April 28, 2022

The Application Process

Video Transcript

[Trisha] Hey, I'm gonna get us started. I know it's 7:02 and everybody is still filtering on, but we are going to go ahead and start so that we have time to talk. I wanna introduce myself first, my name's Trisha Swan. I am at the University of Florida in Gainesville. I'm currently the Chair of the Pediatric Emergency Medicine section for ACEP. And I am a new program director for a new fellowship here in Gainesville. And what we're going to do today, I just wanna introduce a couple of people that are also part of the panel. Dr. Sherita Holmes from Emory. She is going to be helping us answer questions and kind of keeping us all on track. And Stephanie Walson is also here. She is our section liaison. So you may have seen emails coming from her and you may see emails from her in the future. So that is who she is. She helps us coordinate everything through the ACEP PEM section. I have a couple of slides that are filtering through right now, just to give you guys a opportunity list of things that you could get involved with right now. So I'm gonna talk about ACEP's opportunities, and then I'm gonna introduce Dr. Jacobs to you. And she's gonna talk about the American Academy of Pediatrics opportunities. So a couple of things that you see on your screen cycling through. You can join ACEP's Pediatric Emergency Medicine section. If you are an emergency medicine resident, you can join straight through the website. If you're a peds resident, as many of you are, you have to use the peds code, PEDS 30, to get the same price, but we wanna make sure that it's open to all of our residents, both emergency medicine and pediatric residents. So, there are a couple of things that you can do if you want to get a mentor or partner with a faculty member, we have E images competition coming up. So that is a competition where you submit a case with cool images and it is a competition, and if you win for second or third, you get to present at ACEP's national convention. This year, it is in San Francisco in October, so that is an opportunity. So where you go to look for those things, we have a microsite, and that is the third thing that you see on our side is the microsite. We also welcome contributions as an article writer. And if you visit our microsite, you can kind of see the articles that have been written, educational articles, lots of cool ways to get involved. Feel free to reach out to me or Stephanie if you have any questions about ACEP's section, and then I am gonna turn it all over to Liz. Dr. Jacobs is joining us as well. She's gonna be our moderator and panelist today. So let me tell you a little bit about Dr. Jacobs. She did her pediatric residency at Hasbro Children's Hospital in Providence, Rhode Island, and then did her pediatric emergency medicine fellowship at Children's National Medical Center in Washington, DC. She stayed on after fellowship first as associate program director then as a fellowship director. She missed New England, and so she moved back to Rhode Island and she has been the Pediatric Emergency Medicine Program Director for the past decade, which is amazing and very excitingly, she was just elected into the chair role for the American Academy of Pediatric section on emergency medicine. So she really has a lot of interest just outside of pediatric emergency medicine. She likes CPR training in schools, just in time learning, and she loves everything involving the ocean. Right Dr. Jacobs?

[Liz] That is so true. And I am so excited that everyone is joining us tonight. This is, meeting all of you is the favorite part of all of our jobs. I wanted to introduce everyone to the section of emergency medicine through the American Academy of Pediatrics. We will be having our, hopefully fingers crossed, in person meeting this fall in Anaheim, California, so everyone can join us in Disneyland. It costs $10 for trainees to join the section. And there are a couple great opportunities for residents to present. The first is submitting an unknown case for merger quiz, where residents and fellows are pitted against each other for a best case and trying to solve it. The announcement for this should be going out within the next month or so. Also, if you see a really interesting, cool picture do submit it to PinPics, where there also were prizes for best picture and guessing from that. And those are all on the American Academy of Pediatric section website. I wanted to introduce our other three panelists who are going to be joining me on tonight. The first is Terri Coco. Terri is Alabama-born and bred. She started there at the school of fine arts as a dance major, but then saw the light and transitioned to biology and went to both medical school residency and PEM fellowship at Children's Hospital of Alabama. She's been their medical director of their urgent care for 15 years, then transitioned to the pediatric direct, the program director role for the PEM Fellowship there. And she says that being fellowship director is her absolute favorite thing to do. The second person I'd like to introduce tonight is Sujit Iyer, who is at Dell Children's in Austin, Texas. He is the program director also for the Pediatric Emergency Medicine Fellowship. In addition, he is the Director of Pediatric Outreach for the Community Emergency Medicine Departments at Ascension, Texas, and Director of Pediatric Services for US Acute Care Solutions. The last person, last but not least, is Dr. Katie Leonard who completed residency in fellowship training at Wash U in St. Louis, has been associate program director, and then also is their program director and has been heavily involved in the process of recruitment and application for the last six years. So between all of us, we have decades of experience and are eager to answer your questions, but before we, so feel free to type them in the Q&A, but the first thing I wanted just for all of everyone to go around is for my panelist to share, why did you choose pediatric emergency medicine? Terri, hit it.

[Terri] Thank you, Liz. And like Liz said, I am down here in Birmingham, Alabama, and I just wanna thank all of you for joining us today and taking this brief time out of your super busy schedules to learn more about us and what we do. And probably most of us went into this for a lot of the same reasons. And honestly, as I went through residency, we were very heavy loaded with emergency medicine rotations. We did five throughout our residency. And every time I did it, I was like, this is so fun, I love it. I loved every rotation that I went through in residency. And I was like, oh, this is neat. This is neat, this is neat. And emergency medicine just really allows you to see and do everything, and you are also able to, even though people really don't realize this, you can establish relationships with families because they use the emergency room as their primary provider. So you do get continuity of care. You see sick kids, you see not sick kids, but you're really looked up to as someone who can provide help. And I really like having that sense of helping someone. I would also say that shift work seemed to work very well of my biochemistry because that is not for everyone, but I like shift work, I like going to work, working super hard and then going home and spending time with my family. So those are probably the two main reasons why I went into it. And of course it's the patients, 'cause the patients are the best. Who, I mean, you can go to work and watch cartoons and sing and play and laugh with your patients, it's so fun.

[Liz] Totally true, all right. Sujit, what about you? Why do you go into pediatric emergency medicine?

[Sujit] Yeah, heard of, I agree with everything Terri said, you're probably gonna get a lot of us to feel the same way. I think, so my background as a background was I went to college in Austin. I had no plan to do medical school. I was starting to do elementary school teaching and I realized that that was really satisfying, and that you get to have this very quick, intimate relationship with kids and really kind of make them feel better in a certain way in schools. But the frustrating part about teaching is that frankly, then they go off and they go to their parents and you can't really fix a problem necessarily. And in the ER, the best part about the ER is they come in with the problem and you develop the plan, you fix the problem, that's what ER people do best. We really do know what to do for every single type of thing. And as Terri said, whether it's low acuity or high acuity, that feeling never gets old. I think even as you get older in your career, it's actually the most satisfying part, is that anxiety about what to do just goes down 'cause you know what needs to get done. And then the strange part that I didn't think I knew when I applied for fellowship, that I think maybe it's important for you all to ask when you're on the interview trail, is that the door was wide open for where you take your career when you're in pediatric emergency medicine. If you look nationally, there are leaders in pediatric emergency medicine in administration, stimulation, education, quality improvement, the business world, it goes on and on and it's because we have the best snapshot of how healthcare works. And I think it really does, it's a wide open door for any career you may take later on too. So, and that's been a real pleasure.

[Liz] All right, thank you, Sujit, Katie.

[Katie] Yeah, so I think the reason I went to pediatric emergency medicine isn't terribly sophisticated, but probably, you know, where you're at as a resident is I kind of liked everything, but couldn't picture doing like three years and then the rest of my life just doing like one thing. I really liked that we saw everything in the ER and then, you know, the other thing that I think that the other specialties that I think people who end up gravitating towards kind of like are like PICU and NICU because there is a lot of that acute care, but it was the chronic patients that I didn't find as much joy in and the hours and hours of rounding. And so I really just liked, you know, the pace and variety that we saw in the emergency department. So it seemed like a good fit. And like Sujit said, you know, as I've been in the field now, I think one of the things I appreciate most about it is the variety and sort of the other things you can do outside of the clinical spectrum. I think a lot of times when people go into medical school, they picture the doctors they grew up with and having these longitudinal relationships. And while sometimes that can happen in the ED, there's not always that piece, but I think one thing that we can, that we do have is all these sort of side gig opportunities, other areas of interest that you can be passionate about and have sort of a longitudinal thread through your career in whether it's education or information technology, or EMS and pre-hospital care and QI or research, like there's just so much variety in that piece too, and opportunities to change your mind and kind of transition. And so I think that there's just always something that can really sustain you and help you have a nice balance between clinical work and other stuff that you really like too.

[Liz] All right, thank you, Katie. So I can see the questions are blowing up. So we're gonna jump on in. So the first question, I'm gonna give this to Terri is for letters of recommendation, are there certain subspecialty letters that are better than others? Should they all come from PEM? Should they be from other subspecialties? What's your answer to that?

[Terri] So, for me personally, I like seeing a little bit of a variety of letters of recommendation. I would like to at least see one that comes from an emergency medicine physician and it doesn't have to be the division director. It doesn't have to be the medical director or the program director, you know, at that institution. But at least I know it's somebody who has worked side by side in the emergency department with that person. So I like to at least have one, but I also like to see other subspecialties to see how they interacted with this person, you know, how did they, you know, treat their staff? How did they do their patients and were they a team player? And so all of those things that come from different specialties to me, I particularly like.

[Liz] Thank you, all right. Next question to Sujit. So how heavily is research scholarly activity or other clinical endeavors weighed when you're reading applications?

[Sujit] Sure, I think it's a common one, right? So the stress of trying to get something done and then get it published and knowing. So what I always tell residents is the most important thing, especially once it's time to interview is to hear how you took an idea and then participated in it actively to actually take that idea to some type of conclusion. I don't need to see everybody have everything published, but you should have a goal of anything that you're interested in to be able to share the results of that work, the ability to take that idea, do the work and then share that results, whether it's a local research symposium, of course, AAP and PAS are, honestly, they're just so inviting for people to submit posters, ACGME conferences, simulation conferences. I tell residents when you're thinking of a project that the best pieces of advice you can get from faculty is pick a project that has the right scope for you, in terms of time, something that you care about, you actually care about what you're working on, and think of the end in mind, meaning it's okay to think about where will I submit this work once I'm done, locally, regionally or nationally. Because those people you can then, I think it really creates more interest. You end up teaching about those things when you're a resident and it gives us so much more to talk about, because the opposite is also true. And there's probably nothing more disappointing than when you see a research project, then you have a conversation with somebody and you realize they did not want to do that project, but it was going to get published and they felt like that's why they had to stay on it. So I think that's the kind of advice you should be looking for when looking with mentors about what type of research to do. And really don't pigeonhole yourself with this classic research, education, simulation, quality improvement, advocacy. These are all venues that we teach in fellowship and that people go into as careers.

[Liz] Yeah, and I'm gonna jump in now as the moderator and the panelist. I mean, I absolutely agree with Sujit. I think that it's... I want to hear a story about what you're passionate about and more even than pediatric emergency medicine. Are you going to be somebody interested in advocacy? Are you going to be interested in education? What, global health, whatever it is. And I think that's one of the greatest things about pediatric emergency medicine is there's space to explore all of those different career paths. We are not all just sort of randomized, double-blind, placebo control trial researchers. And so when I see an application and I can say, I see this person, they're passionate about global health, they're passionate about ultrasound, they're passionate about advocacy and DI efforts, whatever it might be, that's the person I'm excited to talk to and hear about what they wanna do with it. So I just, I love those kind of stories and career trajectories and it, so it doesn't have to be all about the papers and the research and where you first author and things like that. So I think especially people come from different places where they don't necessarily have that time and training for that. So as long as they're doing something really interesting, that's what gets me excited. Katie, what do you think?

[Katie] No, I totally agree. Like I think if it's something that you contributed to in a meaningful way and like felt passionate about, or at least learned something about the process that you can take, and maybe it ended up being something you weren't so passionate about, but you learned some of the steps and then you have an idea of what you are passionate about and are able to kind of make that translation. And so I think having done something that shows you were interested in peds emergency medicine, you got involved in something and learned some pieces of scholarship in the academic process and contributed in some way, is important.

[Liz] Yeah, and so in order, and kind of to dovetail off of that for you Terri, sort of what makes, what experiences or exposures kind of stand out on an application?

[Terri] You know, we all do so many different things in residency, and there's so many avenues that you can participate in. And I think for me, I like to see someone who has maybe gone above and beyond what necessarily was required in residency and maybe pursued something that they were passionate about and became involved in that it could be advocacy, it could be simulation, it could be ultrasound, it could be so many different things. But I like seeing someone who maybe just thought outside of the box and pursued that passion and did something to either, you know, increase their education or their experiences, gain more knowledge, become more, you know, focused in whatever they are passionate about. I love reading those stories in their personal statement or seeing that in their volunteer list of whatever they're doing or, you know, on their CV. So, I love seeing things that are unique.

[Liz] I absolutely agree 'cause that goes to our next question, which it's like you were a plant. So, about advice and tips regarding that personal statement. And for me it's all about the story. I mean, it's sort of, you know, I love those stories about kind of what you were thinking and where you're wanna do and where you wanna go. And those are the personal statements that stand out for me. What about you Sujit?

[Sujit] Yeah, I think what you're trying to get from personal statement is that sense of introspection that you've taken the culmination of all your experiences and it's not about a specific story. You could probably just read the fact that somebody has thought critically about the moments when they felt satisfied, fulfilled, very enthusiastic or interested, and that's what's propelling them forward more than anything else. It's a, we don't, I tell every fellow, there is no way that I expect you to know exactly what you're gonna do here during these three years. But you do need to know who you are as a person, and what motivates you, because that's gonna be your biggest key to success on what you gravitate towards. There's so many different buckets, even in the three year fellowship, that feels like a long time. I feel like my fellowship has been for 15 years because you keep kind of, you know, gravitating towards different things. And that's the story, I think when Liz talks about a story that we want to hear, what is that thing that really made you enthusiastic about doing this about applying for fellowship?

[Liz] And for me also, that's where the letter of recommendations really come in as well, because those are the, you know, to kind of go back to our first thing, I feel like it's not so much what specialty the person is, but how did they work with you and how did they know you and sort of, and they can speak to those different aspects of you, what about you, Katie. What do you think about when you read personal statements?

[Katie] Yeah, I love that when I can kind of get a sense of the person. I feel like, you know, a lot of them have the things that drew you to PEM and that you like about PEM and like you kind of alluded to those end up being very similar for a lot of people. So I like it when people can give me a glimpse of who they are as a person outside of anything about sort of PEM, quite honestly.

[Liz] Absolutely. So, just shifting gears a little bit on, there's a question about electives and our way electives are important. And if so, any specific focus? I know that in the pandemic away electives were super challenging and at least at my hospital, we were not offering away electives for other people to come in, but according to the FAA, the pandemic's over. So we're, so for the panelists. So let Terri, I'll start with you again. What do you think about away electives?

[Terri] I really think it's a personal choice. I mean, it is not gonna sway someone's application to me if they did or did not do one. And especially over these last two years with the pandemic and how it just changed our whole world and environment. I, you know, if it's something that you feel like you would like to do to get a different experience, gain more knowledge, I think that's fantastic, and that's great, and I like to see that, but it, I don't think that to me it would be anything that would change how I would view the application. I think it's just definitely a personal choice, whether you want to do that or not.

[Liz] What do you think Sujit?

[Sujit] Yeah, I think logistically Liz, you kind of touched on the point that it's become more difficult in the last couple years. And I think even a lot of GME offices are kind of carrying that over frequently, just becoming difficult. I think actually something that Terri said very early on was really important is that we are looking for people on your letters of recommendation that have had experience with you in the emergency department setting. So I do think it's probably important if you have PEM people that are in your purview spending more time with them, if you don't have that time scheduled, is probably maybe the top priority. And if you have no PEM exposure at all, finding perhaps in the EM champion, that makes sense, or that has done some work in the PEM will probably matter more than anything else, 'cause they can really speak to your program, the types of trainings that have come before you, they can speak to the working environment. And as Terri said, the world of PEM is very, very small. So that's probably one of the first letters I look for is we just look for the names and where they're from and you probably gonna know that person. So find that person if you're gonna do an elective with.

[Liz] What about you, Katie?

[Katie] Agree, I think it's really hard, it's been really hard to do away electives. And I would say it's maybe more important if you're coming from a program that doesn't have a true, dedicated, pediatric emergency department, maybe to have that experience where you are working in kinda a tertiary transfer center that sees traumas and the sickest kids. Like if you don't have that opportunity in residency, that would be a good opportunity to try and get before even deciding that PEM fellowship is what you wanna do.

[Liz] And I know for me, it's, you have three years of fellowship to get that kind of training. So I don't expect people to be doing elective after elective, after elective in ultrasound. And I'm gonna do an ultrasound in peripheral guided IVs, you know, because I think that that's what fellowship is about. I mean, I want people to get that experience in residency of doing that rotation in endocrine and doing that rotation in cardiology because we are generalists in many ways. And so you want to see those things. So I think that's, for me, at least that's more important than that you did this incredibly niche away elective in something, 'cause you can do it during fellowship, so. So the next question actually is about our fellows and where do they go at the end of this? And sort of do they get big academic jobs at large academic centers or do they go out into the community? And I know we are actually going to be hosting somethings for our fellows in a couple weeks about this. So, Sujit, since you're gonna be on that panel with me.

[Sujit] Yeah.

[Liz] What kind of jobs do your fellows get at the end of the rainbow?

[Sujit] Yeah, this is a perfect question, right? Like don't sign up for something if you don't know what's gonna happen at the end of it. This is what you should ask at every single interview. So little background about just real quick and then I don't wanna take up too much time. So I went to Baylor in Houston and Texas Children's for residency, then I went to CHOP in Philly. So big kind of classic academic places. I moved to Austin before there was a formal medical school with the intention that the hospital said, "We wanna build a fellowship." So it was this perfect ER person like yeah, sure, like, let's try something, right? So that was 10 years ago. And when we started, I started with Kobe Allen who's moved on. Our initial goal was we really wanted fellowship to be more of a focus on career planning and grooming. Meaning there are infinite careers in pediatric emergency medicine. Are we all exposed and trained to those in fellowship? Maybe, like maybe it's getting better. What, you know, I loved my training, but I saw like two or three different options, and I didn't know that I saw everything. And so we really tried to encourage people to get exposed to everything. We are part of a larger adult EM company. So we actually send our peds folks to go work with EM folks in the community, actually do their EM training shifts, not only in the trauma center, but actually under the EM folks, they kind of get this exposure to like, oh, this is what a peds person would do if they were working as the PEM person in the adult EM world. We have people working on advocacy projects. So I would say that we are probably maybe a third, a third, a third. So we've had about a third of our graduates go to classic traditional academic centers, Texas children's, UT Southwestern, Lurie Children's in Chicago, those types of places. The third have gone into community hybrid settings. They're working really in the private practice model where they are there to see patients, has to see them very efficiently and have a lot less resources. And that is a whole nother skill. If something goes on and it's you and one nurse or maybe a nurse and a tech, can you handle everything? And that's a totally, I think different job. And then a third that probably bridge the gap where they do some shifts in that setting, some shifts in urgent care setting like PEM pediatrics and even and of course we keep about 60% and we are this conglomerate of all those things in our center, so.

[Liz] And it speaks to also, as you look at programs, there are some programs that you spend your entire training in the large academic center. And then there are some programs where you do actually have a formal curriculum and go to a community place. Katie, you have that, is that correct? Your fellows rotate at community sites.

[Katie] They can Moonlight at one of our community sites.

[Liz] Okay, got it. Got it, that's what it is, so perfect. What about you Terri?

[Terri] Ours, our fellows can moonlight in our urgent care area and so they get a little bit of it there, but it's still within the same institution. So it's not like a separate site. But kind of like Sujit said, the beauty of PEM is that when you do graduate and go out into the world, there are so many choices that you can go into. You can go into the academic, you can go into the community. There are places that are hybrid. It's so creative that you will find what fits you the best. And I would say, you know, for our fellows, it is such a wide range. We have, it is kind of like residency, you know, each residency class, one way, it'll kind of swing towards fellowships. And one way it'll, next year it'll swing more towards primary care. It's kind of seems like that in fellowship too. We have some classes who seem to go and do community work and private institutions. And then we have other classes that go into just high volume academic institutions. So for us, I think it's just wide range, and everywhere they could wanna go. We have people who have gone to Africa and started, you know, a pediatric hospital there and started a pediatric emergency medicine fellowship there. So it's just very wide range.

[Liz] And you can usually gather that information, at least most programs do have good websites where they list where their former trainees have gone. And so you can sort of get that feel of a program. Is this a place that's really training people only for academics or a wide range? I know for we at Brown, mostly academic, but we have people who have gone into the community as well. So just pivoting again, there are a couple questions about USMLE and back in the day in board scores and steps one, two and three. And do you look at the scores? Do you use them in some sort of cutoff way at like residents, Katie, do you?

[Katie] I don't, our program doesn't have like the minimum cut off, quite honestly. I think I use them as just sort of an indicator of, "Oh, you seem to have passed all of these tests and you know, we'll probably continue hopefully to pass your boards moving forward." And then, you know, if I think there's like multiple failures, then that's sort of a red flag because peds boards is one of the boards that has the highest bail rate unfortunately, so that's kind of how we use them, but we don't have a minimum at all. Yeah, how you guys do?

[Liz] I know for we at Brown, we don't either. I don't look at the number as much as did you pass or not. And if you didn't pass just, you know, curious why. And I think that's something that's totally, you can put in a personal statement and, you know, kind of putting it out there. I had personal issues that happened around this time. I didn't pass, I mean, whatever it might be, it is certainly not, I at least don't use boards as sort of this gatekeeper scorecard kind of thing at all. I think that we are sort of, I think that that happens at least rumor and residencies, but it doesn't happen at least for me in fellowships, for Sujit and Terri, for you guys?

[Sujit] Yeah, I agree, I think if you do have a failure, it's probably wise to talk about it a little bit in your statement. We have interviewed people who have failed like rotations and in fact, sometimes that was a really compelling reason to wanna meet somebody, strangely enough. Right, like they talk about their journey. And like Liz said about talking, telling your story, it's part of your story, you know, works and all, and that wasn't necessarily, but you probably have to be able to describe that though. I do think that's important if you have a failure on there, you probably have to talk about it.

[Liz] What about you Terri?

[Terri] Same for us. We do not look at a minimum score number. We, you know, a pass is a pass, right? I mean, we've all taken those tests and it's just like, it doesn't matter what the number is, it's a pass. But, you know, some people are just not great test takers and it doesn't mean they don't have the knowledge. And so we totally understand that and accept that. And if someone has failed once, then, you know, I look at it, it's a learning opportunity. They pass the next time and they got it. So just shows me that somebody was resilient, they didn't give up and they wanted to, you know, stay with their passion and what they were wanted to do. So I think that is totally acceptable.

[Liz] Yeah, and there's, I mean, there's so many, I mean, I speak for myself, I am a horrible test taker. I always have been. So I just think you just need, you sort of just need to talk about it and which kind of goes to another question. It seems to be about experiences from medical school and how those play into, we've talked a lot about sort of experiences you've had in residency. But if you, is it okay to talk about things that happened that you did in medical school on your application process? And Katie, why don't you take this one.

[Katie] I guess if you're referencing like bringing things from medical school on your CV, yes, definitely. Even undergrad, I mean, you are really involved and, you know, made a big contribution to your community. I think that that's really valuable to know what kind of shows a pattern of I've been invested, I've been interested, I've done things outside of just kind of the bare minimum of my work. So I think it's fine to put all of that stuff in there.

Liz] Yeah, and I think all of us realize that you're really busy in residency. And so, you know, you may not have the time to be doing all these things that you're passionate about. I mean, I know when I was a resident, I barely could feed my cat. So, I mean, it was, I mean, so certainly if you did something really meaningful in medical school, talk about it. I mean, absolutely. I mean, and you'll talk again, it's all, again, we keep going on the theme of just telling your story and so saying, this was something I was passionate about. I had no time and residency to do this, but I really wanna get back to it in fellowship. And I think that's really important. And so to Terri, the question which kind of dovetails onto this is what do you find is the most important part of the application? Is it personal statement? Is it letters of recommendation? What do you look at first?

[Terri] Probably the first thing I look at is the CV, because it is probably the most all encompassing document that we get, because it really takes you from start to finish, you know, where you've trained, everything you've done from maybe medical school and residency, even undergrad. So I can kind of see the holistic person on the CV. And then to me going into the medical school transcript, the scores, the personal statement, and the letters is more of a deep dive into the person. So the CV needs to be very well done, complete. And I honestly like to see at the very end, the hobbies, you know, that someone's interested in, it gives me a little glimpse into the person, but I think it's really important to have that CV very well done. And I would put something, just something from each avenue you've been in. So undergrad, medical school and residency. If someone was more weighted, just had way, you know, more things in medical school and really nothing from residency, that might be something I would wanna question about more, but really I look at the application as a whole, all of it's important. And I have to tell you, I mean, and I'm sure these other PDs can tell you too, that every year these applications, what everyone is doing in residency, what you guys are doing is so amazing because those of us that are like 20 years out from residency, we did not do hardly any of that. So congratulations to you guys for doing all this amazing stuff.

[Liz] Yeah, and I mean, one thing I wanna bring up on this CV is if you took any time off, a significant time off between college and medical school, medical school and residency, even during residency, things like that, please put that somewhere in your CV, what you did or didn't do. I always worry a little bit about their sort of, when there are these big gaps, you know, I just sort of wanna, I mean, and it may be something I just wanna ask people about that, but if you took two years off and traveled throughout Africa, I wanna hear about that, because I wanna go to Africa. I actually think those things strengthen your CV. I would not look at those things as hurting them. So for me, the most important thing actually, I mean, are the letters of recommendation, just because they speak to the person, and so for that. And I think, and personal statements as well, but for me, letter of recommendation, what about you Sujit?

[Sujit] Yeah, I was gonna actually, as Terri was answering, I would almost put 1A the CV, because I can read the story in facts and 1B right after is I open up all the letters all at the same time. And there's something about reading the CV and then reading three letters in a row about somebody, you can tell what is the real core of that person because there tends to be themes in those letters, you know, and I think people ask a little bit about like collectives and things like that at the beginning. And I think Terri hit on it at the very beginning, which was getting a letter from somebody in the practice of emergency medicine in that setting. If you have 10 people around that's probably the best, some folks don't, that's okay. Because it really speaks to you and all your qualities in that environment. And so I do think it's important for you to advocate for yourself as a resident to make sure you get those experiences, you get that time, you get to find those folks. But even if you don't, because in some places you just can't, and that does not mean you're not a good applicant. Having meaningful time spent with other physician attendings in critical settings, whether it's the ER or usually the ICU, probably the most common places we get letters, sometimes the morgue, that's really important. So cultivate those relationships. It kind of shows how you're able to invest in yourself and work with mentors. I mean, it really speaks to what fellowship is.

[Liz] And so just in watching the time, Katie, I'm gonna transition it just a little bit. But when you're looking at the CV, for people that were non-traditional, meaning that they didn't go college, medical school, residency, fellowship, but they had a job for a couple year, a year or two. They maybe did something before medical school or something between residency and fellowship. What do you think of those people when you read their CVs?

[Sujit] Oh, I love them too. Sorry, I dunno if it was the group, sorry. Yeah, I'm with you. Somebody said all of the... The biggest regret you get in your life as you get older is that you didn't do those things. And so I love hearing about these people that took the time and they said I've had a minor league soccer player, a professional musician, I've had a couple of art, I mean, it's the best because maybe you spent more time to actually think about the process of what it is you're doing as an adult. And so to be able to speak to that, good ER folks can really kind of speak to the breadth of all the people in the world. And a lot of those experiences give you that.

[Liz] Katie, what do you think about that?

[Katie] Yeah, I think it generally is a benefit. If you did the traditional path, you know, you're not, you haven't done a disservice to yourself, but I do think that the non-traditional path oftentimes is just you, like, you've done like more sort of introspective thinking about what you want out of life, and then you have all these like experiences, adulting outside of medicine that are really valuable that you pull into medicine. So it's not a negative thing.

[Liz] Yeah, I mean, 'cause for me, and this is sort of my advice overall is like, you have to have a hobby and interest of passion outside of medicine, otherwise you're going to fry. And so, I mean, and I say that to all of my fellows. What else are you passionate about? And so when you have people talk about these other things, I mean, I forget who talked about the hobbies and then like, I love that. I have a juggler, is one of my third year fellows. She's amazing. And the kids love her because she sits there and she juggles for them all day long. And there's a lot less sedations that happen when she's juggling. So I think, don't think of it as being silly or stupid, like put it on there, it's awesome. What about you? I think Terri, you were the one that talked about the hobbies, right?

[Terri] I mean, I have to agree. I mean that makes you unique, right? Because then that engages us into, "Oh, I wanna know this person more." So it makes us want to talk to you more, meet you, invite you to interview. And you know, there are so many ways to get to where you're going, 'cause I was a dancer and then became a physician, so that was a little unique. But don't think that if you were the traditional way that like what Katie said, that that's a negative, because that shows that you were driven, determined, you knew what you were gonna do and everybody's different. Some people know exactly what they're gonna do from the very beginning. Some people have a winding journey to get to where they're gonna go, but they get there. And both of them are exactly the same, they're important, but it is nice to see something a little that's gonna make you stand out. So just think about something in your life that you can put on there that's gonna really kind of shine and make us notice you and then want to investigate a little bit more about you.

[Liz] And that speaks to, so I'll give this one to Katie about there, let's say that you're not the person who knows exactly what you wanna do in PEM, you don't have your niche yet. How do you talk about that on your application? It's easy when you're like, "I'm gonna do this, I'm gonna solve the world's problems." But what if you haven't gotten there quite yet?

[Katie] Yeah, I think it's, you know, so unfair quite honestly, that we expect or you know, that this is something that we've sort of over the last couple years I think, come to expect a little bit. I mean, I honestly just remember like patting myself on the back. Like I decided that this was the fellowship I was gonna do, here I am, who wants me? So, I think that that's okay. I think just like having enthusiasm and being able to, you know, A, have a sense of yourself and what it is you're interested in, and then just having a sense of enthusiasm for exploring all the different things. I think if you have a sense for what's out there, that's great. And if you, and so I would say talk to people as you're preparing your application and just sort of say like, here's who I am, what do you do in PEM? What do you like about it? Hear what other people like and are doing and see if anything kind of resonates with you and them, "Oh, tell me more." And then when you're doing your application or interviewing, you get to say, well, you know, one of the people I talk to, one of my mentors does this and that sounds really exciting. I would love to explore that more in fellowship. And you know, then it's just like, oh, you are excited about something. You've learned a little bit about the things to do in our field and you'll figure out what you wanna do.

[Liz] Right, and that's for me, yeah, it's just about the enthusiasm. Like, I want people to love it as much as I do. So I mean, and that's okay. I don't need people. That's what fellowship is all about. So, all right, we're on the final stretch guys. So this is going to be our last question, which may be a little bit of a downer, but are there any red flags on the application? Things that really make you pause? All right, Sujit. He's like, hmm.

[Sujit] I know this is like the first time I don't have something to just scream out because that's a tough one. It's a toughie.

[Sujit] I think, Okay, I'll give you one, I'll give you one that has come up a couple times. And sometimes it was a red flag and then sometimes it wasn't at all. So I've had a couple folks recently who had applied for a different fellowship, didn't match and then applied to PEM. Now, maybe that's a really small one off and maybe it was just these last couple years, but it did make me wonder a little and it came up, it came up actually for one person when we talked and it came up, you know, why was it that you chose PEM? And it kind of really at the end was, well, you guys do shift work and this one was not so much shift worky. And that's kind of when I was like, well, that's probably not the right way to have maybe framed this conversation a little bit. So I think, but it's okay. I don't wanna say that answer and tell you that it's okay. It is okay to have like a real circular path. Like it does not need to be linear. And many people have a career as a general pediatrician or have a career in X, Y or Z, and then they kind of discover PEM. But I think that if you're not able to explain it, I guess that going back to that theme of explaining gaps in your career or changes in your career where you took an exit and then you got back on the highway, if you can't explain that really well, or in a real clear way, then I guess that that sometimes speaks to a red flag. That's the best I could come up with in five seconds.

[Liz] All right. Now Terri and Katie have had time to think about it. So Terri, what do you, any red flags for you?

[Terri] So I wouldn't call this a red flag or a negative, but I really like the application to be complete when it is time for it to come out to all of the programs. So getting all of your information into you know, before the deadlines, or at least by the deadlines is so important because especially with the interview season being two weeks shorter, then you know, they've moved the timeline up. So it's going to be compacted and programs are gonna be really trying to make those decisions on who they're gonna interview pretty quickly. So I would highly recommend having your letters in there, your personal statement in there, your CV is all done, your transcripts, your scores, that everything is in there at the same time if you can possibly get it before the deadline.

[Liz] Yeah, and for those applicants who may or may not know, but it's a little bit of a tighter window for us this year. They've moved up on the match by a couple weeks. So we can align with the adult internal medicine match, which is amazing for people who will be couples matching. So, but for all of us, we're just, we're losing two weeks, which is not a huge amount of time, but it is just gonna put a little bit more time pressure on everyone. Katie, red flags.

[Katie] Yeah, I mean, I think that there are some obvious red flags that would be obvious if you had them, if you've, you know, been fired or, you know, failed everything multiple times. I think that if you... I think being kind of intentional about who you ask for letters and making sure that they know you well and would be able to write a strong letter is good because sometimes they lackluster letter of recommendation is so different than the glowing ones, you know, that we see from people who have had good relationships with their letter writers is important. And then I know you Sujit mentioned, you know, if you reply to a different special team didn't match, it made me kind of just wanna say that the last couple of years, I've interviewed applicants and seen applications from people who have applied to PEM and didn't match, which is become sadly, like kind of common, you know, we have so many applicants the last couple of years, and so not matching once and reapplying, isn't a red flag to me, particularly if you've done something really valuable with that year and, you know, gotten clinical experience or some other kind of valuable experience that is gonna set you up to be more prepared and more successful in fellowship. I don't think not matching the first time around is a huge red flag for me.

[Liz] And I know for me, I know this is gonna seem really minor, but attention to detail on your application is very important. I've gotten some with lots of spelling mistakes, and it's sort of, I'm like in the era of Microsoft Word and other things sort of proof, I know it seems crazy, I'm sitting here talking about proofreading. I feel like I'm talking to my child, my ninth grader, "Proofread what you write." But I mean, do that proofread making sure things sort of all line up, making sure things make sense, things like that, because it's attention to detail. And I mean, and for me, that's what it speaks to, is that this is something that it was important that you spent time for this, that you had that attention to detail, which goes along with one of the red flags, which is a little bit different, is like, if you're addressing an email to me and then you type somebody else's name on the email, it's a little bit of a red flag, I'll say it, but you know, it was sort of a funny thing when they're like, "Dear Dr. Iyre, thank you so much for the interview at Dell Children's." And I'm like, "I'm from Brown." Just saying that out loud. So from that, we've all gotten it. And I understand we've all made mistakes, but it just, but it does speak to that sort of, that this is somebody who's going to be looking at all of those attentions to detail. So I will end it on that. So it is 7:56, I am going to wrap this up. I wanted to thank everyone so much for joining us, for this is just part one. There will be a second session late June, early July, time to be announced, where we're really gonna talk about the interview process. I saw in the Q&A, there were lots and lots and lots of questions about sort of interviews and Zoom backgrounds. And will we go virtual or live? And none of us know that yet, but we're all hoping to figure that out by the end of June, please. So we can't wait to see everybody again at the end of June early July. And I can't read to read all of your applications and hear all of your amazing stories out there. So on behalf of the panel and I, thank yo u so, so, so, so much.

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