Potentially Poor SLOE Already Assigned to Programs- Advice

[emtthink]

I rotated at a hospital that shall remain nameless and received an SLOE from them. Based on the feedback that I received during the rotation (after shifts and talking to the PD at the very end of the rotation) I assigned the SLOE to programs prior to my evaluation coming in. All of the feedback I received was positive, I had a very strong knowledge base and formed good differentials and plans. I could work on being a little bit quicker in rooms (which improved towards the end of the rotation). At the end of the rotation the PD said that I did great, and couldn't think of any areas that I needed to focus on to improve.

I received my evaluation back yesterday for the program and one of the comments has me concerned about the strength of the SLOE from this program. "sometimes does not develop a good initial rapport with pt's, families, & staff." Also my grade for this rotation was only a Pass. Clearly I am blind sided.

The rest of my application I feel is strong (with the exception of my Step 1 score). Comlex 1 588, Comlex 2 599. USMLE1 212, USMLE2 254. Leadership on the school level and national level. Applied to 21 DO and 58 MD.

How much would a poor SLOE hurt my chances if the rest of my application is strong? Does anyone know of a way to pull that letter back, because I have another letter that I know is stronger available to use for applications?

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[FallingFromSpace]

Will it hurt you? Possibly. The letter itself may or may not- just because the evaluation you received had that comment doesn't mean it's on your SLOE. Unfortunately, the passing score will hurt you. Your step 2 is fantastic, and you've applied to a good number of programs, but the pass may be a red flag, your step 1 is on the low end, and as a DO you're already at a disadvantage. I actually had a friend in medical school with the same situation- smart, nice, great applicant, STEPs in the 240s, but she had an away at the wrong place and wound up in the same situation: good feedback, told she'd done really well, no advice for improvement, but 2 weeks later she got a pass on a letter she'd already sent. Didn't match, scrambled into a prelim. On the other hand, she'd only applied to 35 programs to start and her third letter came late in the game.

Unfortunately, once a letter's assigned and you've paid the application fee, there's no way to rescind it- it's already been sent to the school. Two things that you can do- 1) if you have a letter you know is better that hasn't yet been sent to those schools, and you haven't reached the cut-off of four letters then you should send it out as well. 2) If you're really concerned, you can apply to additional programs and not send that letter. It's not a great situation, I know, but unfortunately that's how the cards fell. Good luck.

 

[Chest Tube]

I am in the same boat - I have my fingers crossed it will all work out in the end.

 

[Doctor Bob]

Here's the thing about a SLOE.

When they are filled out honestly, some people have to get a poor one. The SLOE is a comparison of you to previous people who have rotated through the program. So, if you go somewhere where they had a bunch of rockstars last year, then through no fault of your own, you'll get a mediocre SLOE.

 

[DO2016EM]

How would you know you have a good SLOE or poor SLOE? I feel like a lot of it is subjective feeling after your rotation, as I have not seen any of mine. Are we basically equating a Pass grade to correlate with a poor to mediocre SLOE? Do some programs actually tell rotators whether or not their SLOE will be strong?

 

[Doctor Bob]

How would you know you have a good SLOE or poor SLOE? I feel like a lot of it is subjective feeling after your rotation, as I have not seen any of mine. Are we basically equating a Pass grade to correlate with a poor to mediocre SLOE? Do some programs actually tell rotators whether or not their SLOE will be strong?

You can ask the PD.
But look at what is asked on the SLOE.
There are a bunch of questions that break people into thirds. So a conscientious form completer should have 1/3 of the people in the top group, a third in the middle, and a third in the bottom.

With questions like "Compared to other EM residency candidates you have recommended in the last academic year, this candidate is in the..." and "How highly would you estimate the candidate will reside on your rank list?", there will be people that are not going to be in the top. And that's just how it is.

End-of-rotation evaluations have been prone to horrendous grade inflation for years. Everyone "exceeds expectations" and gets all 5's out of 5. So they're somewhat meaningless. The SLOE is designed for PDs to tell other PDs how this candidate is in relation to other people. In an ideal situation, everyone would rotate at every institution so PDs could evaluate them. But that can't happen. So the SLOE acts as a surrogate. It is potentially prone to the same grade inflation as end-of-rotation evaluations but if that happened it would render the document useless. So PDs take great care to be honest and accurate in their objective rankings. Because it's what they want to see on the SLOE as well.

 

[Vandalia]

"Well, that's the news from Lake Wobegon, where all the women are strong, all the men are good looking, and all the children are above average."

If you are an average candidate - and the is nothing wrong with that - your eval will say you are not perfect and you will have some bottom third rankings.

Welcome to the real world. Up to this point, you have probably been at the top of everything you have done - at least in the academic world. Now that you are competing against people as good as you, it is almost certain you will not get universal top marks anymore. Especially since it seems like progress is being made to get more accurate evaluations. Not everyone can be above average.

 

[Makati2008]

I rotated at a hospital that shall remain nameless and received an SLOE from them. Based on the feedback that I received during the rotation (after shifts and talking to the PD at the very end of the rotation) I assigned the SLOE to programs prior to my evaluation coming in. All of the feedback I received was positive, I had a very strong knowledge base and formed good differentials and plans. I could work on being a little bit quicker in rooms (which improved towards the end of the rotation). At the end of the rotation the PD said that I did great, and couldn't think of any areas that I needed to focus on to improve.

I received my evaluation back yesterday for the program and one of the comments has me concerned about the strength of the SLOE from this program. "sometimes does not develop a good initial rapport with pt's, families, & staff." Also my grade for this rotation was only a Pass. Clearly I am blind sided.

The rest of my application I feel is strong (with the exception of my Step 1 score). Comlex 1 588, Comlex 2 599. USMLE1 212, USMLE2 254. Leadership on the school level and national level. Applied to 21 DO and 58 MD.

How much would a poor SLOE hurt my chances if the rest of my application is strong? Does anyone know of a way to pull that letter back, because I have another letter that I know is stronger available to use for applications?

I know of two programs that will not interview folks with a Pass. I think you have a good shot though overall. I would just work to improve performance and have an explanation on why you think you performed at a level that got you a pass and how you rectified it.

 

[wonderbread12]

This is why I think the SLOE process will always be too subjective no matter how standardized it is supposed to be. You MAYBE see how one or two attendings actually score you on whatever scoring system (1-5, 1-10) they have. These scores are way to important for docs to be too chicken to show us. I rather see in order to improve and know what it takes to get higher marks. Making it all secretive and not showing students makes it impossible to improve and do stellar.

On a side note, if I hear one more EM doc say "continue to do more re-evaluations of your patient" I think i'll lose my mind. If I did it any more the patient would think I'm a stalker. Just because you cannot think of anything good to say as constructive criticism certainly does not mean you need to make me out to look as if I ignore my patients.

 

[emtthink]

Thank you all for the advice. I do have another letter from a county program that I can use. I was hoping that since this was an academic program and the PD made it sound like I did well that it would help me out even more. I'm assuming it is stronger on that one based on the rotation evaluation. I will also have a letter from an ACGME program that I will be assigning to programs as well.

 

[emtthink]

And I understand that someone has to be in the bottom/middle of the pack. What frustrates me is that the program was not willing to be honest with me when I asked that what I should be working on to improve my performance, and being lied to when I was told I was doing fine

 

[racerwad]

The one other thing to consider, especially as you are now going to start heading out to interviews, is...personality. Your scores suggest that you know the material well and the comment that concerned you had less to do with your knowledge base and more about how you are perceived (not necessarily how you are!). For better or for worse, this was some of the feedback you got belatedly and now is the time to work on it. We all know that first impressions are super important, especially for interviews. Try and figure out why someone might say, "sometimes does not develop a good initial rapport with pt's, families, & staff." Your reviewer did not suggest that this was an all the time issue, but clearly it happened enough and with all manner of people (compared to your peers) that they felt it worth mentioning. Don't take it personally, but rather approach it like any other challenge. Good luck!

 

[Arcan57]

The one other thing to consider, especially as you are now going to start heading out to interviews, is...personality. Your scores suggest that you know the material well and the comment that concerned you had less to do with your knowledge base and more about how you are perceived (not necessarily how you are!). For better or for worse, this was some of the feedback you got belatedly and now is the time to work on it. We all know that first impressions are super important, especially for interviews. Try and figure out why someone might say, "sometimes does not develop a good initial rapport with pt's, families, & staff." Your reviewer did not suggest that this was an all the time issue, but clearly it happened enough and with all manner of people (compared to your peers) that they felt it worth mentioning. Don't take it personally, but rather approach it like any other challenge. Good luck!

That's truly radical thinking that feedback should be used for identifying and working on areas needing improvement and not just a reflection of someone's arbitrary desire to screw you over. Also, reassessing your patient means knowing at every moment where everyone you are caring for in the ED is at in terms of their work up and when they are going to be appropriate for disposition. If I ask you how a patient is doing, the outstanding student is going to be able to wake me through the timeline of the patient's remaining stay and reasons for any delays.

 

[gman33]

A pass is a poor grade for a student going into EM.
That's the grade you give to someone going into Derm at the end of the year who obviously doesn't care.
There must be a reason you got that grade. I'd be concerned about that more than a few individual comments.
Just think about whatever feedback you got, and use it to improve.

How much will it hurt you? Who knows?

If you are concerned, send out applications to every program in existence.

 

[gro2001]

If you are concerned, send out applications to every program in existence.

That's clearly not enough. If the OP is REALLY concerned, he should also send out applications to programs not yet in existence and to previously existing programs, now defunct.

 

[StephBee]

I rotated at a hospital that shall remain nameless and received an SLOE from them. Based on the feedback that I received during the rotation (after shifts and talking to the PD at the very end of the rotation) I assigned the SLOE to programs prior to my evaluation coming in. All of the feedback I received was positive, I had a very strong knowledge base and formed good differentials and plans. I could work on being a little bit quicker in rooms (which improved towards the end of the rotation). At the end of the rotation the PD said that I did great, and couldn't think of any areas that I needed to focus on to improve.

I received my evaluation back yesterday for the program and one of the comments has me concerned about the strength of the SLOE from this program. "sometimes does not develop a good initial rapport with pt's, families, & staff." Also my grade for this rotation was only a Pass. Clearly I am blind sided.

The rest of my application I feel is strong (with the exception of my Step 1 score). Comlex 1 588, Comlex 2 599. USMLE1 212, USMLE2 254. Leadership on the school level and national level. Applied to 21 DO and 58 MD.

How much would a poor SLOE hurt my chances if the rest of my application is strong? Does anyone know of a way to pull that letter back, because I have another letter that I know is stronger available to use for applications?

The one thing I will say that may be your saving grace is that part of the sloe is how many of each grade do they typically give out. If it's a program that only gives HP or Honors to like 1 person a year, it may not be viewed as negatively. Of course, unless you know a lot of peeps who have rotated there and their grades, you just won't know that. But I had a program that I rotated through that flat out said that unless you could completely replace a resident, you wouldn't get an honors. (and I rotated at this during 3rd year so obv I didn't honors it).
PD have a habit of knowing if it is a program that always is harsh in its grading. You did the right thing by applying broadly, so I suspect you'll end up somewhere. Good luck!

 

[Chir0nex]

The one thing I will say that may be your saving grace is that part of the sloe is how many of each grade do they typically give out. If it's a program that only gives HP or Honors to like 1 person a year, it may not be viewed as negatively. Of course, unless you know a lot of peeps who have rotated there and their grades, you just won't know that. But I had a program that I rotated through that flat out said that unless you could completely replace a resident, you wouldn't get an honors. (and I rotated at this during 3rd year so obv I didn't honors it).
PD have a habit of knowing if it is a program that always is harsh in its grading. You did the right thing by applying broadly, so I suspect you'll end up somewhere. Good luck!

Adding to this, there is room for comments. i know students who have been explicitly told that they would have honored except there particular rotation/last year was exceptionally strong and they got bumped down. It sucks, but at the same time they got good comments on the sloe.