The Ultimate Guide to SOAP Preparation for Emergency Medicine Residency

Understanding SOAP in the Context of Emergency Medicine

The Supplemental Offer and Acceptance Program (SOAP) is a structured process that allows unmatched or partially matched residency applicants to obtain unfilled positions after the main residency Match algorithm runs. For emergency medicine residency, where competition has fluctuated significantly in recent years, strategic SOAP preparation can be the difference between continuing your training on time or facing a gap year.

Before you can prepare effectively, you need to be clear about:

• What is SOAP?
  SOAP is a time-limited, NRMP-run process during Match Week that matches eligible unmatched or partially matched applicants with unfilled residency positions. You do not “apply” in the traditional sense; instead, you submit applications in ERAS to programs that have unfilled positions, and then programs initiate contact and offers through a structured series of SOAP rounds.

• Who is SOAP for?
  You may be SOAP-eligible if:

  • You are registered for the NRMP Main Match.
  • You are unmatched or partially matched after the algorithm runs.
  • You have no Match violations and meet all NRMP and institutional eligibility requirements.
  • You are not withdrawn from the Match.

• Why SOAP matters especially in emergency medicine residency
  Emergency medicine (EM) has experienced cycles of oversupply and undersupply of applicants. In recent years, some EM programs have gone unfilled initially, then successfully recruited through SOAP. For applicants:

  • SOAP can provide fresh opportunities in EM that were not on your original list.
  • Many EM applicants also pivot to preliminary surgery, internal medicine, or transitional year positions through SOAP to remain in the clinical pipeline.

The key to success in EM SOAP is early, structured preparation—well before Match Week—and a clear-eyed understanding of your competitiveness and backup pathways.

---

Laying the Groundwork: SOAP Preparation Timeline

Successful SOAP preparation for emergency medicine residency should start months before Match Day. Think of it as building an insurance policy that you hope you never need, but are extremely grateful to have if you do.

1. Six to Nine Months Before Match Week: Strategic Positioning

Focus here is on maximizing your chances to match normally, while quietly building SOAP resilience.

Academic and exam readiness

• Ensure all USMLE/COMLEX scores are released and passing by:
  • USMLE Step/Level 1 and 2 (and OET/English requirement for IMGs).
  • Avoid pending or delayed scores that could jeopardize SOAP eligibility.
• For borderline or failed attempts:
  • Seek explicit, written guidance from your Dean’s office or advisor on realistic EM match chances vs. need for parallel planning (e.g., prelim medicine, transitional year).

Letters of recommendation (LoRs)

• Obtain strong EM SLOEs (Standardized Letters of Evaluation) from:
  • At least one, ideally two, ACGME-accredited EM programs.
  • A third clinical letter from EM, internal medicine, or surgery is helpful for SOAP flexibility.
• Store extra non-uploaded letters in ERAS to give you options in SOAP:
  • For example, a strong IM letter that you may not have used in the main EM application can be deployed if you pivot to IM or prelim spots.

Personal statement framework

• Draft multiple versions of personal statements:
  • Primary EM personal statement.
  • A more general “acute care / hospital-based” personal statement that can be tailored during SOAP.
  • A short, adaptable paragraph that explains:
    • Why you are interested in EM and/or other specialties.
    • Why the SOAP process has led you to re-evaluate your options constructively, without sounding bitter or hopeless.

You don’t need to finalize everything yet, but setting up templates now will reduce stress later.

---

2. Three Months Before Match Week: Building a SOAP Playbook

At this stage, your ERAS is submitted and interviews are underway or wrapping up. Now is the time for dedicated SOAP preparation.

Clarify your risk profile

Discuss candidly with a trusted advisor (EM faculty, program director, or Dean):

• Number and quality of EM interviews.
• Any exam failures, professionalism issues, or big application gaps.
• Your ranking strategy (e.g., only EM vs EM + prelim IM).

Ask them directly:

• “If I go unmatched, what are my best SOAP options considering my profile?”
• “Should I preemptively prepare for prelim internal medicine, prelim surgery, family medicine, or transitional year as parallel plans?”

Define your SOAP target tiers

In EM SOAP preparation, think in terms of tiers, not a single outcome:

• Tier 1: EM categorical positions in SOAP

  • Target EM programs with historical unfilled spots (if available).
  • Community EM programs and newer EM residencies.
  • Areas with less geographic preference (rural or non-coastal).

• Tier 2: Transitional year (TY) or preliminary year

  • Prelim internal medicine or surgery positions.
  • Transitional year programs at institutions with EM residencies can be especially strategic—offering exposure, networking, and possible PGY-2 EM entry later, depending on institutional practices.

• Tier 3: Longer-term strategy

  • If EM options are limited, what 1-year positions will best position you for a re-application to EM or a shift to another specialty you can be happy in?

Write your tentative tiered strategy in a document—you will refine it once you see the official List of Unfilled Programs.

Prepare your “SOAP toolkit”

Create a digital folder (local + cloud) with:

• Updated CV / ERAS PDF.
• Multiple personal statement drafts:
  • EM-focused.
  • General hospital-based / acute care.
  • IM / prelim-friendly version (if relevant).
• List of potential professional contacts for:
  • Letters of support.
  • Quick phone calls or emails to advocate for you during SOAP.

---

3. One Month Before Match Week: Finalizing Documents and Mindset

The month before Match Day is the time to polish and finalize, not to start from scratch.

Refine personal statements for SOAP

Create ready-to-go templates you can adapt in hours, not days:

1. Emergency Medicine SOAP Personal Statement (shorter, direct)
   Include:

   • A concise narrative about your path to EM (clinical examples from EM rotations).
   • Emphasis on EM-relevant qualities: rapid decision-making, teamwork, resilience, communication under pressure.
   • A positive, forward-looking tone—avoid any mention of “SOAP” or “going unmatched.”

2. Preliminary / Transitional Year Personal Statement
   Emphasize:

   • Desire to build strong clinical foundations.
   • Interest in caring for acutely ill patients and working in high-volume settings.
   • Openness to contributing across departments and working varied schedules.

You can tweak opening and closing paragraphs quickly once you know specific programs and positions.

Update your experiences and CV

• Make sure ERAS entries are current:
  • New research, QI projects, EM shifts, volunteer work.
  • Extra responsibilities (chief of interest group, teaching, etc.).
• Confirm there are no typos or inconsistencies in:
  • Dates.
  • Positions held.
  • Exam attempts.

Mental and logistical preparation

• Clear your schedule for Match Week, especially Monday–Thursday:
  • Minimal clinical duties (if possible).
  • Reliable Wi-Fi and a quiet place to take calls and Zoom interviews.
• Prepare emotionally:
  • Discuss with family or support system what the week may look like.
  • Plan how you will manage distress if you learn you are unmatched (e.g., brief time to process, then execute your plan).

---

Match Week: Executing a High-Yield SOAP Strategy for EM

When Match Week begins, your preparation becomes action. The EM match and SOAP process can be emotionally intense; having a calm, stepwise approach is crucial.

Monday Morning: “You Are Unmatched” — Immediate Next Steps

If you receive notification that you are unmatched or partially matched:

1. Allow yourself a finite emotional window.
   Give yourself a few hours to feel upset, then deliberately shift into problem-solving mode. You have limited time; every hour counts.

2. Contact your Dean’s office and EM mentors early.

   • Many schools have SOAP “war rooms” or dedicated advisors.
   • Let your EM faculty know quickly so they can:
     • Review unfilled EM positions with you.
     • Call or email programs where they have relationships.

3. Clarify your SOAP eligibility and options.

   • Fully unmatched vs partially matched (e.g., you matched to a prelim year only).
   • US vs international grad, visa issues, exam failures—these all shape your realistic targets.

Accessing the List of Unfilled Programs

Once the NRMP releases the List of Unfilled Programs (for SOAP-eligible only):

• Filter for emergency medicine residency:

  • Note location, program size, and affiliated hospitals.
  • Mark:
    • Programs your mentors know personally.
    • Programs that have historically participated in SOAP.

• Then filter for:

  • Transitional year (TY) programs.
  • Prelim IM and prelim surgery programs.
  • Programs at institutions with EM residencies (particularly beneficial).

Create a spreadsheet with columns for:

• Program name, specialty, and NRMP code.
• Location and setting (urban, suburban, rural).
• EM or non-EM (TY/IM/Surg).
• Notes from mentors (e.g., “PD is EM-friendly,” “accepts IMGs,” “strong teaching culture”).
• Priority tier (1–3).

---

Submitting SOAP Applications Strategically

You are limited in the number of programs you can apply to during SOAP (historically 45 total). Every application must be intentional.

Prioritize EM without overcommitting

For an EM-focused applicant:

• Start with EM positions that:
  • Are in regions you would realistically attend.
  • Align with your academic record (community vs academic center).
• For example:
  • Apply to 20–30 EM programs if available and appropriate.
  • Reserve remaining slots for:
    • TY programs.
    • Prelim IM or surgery at EM-affiliated institutions.
• Avoid using all of your 45 slots on EM if your advisors are concerned about competitiveness; you want enough backup in prelim/TY options.

Tailor your materials efficiently

• For each EM program:
  • Use your EM SOAP personal statement with minor customizations (1–2 sentences referencing:
    • Their patient population.
    • Academic vs community focus.
    • Training strengths drawn from their website).
• For TY / prelim programs:
  • Use the prelim-focused personal statement.
  • Emphasize flexibility, strong work ethic, and goal of building solid clinical skills.

You will not have time for extensive custom essays; focus on short, meaningful tailoring.

---

Communicating with Programs During SOAP

Understand the rules

• You cannot initiate contact with programs about unfilled positions before they receive your SOAP application.
• Programs can reach out to you by:
  • Phone.
  • Email.
  • Video interview.

Review NRMP and your school’s guidelines carefully so you do not violate communication rules.

Prepare for rapid-fire interviews

SOAP interviews are often:

• Short (10–20 minutes).
• Variable: from structured questions to informal conversations.
• Focused on:
  • Why you went unmatched (sometimes indirectly).
  • Why their program.
  • Your resilience, teachability, and professionalism.

Common EM SOAP questions:

1. “Tell me about yourself and your interest in emergency medicine.”
2. “What do you think happened in your initial EM match process?”
3. “How will you handle the pace and acuity of our ED?”
4. “If you don’t match into EM now, what is your long-term plan?”

Action tips:

• Be honest but concise.

  • Avoid blaming schools, programs, or “the system.”
  • Own any weaknesses and show specific steps you’ve taken to address them (extra rotations, improved exam performance, remediation).

• Emphasize:

  • Concrete EM experiences (case examples from rotations).
  • Strengths in teamwork and interprofessional communication.
  • Willingness to work hard in any shift pattern.

• For non-EM prelim / TY interviews:

  • Frame EM interest positively but avoid sounding like you’re only using them as a stepping stone.
  • Emphasize that a strong preliminary year will make you a better EM physician, internist, or whatever direction you may eventually take.

---

After SOAP: Planning Your Path in or Around Emergency Medicine

Whether SOAP leads to an EM categorical spot, a prelim year, or no position at all, you still have agency in shaping your future.

Scenario 1: You SOAP into Emergency Medicine

If you match into an EM position through SOAP:

• Celebrate and then clarify expectations:

  • Ask for program materials, orientation schedules, and any early requirements.
  • Show early engagement—this was likely a mutual leap of faith.

• Address perceived weaknesses:

  • If limited SLOEs or exam performance contributed to your initial non-match, work with your new PD to:
    • Create a study plan.
    • Seek early feedback during intern year.

• Integrate quickly:

  • Volunteer for committees, QI projects, or resident roles.
  • Build trust with faculty and co-residents; SOAP does not define your value as a resident.

Scenario 2: You SOAP into a Preliminary or Transitional Year

Many EM applicants successfully re-enter the EM match after a strong prelim or TY year.

Action strategies:

• Seek EM exposure:
  • Elective ED rotations if your prelim program allows.
  • Moonlighting in ED-like settings later in the year, if permissible and safe.
• Obtain new letters:
  • From hospitalists, surgeons, or ED faculty who can attest to your clinical acumen and work ethic.
• Rebuild or refine your EM application:
  • Rewrite your personal statement highlighting:
    • Growth during your intern year.
    • Concrete evidence of improved clinical performance and maturity.
• Network with EM programs:
  • Attend EM conferences (e.g., ACEP, SAEM) if affordable.
  • Connect with EM educators interested in residents pursuing EM pathways.

Scenario 3: You Do Not Match in SOAP

This is painful, but it is not the end of your journey. Many physicians have walked this path and ultimately found satisfying careers in EM or other fields.

Key steps:

• Debrief with advisors:

  • Request a brutally honest assessment of your application.
  • Clarify whether EM remains viable or whether a pivot to another specialty is more realistic.

• Build a structured gap year (or more) plan:

  • Full-time clinical research in EM or hospital medicine.
  • Clinical jobs allowed by your degree and licensing (e.g., scribe, clinical research coordinator, teaching roles, sometimes non-physician provider roles abroad depending on training).
  • Additional degrees or certifications only if they truly advance your goals (and not as procrastination).

• Prepare an improved application:

  • Address the core issues:
    • Exam failures → remediation, retakes, or strong clinical performance elsewhere.
    • Weak letters → new mentors and clinical supervisors who can champion you.
    • Limited EM exposure → targeted EM experiences.

The goal is not just to “try SOAP again next year,” but to be a clearly stronger, more mature candidate when you re-apply.

---

Practical SOAP Preparation Checklist for EM Applicants

Use this condensed checklist to organize your SOAP preparation:

6–9 months before Match Week

• Pass all required exams; confirm no pending scores.
• Obtain at least 1–2 solid EM SLOEs; consider extra non-EM LoRs for flexibility.
• Draft base EM personal statement and a general hospital-based statement.

3 months before Match Week

• Meet with EM advisor/Dean to assess match risk and parallel plans.
• Define target tiers:
  • Tier 1: EM categorical.
  • Tier 2: TY/prelim (IM/Surg) at EM-affiliated institutions.
  • Tier 3: Longer-term alternatives.
• Build a SOAP toolkit folder (CV, statements, LoRs list, contacts).

1 month before Match Week

• Finalize EM and non-EM SOAP personal statement templates.
• Update ERAS experiences and review thoroughly for errors.
• Plan logistics: time off, quiet workspace, reliable tech.

Match Week

• On Monday, if unmatched/partially matched:
  • Contact Dean’s office and EM mentors immediately.
  • Organize a spreadsheet for unfilled programs.
• Filter unfilled list for EM, TY, prelim IM/Surg, and prioritize.
• Use limited SOAP applications (e.g., 45) strategically across tiers.
• Prepare for brief, high-yield interviews; practice concise explanations of your journey.

Post-SOAP

• If placed: engage early with your program; address weaknesses.
• If not placed: create a structured 1–2 year plan with advisors, focusing on tangible improvement.

---

FAQs About SOAP Preparation in Emergency Medicine

1. Should I tell EM programs during SOAP that I am only interested in EM and nothing else?
You can express clear enthusiasm for EM, but avoid sounding inflexible or dismissive of other clinical experiences. Programs want residents who are committed to EM yet mature enough to appreciate broad-based training. In interviews, focus on why EM is the right fit and how your prior and potential prelim experiences would make you a better EM physician.

2. If I failed an exam (Step/Level 1 or 2), do I still have a chance in EM SOAP?
Yes, some applicants with past failures do obtain EM positions through SOAP, especially at community or newer programs. However:

• Your overall application must show clear improvement (e.g., higher later scores, strong clinical evaluations).
• Advisors may recommend a balanced SOAP strategy, including prelim or TY programs to build a stronger record before reapplying to EM.

3. How many unfilled EM programs can I realistically expect in SOAP?
This fluctuates yearly based on national application trends and program expansion or contraction. Some cycles have seen a notable number of unfilled EM spots; others fewer. You won’t know exact numbers until the unfilled list is released. This uncertainty is why you must prepare both EM and non-EM pathways in your SOAP strategy.

4. If I SOAP into a transitional or preliminary year, what are my chances of later getting into an EM residency?
Many residents successfully transition from TY or prelim years into EM. Your chances depend on:

• Performance during your prelim year (evaluations, letters, professionalism).
• Strategic EM exposure (rotations, conferences, research).
• How well you address the reasons you went unmatched initially.
  Programs often view strong performance in a rigorous intern year as powerful evidence of readiness for EM.

---

Thoughtful SOAP preparation in emergency medicine residency is not a sign of pessimism; it is an exercise in professionalism, self-awareness, and resilience. By planning early, building flexible pathways, and responding calmly during Match Week, you maximize your chances of securing a position—whether in EM directly or via a stepping-stone prelim or transitional year—while keeping your long-term career goals firmly in view.