What You Need to Match into Emergency Medicine for Residency

This post was originally uploaded on September 20th, 2019 and edited on July 7th 2023 by Dr. Alexandria Foster.

How to Match into an Emergency Medicine Residency Program

Residency application season is here! Today we are looking at what you need to successfully match into an Emergency Medicine Residency Program. The NRMP conducts an annual survey to determine what factors Program Directors consider when deciding which candidates to interview and rank for their residency program. The results are compiled into an “at a glance” tool. This is extremely helpful in gauging where your application packet stands compared to the applicant pool, and whether adding additional components, like a letter of recommendation (LOR) in the specialty, could give you a leg up as programs review your application. Additional helpful resources include the “The Residency Explorer Tool” and the “EMRA Match” tool.

Factors Considered for Emergency Medicine Residency

Selection Criteria for an Interview –

• LOR in the specialty is a MAJOR factor, while having a good Step 1 score and clerkship grades are also highly important. However, the data below is before Step and Level 1 became pass/fail. It is difficult to predict how important Step/Level 1 pass/fail will be compared to previous years.  
• The SLOE is relatively unique to emergency medicine but this is a specific type of letter of recommendation you need when applying to emergency medicine. There are eSLOEs, SLOEs, oSLOES, and SLOEs from EM subspecialties. The importance of a good SLOE cannot be stressed enough. Even if you have amazing board scores, a poor SLOE can significantly decrease your chances of matching into a program. More information on how to obtain SLOEs can be found here: https://drive.google.com/file/d/1w0riO0g2cq3_THt0_wRYHNaq_2ZMzlkg/view?pli=1

Step 1 and Step 2 Scores:

Step 1 and Level 1 – Score

• • • Now that the NBME and NBOME have transitioned to pass/fail, it isn’t clear how much weight programs are placing on Step 1. Some programs will place a filter to screen out students who have a failed exam. What most people are predicting will happen is a bigger focus on Step 2 scores, clerkship grades, and of course SLOEs.

USMLE Step 2 CK and Level 2 – Score

• • • Around 215 seems to be the minimum threshold at which programs will grant interviews with the average applicant scoring around 240, near the national average.
    • There’s an evident score overlap where programs don’t typically grant interviews based on COMLEX scores. This may stem from difficulties in interpreting and comparing COMLEX scores with USMLE scores.

Types of Applicants Considered:

• • International Grads (U.S. and non-U.S.) are likely to have moderate difficulty matching into emergency medicine: 22% of programs report never interviewing US IMGs, and 56% of programs report never interviewing non-US IMGs. This is a pretty hefty proportion. Only 12% of programs report often interviewing US IMGs, and <1% of programs report often interviewing non-US IMGs. If you’re an IMG, we recommend doing your homework to determine which programs may be more likely to consider IMGs. We definitely recommend a backup specialty to apply to.
• • Osteopathic graduates should be able to match into emergency medicine: 60% of programs will often interview DO applicants, and 62% of programs often rank them. Only 5% of programs will never interview a DO applicant. If you went to an osteopathic school you might want to take a look into the MD/DO composition of programs you’re applying to. This should not be a prohibitive barrier for you, especially with a competitive SLOE.

• Interviewing to Ranking: If you receive an interview for an EM program you have about a 2/3 chance of being ranked. Make a rankings list of at least 8-10 programs. Once you have 10 interview invitations, prioritize and cancel as more come in because you’ll likely get ranked.

• Expect to receive interview invitations in October: A full 47% of interview invitations are sent out in October. While you may receive invites in September and November (or beyond!), this is the densest month for offers. Numerous students report receiving interviews as far out as late January due to last-minute cancellations by students. If your dream program hasn’t offered an interview yet, send a polite email to express interest.

• Expect to interview in November/December: 64% of total interviews are conducted during these two months Only 13% of interviews will occur before November, which gives you ample time to prepare. For further discussion on how to prep for your interview, see our blog post on How to Crush your Residency Interview. 

What’s Less Important for an Emergency Medicine Residency?:

• Focus on getting great SLOEs on your audition rotations. 
• Board exams aren’t the end all be all for emergency medicine but scoring in the average range seems to be the threshold for most interview offers
• The MSPE/Dean’s letter isn’t particularly important for emergency medicine
• Grades in your required clerkships are not as important in emergency medicine as in other specialties but your rotation in emergency medicine IS important.

Summary for Emergency Medicine Residency Applications:

• A strong EM application needs passing Step 1, 240+ on Step 2, strong SLOE, and a good EM rotation grade.

• Emergency medicine is slightly more difficult to apply into as an international grad, but this does not need to be a prohibitive barrier! We only recommend that you do your research to identify programs with active IMG residents and establish proper connections.

• If you’ve failed an exam, apply broadly and consider a back-up specialty.
• Expect Interviews in November-December. Reach out to programs you have high interest in if you haven’t heard from them by late October-November. Once you have about 10 interview invitations, you can consider being a bit more selective about which ones you actually take (but not before).

Keep in mind while these surveys are helpful to get a glimpse into program directors’ thought processes, only a small percentage (usually 20-25%) of programs actually respond to the NMRPs surveys. So make connections, find mentors, talk to people you know in emergency medicine to help make your match successful. Good Luck! ☺ 

Wondering about your chances of matching into other specialties for residency? Check out our analysis of the NRMP directors survey “at a glance” tool for areas including anesthesia, dermatology, family medicine, transitional year, psychiatry, neurology, and more under the Residency Applications category of our blog! If you need further or specialized assistance understanding which residency specialties you are best suited to apply to, you can contact us or visit our residency advising page to learn more about how Elite Medical Prep residency advising services.