How competitive is emerg and how do we start early?

[lovestruck]

I've been thinking about emerg for residency, but have heard it can be somewhat competitive. How competitive is it really if you're not too picky about location (I'll go anywhere in Ontario except NOSM)?

 

Also, what can we do to prepare for residency? Apart from emerg electives of course!

[Lactic Folly]

You can check the CaRMS stats as well as the posts from the multiple EM people on this board, but this is just a well-intentioned heads up that "anywhere in Ontario except NOSM" is not the conventional definition of "not too picky about location."

[lovestruck]

You can check the CaRMS stats as well as the posts from the multiple EM people on this board, but this is just a well-intentioned heads up that "anywhere in Ontario except NOSM" is not the conventional definition of "not too picky about location."

 

For residency, I'd like to stick to urban centres in Ontario since I want maximum clinical exposure and programs with strong research faculties. However, once it comes to the job markey I'll go anywhere in Canada really.

 

I know the CaRMS stats: 63 people applied for 65 spots, 2 spots left for the 2nd round. So it looks good! But what did these people have to do to get their top choice with respect to program AND location?

[Lactic Folly]

I don't think those are the correct stats you're referring to - in 2013, 98 people ranked EM as a first choice:

https://www.carms.ca/pdfs/2013R1_MatchResults/Table_11_En.pdf

 

Success rate more like 68% according to this table:

https://www.carms.ca/pdfs/2013R1_MatchResults/Table_19_En.pdf

 

I'd search for posts by Satsuma, rogerroger, ploughboy, boringem (sorry if I forgot anyone).

[NLengr]

For residency, I'd like to stick to urban centres in Ontario since I want maximum clinical exposure and programs with strong research faculties. However, once it comes to the job markey I'll go anywhere in Canada really.

 

I know the CaRMS stats: 63 people applied for 65 spots, 2 spots left for the 2nd round. So it looks good! But what did these people have to do to get their top choice with respect to program AND location?

 

With emerg you'll likely rank all programs in the country and be happy to match anywhere. It's one of the most competitive.

[Cat_eyed]

Oh dear. Lovestruck my friend, it is much more competitive than that unfortunately. At my med school many people who wanted Emerg did not get in and even among those that did, many did not go to their top choice in location. That's just the way it is with competitive specialties. To have a better chance, broaden your willingness to go other places in Canada; there are excellent centres outside of Ontario

[tooty]

It's more competitive than the stats show because some people get zero interviews, meaning the carms stat of (number of applicants who ranked emerg as first choice) underestimates the number of emerg gunners.

 

In terms of improving your chances, you can't go wrong with being 1) likeable and a team player, 2) knowledgeable, and 3) hard-working. Don't be lazy, don't be a douche, and know your emerg topics better than the average bear. Residents talk. Even I hear, as an off-service resident, how excellent or poor the rotating elective students are in my rotations.

[rogerroger]

For residency, I'd like to stick to urban centres in Ontario since I want maximum clinical exposure and programs with strong research faculties. However, once it comes to the job markey I'll go anywhere in Canada really.

 

I know the CaRMS stats: 63 people applied for 65 spots, 2 spots left for the 2nd round. So it looks good! But what did these people have to do to get their top choice with respect to program AND location?

 

This year there were 98 first choice applicants to EM for 68 spots. This is for the FRCPC EM program. In the last few years the CCFP EM stats have been similar to sightly more competitive. If you are interested in urban centers and research it sounds as though you may be gravitating more towards the five year stream. If this is the case then you need not worry about NOSM as there is no royal college emerg program there.

 

Others and myself have written a lot about this topic. As noted already the biggest thing is electives. Do tons of emerg electives, work hard, be normal and have a reasonable knowledge base.

[lovestruck]

This year there were 98 first choice applicants to EM for 68 spots. This is for the FRCPC EM program. In the last few years the CCFP EM stats have been similar to sightly more competitive. If you are interested in urban centers and research it sounds as though you may be gravitating more towards the five year stream. If this is the case then you need not worry about NOSM as there is no royal college emerg program there.

 

Others and myself have written a lot about this topic. As noted already the biggest thing is electives. Do tons of emerg electives, work hard, be normal and have a reasonable knowledge base.

 

Do you mean electives in preclerkship or clerkship?

 

I've already set-up 2 possible electives in preclerkship but don't really know where to go from here. I'm doing an international elective this summer and have the option of doing ER there as well.

 

Apart from the basics (work hard/don't be an idiot) anything else a preclerk can do? I know we can do clerkship electives at other universities, but can we do this as preclerks?

 

I find that we just don't get enough info about this. All the emerg docs that I've talked to did the 2 yr GP + 1 yr emerg and work in an urban setting but admit that these days thats just not possible. They simply don't know what we need to get to ER these days and we don't have access to ER residents to ask them!

[Lactic Folly]

I find that we just don't get enough info about this. All the emerg docs that I've talked to did the 2 yr GP + 1 yr emerg and work in an urban setting but admit that these days thats just not possible. They simply don't know what we need to get to ER these days and we don't have access to ER residents to ask them!

 

You have ER residents on this board, who have kindly invested their time to provide advice, as rogerroger mentioned. Have you looked up the previous posts of the people mentioned?

[rmorelan]

Do you mean electives in preclerkship or clerkship?

 

I've already set-up 2 possible electives in preclerkship but don't really know where to go from here. I'm doing an international elective this summer and have the option of doing ER there as well.

 

Apart from the basics (work hard/don't be an idiot) anything else a preclerk can do? I know we can do clerkship electives at other universities, but can we do this as preclerks?

 

I find that we just don't get enough info about this. All the emerg docs that I've talked to did the 2 yr GP + 1 yr emerg and work in an urban setting but admit that these days thats just not possible. They simply don't know what we need to get to ER these days and we don't have access to ER residents to ask them!

 

Electives during your senior time. Preclerkship electives are good for basic learning, exposure but electives away are where the money is at

 

You generally don't do away electives during preclerkship - the system is busy enough as it is trying to fit in all the elective students. Things are very tight actually - hence in large part the warning about doing the bookings early etc.

 

You know working hard, knowing your stuff in advance and not being a jerk really, really count for a lot.

[aaronjw]

Electives during your senior time. Preclerkship electives are good for basic learning, exposure but electives away are where the money is at

 

You generally don't do away electives during preclerkship - the system is busy enough as it is trying to fit in all the elective students. Things are very tight actually - hence in large part the warning about doing the bookings early etc.

 

You know working hard, knowing your stuff in advance and not being a jerk really, really count for a lot.

 

I see this repeated often on this board and frankly it confounds me. Are there really a high proportion of students that are so problematic that there needs be warnings about not being an arse? Lol

[Lactic Folly]

I see this repeated often on this board and frankly it confounds me. Are there really a high proportion of students that are so problematic that there needs be warnings about not being an arse? Lol

 

Well, this may be more accurately stated as being careful not to be *perceived* as potentially difficult in any way... whether or not that perception reflects the real you, that perception is what people will go on when making their decisions.. in the medical school setting, it is assumed everyone is putting their best foot forward on electives, so any hint of an undesirable personality trait, even during a brief exposure, evokes caution as this could represent the tip of the iceberg, which would result in potential great headaches when working closely with that person for several years. It really is joining a family, and even the most healthy families encounter conflicts from people bumping into each other from time to time... if potential problems can be averted when there is chance to do so, so much the better, goes the common thinking...

[rmorelan]

I see this repeated often on this board and frankly it confounds me. Are there really a high proportion of students that are so problematic that there needs be warnings about not being an arse? Lol

 

well....yeah pretty much.

 

I have already seen elective students shoot themselves down in a blaze on elective by simply being annoying or very "jerkish". There is a difference between being eager and being pushy, there is a proper way of working with the rest of the team of support staff (ie. with respect) and some understanding of chain of command. Some of it I am sure is in the eagerness to impress in a hurry but it can kill your chances so very quickly.

 

Nothing scares programs more than the thought of being stuck with the wrong person for 2-6 years

[Lactic Folly]

(but you gotta use the right amount of teeth)

 

Which begs the question.. how is this different from a business internship, or articling in law, or trying to advance in an organization in any other field?

[rogerroger]

Which begs the question.. how is this different from a business internship, or articling in law, or trying to advance in an organization in any other field?

 

 

Yup, no difference. Unfortunately, it is exactly the same crummy game IMO.

[Lunasly]

well....yeah pretty much.

 

I have already seen elective students shoot themselves down in a blaze on elective by simply being annoying or very "jerkish". There is a difference between being eager and being pushy, there is a proper way of working with the rest of the team of support staff (ie. with respect) and some understanding of chain of command. Some of it I am sure is in the eagerness to impress in a hurry but it can kill your chances so very quickly.

 

Nothing scares programs more than the thought of being stuck with the wrong person for 2-6 years

 

If you don't mind, can you provide any examples of encounters?

[NLengr]

I am of the opinion that most medical professionals are very difficult to tolerate, including myself. Being an arse is therefore the default.

 

Being an elective student is probably one of the most awkward, horrible experiences during medical school. It requires one go to an unfamiliar land for two to four weeks, learn an unfamiliar system, and try to get along enough with unfamiliar, and often jerky, academic physicians and residents so that they don't shitcan your application come match time. Learning is not the objective - fellatio is (but you gotta use the right amount of teeth)

 

The whole business is frankly retarded.

 

Brooks, I agree with you too. Physicians (residents included) are much more difficult to get along with as a group than the general public, or even other groups of professionals. Working as a team is certainly not our strong suit.

 

Electives suck as an experience. You do learn a fair bit, but that's balanced off by a 2-3 week long job interview where even a single innocent comment, action or mistake can destroy your application. To make things worse, given the personalities of some residents/staff, it's things that in the non medical world wouldn't even be an issue.

 

As much as people stereotype engineers as socially awkward and unable to relate to people, I gotta say, my time in engineering had much more teamwork, congeniality and support, with less toxic personalities, than my time in medicine.

[NLengr]

If you don't mind, can you provide any examples of encounters?

 

One that's often seen, and I probably did myself as a med student, is to answer a question correctly and confidently, that a resident has gotten wrong. The student might hope to impress the staff (and they will), but depending on the resident, it could mean that resident shoots down your application at review.

 

One thing nobody told me, and I wish I had known is to be VERY careful in that situation. Some residents have issues with being shown up by residents/students junior to them. The problem is you generally don't know what residents are like this and you can't intentionally be wrong all the time. I don't care in that situation, but I know a fair number of people across multiple programs, who would have a giant issue with it (which is ridiculous IMO).

 

Thinking about it, I wonder how many applications get ****canned for this very reason. I bet it's not an insignificant number.

[aaronjw]

 

As much as people stereotype engineers as socially awkward and unable to relate to people, I gotta say, my time in engineering had much more teamwork, congeniality and support, with less toxic personalities, than my time in medicine.

 

Not sure my wife who is an engineer would agree. A lot of turf war in engineering where margins are lower today than they have ever been and each firm doing their level best to retain as much of the pie instead of doing their level best to serve the client best interest. The only benefit is its not career suicide in your training to appear smart.

[NLengr]

Not sure my wife who is an engineer would agree. A lot of turf war in engineering where margins are lower today than they have ever been and each firm doing their level best to retain as much of the pie instead of doing their level best to serve the client best interest. The only benefit is its not career suicide in your training to appear smart.

 

I'm talking about interpersonal interactions, not interactions between competing firms.

[Lactic Folly]

One that's often seen, and I probably did myself as a med student, is to answer a question correctly and confidently, that a resident has gotten wrong.

 

In this situation, it's key to know whether the question was posed to the resident alone, or whether the question was opened to everyone in the group. If open to everyone, then it's fair game for the student, although the socially aware student will make an attempt to answer tactfully.

 

If the student interjects without being asked, then this is something our staff look poorly upon as well - it suggests an attitude of one-upmanship which may work in the competitive medical school environment, but is not desired in the residency team environment. Culture likely varies across programs though.

[Lactic Folly]

You're totally right about the whole "getting things wrong intentionally" crap. Back in clerkship I've heard of this, got spooked, and managed to silence my way into a few mediocre evaluations because my team had a few residents who didn't know certain simple things (like the effects of beta-two sympathetic stimulation, etc.) and I just kept my mouth shut(the evals basically said I don't say anything, which was true: "great notes and discharge summaries, but too quiet on rounds").

 

Yes, I always found this a difficult balancing act as well.

As mentioned in my last post, I've since learned from others a few methods of not selling yourself short, while trying to ruffle fewer feathers:

- phrase as a question

- start by agreeing with part of what the other person said, and then add your piece

- saying that you were just taught this, or came across this, etc.

 

However, putting oneself in the shoes of the resident who has just had a basic gap in knowledge exposed before the staff, and then answered correctly by someone more junior to boot, some discomfort is unavoidable in almost anyone. It's just that the good people won't be inclined to act in a petty manner because of it.

[rogerroger]

I can understand the concern voiced about answering questions a resident does not know. However, realistically I can't imagine anyone in my resident cohort getting peeved around this. I'm certainly bias, but emerg people tend to be pretty down-to-Earth guys and gals. I certainly don't care, and it happens.

 

The knowledge required in medicine is vast. We can't know it all. There are times when staff don't know an answer and a resident does. This is normal and happens more often then you may think. There are simply times when a clerk may know an answer a resident does not know. If you don't speak up during these times then you are selling yourself short and possibly even negatively influencing the care of a patient. Just answer diplomatically and not obnoxiously. Remember, success as a clerk is just as much about social graces as it is about knowledge. As stated above, voicing you answer as a question is a good tip if concerned.

 

If your application gets canned because you pissed a resident off by simply knowing something they did not then I would consider it a hidden favor. I wouldn't want to be part of a program where such a culture prevailed among your future colleagues.

 

Just my two cents.

[NLengr]

Just answer diplomatically and not obnoxiously. Remember, success as a clerk is just as much about social graces as it is about knowledge.

 

That's the key. It's a fine line to walk.

 

There are lots of residents out there that are nut bags. That's what makes it harder.