factors make you stand out in an emergency medicine elective? 

PA: The medical students that stand out to me are the ones that seem interested, eager and come in with some base knowledge. We don’t expect med students to come in functioning like an intern, but we expect you to want to learn and get better. Progression in residency—just like in medical school—is one of the most important things. Just show a willingness to learn, don’t sit on your cell phone between patients. Ask the nurses to teach you something; they have a wealth of knowledge. Stay active, and stay eager. 

GE: Someone once told me, ‘Be seen but not heard.’ It takes time to learn that. Often people who are interested in emergency medicine are naturally high energy, extroverted people, so just try to find a balance. 

AJ: I rotated through Kern’s emergency room as a medical student and I really enjoyed it. I tried hard in so many different areas, whether it was showing up early or demonstrating my medical knowledge base, but when I got the residency position, one of the upper residents said, ‘We chose you because you’re teachable.’ Now here I am, a few years later, teaching medical students and interns. So the factors that I look for are being able to learn something, knowing what can go wrong and how to fix it, being prepared and being able to execute using your knowledge and skills. 

How important is it to have elective clerkships or letters that reflect experience in busy trauma centers?

GE: With standardized letters of evaluation (SLOEs)*, I think that some programs carry more weight than others. If you can get yourself into a Level 1 trauma center with a busy emergency department—it doesn’t have to be university based—it will make a difference, as opposed to doing an elective at an emergency department that has no residency program. At the very least, do an elective at a program that has an emergency residency program there. From what I understand, those letters will be given more weight. 

PA: I completely agree. I wouldn’t worry as much whether your letter is from a Level 1, 2, 3, etc. trauma center, but like Gino said, the most important thing is that there is an emergency medicine residency there. We keep talking about SLOEs: Most programs require one if not two of these letters, which can only be filled out by faculty members of an EM program. So while it’s great that if you can get experience from a hospital with a trauma center, I think going somewhere you can get exposed to residents and get the right kinds of letters is important.  

GE: I think the people who struggled with interviews were the ones didn’t do any emergency rotations at hospitals with EM residency programs. The first hospital where I did an elective had a residency program, they wrote me a nice letter, and I think it was a big part of how many interviews I got. Doing your electives at a residency gives you the opportunity to showcase yourself to that particular program, plus, a letter from there will carry more credibility as you apply to other programs.

*Standardized letters of evaluation (SLOEs) are letters from an emergency medicine faculty member that serve as part of your EM residency application in ERAS. The SLOE was developed as an evaluative tool to provide a global perspective on an applicant’s candidacy for emergency medicine training by providing meaningful comparisons to peers.

Source: https://www.cordem.org/i4a/pages/index.cfm?pageID=3743 

What is a good Step 1 cutoff score for EM applications, and how important is your Step 1 score vs. your Step 2?

PA: In my opinion, you shouldn’t give yourself any red or yellow flags when applying to residency, so it is important to do well on the United States Medical Licensing Exams (USMLE). Anecdotally, I’d say people who had Step 1 scores in the mid-230s and above were getting more interviews then those below that number. So I’d target a score in the mid-to-upper 230s, or higher. 

AJ: I don’t know if there’s a discrete cutoff, but I do agree: The higher the score, the more interviews you’ll get. One of my mentors told me not to pay attention to the cutoff score—just do whatever you can to score as high as you possibly can, in order to land in emergency medicine.

When it comes to Step 2 vs. Step 1, some program directors may look at the higher of the two scores, but some students may not have taken Step 2 when it comes time for interviews. However, you don’t want to score high on Step 1 and then low on Step 2. It’s good to score well on Step 1 and then score higher on Step 2. Really, just do the best you can, you’ll have to make sacrifices but in the end, it will be worth it. 

Did you apply to a backup specialty? If so, how did you split the rank list between the two specialties?

GE: Yes. I applied to a lot of EM and then a lot of internal medicine (IM) as well. I think it makes sense, based on how competitive the specialty is. I just ranked my 6-7 EM, and then 10 IM after that. I went on a lot of interviews but I mean for security, it just helps you sleep at night. The goal is to match.

PA: I did apply for IM as a backup too. I didn’t know what to expect when coming for interviews. I didn’t want to do IM that much but it was an alternative pathway to getting into something like critical care that I would be more interested in. If I had to redo it, I would probably still apply for a backup specialty because of the fear of the unknown. I ended up getting more than enough EM interviews, but a lot of my interviews came in December, January, late November, etc., which would’ve made me really nervous. 

Can you recommend any books that help with the residency process and matching in EM?

PA: In addition to the NRMP website, I read a lot of forums online, which can be a dangerous place… Take it all with a grain of salt. But there’s a lot of useful information online. There’s a lot of people who have been in your shoes before and like to write about it.

AJ: One of my favorites was the EM Medical Student Survival Guide. I think the pdf should be available on Amazon or on the EMRA website.

GE: I didn’t read this before, but for emergency, I read the 3 Minute ER Presentation.

Any last remarks?

PA: In regards to matching in emergency medicine as an AUC graduate, it’s obviously something that’s very attainable. Of course, we all think this is the best field and specialty to get into! But the simple thing is to work hard, and the hard part is to actually do it. If you ever have questions, I’m sure you can get our contact information – feel free to send us an email and we’d be happy to help out.

GE: Taking feedback is so important with this specialty. For every 10 people I ask for feedback, I’d say maybe one person gives me true feedback. You can’t grow unless you pay attention to things you can work on and fix. To be coachable, you have to be able to take feedback like a champion.

Check out the full recording on YouTube