Making a Match

The most important part of your emergency medicine residency application

Michelino Mancini, DO, shares how students can stand out when applying and matching into emergency medicine residency programs.


For this upcoming Match, Michelino Mancini, DO, will receive about 1,100 applications to fill just seven emergency medicine residency positions at Lakeland Health in St. Joseph, Michigan.

Here’s what emergency medicine program directors look for in residency applications and interviews, according to Dr. Mancini.

The Application

1. The SLOE

Dr. Mancini weighs the SLOE the heaviest when looking at applicants for his emergency medicine program. A SLOE, the standard letter of evaluation, is similar to a traditional letter of recommendation. It allows program directors to gauge a student’s performance and readiness for emergency medicine in comparison to other applicants.

After completing two or three emergency medicine rotations before fall of their fourth year, students preferably should have two SLOEs in their application.

The SLOE assesses patient care, ability to multitask, decision-making and interpersonal skills. It also asks evaluators if they had the chance to match the candidate into their residency program, where would they fit them in their match process.

Students can receive honors, high pass, pass, low pass or fail grades on their rotations.

Dr. Mancini says when he sees an institution give honors constantly it makes him question the accuracy of the score.

“A very strong SLOE from an institution that has a good distribution of scores and a good historical distribution of SLOEs is of No. 1 importance across the board, “ Dr. Mancini says.

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A high COMLEX score isn’t everything, but it does help program directors determine whom they’d like to invite to interview.

According to an NRMP report, students who matched into an emergency medicine program had a COMLEX Level 1 score between 550-640 with a mean score of 593 and a COMLEX Level 2-CE score between 560-670 with a mean score of 610.

“If you’re significantly off from that deviation, then it’s going to be more difficult for you to get an interview,” Dr. Mancini says.

Some programs have cutoff scores that will determine whether they’ll move an applicant forward. About 40 percent of emergency medicine program directors have a target score they are looking for applicants to score on the COMLEX Level 1.

Michelino Mancini, DO

3. Engagement in the medical field

While having a reputable SLOE and strong COMLEX scores is important, applicants engaged in the medical profession also stand out. This can be via committees, research or involvement in national societies.

Seeing students involved in medicine outside of school is more important than work experience to Dr. Mancini.

“We want them to be engaged within the residency program when they’re outside of work too,” Dr. Mancini says.

After you’ve submitted your application, here’s what program directors are looking for during the interview.

1. The Fit

Dr. Mancini says program directors are simply looking for the right fit to fill slots in their residency programs.

“You’re already good enough to get in if they’ve invited you to an interview and you have all the qualifications. They’re inviting you to see how you will fit in the program,” says Kathleen Clarke, DO, an emergency medicine resident at Lakeland Health.

Visiting the program lets them see how you interact with faculty, staff and residents.

“When you’re having a conversation with them that has nothing to do with medicine, you’re able to learn their personality traits and what makes them tick,” Dr. Mancini says.

2. ‘Spongability’

The top trait Dr. Mancini looks for when interviewing candidates is “spongability.” He’s looking for residents who are receptive to positive and negative feedback.

He tries to identify candidates who might be resistant to this type of teaching by asking questions such as:

  • Has there ever been a time where you’ve been extremely stubborn to change?
  • Have there been times that you’ve encountered an uncomfortable position in patient care or didactics? What did you do in this position?
  • Have you ever encountered a challenge and failed? What did you do when you failed?

3. The SLOE

While rotating at the program can help give students a more in-depth view of the program, Dr. Mancini says it’s not necessary. He says this is why SLOEs are so valuable.

“We can’t have 1,100 students do audition rotations with us, but we can compare you with others via the SLOEs,” Dr. Mancini says.

In the NRMP Program Director Survey, 88 percent of emergency medicine program directors cited letters of recommendation in the specialty as important when ranking applicants.

For further reading

How to make the most of emergency medicine rotations

How I matched into an ob-gyn residency

Tips for prepping your Match rank order list

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