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

Broder, Joshua Seth

Cheaito, Mohamad Ali

Dyne, Pamela L.

Epter, Michael L.

Harter, Phillip M.

Kazzi, Amin Antoine Nabih

Mattu, Amal

Schmitt, Anne

AUB ScholarWorks (American Univ. of Beirut)

The Journal of Emergency Medicine, Vol. 56, No. 4, pp. e61–e64, 2019 2018 The Authors. Published by Elsevier Inc. This is an open access article under theCC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).0736-4679/$ - see front matterRECEIVED: 2 NoACCEPTED: 9 Nohttps://doi.org/10.1016/j.jemermed.2018.11.002MedicalStudent ForumAN OVERVIEW OF THE ALLOPATHIC MATCHAnne Schmitt, MD,* Pamela L. Dyne, MD,† Joshua Broder, MD,‡ Mohamad Ali Cheaito, MD,§Phillip M. Harter, MD,k Amal Mattu, MD,{ Micheal Epter, DO,# and Amin Kazzi, MD, MAAEM, FAAEMk*Kaiser Permanente Medical Center, Oakland, California, †Department of Emergency Medicine, Olive View-UCLA Medical Center, DavidGeffen School of Medicine at UCLA, Los Angeles, California, ‡Division of Emergency Medicine, Department of Surgery, Duke UniversitySchool of Medicine, Durham, North Carolina, §Department of Emergency Medicine, American University of Beirut Medical Center, Beirut,Lebanon, kStanford University School of Medicine, Stanford, California, {University of Maryland School of Medicine, Baltimore, Maryland, and#Maricopa Medical Center, Phoenix, ArizonaReprint Address:Amin Kazzi, MD, MAAEM, FAAEM, Department of EmergencyMedicine, American University of Beirut Medical Center, POBox 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon, Abstract—The number of allopathic emergencymedicine(EM) programs has been progressively increasing over theyears. In 2018, allopathic EM postgraduate year-1 spots,compared with 2012, increased by around 60% to reach2278 positions. EM is considered a competitive specialtyand therefore, in this article we help guide students interestedin EM through the allopathic match requirements, applica-tion process, interviews, and ranking EM programs. Addi-tionally, we tackle the combined emergency medicineresidency programs, namely the combined EM-Family Med-icine (FM), EM-Anesthesiology, EM-Internal Medicine (IM),EM-IM-Critical Care Medicine, and EM-Pediatrics resi-dency programs. Finally, we explain the increased likelihoodof matching with the single graduate medical educationaccreditation system expected to happen in theyear 2020.  2018 The Authors. Published by ElsevierInc. This is an open access article under the CC BY-NC-NDlicense (http://creativecommons.org/licenses/by-nc-nd/4.0/)., Keywords—emergency medicine; allopathic; match;combined programs; Memorandum of UnderstandingINTRODUCTIONMatching for residency may seem like one of the mostdaunting processes you have faced along the difficultpath to becoming a physician. You have agonized overvember 2018;vember 2018e61your choice of college and medical school, conqueringdifficult and exhausting standardized tests to stand whereyou are today. Now you must not only choose a specialtyfor the rest of your professional life based on very limitedexposure in medical school, but also decide where in thecountry you want to live and potentially practice. Yoursuccess and happiness hang in the balance.Relax. You have already succeeded, and you are aboutto embark on the most exciting, challenging, andrewarding part of your medical career thus far. Matchingfor residency today is about choosing a field that willstimulate you for the rest of your life, and the process isnot as difficult as it may first appear.DISCUSSIONLet’s start with the numbers. In the year 2018, 220 allo-pathic programs offered 2278 positions, as comparedwith the 1668 emergency medicine (EM) positionsoffered by 153 allopathic programs in 2012. The numberof offered postgraduate (PGY)-1 positions has beensteadily increasing over the past years, reaching its high-est number ever in 2018 (7.5% of all PGY-1 slots) (1,2).Allopathic programs are those programs that qualifygraduates to sit for the American Board of Emergencye62 A. Schmitt et al.Medicine certification process administered by theAmerican Board of Medical Specialties (2). Of thesePGY-1 spots in 2018, 2265 positions were filled. Therewas a total of 2901 applicants to the 2278 positions(2693 of which ranked EM first), and of the total appli-cants, 1838 were ‘‘U.S. seniors,’’ that is, 4th-year medicalstudents in U.S. allopathic medical schools. The otherspots were filled by a combination of U.S. graduates(i.e., graduates of a U.S. allopathic school of medicine),osteopathic medical school graduates, and internationalmedical graduates. In addition to the allopathic positions,there are a number of spots offered by osteopathic pro-grams.Admittedly, for both the osteopathic and allopathictracks, EM is a competitive field, but the numbers donot define an impossible task. In 2018, around 8.6% ofU.S. seniors applying to EM were unable to match inthe field (2). Your interest in EM defines you as a capableand enthusiastic candidate, and you should approach theMatch with optimism.WHAT IS THE ‘‘MATCH’’?The ‘‘Match,’’ short for the National Resident MatchingProgram (NRMP), is the nationally accepted, unified pro-cess through which applicants for residency positions areplaced within their preferred allopathic programs.Eligible applicants include senior students and graduatesof: 1) U.S. allopathic and osteopathic medical schools; 2)Canadian medical schools; and 3) foreign medicalschools who have been certified by the Educational Com-mission for Foreign Medical Graduates (ECFMG).Most specialties—including EM—participate in theNRMP. Today, a computer algorithm matches applicantsand programs based on the preferences they each have.As recently as 1996, this process was weighted slightlyto the benefit of residency programs. Today, the algorithmfavors you, the applicant (3).HOWAND WHEN WILLYOU APPLY TORESIDENCY PROGRAMS?The application process is managed and organized via theElectronic Residency Application Service, or ERAS,which is administered by the Association of AmericanMedical Colleges. U.S. seniors typically register duringthe fall of their fourth year of medical school withERAS and fill out a common electronic application. Us-ing a computer application, the applicant will fill outyour demographic information, a personal statement,and his or her curriculum vitae, which will be enteredinto ERAS using their format. The application can besaved and resumed at any time. In addition, the MedicalStudent Performance Evaluation (Dean’s letter), USMLEor COMLEX scores, and recommendation letters willalso be electronically sent.The applicant should be also aware of the differentkinds of letters or recommendations he/she may receive.Narrative letters of recommendation are usually very sub-jective and not very reliable (4,5). In order to provide aclearer picture of a student’s performance on an EMrotation, standardized letters of evaluation (SLoE) weredeveloped by the Council of Residency Directors inEmergency Medicine. The SLoE can be found at www.cordem.org and is updated annually. A SLoE should befilled out exclusively by EM faculty, whereas narrativeletters of recommendation are to be filled by non-EM fac-ulty. Moreover, many programs offer ‘‘Group SLoEs’’ forstudents who have rotated with them. These are facultyconsensus evaluations written on behalf of the programby a key faculty member, such as a clerkship director orresidency program director. Applicants may select whichletters are sent to which programs, allowing them to mixand match as necessary.Usually, the medical school’s student affairs depart-ment assists U.S. seniors and U.S. graduates with this pro-cess. International medical graduates, on the other hand,can use the ECFMG as the primary contact in addition tothe assistance that can be provided by their medicalschools. The Medical Student Performance Evaluation(MSPE), formerly referred to as the ‘‘Dean’s letter,’’will be uploaded onto ERAS, usually on the first ofOctober. The application is completed once the applicantfills the ERAS application and uploads the USMLEscores, MSPE, and three or four letters of recommenda-tion. Although not recommended, the applicant canpush the deadline red zone because transmission is elec-tronic. Soon after the application is complete, applicantswill receive invitations to interview with programs. Someprograms invite applicants for interviews before theMSPE comes out, but many do not. The applicant shouldbe patient if he/she didn’t hear from all programs at thesame time. Each program has its own review process,and some take a bit more time. These interviews are typi-cally offered in November, December, and January (3).After applicants complete their interviews, they willbe asked to rank programs with which they would liketo match. This rank order list is submitted via NRMPand is due in February of the fourth year of U.S. seniors.Your rank list should reflect the applicant’s true prefer-ences in descending order. Programs also submit similarlists of their preferred applicants. In mid-March, at a spe-cific hour of the day (currently noon Eastern StandardTime) on ‘‘Match Day,’’ applicants nationwide willopen envelopes revealing their one and only Match. Un-like college and medical student application processes,applicants will not receive acceptances from multipleprograms. Note that the applicant at this point wouldTable 1. Summary of the Launching Year, Length of Training, and Number of Programs, Positions, and Applicants in 2018 forEach of those ProgramsProgramLaunchingYear (6)Length of Training,Years (6)Number of Programsin 2018 (2)Total Number ofPositions in 2018 (2)Total Number ofApplicants in 2018 (2)EM-Anesthesiology 2016 5 or 6* 1 2 3EM-FM 2005 (7) 5 or 6† 2 4 27EM-IM 1989 5 11 26 94EM-IM-Critical Care Medicine 1999 6 6 (9)EM-Pediatrics 1998 (8) 5 4 8 42EM = emergency medicine; FM = family medicine; IM = internal medicine.* If the institution offers a 4-year EM program.† If the institution offers a 4-year EM or a 4-year FM program.An Overview of the Allopathic Match e63have signed an agreement in advance to attend the oneprogram selected for him/her by the Match (3).Also, it is worth noting that in addition to categoricalEM residencies, there are five types of combined EM res-idency programs (6). These include combined EM-Family Medicine (FM), EM-Anesthesiology, EM-Inter-nal Medicine (IM), EM-IM-Critical Care Medicine, andEM-Pediatrics residency programs. Table 1 summarizesthe launching year, length of training, and number of pro-grams, positions, and applicants in 2018 for each of thoseprograms. The number of applicants applying to theseprograms has been relatively constant over the past4 years (2,6–9). Studies report high career andresidency choice satisfaction among graduates ofcombined EM residency programs (8,10,11). Graduatesof the combined EM-Anesthesiology program, forexample, are expected to ‘‘capitalize on the complemen-tary strengths of both programs’’ (12).Now, in the less likely event of not matching with anyof the programs on their rank list, applicants will be noti-fied by their medical school (or ECFMG, if appropriate)on the Monday prior to Match Day. As such, these appli-cants can enter a secondary Match, which, as of thiswriting, is a new process.Keep in mind that matching will be more likely aftercombining the allopathic and osteopathic match pro-cesses, which is expected to happen in the year 2020 ac-cording to the Memorandum of Understanding. Allprograms are required to complete this single accredita-tion process. This will provide numerous additional pro-grams for allopathic students (13–15).HOW EASY IS ALL OF THIS IN PRACTICE?Today, the ease of the Match process may tempt theapplicant to apply to every program nationwide, drivenby rumors like describing the case of a brilliant and hard-working friend who was rejected by all 30 programs towhich he or she had applied. Instead, our advice to youis to take a deep breath, step back, and think about themonths and years ahead. Every EM residency programmeets high standards for academic and clinical training.All allopathic EM programs participating in the Matchare accredited by the Accreditation Council for GraduateMedical Education to assure that residents get a high-quality education. All matched applicants will be eligiblefor board certification regardless of the program theymatched with, and life will not end if that program isnot the applicant’s first choice.Acknowledgments—This work was supported by the Depart-ment of Emergency Medicine at the American University ofBeirut Medical Center (AUBMC). The funding source wasnot involved in the preparation of the article, writing of thereport and decision to submit the article for publication. Thisresearch received a non-restricted educational grant from thenot-for-profit Resident Student Association (American Acad-emy of Emergency Medicine) and the Department of Emer-gency Medicine at the American University of Beirut.REFERENCES1. National Resident Matching Program (The Match). Results anddata: 2012 main residency match. Washington, DC: National Resi-dent Matching Program; 2012.2. National Resident Matching Program (The Match). Results anddata: 2018 main residency match. Washington, DC: National Resi-dent Matching Program; 2018.3. Iserson KV. Getting into a residency: a guide for medical students.Austerlitz, NY: Galen Press; 1996.4. Dirschl DR, Adams GL. Reliability in evaluating letters of recom-mendation. Acad Med 2000;75:1029.5. Morgenstern BZ, Zalneraitis E, Slavin S. Improving the letter ofrecommendation for pediatric residency applicants: an idea whosetime has come? J Pediatr 2003;143:143–4.6. American Board of Emergency Medicine. Combined training pro-grams. Available at: https://www.abem.org/public/for-program-directors/combined-training-programs. Accessed October 8, 2018.7. Cattoi R.MC-FP Early Start, EM/FMCombined program. Ann FamMed 2006;4:468–9.8. Strobel AM, Chasm RM, Woolridge DP. A survey of graduates ofcombined emergency medicine–pediatrics residency programs: anupdate. J Emerg Med 2016;51:418–25.9. American Board of Internal Medicine. Internal Medicine/EmergencyMedicine/Critical Care Medicine Programs. Available at: https://e64 A. Schmitt et al.www.abim.org/certification/policies/combined-training/internal-medicine-emergency-medicine-critical-care-medicine/programs.aspx. Accessed October 8, 2018.10. Kessler CS, Stallings LA, Gonzalez AA, Templeman TA. Com-bined residency training in emergency medicine and internal med-icine: an update on career outcomes and job satisfaction. AcadEmerg Med 2009;16:894–9.11. Katz ED, Katz JT. Careers of graduates of combined emergencymedicine/internal medicine programs. Acad Emerg Med 2002;9:1457–9.12. Tobin JM, Lumb PD. The anesthesiology/emergency medicinecombined residency: defining a new future for trauma resuscitation.Curr Anesthesiol Rep 2016;6:59–64.13. Hoffman M. MD or DO: blurring the lines between osteopathic andallopathic medicine. Available at: https://www.mdmag.com/medical-news/md-or-do-blurring-the-lines-between-osteopathic-and-allopathic-medicine. Accessed October 8, 2018.14. Muldowney D. The 2020 accreditation and match merge: DO, MD,and good news for Trinity grads. Trinity School of Medicine.Available at: 2018. https://www.trinityschoolofmedicine.org/blog/the-do-md-merge-good-news-for-international-medical-students.Accessed October 8, 2018.15. Ella M. Residency merger – the impact on current med students.Merck Manual Med Student Stories. Available at: 2016. http://medstudentstories.merckmanuals.com/residency-merger-the-impact-on-current-med-students/. Accessed October 8, 2018.

An Overview of the Allopathic Match

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An Overview of the Allopathic Match

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