Emergency Medicine

Department Website: med.unc.edu/emergmed

FAQs/Course Recommendations/Additional Info

Please refer to the EMRA Advising Guide at the bottom of this page for detailed information about applying to Emergency Medicine.

How do students get assigned a career goal advisor?
Students meet with the clerkship directors (Dr. Howard Choi and Dr. Julie Saleeby Carpenter) during their EM401 EM AI clerkship. Unfortunately, due to the volume of students applying into EM we are unable to accommodate EM-specific career advising earlier than the start of Indy Phase. An informational talk is given to App Phase students during their fall Career Day in September.

What should my Individualization Phase look like?
Most students are first exposed to EM during their CBLC block, when they do 3-5 shifts in the ED. Students interested in EM should focus on doing well on core clerkships. You should err on doing your EM401 EM AI clerkship in Apr-July so that you have time to do your away rotations (more on that below).
Recommended Courses:

AI/Acting Internship	CC/Critical Care	ACS/Advanced Clinical Selective	Electives
UNC EM AI (ERMD 401-2 – UNC & Wake Med) in Chapel Hill is required for ALL students applying into EM, regardless of your AHEC site. We recommend at least one VSAS away rotation *AND/OR* one other UNC off-site EM AI elective (e.g. Wilmington, Rex, Asheville, etc)	It does not really matter which ICU, so choose the one that best fits your interests	Pick an ACS that will enhance your EM knowledge, such as radiology, dermatology, sports medicine *OR* an ACS in an area that you think there is some knowledge deficit (wards nephrology, cardiology, etc.). For EM, you need to have a broad knowledge of everything, so you can't go wrong	Your EM electives will always count as electives. Choose your other electives using the same principles as above. You can also consider subspecialty areas within EM (ERMD 408 -- ultrasound, tox, global medicine, etc.). These can be taken at UNC or at other institutions

Do all my rotations need to be in Emergency Medicine?
All UNC SOM students applying into EM are expected to take EM 401 (UNC Medical Center/WakeMEd EM Advanced Internship) sometime between March and September of MS4. This counts as their home institution Standardized Letter of Evaluation (SLOE) for ERAS. Students need a minimum of two SLOEs for their EM application; however, three SLOEs is more competitive. Each additional away rotation students do gives students another SLOE. This means that students must do one or more away rotations in emergency medicine in order to get their remaining SLOE.
Therefore our recommendation is that you do the UNC AI, and two away rotations. This can be either another EM AI within UNC (e.g. Wilmington) and a VSAS away rotation, or two VSAS rotations. See below for more information.
Ideally you would do your away rotations in time for these SLOEs to be submitted to ERAS in September (exact date TBA). You may think it is preferable to do your away after your UNC AI (so you can put your best foot forward on your away rotation), but this is not necessary, and plenty of students end up taking the UNC AI after their away rotation.

Should I do an away rotation?  What in?
As described above, you need a minimum of one away rotation. However, our recommendation is that most students should do two away rotations.

• Everyone should have UNC AI + one VSAS away rotation as your second SLOE.
  • This is the official recommendation from EMRA, ACEP, SAEM, CORD, CDEM, etc.
  • You should strive to do your VSAS away rotation at an institution or in the geographic region that interests you for residency.
• In our experience, however, many applicants have a total of three SLOEs and this is seen as more competitive. Thus if you can swing it, two away rotations will look better for your application because it gives you more EM experience and two additional SLOEs.
  • This of course depends on your competitiveness, schedule timing, finances, etc and is not an expectation.
  • The easiest and most cost-effective way to obtain two additional SLOEs is to do a Wilmington or /Rex rotation and a VSAS away rotation.
  • Alternatively, you could choose to do two VSAS away rotations. This is a good strategy if you want to see two different regions/institutions, or if you are very set on a specific region and want to demonstrate that by doing two away rotations there.
  • If you are a weaker candidate (e.g. App Phase grades, Step 2 score) or are couples matching, we strongly recommend you do two away rotations.

Do I need a rotation at UNC if I spent my time in Charlotte/Asheville/Wilmington?
Yes. All UNC SOM students applying into EM – regardless of their AHEC site – are expected to take EM 401 (UNC Medical Center / WakeMed EM Advanced Internship) sometime between March and September of MS4. This counts as their one Standardized Letter of Evaluation (“SLOE”) for ERAS and counts as their home institution.

Note that Charlotte Medical Center (Atrium Health) separated from UNC. UNC students now have to apply to it via VSAS and acceptance is not guaranteed as it is a highly competitive away rotation.

We’re fortunate at UNC to have opportunities at Wilmington (EM422), Rex (EM426), Charlotte (EM440). They provide excellent EM experiences, have no VSAS selection process, and may be eligible for AHEC housing. The thing about these rotations is that they are technically not away rotations. True away rotations are those that you apply to via VSAS. Our recommendation is that every student should strive to do at least one VSAS away rotation.

All three UNC opportunities above provide SLOEs. So these can not only be valuable ED experiences in and of themselves, but also supplement your SLOE count.

When do I need to meet with my career goal advisor?  How do I prepare?
You will meet with the Clerkship Director during your EM401 EM AI rotation, and instructions will be given to you during your AI about how to prepare for this meeting. Unfortunately due to the volume of students applying in to EM, we are unable to accommodate EM-specific career advising earlier than the start of Indy Phase. An informational talk is given to Foundation Phase at the Career Opportunity Services Session and App Phase students during their fall Career Day in September.

How many letters of recommendation do I need?  From whom should I get them?
Please note the above information regarding SLOEs. See also this FAQ about SLOEs!!
As an aside, you can – and should – still include letters of reference from non-EM faculty, e.g. if you did well on internal medicine or critical care. Just keep this in mind for when you start working on your ERAS application and it comes time to ask them for a reference letter.
A letter of reference from a physician in a specialty other than EM carries less value than a SLOE, but you may have a mentor or advisor from a different specialty who has worked closely with you who can write a strong letter of support.

When do I ask for my letters?  What do they need?
As described above, you will receive a SLOE from each EM rotation based on your performance there. If you forward the coordinator the ERAS letter request, they will upload it.

If you have chosen to ask a non-EM faculty for an ERAS letter, you should ask them to use an OSLOE. This form was just introduced in 2020. Essentially, the point is for this OSLOE to replace the old narrative LOR that you would ask of someone from IM, surgery, OBGYN, etc. (EM just wants everything to be a SLOE, it seems)

Your letter writer would fill out an OSLOE at this link. At the bottom of that form, it says “Submit” – which I believe prints out a SLOE PDF that the letter writer saves and then uploads to the ERAS LoR Portal.

Now, this is a new development and may be strange to some letter writers. Furthermore, you cannot force a letter writer to use this form if they are unfamiliar with it. In prior application cycles, for instance, we anecdotally saw only about half of letter writers use OSLOEs. If your letter writer prefers to write a traditional letter and upload that, then that’s fine. This will not affect your application.

How do I determine the best programs I should apply to?
Ideally you would have done this before applying to your VSAS away rotations. Only you can determine the program that is the best fit for you. … Picking a residency program based upon “reputation” should be avoided. There is no ‘best’ residency program, only a set of programs that will be the best fit for you based upon your future goals, learning style, and lifestyle. Please refer to the EMRA guide at the end of this document.

I just got this great piece of news…do I need to notify programs
Residency programs do not really receive “push notifications” for updates you submit to ERAS after the deadline. However, programs will still send interview offers even if missing an away SLOE (or “great piece of news”). If you are expecting an away SLOE (or “great piece of news”) to be uploaded to ERAS after the deadline:

• If you have an interview offer from a program you’re interested in – then there is no need to contact them to update them that your away SLOE (or “great piece of news”) is now uploaded to ERAS. (i.e. they’re already interested in you!)
• If you have not yet been offered an interview at a place you’re interested in and your away SLOE has just been uploaded (or you just got a “great piece of news”) – then it may be worthwhile to reach out to them to let them know. This also serves as a way to remind them of your application.

My LORs aren’t in, and ERAS just opened!
Please see above.

I am waitlisted for an interview at X and I’d really like to see that program.  What do I do?
See below. With regards to preference signaling / tokens, there are two strategies. (1.) Use your tokens on your “true” top five, even if they are reach programs. (2.) Use your tokens on a “realistic” five programs, with a mix of reach and realistic. As of 3/2022, guidance is still forthcoming, but at this time we recommend the second approach.

I didn’t get an interview at X program.  Should I send them a “letter of intent”?
This does not hurt; aim to do this by around Halloween. If by early November, you do not have 10 interviews scheduled, you should reach out to your career advisors so that they can help in reaching out to programs.

Should I send thank you letters to programs?
We agree with the Guide’s suggestion regarding Thank You letters after your interviews: “It is common courtesy to thank your interviewers for their time; however, the overall value of the thank-you note varies greatly among program leaders. Generally, an email is just as acceptable as a handwritten letter, although there is likely some variation in this belief. There is no rule on the timing of the note, but it is best to send it immediately after the interview, before it moves too far down your to-do list. Sending a note is unlikely to significantly change the way a program ranks you, although it cannot hurt, and is a common professional courtesy that will be noticed as your career continues.”

Should I send a letter to the program I am planning to rank #1?
It does not hurt. Although you should send your #1 – and only your #1 – such an email. i.e. only send this to one program. Sending more than one program a promise that you are ranking them #1 is a surefire way to ruin your credibility… program directors talk!

How do I respond if a program reaches out to me after my interview?
Please see EMRA guide.

Additional Resources
https://www.emra.org/books/msadvisingguide/msag/