What If I Do Not Match? Scrambling for a Spot and Going Outside the Match.

Matching into emergency medicine (EM) is getting progressively more competitive. Applicants must therefore prepare for the possibility of not matching and, accordingly, be ready to participate in the Supplemental Offer and Acceptance Program (SOAP). In this article, we elaborate on the SOAP and the options for applicants who fail to match during Match Week. Alternative courses of action include applying for a preliminary year, matching into a categorical residency program, or aiming to secure EM spots outside the Match through the Council of Emergency Medicine Residency Directors, Society for Academic Emergency Medicine, and American Association of Medical Colleges

The utility of chest X-ray vs. computed tomography in febrile neutropenia patients presenting to the emergency department

Introduction: Pulmonary infections are not uncommon in patients with febrile neutropenia. Physicians have agreed to perform a chest X-ray (CXR) for all febrile neutropenic patients presenting with respiratory signs/symptoms. Nevertheless, they were divided into two groups when it came to asymptomatic febrile neutropenic patients (i.e. without respiratory signs/symptoms). A superior alternative to CXR is Computed Tomography (CT). CT, in comparison to CXR, was shown to have better sensitivity in detecting pulmonary foci. The aim of our study is to compare the diagnostic performance of CT and CXR in febrile neutropenic patients presenting to the emergency department, regardless of their clinical presentation. We are also interested in the predictors of pneumonia on chest imaging. Methodology: This is a retrospective cohort study conducted on febrile neutropenic adult cancer patients presenting to the emergency department of the American University of Beirut Medical Center. Results: 11.4% of 263 patients had pneumonia although 27.7% had respiratory signs/symptoms. 17.1% of those who were symptomatic and did a CXR were found to have pneumonia. 41.7% of those who were symptomatic and did a CT were found to have pneumonia. 30% had negative findings on CXR but pneumonia on CT. Conclusion: Patients with positive findings of pneumonia on chest imaging mainly had solid tumors, profound neutropenia, a higher CCI and a longer LOS. The presence of respiratory signs is the main predictor of positive pneumonia on chest imaging. CT is superior to CXR in detecting pulmonary foci in the population studied. Copyright © 2020 El Majzoub et al. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Role of urine studies in asymptomatic febrile neutropenic patients presenting to the emergency department

BACKGROUND: The role of urine studies in the detection of urinary tract infection (UTI) in febrile neutropenic patients with urinary symptoms (having a urinary catheter or having a positive urine analysis) is inarguable. However, the evidence is scarce regarding the indication for urine studies in asymptomatic (i.e., without urinary symptoms) patients with febrile neutropenia (FN) presenting to the emergency department (ED). The aim of this study is to evaluate the need for obtaining urine studies in asymptomatic febrile neutropenic patients. METHODS: This was a retrospective cohort study conducted on adult cancer patients who presented to the ED with FN and had no urinary symptoms. We included all ED presentations of eligible patients between January 2013 and September 2018. Student's t-test and Wilcoxon rank-sum test were used for continuous data, while Chi-square and Fisher's exact tests were used for categorical data. Participants were divided into two groups based on their urine culture (UC) results: Negative and positive UCs. Two cut-off s were used for positive UC results: ≥105 cfu/mL and ≥104 cfu/mL. RESULTS: We included 284 patients in our study. The age of our patient population was 48.5±18.5 years. More than two-thirds (68.7%) of patients had severe neutropenia, while only 3.9% and 9.9% of the patients had positive UCs at ≥105 cfu/mL and ≥104 cfu/mL, respectively. UCs were expectedly positive in most patients with urinalysis (UA) abnormalities. However, 27.3% and 32.1% of patients with positive UCs at ≥105 cfu/mL and ≥104 cfu/mL respectively had a normal UA. CONCLUSIONS: In our study, the incidence of UTI in adult febrile neutropenic cancer patients who present to the ED without urinary symptoms is low. Consequently, routine urine testing may not be warranted in this population, as it adds unnecessary fi nancial burdens on the patients and delays timely management. © 2021 World Journal of Emergency Medicine

The Osteopathic Applicant

The number of osteopathic students choosing emergency medicine (EM) as a specialty is continuously increasing. However, EM remains a competitive specialty. Accordingly, in this article we guide osteopathic students interested in EM through the Comprehensive Osteopathic Medical Licensing Examination (COMLEX), the United States Medical Licensing Examination (USMLE), third- and fourth-year rotations, and the match process. Additionally, we provide tips on the process of applying to allopathic programs and we discuss the timeline of both the allopathic and osteopathic match. Finally, we discuss the effect of the Single Accreditation System and the Memorandum of Understanding, an agreement to merge the allopathic and osteopathic graduate medical education systems into a single graduate medical education accreditation system. This is expected to be completed as of July 1, 2020. Therefore, we elucidate the expectations for osteopathic applicants (particularly with regards to the USMLE and COMLEX examinations). © 2018 The Author

Is Emergency Medicine the Right Choice for Me?

One of the hardest decisions a medical student has to make is the choice of specialty. Many studies have explored what influences the choice of emergency medicine (EM) as a specialty. In this article, we elaborate on the most important incentives, including the diversity in patients’ presentations, having a defined and flexible schedule, the plasticity in choosing and changing a practice location, and the acuity of care and trauma experience. Additionally, we tackle some of the challenges that emergency physicians face. For instance, having to follow a different thought process than most other physicians, as well as the patients’ quality and expectations. We also address some of the concerns regarding the specialty, specifically burnout, stress, and the fear associated with maintaining a career in EM. Finally, we provide students interested in EM with some resources that can provide them with further guidance to decide whether EM is the right choice for them. © 2018 The Author

An Overview of the Allopathic Match

The number of allopathic emergency medicine (EM) programs has been progressively increasing over the years. In 2018, allopathic EM postgraduate year-1 spots, compared with 2012, increased by around 60% to reach 2278 positions. EM is considered a competitive specialty and therefore, in this article we help guide students interested in EM through the allopathic match requirements, application process, interviews, and ranking EM programs. Additionally, we tackle the combined emergency medicine residency programs, namely the combined EM-Family Medicine (FM), EM-Anesthesiology, EM-Internal Medicine (IM), EM-IM-Critical Care Medicine, and EM-Pediatrics residency programs. Finally, we explain the increased likelihood of matching with the single graduate medical education accreditation system expected to happen in the year 2020. © 2018 The Author

Writing the Curriculum Vitae and Personal Statement

Two of the most important components of the medical student's application for the National Resident Matching Program are the curriculum vitae (CV) and personal statement (PS). The aim of the CV is to give an itemized account of the applicant's accomplishments since the beginning of their undergraduate studies, with the main emphasis on their activities and performance in medical school. The PS, on the other hand, is the applicant's chance to give program directors (PDs) a sense of who they are. The purpose of the PS is to complement but not rehash the CV. It is an opportunity to convey what makes them fit for a residency in emergency medicine (EM). A well-written statement should guide the reader through the heartbreaks, triumphs, and inspirations that drive the applicant. Applicants should remember that the CV and PS are the first impression they brand. Both the CV and PS should be brief; easy to read; professional; honest; consistent; and free of clichés, spelling mistakes, and grammatical errors. © 2019 The Author

Letters of Recommendation

Letters of recommendation (LORs) are a central element of an applicant's portfolio for the National Resident Matching Program (known as the “Match”). This is especially true when applying to competitive specialties like emergency medicine (EM). LORs convey an applicant's potential for success, and also highlight an applicant's qualities that cannot always be recognized from a curriculum vitae, test scores, or grades. Traditional LORs, also called narrative LORs, are written in prose and are therefore highly subjective. This led to the establishment of a task force by the Council of Emergency Medicine Residency Directors in 1995 to develop a standardized LOR. Revisions of this form are now referred to as a standardized letter of evaluation. These evaluations in this format have proven to increase inter-rater reliability, decrease interpretation time, and standardize the process used by EM faculty to prepare evaluations for EM applicants. In this article, we will discuss LORs; address applicants' concerns, including from whom to request LORs (EM faculty vs. non-EM faculty vs. non-clinical faculty), number of LORs an applicant should include in his or her application materials, the preferred manner of requesting and the timing in which to ask for an LOR, as well as the philosophy behind waiving the right to see the letter. © 2019 The Author

Selecting a Medical School Advisor

Having an advisor offers medical students many advantages, including increased likelihood of matching into their top choices. Interestingly, students who choose emergency medicine (EM) as a specialty are more likely to seek advising. However, finding and optimally utilizing an EM faculty advisor is often challenging for the medical student. In this article, we tackle the different ways to seek advising, including the ‘virtual advisor program’ implemented by the Society for Academic Emergency Medicine, the ‘e-Advisor Program’ instigated by the Clerkship Director in EM Group, the ‘member exclusive mentorship program’ of the Emergency Medicine Residency Association, as well as peer-based mentoring. More so, we discuss the consensus recommendations developed by the Student Advising Task Force to guide both students planning to apply to EM and their advisors to ensure high-caliber advising. © 2019 The Author(s

Combined Residency Programs in Emergency Medicine

There are currently 5 combined residencies in emergency medicine (EM), namely EM/pediatrics, EM/internal medicine, EM/internal medicine/critical care, EM/family medicine and EM/anesthesiology. These combined programs vary from 5–6 years in length. Like categorical programs, the decision to enter a 5- or 6-year program should be an informed and comprehensive decision. We describe the history and current status of the combined EM programs, discuss the process of applying to a combined EM program, describe the life of combined EM residents, and explore common career opportunities available to combined EM program graduates. © 2019 The Author