The Underrepresented Applicant

Emergency Medicine Applying Guide

Liza Smith, MD, Ronnie Ren, MD, Michael Zhou, MD, Melanie Camejo,

MD, Caitlin Schrepel, MD and Alexis Pelletier-Bui MD

on behalf of the CORD-Advising Students Committee in Emergency Medicine

(ASC-EM)

https://www.pixabay.com

This application guide is intended for Emergency Medicine bound medical

students who identify as being from a group which is underrepresented in the

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focus, groups traditionally considered to be Underrepresented Minorities (URM),

including Black, Hispanic, and Native American doctors, remain underrepresented in

their respective proportions among EM trainees.

unique challenges for applicants to Emergency Medicine (EM) who identify within

underrepresented groups.

The Association of American Medical Colleges (AAMC) defines persons who are

underrepresented in medicine as:

"Those racial and ethnic populations that are underrepresented in the medical

and others (LGBTQ+), those who have physical disabilities, or those who are from

lower socioeconomic status. These groups have yet to be widely included in definitions

of underrepresented on a national level, however. As such, these groups are

under-recognized and are often not included in data collection regarding

underrepresented persons, so there is very limited information on the state of these

populations within medicine in general and within EM specifically. This addendum to

the general EM applying guide aims to address all those who are underrepresented,

whether it be a group specifically listed in this guide or not.

Being an Underrepresented Minority (URM) in medicine should be a point of pride,

especially when getting into medical school alone is an incredible achievement only a

One challenge facing URMs is overcoming the stigma that may come with being

perceived as “different” in some way. This difference may be embraced by some, but

others may try to minimize it for a variety of reasons. There is a fine balance between

being proud of your heritage/embracing your uniqueness and trying to blend in with

your medical school class. Finding the right balance is different for everyone. With this

equals.

Another challenge is that application reviewers are human, and therefore prone to bias,

often on a subconscious, or implicit level. Overt discrimination based on race, gender,

religion, sexual orientation, etc. is unacceptable in the selection process, but it remains

an unfortunate fact that URM’s may face implicit discrimination when subconscious

interviews was significantly higher for the non-URM group--20 interviews versus 15

interviews for the URMs.

interviews attended, so there could be other factors, such as the socioeconomic

challenges of attending many interviews, influencing these data.

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To address this issue, ACEP has supported implicit bias training for all EM providers.

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The Implicit Association Test (IAT) is one tool used within medical education to assess

subconscious associations of particular groups with certain positive and negative

which will hopefully, over time, mitigate these inequalities , and many programs are

actively looking to bring more diversity into their residency classes as well as to their

faculty at all levels.

Maximizing Your Application

The majority of the application of an URM student should not differ from that of a

non-URM student. Factors such as supportive SLOEs, good clinical rotation grades,

strong board scores, extracurricular activities, and leadership roles should still be the

emphasis of the application.

Preclinical Years

Medical school demands can feel overwhelming, even worse if you feel isolated.

school resources for wellness, academics, and mental health support. Others may

not a sign of weakness, but a measure of self-awareness and an important part of

becoming a better physician.

Find a good mentor. The majority of URM physician leaders credit at least a part of

An adviser or mentor with similar URM background and understanding of your specific

needs as an EM bound applicant is of course helpful. They can offer perspective in

ways non-URM advisers often cannot. Finding this connection can be logistically

challenging for many students, however. Worse, pigeonholing oneself to a mentor

based solely on their minority background - by choice or by well-intentioned

encouragement - may backfire if they are not equipped to advise you on EM specific

issues. You may find yourself seeking out more than one mentor, each one bringing his

or her own expertise and perspective to your experience. Utilize diversity groups within

differences, creating a mutually enriching relationship. At a minimum, these mentors

can explain the universal expectations for matching in emergency medicine, even if

that path might not be equitable yet. Understanding the importance of role models and

mentorship in the recruitment and advancement of underrepresented applicants, many

programs are seeking out ways to recruit and retain faculty at all levels from

traditionally underrepresented minority groups.

There are additional opportunities specifically for Underrepresented Minority students

during the preclinical years. Many institutions offer diversity summer fellowships which

take place between first and second year of medical school in addition to some more

longitudinal projects for URM students. Although these programs are sponsored

through many different organizations and institutions, PENN has compiled a good

representative list here. If this is something you are interested in, it is worth doing your

own search to see what additional opportunities are out there as this list is by no

EM--trying out a new geographic area, a different type of clinical setting, a different

learning environments and are eager to increase the diversity of their residency classes.

One of the ways programs have sought to recruit underrepresented applicants is

through Visiting Elective Clerkships for students from groups underrepresented in

medicine. These electives often offer a stipend to offset the cost of rotating at an away

Electronic Residency Application Service (ERAS)

ERAS includes the curriculum vitae section of your application which shows the

education, work, extracurricular, leadership, and volunteer experiences you have

completed up to this point. ERAS asks applicants to upload a photograph of

themselves which will be visible on the front page of the application. Including a

photograph is optional, but is almost universally expected. There have been

In regards to the rest of the ERAS application, one must keep in mind that for some

applicants, their URM status is not so clearly discerned from a name or a picture, for

instance. For these applicants, you or your advisors may question whether or not to

include certain aspects of your previous experiences if they highlight or bring attention

to your URM status. For example, many LGBTQ+ applicants are concerned about

“outing” themselves in their application if their previous work, volunteer, and

extracurricular experience is strongly associated with LGBTQ+ organizations or causes,

as this may open them up to implicit or explicit bias from application reviewers. In a

2015 study, 43.5% of medical students who concealed their sexual identity in medical

school stated they did so because they feared discrimination.

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Speaking on behalf of

EM advisors and educators, we feel that all of you should be proud of all the work that

you have done and, in general, should not hesitate to include it on your application.

Ideally, you want a program where you feel comfortable being yourself, but if you are

uneasy about this decision, it can be helpful to discuss your concerns with your

less-competitive. An argument can be made for these applicants to be fully

implicit bias among reviewers. Some applicants or their advisors may feel that the best

course of action for them is to limit how much of their URM status they reveal in the

initial application. It is also important to acknowledge that there may be occasions

when an advisor or a dean may recommend excluding certain portions of your

You should put forward the version of yourself that you are most confident and

comfortable being.

Personal Statement

A personal statement is by definition personal, but some URM applicants may worry

about revealing too much and once again opening themselves up to implicit bias

among reviewers. You will want to write about personal experiences that mean

don’t spend too much time angsting over it.

Program Selection

Just as there are many factors that go into choosing an away rotation, there are even

more that go into selecting the program where you will complete residency training. Try

to choose a location where you will be happy spending the next three or four years of

your life. Residency can be even more demanding than medical school, and having a

strong support network can be even more critical. This may mean pursuing programs

that are close to family and friends or one that has other URM members or serves a

community where you feel a connection.

Looking through a program’s current residency classes and faculty may help an

applicant identify programs that are likely to provide easier access to opportunities for

program’s website, however.

While some programs may not on the surface seem diverse, it is often not due to the

lack of effort, and they may have robust strategies for providing support and

opportunities to URMs. Developing diversity takes time and is made more difficult by

the fact that other programs with already established diversity may be more attractive

For married applicants, or those who have or plan to have a family, finding a location

where your significant other and/or children will thrive is also important. Speaking with

faculty and residents on interview day or at the pre-interview social events can be a

great way to get insight and information on this. Websites such as the US Department

of Education site can provide helpful data as well. It is also important to mention that

while marriage equality is law in all 50 states, there is much more nuance regarding

acceptance and legal recognition of same sex adoptive parents or insurance coverage

for assisted reproduction. Resources such as the Equality Map through the Movement

A general rule of thumb is to just be yourself during the interview day. This is a time to

see if you “click” with the program and the people that you are interviewing with. Be

aware that any topic on your application can be brought up as a discussion point, so

be ready to confidently talk about all aspects of your application. While no applicant

should unwillingly endure personal questions about their race, religion, sexual

orientation, etc - and these topics are technically “illegal” unless mentioned in your

application - you should be ready to address these subjects if they were to arise.

However well-meaning the interviewer might be, these conversations are potentially

awkward and may contain uncomfortable or even insulting questions. If you are

uncomfortable with the direction of the interview or with answering a particular

question, explain that to the interviewer and then move on to discussing something

else. Interview day is supposed to be an exciting day. Highlight your achievements by

putting forward your most accomplished and confident self.

opportunity to control the narrative on this subject. It may benefit you to discuss with a

What are some tools and resources that can help me?

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EMRA: Many resources available through the Diversity and Inclusion Committee,

the needs of underserved communities, and increasing the number of clinically

excellent, culturally competent and socially conscious physicians.”

AMSA-REACH: The American Medical Student Association's Race, Ethnicity, and

Culture in Health Action Committee has a tremendous list of resources available for

students looking to get more involved.

AMA-MAS: The American Medical Association-Minority Affairs Section is free for all

students, regardless of AMA membership and offers many scholarship programs and

awards.

underrepresented groups including, but not limited to:

Latino Medical Student Association (LMSA)

Gay and Lesbian Medical Association (GLMA)

Muslim Medical Student Association (MMSA)

Key Points

system, including mentors and advisors, to successfully navigate medical school

and residency application process.

comfortable being--highlighting the most accomplished, confident version of

yourself.

Diversity and Inclusion Are Critical to the American College of Emergency Physicians'

Future Success. Ann Emerg Med. 2017 Jun;69(6):714-717.

Druck J. 167 Factors Important to Underrepresented Minority Applicants when

Selecting an Emergency Medicine Residency Program. 2015; 66 (4): S59–S60.

College of Emergency Physicians' Future Success. Ann Emerg Med. June

2017;69(6):714-717.

School Admissions. Acad Med. March 2017;92(3):365-369.

Unconscious Bias in the Residency Application Process? The American Journal of

Orthopedics. September 2015:E358-59.

https://www.emra.org/emresident/article/diversifying-emergency-medicine/).