EMRA and CORD Student Advising Guide - Building Your ERAS Application (2024)

Ch. 7 - Building Your ERAS Application

By now, you have started to consider the different types of EM residencyprograms available (Chapter 4), you have completed or scheduled your EMclerkships and USMLE exams (Chapters 3 and 5), and it’s time to understandhow you actually go about applying to residency programs. There are severalcomponents of the application, and each will impact your competitiveness(Chapter 8).

The Electronic Residency Application Service

ERAS is a platform offered by the AAMC and used by most specialties for senior medical students applying for residency positions.¹

The ERAS application helps you get a foot in the door with an interviewinvitation. In addition, it provides content, so residency program leaders canlearn about you and help prompt interview discussion. Furthermore, theapplication helps guide the program director’s rank list.

How Do I Create an ERAS Account?

Registering for ERAS requires a “token” that will be provided to your medicalschool’s Dean’s office.

Know The Timeline

Keep key dates in mind when approaching the application process. The first isthe date ERAS opens and you can begin editing your application and uploadingdocuments. Historically the opening date was July 1; however, for the 2019application cycle, ERAS opened earlier (June 7) so applicants could have moretime to work on their application. Also new to the 2019 application cycle, ERASbegan allowing students to start applying to ACGME-accredited programs inearly September (Sept. 5).

Residency programs are granted access to applications and supportingdocuments beginning Sept. 15 at 9 a.m. ET. All applications submittedup to this point will be stamped with that date and time. The early submissionwindow was created simply to avoid technical difficulties related to thehuge volume of applications being submitted simultaneously. Submittingyour application before Sept. 15 will help reduce the possibility ofoverwhelming the website, but it will not give you any advantage in terms ofwhen programs will receive your application.

Stick to the Timeline!

Some program leadership may start looking at applications on Sept. 15 whileothers wait until Oct. 1 when the MSPE is available. However, it is imperativethat you submit your application as close to Sept. 15 at 9 a.m. ET as possible. Ina prior survey of PDs, only 15% of respondents stated that it was “highly likely”that an application would be reviewed if it were completed after the ERASopening date.⁶

Regardless of when you apply, once you certify and submit your application, youwill not be able to make changes other than on the Personal Information sectionand uploading additional letters. Consider assembling your application in Juneof your fourth year to avoid delays.

The Components of ERAS

• Personal and biographic information
• Curriculum Vitae (education, experience, licensure, publications)
• Personal Statement
• Letter(s) of Recommendation
• USMLE transcript and/or COMLEX-USA transcript
• Medical Student Performance Evaluation (MSPE or “Dean’s Letter”)
• Medical school transcript
• Photo (optional)

Personal and Biographic Information

This section is where you enter your basic demographic and biographicinformation as well as military service obligations and whether or not you arecouples matching. There is also a section for you to include your NRMP matchID, which you will get when you register for the NRMP Match. This is a separateprocess from creating and submitting your ERAS application. You must go to theNRMP website (www.nrmp.org) to register. Note that NRMP match ID registrationdoes not open until Sept. 15 at 12 p.m. EST. You do NOT need this ID number inorder to submit and certify your ERAS application, and you can add it later — sodon’t wait for it.

Couples Match: Discuss with your advisors and partner if you will discloseyour couples match status on ERAS. There are benefits and potential risksof doing so. You are not mandated to disclose. A handful of programs maywant to avoid EM-EM couples. Additionally, if a partner is applying to aspecialty that is not offered at the same institution, some PDs may not beaware of the non-EM training programs offered at hospitals nearby, leadingthem to think the interview may be low-yield.

Curriculum Vitae

The CV is simply a combination of several individual sections within ERAS that iscompiled into a different format for readers in case they prefer to view the itemsin one document rather than on separate tabs within ERAS. These individualsections include Education (along with awards, membership in professionalsocieties, languages spoken, hobbies/interests, and interruptions in medicaltraining), Experience (research, work, and volunteer), Licensure (board scores,life support certifications, prior licensure information), and Publications.

While board scores, SLOEs, and medical transcripts provide objectivedata for residency program leadership, this section allows you to describeaccomplishments outside of the classroom/wards, as well as to highlightpersonal qualities and attributes not captured elsewhere in the application.This section is often thought of as the “X-factor” of your application and helpsreviewers gauge if you resonate with the program’s values. There is a realopportunity to stand out from other applicants; just listing your experiencesdoes you a disservice. The application is much stronger if you include briefdetails of each activity to highlight your role and specific characteristics youdeveloped through each experience. Demonstrate what you learned from eachexperience or how it made you a better person. Also, take advantage of thepersonal interests section. This is one of the few chances you will have to talkabout yourself outside of medicine, and it’s frequently a great springboard forconversations during program interviews. A common pitfall in this section of theapplication is exaggerating the amount of time committed to each activity. Betruthful always.

Personal Statement

Personal statements can cause a high level of anxiety. How do you write apersonal statement that captures your excitement as you apply to the field youwant to practice? What is the role of the personal statement? How does it differfrom other parts of your application? How much will it matter? A survey of EMresidency directors showed the most influential components of residencyapplications are SLOEs, residency interviews, EM evaluations/grades, andclinical clerkship grades. The personal statement ranked below all of thesecomponents in importance.² This is good news and bad news. It is unlikely agreat personal statement will make up for an application that is otherwise poor,but sometimes a great personal statement can tip the scales in your favor.

So how do you write such a statement? The personal statement allows theresidency selection committee to “meet” you before meeting face-to-face.Introduce yourself. Show (rather than tell) programs that you have the qualitiesto be a great resident by using examples from your previous experiences andachievements. Writing about how much you enjoy emergency medicine doesnot distinguish you from any other applicant; focus instead on what makesyou unique. Describe the challenges you’ve faced to demonstrate your abilityto persevere. Highlight how your previous experiences show your passions,values, and goals, and how you plan to channel your intelligence, creativity, andcompassion into your career. Don’t go overboard by including examples fromevery previous experience; you will have a chance to talk about these in theexperiences section. Choose a few examples that really highlight who you areand what you’re looking for in a residency. Committees want to know you will bea good fit with their program, so discuss what you are looking for in a residencyprogram and what you want to gain from the next 3–4 years of your life. Makethe personal statement personal.

Other essential facts that apply to all writing you are submitting apply here too.³Edit your statement, put it away for a few days, then edit again with fresh eyes.Have those you trust read it as well. Take the recommendations with a grain ofsalt, but make sure you correct all spelling and grammar.

Although it is stressful, try to have some fun with the process. It is, by definition,the most personal part of the application. Allow yourself to reflect on what
makes you really you, and let that shine through.

Each statement is limited to 28,000 characters. There is no limit to the numberof personal statements that can be created, and you can create program-specificpersonal statements (but be very careful not to send the wrongstatement to the wrong program).

Letters of Recommendation

In Chapter 5: Applying for Away Rotations, it was discussed that the SLOEobtained at the end of each EM clerkship is the single most crucial componentof your application and that 2 of them are recommended.^2,4,5

ERAS allows you to submit a maximum of 4 LoRs to each program, but it is notnecessary to upload 4. It is variable how many total letters a program will wantbefore they consider a student’s application to be “complete enough” to offeran interview. It is important to know that after 4 LoRs are assigned to aprogram, you can no longer remove/add LoRs. Therefore, if you performeda later away rotation (September or later) but are counting on this rotation fora SLOE, it is important to leave a LoR spot open for this SLOE at the timeof your initial application submission. Additional letters can be added asthey become available, but do not delay submitting your applications whilewaiting for SLOEs to be uploaded.

Within ERAS, you must enter the names and titles of your letter writers, thespecialty the letters will be used to apply to (emergency medicine), and whetheror not you waive the right to view each LoR. In general, applicants normally waive the right to review their LoRs, allowing letter writers to provide an honestassessment. Once a LoR entry has been confirmed, you will be provided with aunique Letter ID and Letter Request Form that can be delivered to LoR authorsby email directly from ERAS (with an optional custom message), or downloadedas a PDF, with instructions on how to upload your LoR.

While having both SLOEs uploaded by Sept. 15 can be to your advantage,it’s not a deal-breaker; many programs will still consider you with only oneSLOE at the time of file review and interview offer — both will just need to beuploaded by time of applicant ranking. A third SLOE is rarely suggested butmay be beneficial if you have red flags or had a challenging rotation.^7,9 On EMRA Match,¹⁰ programs list how many SLOE(s) they expect to consideran applicant for an interview.

In addition to the 2 SLOEs recommended from your clerkship experiences,you can add LoRs from another EM faculty member with whom you haveworked closely (for example, from a subspecialty rotation such as ultrasound,toxicology, EMS, etc.) or from a non-academic EM physician or a physician notin the specialty. However, it is important to note that SLOEs generated by EMexperiences that are affiliated with a residency training program carry morecredibility than a LoR from a non-academic EM physician or a physician not inthe specialty.⁵

Latecomers: While studies show a LoR from a physician in a specialtyother than EM carries less value than a SLOE, you may have a mentor oradvisor from a different specialty who has worked closely with you.⁴ You canconsider including a non-EM LoR if you had a strong relationship with thewriter. Be sure to leave room in ERAS to upload 2 SLOEs before submittingyour rank list.

USMLE or COMLEX Transcripts

Within ERAS, applicants must authorize the release of their Step scores fromthe NBME by entering their USMLE ID and paying a transcript fee. You can trackthe status of your transcript request by logging back into ERAS. If your Step 2scores are not available at the time of your initial application, you must log backinto this section of ERAS and select “Resend My Scores.”

Guidance about when to take USMLE Step 2 CK can be found in Chapter3: Third Year and Planning for Fourth. Information about how your USMLE/COMLEX scores should influence your application strategy can be found inChapter 8: Apply Smarter, Not Harder: Understand Your Competitiveness.

Medical Student Performance Evaluation (Dean’s Letter)

The MSPE is not a letter of recommendation, but rather a summary of yourperformance throughout medical school. The MSPE is a valuable part of yourapplication because it gives a broader perspective of your four years of medicalschool. This evaluation emphasizes strong attributes demonstrated throughoutyour medical education, highlights your accomplishments during this time, andaddresses any red flags or difficulties. It also provides a narrative to your clinicalclerkship performances. The MSPE traditionally includes your rank comparedto classmates, and this can help you gauge your competitiveness as anapplicant; however, not all medical schools have a class ranking system. In thiscase, your school will indicate this in the MSPE. Check with your dean aheadof time to understand your institution’s process so you understand your owncompetitiveness. Training programs do not rely heavily on this component of theapplication when selecting applicants for interview, likely because it is releasedlater than the rest of your residency application (Oct. 1 compared to Sept. 15).However, the MSPE is rated highly in importance when it comes to deciding howto rank applicants.²

Medical School Transcript

This is simply a list of your preclinical and clerkship grades, which is releasedprior to the MSPE. Your MSPE will provide more detailed information aboutyour clerkship performances. By the time you are putting together your ERASapplication, there is not much you can do about any of this information. Whilebasic sciences grades have been ranked lower in terms of importance toresidency programs, performance in required third-year clerkships is cited asbeing heavily valued.^2,4

Photo

This is optional, but the vast majority of applicants do upload a photo to ERAS.While your photo does not need to be from a professional photographer, youneed to appear professional. No selfies!

The Bottom Line

• Be honest on your application; do not inflate your accomplishments or involvement in anything. Program directors also look for congruence. They want to make sure the person they interact with on the interview day isconsistent with the person they see on paper.
• Anything on your application is fair game to be discussed further in an interview. If it is on your application, be prepared to talk about it!
• Spelling and grammar errors can be a kiss of death. Spend time making your application clear, crisp, and error-free. From the ERAS site, you can print your application to review for errors. Have friends, family, and mentors read over your application before you submit.
• Stick to the timeline. It is OK to not have 2 SLOEs uploaded by Sept. 15, but you must have your application submitted by this date. Do not submit late!