Knowing our audience of advisors well, we here at ASC-EM won’t bother hunting for citations to adorn this sentence: We are all suffering from burnout of historic proportions.  Whatever one’s politics, beliefs, position and physical capacity, the last two and a half years have been hard in a way that might (if one were prone to such thoughts) seem almost specifically targeted to make life difficult for ER doctors and educators.  

While the constant unpredictability under which we’ve lived since January of 2020 seems to have abated somewhat, May is traditionally one of the most uncertain times for med school advisors: We are still solidifying exactly who in our institutions will be applying in emergency medicine; those students are applying for away rotations while still waiting for offers; we don’t yet have our students’ step 2 scores.  Until recently, we didn’t even know if interviews would be virtual again this year (based on EM-specific and AAMC recommendations, they will). 

And now we know, as of an announcement last month, that EM will be one of the many specialties participating in the AAMC’s supplemental application in the 2022/23 ERAS application cycle, specifically in the program signaling portion.

It feels important to note that this is a new and (viewed from some angles) complicated process, so it may take a couple of reviews before you and students are on the same page.  Attending the 5/26 CORD Connects on Preference Signaling will likely help, as will reviewing the upcoming CORD Application Process Improvement Committee Guide (due in early June).

But, without further ado, the ASC-EM Quick Guide to Preference Signaling for EM advisors:

Background: The AAMC (and others) have noted that many students’ Match strategies include a broad application approach.  This ever-widening pool of applications has made it increasingly hard for programs to fully and holistically assess each applicant, and virtually impossible to determine by the fact of application alone whether a given candidate is truly considering a program.

And so a supplemental ERAS application (or “supp-app”) was born.  The supplemental application consists of three parts: 

• the Past Experiences section (not used by EM in the 22/23 season)
• the Geographic Signaling section (not used by EM in the 22/23 application season)
• Program Signals, which will be used by EM in the 22/23 application season*

_{* in a way that is different from all other specialties’ use of program signals–so take care with any double-applying students}

Using Program Signals, a student can signal to a program–before interview invites go out–that that program is of special interest to the candidate.  These signals are meaningful because they are rare. No matter how many programs an applicant chooses to apply to, in EM the student will only receive five tokens with which to communicate early interest. Basically, it allows the students to say to a program that they *really* want to interview, and will likely accept and actually attend an interview if offered.  The hope is that this change allows a better assessment of fit/interest by PD’s before they offer their limited interview spots. 

A similar system has been  piloted with ENT and a few other specialties, with some evidence that signals may have led to interview offers to students  that wouldn’t otherwise have been made.  Deep dive into AAMC data from the pilot in other specialties here. 

A final (and oddly anticlimactic) logistical note: The supplemental application will be distributed to students as a separate email after they have already logged into the ERAS system.  For the process to work as planned via an automatically triggered email, the student must have logged into ERAS before 8/1/2022.  This is the type of deadline that should be distributed centrally by your students’ school, but as the process is new and differs by specialty, it may be helpful to know one step beyond our own scope on this aspect (as on so many others) of emergency medicine.

Shannon Moffett MD @BrickCityEM, Adam M. Nicholson MD, and Liza Smith MD in conjunction with CORD ASC-EM (advising students committee in emergency medicine)