Background: Applicants to emergency medicine (EM) residency training applied to an average of 56.6 programs each in 2018, more than double the number compared to one decade ago. Objective: To determine which factors influence EM-bound medical students’ perceptions of their competitiveness and influence the number of applications submitted. We hypothesized that lack of SLOE transparency may be a leading cause of over application.
Methods: Fourth year medical students attending the EMRA Medical Student Forum at the 2018 Scientific Assembly were asked to complete a 24 question online survey. An observational, cross-sectional, convenience sample of 132 students were invited to complete the survey, for which there was an 80.2% response rate. Students who were IMGs, couples or military matching, had not taken Step 1, or had not completed or received their grade from at least one EM rotation were excluded. Descriptive, summary statistics were calculated for all questions (n=72).
Results: The median Step 1 score was 226.3, and 15.9% were AOA. Students were 61.1% MD and 38.9% DO. Step 1 scores decreased perceptions of competitiveness for 53% of students, while increasing perception in 35%. Feedback from EM mentors and rotations (75% and 71%), leadership and extracurricular activities (67% and 66%), and SLOE strength (65%) contributed to increased perception of competitiveness. The most common factors increasing the number of applications submitted included; EM is becoming more competitive (83%), lack of SLOE transparency (70%), belief that they are less competitive than the average applicant (69%), or they were unsure about their competitiveness (66%). Nineteen percent decreased their number of applications due to ERAS cost.
Conclusions: Factors varied in their effect on perception of competitiveness. Step 1 scores caused more than half of applicants to decrease their perception of competitiveness. Feedback from EM mentors and EM rotations were the top two factors that increased applicants’ perception of competitiveness. Most factors surveyed caused students to increase their number of residency applications. The top three factors increasing applications were the belief that EM is becoming more competitive, lack of SLOE transparency, and an applicant’s belief that they are less competitive.