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Clerkship Corner Winds of Change Are Blowing This Emergency Medicine Residency Application Cycle
Winds of Change Are Blowing This Emergency Medicine Residency Application Cycle
By Sharon Bord, MD and Bradley S. Hernandez, MD on behalf of the SAEM Clerkship Directors in Emergency Medicine academy
For the past decade there has been little change to the emergency medicine residency application cycle. Every summer, nervous emergency medicinebound medical students would diligently complete their ERAS (Electronic Residency Application Service) applications, meticulously edit their personal statements and anguish over which programs to apply. Save for a brief, failed two-year operational pilot of the AAMC standardized video interview to assess professionalism, the process has been remarkably unchanged over 10+ years since the introduction of the standard letter of evaluation (SLOE).
For years the USMLE step 1 score has been a critical part of the EM application. As of January 26, 2022, the USMLE (United States Medical Licensing Examination) step 1 exam will be exclusively pass/fail. What that means for this 2022-2023 application cycle is that some applicants will have a traditional step 1 score and others will have only a pass or fail on their transcript. For this one year, it will be up to programs to decide how to navigate these varied exam results. Looking forward to future application cycles, the majority of students will have only a pass/fail grade on step 1. While studies have shown that USMLE step 1 scores are somewhat predictive of in-training exam scores and licensing exam passing rates, they are well documented to be an imperfect evaluation tool to predict resident clinical performance. This change will also be impactful on emergency medicine (EM) residency programs during application review, especially for those programs who use step 1 score filters as an initial screening tool of ERAS applications. This year the SLOE (standardized letter of evaluation), which has consistently been highlighted as the most valuable aspect of a student’s file by program directors, will also look somewhat different. Based on feedback from the Council of Residency Directors (CORD) and Clerkship
Directors in Emergency Medicine (CDEM) communities, the SLOE will now include categories that will assess students based on EPA (Entrustable Professional Activities) standards and readiness for residency. The classic question of dividing students into thirds as a global assessment also has undergone a revamp with the recognition that most students will require a standard amount of guidance during residency. These changes will potentially be challenging for seasoned letter writers and readers, but it is anticipated that they will provide a more accurate overview of student performance and prediction of success in residency.
The last significant change this application season is the opportunity for EM applicants to submit a preference signaling token to five EM programs through the ERAS supplemental application. Preference signals were first introduced by ENT during the 2020–2021 application season. Last year urology, internal medicine, general surgery, and dermatology implemented them. Preference signaling tokens, submitted concurrently with the ERAS application to EM residency programs, allow applicants to communicate genuine interest in a residency program in a transparent and equitable manner. It is common for residency applicants to have an occult geographic or academic interest in a particular location or program but there is not a unified way to communicate that interest. These tokens are an equitable signal of that interest. They are also considered to be especially useful for lower quartile applicants whose applications may get more serious attention by residency programs due to their preference signal. At the start of this 2022-2023 application season, more than 95% of EM residency programs have enrolled in this voluntary trial of preference signaling tokens.
While change can be difficult, the hope is that these measures will lead to an increasingly fair and equitable application process. The number of medical schools and EM residency programs has continued to grow, and EM-bound students are applying to a larger number of programs. As we continue to navigate this growth and the challenges of COVID-19 this application season, these exciting transformations are hoped to bring about a positive change in the application process and we anticipate clear skies ahead.
ABOUT THE AUTHORS
Dr. Bord is an assistant professor in the department of emergency medicine at the Johns Hopkins University School of Medicine. She has a focus on both undergraduate and graduate medical education and is the director for the required medical student clerkship and subinternship in emergency medicine. She also directs the capstone course, TRIPLE, for graduating fourth year medical students teaching critical skills to aid with the transition to internship and beyond. Dr. Hernandez is a senior staff physician at Regions Hospital in St. Paul, Minnesota and is an assistant professor in the department of emergency medicine at the University of Minnesota Medical School. He attended medical school at the University of Iowa College of Medicine and residency training at Regions Hospital. He is an assistant residency director, clerkship director and gameday physician for the Minnesota Vikings.
About CDEM
Clerkship Directors in Emergency Medicine (CDEM) represents the interests of undergraduate medical educators in emergency medicine. It serves as a unified voice for EM clerkship directors and medical student educators and provides a forum for them to communicate, share ideas, and generate solutions to common problems. For more information, visit the CDEM webpage. Membership in SAEM's academies and interest groups is free. To participate in one more groups: 1.) log into SAEM.org; 2.) click “My Participation” in the upper navigation bar; and 3) click “Update (+/-) Academies or Interest Groups.”
