u/ALilSliceOfPie

3rd year medical student applying into EM/IM this coming cycle and had a couple questions I couldn't find clear answers to:

1. My understanding is that EM/IM programs fall under the EM umbrella and therefore use ResidencyCAS. However, a handful of program websites still reference ERAS. Are those just outdated, or are some programs still using ERAS this cycle?
2. How do letter requirements differ from standard EM? Do EM/IM programs require fewer SLOEs in favor of IM LORs, or are the expectations essentially the same as a traditional EM application?
3. Seeing as the residencies are spread across the country, getting auditions or electives with the EM/IM programs can be very tricky. Do these programs expect audition or elective experience in both EM and IM, or is EM audition rotation weight dominant?

Any insight would be appreciated, thanks!

Please forgive the long rant.

I was that person in school who was interested in a new thing every week. I went into medical school wanting to be a Mohs surgeon because I found the procedure to be fascinating and I had some derm experience before starting. Then I wanted to do ENT and shadowed, and found it very interesting, but eventually fell off. I thought I wanted to be a nephrologist, general surgeon, ortho, cardiologist, I wanted to be everything, but also nothing fully fit with who I wanted to be.

Eventually, I settled on IR before starting clerkship. I thought the procedures were fascinating and I love imaging. I had the connections, the interest, and the drive to do it. Going through clerkship, each specialty left me with the sense of "I'd love doing this", until my next one came around and I found that one to somehow be better than the last. I chalked it all up to my general interest in medicine, and said that IR would be the best of everything.

Then I did a month in the ICU and my world changed. I was surrounded by the most competent team yet, with doctors that loved to teach more than anything. I thought the pathologies were interesting, and while the rounding for 3+ hours was exhausting, I didn't mind the learning. I loved the intersection of the critical aspects of EM and the deep diagnostic efforts of IM. In fact, when I went to another IM floor the next month, I used so much of the knowledge from my ICU rotation to be a useful member of the team. Eventually, my desire for IR faded, and I think i'm all in on CCM as of now.

But now the question is how do i know this is what will be the best fit for me? My mind clearly changes very easily, and I'm scared that I'll apply EM, IM, or even EMIM and be disappointed in myself for not going after something like IR. I also worry my time in the ICU was a fluke: I was only expected to carry 1-2 patients, not expected to write any notes, was let out at 1pm, no weekends or nights. In fact, a lot of my clerkship at my smaller hospital was like this. While I liked the medicine and the work culture from what I saw in the ICU, i'm terrified of making my mind up based on a fabrication of what its actually like. Now I know IM and EM are safe bets because if i dont like the ICU after all, then there are other avenues, i dont even have to do a fellowship if i dont want to, and training would be shorter than my surgical or IR colleagues.

Theres so much going through my mind, and I just started my last core rotation, so it feels like there are a million deadlines coming faster than expected. I have a ton of IR and rads electives for the rest of the year, and I know i need to change them but I am paralyzed by the indecision and the fear of picking a career that I do not like based on 1 good experience. There is so much more that I am overthinking that would make this post even longer. Does anyone have any advice for this analysis paralysis prior to residency apps?