Away Rotations to Avoid (that blindside you with SLOEs)

[Status Sciaticus]

Since I have been perusing through the 15-16 and 16-17 EM application and ROL threads for a while, I kept seeing many people from last year who were totally blindsided by their SLOEs when they thought they were doing well ( and received verbal feedback to that effect). However, they were blindsided by receiving a crappy SLOE that led to less interviews than they deserved.

Now that many are are already in their first year, would any of you share which programs did that so we as MS4s can avoid shooting ourselves in the foot?

You can also PM it to me and I can post it if you want to maintain anonymity.

People said to avoid:
UTH x3
UNLV x2
MetroHealth x1
Denver x3
LSUNO x1
Cook x1
Palmetto Health Richland x1
Texas A&M Scott & White x1

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[Petypet]

ballsy

 

[Status Sciaticus]

ballsy

How so? Wanting to be graded equitably for your work doesnt sound ballsy to me.

 

[CliveStaples]

There are natural limitations to the usefulness of this information. First, since these are letters of evaluation (not recommendation) it is necessary that 1/3 of people receiving SLOEs from an institution receive "bottom 1/3" grades (which is the lowest rating you can receive) and naturally everybody who receives these scores is going to be disappointed with them. Second, since we waive our rights to see these letters in their entirety, we are left trying to determine how strong our letters are based on secondhand information we receive from programs during interviews or our home program (if they are transparent). We also need to keep in mind that even bottom 1/3 evaluations are people who will very likely match into EM. Program directors do keep that information in mind.

Everybody doing an away at a reputable program is probably a very intelligent person. 1/3 of them will still be the bottom 1/3, regardless of their verbal feedback. You can get "good job" but if your other two peers get "great job" you're still the bottom 1/3.

 

[Cinematographer]

Please refer to something I said on the away rotations thread: for every negative experience there are probably 9 positive ones. So, unless you see a regular pattern of multiple negative experiences at xyz program, then I would take anonymous, negative reviews with a grain of salt.

 

[emergencythrowaway201717]

Made a new throwaway account specifically for this. Will post specific details once match lists are submitted but want to comment on why I think this thread is long overdue.

I believe there is enormous value in this thread. There needs to be, by definition, a bottom 1/3 group. But this should not be a surprise to applicants after they apply. I agree that courtesy interviews are a waste for both parties, but honest feedback is a minimum courtesy a program should offer to their students. If you are told you are doing a good job and no issues are brought up, then you shouldn’t be getting a bottom 1/3 eval. Bottom 1/3 means something has to be "bad". If all applicants are so amazing, then the bar is set higher and you should be told what areas you are lacking in. Otherwise it becomes a matter of popularity rather than objective skill. When a program gives dishonest feedback in the form of a blindside bad SLOE (which can be deduced from a combination of invite mix and comments on the trail) in spite of no negative verbal feedback, it hurts a candidate since it prevents them from knowing where they stand with the application. This leads to many people over/under applying because they don’t know where they really stand. A platform for applicants to know which programs have a history of doing this is valuable to applicants so that they can be more informed in choosing where to do aways. This serves as proof of concept that a program has blindsided people before. Obviously there will always also be people who have had good experiences with these programs. This isn’t just about “I got a bad letter”, but about there being deeper issues with the rotation/feedback leading to the bad letter.

Most of us don’t have to deal with this so its easy to say that its an anomaly. Those who experienced it know how frustrating it can be to be sitting on only a few invites despite an otherwise solid app.

 

[bananasinpijamas]

I understand your anxiety over this, but this is not going to help you. At any given place, they will rank 1/3 very highly and the rest are kind of lukewarm/cold/not very good. Even those places where someone apparently got some very unfair SLOE, it could have been one person who just hated his guts and not the most fair representation of that program. When applying for aways, look for places you would like to work at since you are also checking them out and trying to find out what you want in a program. SO, don't stop yourself going to somewhere like Denver because 1/100 of rotators had a bad SLOE. And also do not go to a program you don't care about just because everyone gets a good SLOE there (don't think that would be a real place).
ALSO keep in mind that what people call a bad SLOE sometimes is just a high pass or a pass, which is the average SLOE. Best thing to do is to have a good attitude and ask from the very beginning how you can get some feedback throughout the rotation.

 

[EMhopeful2017]

I don't think yall understand the point of this thread. There are certain places out there that only honor one or two people per year (one of them that is on the list). Is that okay? Debateable, but why rotate at a place that honors so few people? At that point it's less to do with your personal performance and more to do with luck.

 

[EMapplicant2017]

I don't think yall understand the point of this thread. There are certain places out there that only honor one or two people per year (one of them that is on the list). Is that okay? Debateable, but why rotate at a place that honors so few people? At that point it's less to do with your personal performance and more to do with luck.

Basically the competitive/famous programs with a huge number of students applying to rotate are those tougher to honors.

Denver, Cook, Highland are a few that I've heard or known. Just to name a few...

 

[bananasinpijamas]

SLOE-writing institutions are supposed to abide by the rule of thirds for "ranking" the applicant within the SLOE. I have made it through the interview trail, conferences, and speaking to plenty of people and have never heard of such a place that just honors a couple people. I know of places with P/NP only, and it does not affect the application negatively for having a "P" only.
Those competitive places mentioned above honor the same percentage of people as other programs but you may be competing against "better/smarter" applicants or just being graded with higher standards and therefore harder to honor despite doing good work. Also, places like Highland or Denver have 5-10X as many rotators as your average EM program, so higher number of "unfortunate" SLOEs are going to come from those places. If people want to play it safe, then maybe they should avoid all big-name programs, but then I think where you get your SLOEs matters a bit.

 

[EMhopeful2017]

SLOE-writing institutions are supposed to abide by the rule of thirds for "ranking" the applicant within the SLOE. I have made it through the interview trail, conferences, and speaking to plenty of people and have never heard of such a place that just honors a couple people. I know of places with P/NP only, and it does not affect the application negatively for having a "P" only.
Those competitive places mentioned above honor the same percentage of people as other programs but you may be competing against "better/smarter" applicants or just being graded with higher standards and therefore harder to honor despite doing good work. Also, places like Highland or Denver have 5-10X as many rotators as your average EM program, so higher number of "unfortunate" SLOEs are going to come from those places. If people want to play it safe, then maybe they should avoid all big-name programs, but then I think where you get your SLOEs matters a bit.

well then you need to talk to more people, or different people

 

[Status Sciaticus]

Please refer to something I said on the away rotations thread: for every negative experience there are probably 9 positive ones. So, unless you see a regular pattern of multiple negative experiences at xyz program, then I would take anonymous, negative reviews with a grain of salt.

Yes I have read your away rotation threads several times. In fact, I made my away list based on those reviews. I agree that SDN has a self selection bias where people who did very well or very poorly will tend to report it and get polarized reviews. However, the point of this thread is not to see where they get a negative SLOE from. Its to see where they get a negative SLOE from where the faculty and residents led the student to believe they were doing well.

I understand your anxiety over this, but this is not going to help you. At any given place, they will rank 1/3 very highly and the rest are kind of lukewarm/cold/not very good. Even those places where someone apparently got some very unfair SLOE, it could have been one person who just hated his guts and not the most fair representation of that program. When applying for aways, look for places you would like to work at since you are also checking them out and trying to find out what you want in a program. SO, don't stop yourself going to somewhere like Denver because 1/100 of rotators had a bad SLOE. And also do not go to a program you don't care about just because everyone gets a good SLOE there (don't think that would be a real place).
ALSO keep in mind that what people call a bad SLOE sometimes is just a high pass or a pass, which is the average SLOE. Best thing to do is to have a good attitude and ask from the very beginning how you can get some feedback throughout the rotation.

As I mentioned above, the point of this thread is not to see where they get a negative SLOE from. Its to see where they get a negative SLOE from where the faculty and residents led the student to believe they were doing well. If your faculty/residents do not offer you feedback on where you can improve because they say you're doing a great job, then its natural to take it as you being in the top 1/3. If they tell you that you need to improve on 1, 2, and 3, then you can actually take steps to improve on your deficiencies, rather than go with your limited understanding of what an honors entails in their mind. We're not mind readers after all.

Secondly, I understand that someone has to be in the bottom 1/3, but you should know how you stack up based on how your colleagues are doing compared to yourself. Places like Hennepin and Indiana provide you with daily oral and written feedback that allows you to tangibly understand your deficiencies that you can improve on the next day, whereas if you receive no constructive criticism, then you would naturally assume there are not any in the minds of your evaluators, and thus should manifest in a great SLOE.

When you have your department staff telling you to avoid certain places, then its not just one or two or even a handful of bad evaluations from an institution, its a pattern.

 

[bananasinpijamas]

.

 

[Whiteshoes]

Unfortunately the Standardized Letter of Evaluation is anything but standardized. This whole process of figuring out which places to avoid or goto is so subjective. All it takes is 1 faculty & 1 shift to hinder 4+ years of hard work towards your goals.

On the other hand, I recall at one of my aways where a student handed his daily eval to an attending and then left for the day. The attending and resident openly discussed all his rookie mistakes & pretty subpar to average performance for the day. Then when filling out the form the resident asked the attending "how come you gave him an above average to great feedback and didn't put down any of the mistakes in the "needs improvement" section?" Then the attending replied, "Well see, if I put that down on your (the resident) eval you'll still have a job, might barely affect you at all. If I put that on his (student's) eval then that little simple honest mistake due to just being a novice learner gets written in stone, can get interpreted by a PD as the student being incompetent, and it might affect his chances of finding a job, change his life/career forever".

That was kind of the attending to take all that into consideration but that just proved to me how subjective this system is. Then I've also heard of those "malignant" faculty/programs which have more attendings who are very reassuring and nice to the student but then very critical in their evaluations.

If I was your average MS3 reading all this and there are trends or rumors/sdn say "avoid so and so program" even if the sample size is small I wouldn't wanna risk my future career on it.

Anyways, I think it's best to ask the MS4's at your school which places to avoid since most ppl are regionally looking at the same programs as the class above them.

 

[racerwad]

Yes I have read your away rotation threads several times. In fact, I made my away list based on those reviews. I agree that SDN has a self selection bias where people who did very well or very poorly will tend to report it and get polarized reviews. However, the point of this thread is not to see where they get a negative SLOE from. Its to see where they get a negative SLOE from where the faculty and residents led the student to believe they were doing well.

As I mentioned above, the point of this thread is not to see where they get a negative SLOE from. Its to see where they get a negative SLOE from where the faculty and residents led the student to believe they were doing well. If your faculty/residents do not offer you feedback on where you can improve because they say you're doing a great job, then its natural to take it as you being in the top 1/3. If they tell you that you need to improve on 1, 2, and 3, then you can actually take steps to improve on your deficiencies, rather than go with your limited understanding of what an honors entails in their mind. We're not mind readers after all.

Secondly, I understand that someone has to be in the bottom 1/3, but you should know how you stack up based on how your colleagues are doing compared to yourself. Places like Hennepin and Indiana provide you with daily oral and written feedback that allows you to tangibly understand your deficiencies that you can improve on the next day, whereas if you receive no constructive criticism, then you would naturally assume there are not any in the minds of your evaluators, and thus should manifest in a great SLOE.

When you have your department staff telling you to avoid certain places, then its not just one or two or even a handful of bad evaluations from an institution, its a pattern.

I think the bolded is a key limitation in your understanding of how anyone is evaluated. Just because no one has any issues or constructive criticism does not mean you are in the "top 1/3" and that "should manifest in a great SLOE." It actually just means you are average. You have done nothing to require correction and have done nothing to set yourself apart from the others. You just are there. Moreover, you'd be surprised how big the gulf is between the best and the middle. Unfortunately, a lot of is intangible and varies between programs and between applicants. I have definitely worked with a few students in my limited time that were amazing on paper, clinically competent in real life, Honored the rotation, and still were in the middle to lower thirds on our program's SLOEs.

All anyone can do is their best and hope that things work out in your favor. For some of us, it won't.

It takes quite a bit more than just one bad eval to sink an entire rotation. That doesn't even usually make rise to the level of consideration on the part of the letter writer. If all the other evals are good, the writer knows to consider the bad one an outlier. Our program goes so far as to evaluate how interviewers tend to score applicants and their historic biases and weigh them accordingly when calculating interview scores. The same cares goes into our SLOES (and I'm sure this is true for other places).

When med school started, it took some of us by surprise that we were now the dumb kids. The same holds true for this phase of life as well. Some of us are not as amazing as our Moms tell us we are. Also, for students that are told not to go certain places, it might because your school knows that you, not the program, might be the issue, just like when my mom told my short, lazy adolescent self to focus on school rather than hope for an athletic scholarship.

Finally, why on earth would anyone even want to match at any of these above programs if you can't trust them to mentor and evaluate you during a key part of your training as a med student? Either the premise of the OP's claim is false, or those programs do a disservice to their residents. I think it is pretty obvious what the answer is.

 

[emergencythrowaway201717]

I think the bolded is a key limitation in your understanding of how anyone is evaluated. Just because no one has any issues or constructive criticism does not mean you are in the "top 1/3" and that "should manifest in a great SLOE." It actually just means you are average. You have done nothing to require correction and have done nothing to set yourself apart from the others. You just are there. Moreover, you'd be surprised how big the gulf is between the best and the middle. Unfortunately, a lot of is intangible and varies between programs and between applicants. I have definitely worked with a few students in my limited time that were amazing on paper, clinically competent in real life, Honored the rotation, and still were in the middle to lower thirds on our program's SLOEs.

All anyone can do is their best and hope that things work out in your favor. For some of us, it won't.

It takes quite a bit more than just one bad eval to sink an entire rotation. That doesn't even usually make rise to the level of consideration on the part of the letter writer. If all the other evals are good, the writer knows to consider the bad one an outlier. Our program goes so far as to evaluate how interviewers tend to score applicants and their historic biases and weigh them accordingly when calculating interview scores. The same cares goes into our SLOES (and I'm sure this is true for other places).

When med school started, it took some of us by surprise that we were now the dumb kids. The same holds true for this phase of life as well. Some of us are not as amazing as our Moms tell us we are. Also, for students that are told not to go certain places, it might because your school knows that you, not the program, might be the issue, just like when my mom told my short, lazy adolescent self to focus on school rather than hope for an athletic scholarship.

Finally, why on earth would anyone even want to match at any of these above programs if you can't trust them to mentor and evaluate you during a key part of your training as a med student? Either the premise of the OP's claim is false, or those programs do a disservice to their residents. I think it is pretty obvious what the answer is.

I would argue this is the root of the problem in mentality. Some people want to be "WOWed", which becomes subjective. Call it intangibles, but if it can't be put it into words then its either the evaluator not being able to give feedback properly(which is a problem) or its just cognitive dissonance over putting how much someone is liked into a quality measure. The point of the SLOE is to comment on quality. If someone is doing everything right, they shouldn't get a lukewarm SLOE. And vice versa, a great SLOE shouldn't be a popularity contest. It should be about objective measures, not gut feelings which can be influenced by any number of confounders.

A lot of blame is being put on the student but programs don't really want to face how subjective the process is. I don't mean to pick on one poster by any means. I just think this comment exemplifies a mindset that leads to the general problem here.

 

[GonnaBeADoc2222]

I have definitely worked with a few students in my limited time that were amazing on paper, clinically competent in real life, Honored the rotation, and still were in the middle to lower thirds on our program's SLOEs.

I get a laugh when I think about these programs arguing over which great student is better then whom. It reminds me of debates you hear on sports talk TV shows about who's better: Normar vs Jeter, Brady vs Rogers.

Sometimes a good player is a good player and you'd be lucky to have any of them join your team.

 

[CliveStaples]

I would argue this is the root of the problem in mentality. Some people want to be "WOWed", which becomes subjective. Call it intangibles, but if it can't be put it into words then its either the evaluator not being able to give feedback properly(which is a problem) or its just cognitive dissonance over putting how much someone is liked into a quality measure. The point of the SLOE is to comment on quality. If someone is doing everything right, they shouldn't get a lukewarm SLOE. And vice versa, a great SLOE shouldn't be a popularity contest. It should be about objective measures, not gut feelings which can be influenced by any number of confounders.

A lot of blame is being put on the student but programs don't really want to face how subjective the process is. I don't mean to pick on one poster by any means. I just think this comment exemplifies a mindset that leads to the general problem here.

I don't want to come across as sounding insensitive because I really do understand the place you're coming from. But being evaluated subjectively based in part on how you make your evaluator/colleagues "feel" is how we are going to be evaluated for the rest of our careers. You call it a popularity contest, and I call it a cultivated skill set.

The good news is that it's not just one category that you're evaluated, and the SLOE has clearly defined categories where you score people. Meaning that it's asking them objectively in different categories how the student performed. None of the categories are "how cool was this student."

Again, we get back to the problem that some people feel like "doing everything right" should earn top 1/3 scoring. Scoring isn't based on how well you do in a vacuum, but how well you do relative to your peers. Yes, it would be great if preceptors would tell the "average" rotator how to elevate their performance, but if they tell everybody how to do it then it becomes the average performance again, now doesn't it

 

[emergencythrowaway201717]

I don't want to come across as sounding insensitive because I really do understand the place you're coming from. But being evaluated subjectively based in part on how you make your evaluator/colleagues "feel" is how we are going to be evaluated for the rest of our careers. You call it a popularity contest, and I call it a cultivated skill set.

The good news is that it's not just one category that you're evaluated, and the SLOE has clearly defined categories where you score people. Meaning that it's asking them objectively in different categories how the student performed. None of the categories are "how cool was this student."

Again, we get back to the problem that some people feel like "doing everything right" should earn top 1/3 scoring. Scoring isn't based on how well you do in a vacuum, but how well you do relative to your peers. Yes, it would be great if preceptors would tell the "average" rotator how to elevate their performance, but if they tell everybody how to do it then it becomes the average performance again, now doesn't it

You don't come off as insensitive (at least not to me). I'm not offended by the fact that life is unfair etc. etc. I get it, its part of the game as it is now.

My argument is that it shouldn't be this way cause its not what should be evaluated which is medical knowledge and skill. By the same logic, people get discriminated against every day, but the fact that it happens doesn't make it ok. I'm not bitter about my situation. I interviewed at some awesome programs and I'll be ok. But I think applicants deserve more transparency in how things are done and that's where threads like this come in. Its great to have this discussion about programs that do these things here cause it gives applicants the option to know what they're walking into. Having this database out there gives some power back to the students.

We have this mantra in medical education that medicine is more than just knowledge (which is the part I agree with) and therefore we need to rely on subjective evaluation. But there is no good evidence base that this subjective evaluation predicts real outcomes. At best, it predicts future subjective evaluation (there was a study showing a correlation between subjective M3 grades and step 2 scores and subjective PD evals of residents a couple of years ago I believe). And yet, we treat this assumption as absolute fact.

And as far as telling people what they are doing wrong and how to fix it, that's the job of an educator. It shouldn't be some social mind reading game. If you don't want to help your students figure out how to improve, you need to rethink whether you should be in academics. Medicine is tough as it is and it should be about how well we can do things and how much we know. Not about figuring out what looks good, even if looking good is empirically important in life.

 

[WildcatS11]

Basically the competitive/famous programs with a huge number of students applying to rotate are those tougher to honors.

Denver, Cook, Highland are a few that I've heard or known. Just to name a few...

Cook county is actually notorious for giving everyone honors. To a point that its eyebrow raising if someone DOESNT honor their cook away.

 

[Apollyon]

See, what I wait for is some med student to sue because they didn't get honors. Then, programs will all be snake bit, and all SLOEs will become worthless.

 

[tux4]

You don't come off as insensitive (at least not to me). I'm not offended by the fact that life is unfair etc. etc. I get it, its part of the game as it is now.

My argument is that it shouldn't be this way cause its not what should be evaluated which is medical knowledge and skill. By the same logic, people get discriminated against every day, but the fact that it happens doesn't make it ok. I'm not bitter about my situation. I interviewed at some awesome programs and I'll be ok. But I think applicants deserve more transparency in how things are done and that's where threads like this come in. Its great to have this discussion about programs that do these things here cause it gives applicants the option to know what they're walking into. Having this database out there gives some power back to the students.

We have this mantra in medical education that medicine is more than just knowledge (which is the part I agree with) and therefore we need to rely on subjective evaluation. But there is no good evidence base that this subjective evaluation predicts real outcomes. At best, it predicts future subjective evaluation (there was a study showing a correlation between subjective M3 grades and step 2 scores and subjective PD evals of residents a couple of years ago I believe). And yet, we treat this assumption as absolute fact.

And as far as telling people what they are doing wrong and how to fix it, that's the job of an educator. It shouldn't be some social mind reading game. If you don't want to help your students figure out how to improve, you need to rethink whether you should be in academics. Medicine is tough as it is and it should be about how well we can do things and how much we know. Not about figuring out what looks good, even if looking good is empirically important in life.

You are absolutely right. It should not be this way. But people have to understand that it is this way for a lot of people filling out these evals and you have to prepare accordingly. From my aways I gathered a few important points that seemed universal in what the attendings/residents wanted from me:

Eagerness, good differential of what will kill you first, teachability, helping ED workflow whenever possible (wheeling patients/doing IV's/etc), showing up on time for your shift, and can hold a normal conversation/shoot the sh** with them.

All of the above except the last should come natural over the course of the rotation if you have a genuine interest in the field and want to learn. The last point can be difficult at times depending on yours and their personality and it sucks but if you do all the other stuff above (especially help move the room) they will like you and it results in a good eval. You have to play the game.


Sent from my iPhone using SDN mobile app

 

[emergencythrowaway201717]

O

You are absolutely right. It should not be this way. But people have to understand that it is this way for a lot of people filling out these evals and you have to prepare accordingly. From my aways I gathered a few important points that seemed universal in what the attendings/residents wanted from me:

Eagerness, good differential of what will kill you first, teachability, helping ED workflow whenever possible (wheeling patients/doing IV's/etc), showing up on time for your shift, and can hold a normal conversation/shoot the sh** with them.

All of the above except the last should come natural over the course of the rotation if you have a genuine interest in the field and want to learn. The last point can be difficult at times depending on yours and their personality and it sucks but if you do all the other stuff above (especially help move the room) they will like you and it results in a good eval. You have to play the game.


Sent from my iPhone using SDN mobile app

Or sometimes you do all that and still no dice. There is an element of randomness and luck. It evens out over the large applicant pool but can totally mess with your individual app. Then add the fact that different places have different grade distributions or are known for writing lukewarm vs fluffy SLOES and a system that was supposed to introduce some objectivity into the mix ends up being a game of Russian roulette that applicants have to play with their careers.

 

[racerwad]

I would argue this is the root of the problem in mentality. Some people want to be "WOWed", which becomes subjective. Call it intangibles, but if it can't be put it into words then its either the evaluator not being able to give feedback properly(which is a problem) or its just cognitive dissonance over putting how much someone is liked into a quality measure. The point of the SLOE is to comment on quality. If someone is doing everything right, they shouldn't get a lukewarm SLOE. And vice versa, a great SLOE shouldn't be a popularity contest. It should be about objective measures, not gut feelings which can be influenced by any number of confounders.

A lot of blame is being put on the student but programs don't really want to face how subjective the process is. I don't mean to pick on one poster by any means. I just think this comment exemplifies a mindset that leads to the general problem here.

You make good points and I think I did not explain myself as well as I could have. Evaluators are "wowed" when they see a student who has the skills and knowledge and puts them into use better than anyone else. Personality has something to do with it, but it is not simply a popularity contest. On the SLOEs that I have read, as you astutely pointed out, there is no place for the discussion of intangibles. But simply because they did everything right and nothing "wrong" does not mean they deserve Honors or anything more than comments like, "did well, no problems." A great SLOE usually describes someone who not only does better than this imaginary student, but does it either more quickly, more efficiently, or some other superlative in comparison.

You say blame, but I think it is responsibility. The programs have hundreds of qualified applicants that we can rank and review based solely on objective criteria, but no one would want that. Being able to put the intellectual horsepower students have displayed through their board scores and grades is the key to success on rotations and is the student's responsibility alone. I agree that programs should be honest and provide high quality feedback in real time.

I get a laugh when I think about these programs arguing over which great student is better then whom. It reminds me of debates you hear on sports talk TV shows about who's better: Normar vs Jeter, Brady vs Rogers.

Sometimes a good player is a good player and you'd be lucky to have any of them join your team.

We definitely have had conversations like this and I'd be surprised if we are the only ones. We don't want just the good ones - we want the good ones that are also a good fit and it's worth the time to talk about it.

 

[alpinism]

See, what I wait for is some med student to sue because they didn't get honors. Then, programs will all be snake bit, and all SLOEs will become worthless.

Which would be the ultimate irony since the specialty of EM itself is now guided by reducing your risk of lawsuits rather than providing honest feedback to patients.

 

[mega_colon]

My $0.02...The SLOE is meant to be an objective evaluation similar to deans letters, step scores, etc.

The difference is things like step scores and deans letters are known quantities in your application. If I know i have a 205 step then my application strategy will be very different than if I have 260s.

The problem is that SLOEs are so critical to your app and at the same time you waive your right to see them. It is similar to applying without knowing your step scores.

It really doesnt make sense to have people apply with really very little knowledge of their competitiveness based on SLOEs.

I think if it were culturally acceptable to know what was in your SLOEs, students would have a better idea how competitive they are and adjust their application strategy accordingly.

 

[Aonyx]

The first place I rotated at I felt like I got almost no feedback from and had no idea what my SLOE would look like and I ended up getting apparently very high marks and honored the rotation.

The second place I was at I worked my butt off and sent my evaluations to both the resident and attending (electronically) and asked for verbal feedback whenever I had the chance. Generally, the feedback I got was really positive. I came to find out halfway through the rotation that none of my previously sent evaluations could have been completed because there was an issue with the program that my evaluations had no receptacle for them to be turned in to. Clearly this was a mistake that happened somewhere that affected me and only me (out of 14 rotators). The chief resident helped me out by trying to get my original evaluators to fill out my evaluations again, but obviously if I only worked with that person one time 2 weeks ago they might not remember me that well. Without that hard feedback, I have no idea how I did on the rotation, but given I continued to get interviews after I assigned the SLOE, I guess it couldn't have been but so bad, and I can hope that my 3rd SLOE would demonstrate that whatever was on the 2nd one was an exception, rather than the norm. It just seemed like a situation where I did everything seemingly right, but got messed up by something out of my control. I was grateful for the help of the chief resident, but it was still pretty disappointing.

In the end, you just have to do your best. Be there on time, seem interested and enthusiastic, and dont complain. Try to do a good presentation, but it can be hard to nail down exactly what your particular resident or attending wants especially if you're doing multiple aways and multiple attendings. Try to control the things you can.

 

[CliveStaples]

My $0.02...The SLOE is meant to be an objective evaluation similar to deans letters, step scores, etc.

The difference is things like step scores and deans letters are known quantities in your application. If I know i have a 205 step then my application strategy will be very different than if I have 260s.

The problem is that SLOEs are so critical to your app and at the same time you waive your right to see them. It is similar to applying without knowing your step scores.

It really doesnt make sense to have people apply with really very little knowledge of their competitiveness based on SLOEs.

I think if it were culturally acceptable to know what was in your SLOEs, students would have a better idea how competitive they are and adjust their application strategy accordingly.

Now that I can agree with. If you just made it to where SLOEs got sent out whether you wanted to or not (like you HAVE to get a SLOE if you do a rotation and it MUST be uploaded) then it would surely be acceptable for you to read your own letter and thus more accurately gauge your competitiveness. However, we will always be expected to waive our rights to read the letter if we could choose not to upload a letter.

 

[racerwad]

My $0.02...The SLOE is meant to be an objective evaluation similar to deans letters, step scores, etc.

The difference is things like step scores and deans letters are known quantities in your application. If I know i have a 205 step then my application strategy will be very different than if I have 260s.

The problem is that SLOEs are so critical to your app and at the same time you waive your right to see them. It is similar to applying without knowing your step scores.

It really doesnt make sense to have people apply with really very little knowledge of their competitiveness based on SLOEs.

I think if it were culturally acceptable to know what was in your SLOEs, students would have a better idea how competitive they are and adjust their application strategy accordingly.

I agree with the sentiment but I can see why programs would still want to keep certain portions of the SLOEs confidential. I think that the narrative portions should be available for student review for the reasons you mentioned. It would also serve to keep the commentators honest if they knew that their comments, even anonymous, would come back to the student.

Perhaps my experience was unique but all of my clinical rotations had an evaluation form filled out by the preceptor(s). For my EM electives, I could view my evaluation, read the comments, and see the grade the program gave me. Based upon the feedback I got from interviewers, these evaluations were identical to my SLOEs. This is how I "knew" what was on them - is this not the experience of others? I ended up rotating at 4 places and it was the same pattern for all of them. I find it hard to believe that this is a unique experience.

 

[mega_colon]

I agree with the sentiment but I can see why programs would still want to keep certain portions of the SLOEs confidential. I think that the narrative portions should be available for student review for the reasons you mentioned. It would also serve to keep the commentators honest if they knew that their comments, even anonymous, would come back to the student.

Perhaps my experience was unique but all of my clinical rotations had an evaluation form filled out by the preceptor(s). For my EM electives, I could view my evaluation, read the comments, and see the grade the program gave me. Based upon the feedback I got from interviewers, these evaluations were identical to my SLOEs. This is how I "knew" what was on them - is this not the experience of others? I ended up rotating at 4 places and it was the same pattern for all of them. I find it hard to believe that this is a unique experience.

This is how it was for me where I rotated, though it seems like there are many places with less consistent evaluation processes.

 

[racerwad]

This is how it was for me where I rotated, though it seems like there are many places with less consistent evaluation processes.

Isn't the school in charge of this portion of the evaluation process? I assumed that every school requires every student to be evaluated on every rotation. It seemed unlikely that any clerkship director, PD, or APD is going to do anything beyond cutting and pasting the comments from the SLOE into the school eval; therefore, everyone's school evaluations ought to serve as a proxy for the SLOE itself.

Has this not been the case for anyone? Has anyone who rotated at the above named programs gotten a school eval with a certain set of comments and grades and somehow found out that their SLOEs from the same programs said something different? I'm genuinely curious. I aware that there are some limitations due to timing of assigning SLOEs, etc, but reviewing your own records should give you a pretty good idea how you're doing.

 

[doggydog]

.

 

[Aonyx]

Isn't the school in charge of this portion of the evaluation process? I assumed that every school requires every student to be evaluated on every rotation. It seemed unlikely that any clerkship director, PD, or APD is going to do anything beyond cutting and pasting the comments from the SLOE into the school eval; therefore, everyone's school evaluations ought to serve as a proxy for the SLOE itself.

Has this not been the case for anyone? Has anyone who rotated at the above named programs gotten a school eval with a certain set of comments and grades and somehow found out that their SLOEs from the same programs said something different? I'm genuinely curious. I aware that there are some limitations due to timing of assigning SLOEs, etc, but reviewing your own records should give you a pretty good idea how you're doing.

I would think that this would be true, mostly. I would hope that they wouldn't fill out a glowing eval for my school and trash me on the SLOE...but anything ia possible.

 

[racerwad]

I would think that this would be true, mostly. I would hope that they wouldn't fill out a glowing eval for my school and trash me on the SLOE...but anything ia possible.

I suppose anything is possible but I don't think this happens at all, let alone with enough regularity to be something to be concerned about. While nothing is perfectly transparent, I fail to see how students can ask for much more than being able to read the comments included in their school's rotation grade. The honest reality is that some of us are great, most of us are ok, and some of us suck. Based upon the numbers in the OP about negative experiences, it seems like those students who reported these experiences were outliers for one reason or another. You should rotate at those institutions that interest you, period.

I'm still wondering if @GandalfTheWhite or their alter-ego @emergencythrowaway201717 would apply, interview, or rank any of these programs they called out in the their first post. If I believed what they did, I know I wouldn't. I'm curious if anyone else would? Even though we don't like to "rank" the quality of EM programs here, I think it's safe to say that none of these places would be considered marginal or "low-tier" training institutions.

 

[emergencythrowaway201717]

I suppose anything is possible but I don't think this happens at all, let alone with enough regularity to be something to be concerned about. While nothing is perfectly transparent, I fail to see how students can ask for much more than being able to read the comments included in their school's rotation grade. The honest reality is that some of us are great, most of us are ok, and some of us suck. Based upon the numbers in the OP about negative experiences, it seems like those students who reported these experiences were outliers for one reason or another. You should rotate at those institutions that interest you, period.

I'm still wondering if @GandalfTheWhite or their alter-ego @emergencythrowaway201717 would apply, interview, or rank any of these programs they called out in the their first post. If I believed what they did, I know I wouldn't. I'm curious if anyone else would? Even though we don't like to "rank" the quality of EM programs here, I think it's safe to say that none of these places would be considered marginal or "low-tier" training institutions.

Honestly this is the only reply I actually did find offensive. Cause its immpossible that multiple people see things differently than you right? So they must actually be the same person.

All I see here is assumptions about people thinking its unlikely programs might not actually be doing a very good job at student evals or dishonest feedback. No actuall data to back it up. At the same time, many posters have had these kinds of experiences. Its easy to dismiss it but the facts are it happens pretty often.

All we are asking for is to be given honest feedback as to where we stand and to point out the places that don't do that.

Im not saying these are all bad places. Some might be great to train at. But the process for choosing an away is different than the process of choosing a residency. Residency is about learning. Aways are about evals and SLOES.

 

[racerwad]

Honestly this is the only reply I actually did find offensive. Cause its immpossible that multiple people see things differently than you right? So they must actually be the same person.

All I see here is assumptions about people thinking its unlikely programs might not actually be doing a very good job at student evals or dishonest feedback. No actuall data to back it up. At the same time, many posters have had these kinds of experiences. Its easy to dismiss it but the facts are it happens pretty often.

All we are asking for is to be given honest feedback as to where we stand and to point out the places that don't do that.

Im not saying these are all bad places. Some might be great to train at. But the process for choosing an away is different than the process of choosing a residency. Residency is about learning. Aways are about evals and SLOES.

My apologies for the unintended ad hominem. I guess more than one person can disagree with my position; it just comes as a surprise

There is actually no data for your supposition that there is a statistically significant amount of deceptive feedback at major EM training programs across the country. It does not happen all that often, if at all. According to someone who has counted (that is, the OP), it has happened 8 times at 6 programs in 2 years. According to the NRMP's Charting Outcomes data, there were 3716 positions across those two years - it's safe to assume the total number of applicants is even greater. I do not believe that the system is as broken as is suggested. I would argue that there is a mechanism to know the narrative content of your SLOEs.

Residency is indeed about learning, but I would argue that aways are far more than just SLOEs. Some of the things students ought to be learning during their aways are as important as the things we learn in residency: what type of training program should I focus on, will this training environment suit me, are there mentors in the niches I'm interested here, how will this program in particular support my educational needs, etc. I think that how a program treats its medical students is a measure of how it will treat its residents. That is certainly something I looked for and found to be accurate (N=1).

 

[emergencythrowaway201717]

My apologies for the unintended ad hominem. I guess more than one person can disagree with my position; it just comes as a surprise

There is actually no data for your supposition that there is a statistically significant amount of deceptive feedback at major EM training programs across the country. It does not happen all that often, if at all. According to someone who has counted (that is, the OP), it has happened 8 times at 6 programs in 2 years. According to the NRMP's Charting Outcomes data, there were 3716 positions across those two years - it's safe to assume the total number of applicants is even greater. I do not believe that the system is as broken as is suggested. I would argue that there is a mechanism to know the narrative content of your SLOEs.

Residency is indeed about learning, but I would argue that aways are far more than just SLOEs. Some of the things students ought to be learning during their aways are as important as the things we learn in residency: what type of training program should I focus on, will this training environment suit me, are there mentors in the niches I'm interested here, how will this program in particular support my educational needs, etc. I think that how a program treats its medical students is a measure of how it will treat its residents. That is certainly something I looked for and found to be accurate (N=1).

OP correct me if I'm wrong, but I thought the list was for people who contacted him saying they had a blindside SLOE, not from going through all the posts. Also not every applicant is commenting on SDN so the sample size is smaller than the 3716 that matched. I'd argue that it doesn't take a huge number to show the system is broken. Even in a bad random system there are still those who get good grades and don't complain and those who got bad grades in line with their feedback. The problem is those who got bad SLOEs in spite of positive feedback. Even if the system was totally random (which I'm not suggesting), this number would still be a minority of cases but serve as proof of concept. And when there are programs that are known to give good grades and fluffy SLOEs, I see no reason to jeopardize your career for one of the places that doesn't.

(Also I agree that there are other things to learn from an away but the primary objective is the SLOE. Before aways were required, fewer people did them, but the other learning benefits were still there)

 

[Status Sciaticus]

I suppose anything is possible but I don't think this happens at all, let alone with enough regularity to be something to be concerned about. While nothing is perfectly transparent, I fail to see how students can ask for much more than being able to read the comments included in their school's rotation grade. The honest reality is that some of us are great, most of us are ok, and some of us suck. Based upon the numbers in the OP about negative experiences, it seems like those students who reported these experiences were outliers for one reason or another. You should rotate at those institutions that interest you, period.

I'm still wondering if @GandalfTheWhite or their alter-ego @emergencythrowaway201717 would apply, interview, or rank any of these programs they called out in the their first post. If I believed what they did, I know I wouldn't. I'm curious if anyone else would? Even though we don't like to "rank" the quality of EM programs here, I think it's safe to say that none of these places would be considered marginal or "low-tier" training institutions.

We arent the same people. Both of us just disagree with you on this topic.

OP correct me if I'm wrong, but I thought the list was for people who contacted him saying they had a blindside SLOE, not from going through all the posts. Also not every applicant is commenting on SDN so the sample size is smaller than the 3716 that matched. I'd argue that it doesn't take a huge number to show the system is broken. Even in a bad random system there are still those who get good grades and don't complain and those who got bad grades in line with their feedback. The problem is those who got bad SLOEs in spite of positive feedback. Even if the system was totally random (which I'm not suggesting), this number would still be a minority of cases but serve as proof of concept. And when there are programs that are known to give good grades and fluffy SLOEs, I see no reason to jeopardize your career for one of the places that doesn't.

(Also I agree that there are other things to learn from an away but the primary objective is the SLOE. Before aways were required, fewer people did them, but the other learning benefits were still there)

I've posted what others have said about places they rotated at, not from the away rotation thread. Regardless about whether its statistically significant or not, Im not here doing a retrospective study. Its merely providing anecdotal data and should be construed as such. What you choose to do with it with regards to your away rotation selection is upto you, but its better to have this information available at hand, rather than not.

 

[SpacemanSpifff]

OP correct me if I'm wrong, but I thought the list was for people who contacted him saying they had a blindside SLOE, not from going through all the posts. Also not every applicant is commenting on SDN so the sample size is smaller than the 3716 that matched. I'd argue that it doesn't take a huge number to show the system is broken. Even in a bad random system there are still those who get good grades and don't complain and those who got bad grades in line with their feedback. The problem is those who got bad SLOEs in spite of positive feedback. Even if the system was totally random (which I'm not suggesting), this number would still be a minority of cases but serve as proof of concept. And when there are programs that are known to give good grades and fluffy SLOEs, I see no reason to jeopardize your career for one of the places that doesn't.

And I would argue the opposite. The system works for the vast majority of applicants.

Residency is indeed about learning, but I would argue that aways are far more than just SLOEs. Some of the things students ought to be learning during their aways are as important as the things we learn in residency: what type of training program should I focus on, will this training environment suit me, are there mentors in the niches I'm interested here, how will this program in particular support my educational needs, etc. I think that how a program treats its medical students is a measure of how it will treat its residents. That is certainly something I looked for and found to be accurate (N=1).

+1 to the bolded. The theme of this thread strikes me as strange. As someone who was in this spot a year ago, the idea of avoiding certain shops just because someone on SDN felt they were wronged by a "bad SLOE" is ridiculous. My approach was, "What type of programs am I attracted to? What do I think is valuable in a program? Where do I want to practice?" I talked to mentors, EM docs, friends, etc. and compiled a list of programs that fit my desired metrics. Then I did my best to crush the rotation.

 

[Mo_$$_Mo_Debt]

Since I have been perusing through the 15-16 and 16-17 EM application and ROL threads for a while, I kept seeing many people from last year who were totally blindsided by their SLOEs when they thought they were doing well ( and received verbal feedback to that effect). However, they were blindsided by receiving a crappy SLOE that led to less interviews than they deserved.

Now that many are are already in their first year, would any of you share which programs did that so we as MS4s can avoid shooting ourselves in the foot?

You can also PM it to me and I can post it if you want to maintain anonymity.

People said to avoid:
UTH x3
UNLV x2
MetroHealth x1
Denver x1
LSUNO x1
Cook x1
Palmetto Health Richland x1
Texas A&M Scott & White x1

 

[Mo_$$_Mo_Debt]

Blind-sided sloes happen for sure, even to great students. I have even had a PD tell me that they cannot trust letters from one of the mentioned programs because they wrote everybody a terrible letter, including their own best residents.

 

[Wroooong]

I did a rotation at MetroHealth, and it was phenomenal. Also, they gave really clear feedback throughout the entire month. The CD reminded us regularly they were available for midrotation feedback, and when I met he told me what feedback I'd been getting and how to improve. At the end of block meeting he listed all the feedback, told me my grade, and asked if I had anything I'd like to add that wasn't included. I feel that blindsided in this case must really just means not getting the grade that someone wanted. I agree with the fact that it seems many med students are used to the grading of their clinical rotations at home, where grades tend to be inflated. Suddenly they are on an away with 8 other people who are trying their hardest to honors when only a few can, and they aren't used to being told that their best is average (or below). That's not being blindsided, or some unfairness in the system, it's just the reality that SLOEs were created to stratify students based on performance in the ED. I think what throws people off is that a med student's ability to perform might not correlate to grades or scores, that's just the nature of the specialty.

 

[gamerEMdoc]

I have never once written a SLOE that was a bottom 1/3 and then given a student a great student eval for their school. The two go hand in hand. So I agree, no one should get blindsided.

But from the other side of the aisle, I will say that it is frustrating that there is a sense that everyone is entitled to a minimum of a top 1/3 sloe for just showing up by some students. I'm certainly not saying that's everyone, but there are definitely students who greatly over-rate their ability compared to their peers and get frustrated when they arent given the grade they want but rather the grade they earned. The SLOE ranks you vs your peers. Everyone can't be top 1/3. The majority should fall in the middle.

 

[tux4]

I received a SLOE that was bottom 3rd and then the next page I of the SLOE said nothing but good things. They are krap sometimes


Sent from my iPhone using SDN mobile app

 

[jw3600]

How do people see/know their SLOEs? Am I missing something. The most I've received is a vague description of the "quality."

 

[SpacemanSpifff]

I received a SLOE that was bottom 3rd and then the next page I of the SLOE said nothing but good things. They are krap sometimes


Sent from my iPhone using SDN mobile app

See @gamerEMdoc post - you can perform well, and still fall below 2/3 of your colleagues. Being "good" does not mean top 1/3.

 

[Mo_$$_Mo_Debt]

How do people see/know their SLOEs? Am I missing something. The most I've received is a vague description of the "quality."

Hello. My school assigns an overall percentage and separates people into honor, high pass, and pass. They then state: while I can't tell you what your SLOE says, we break people up in a very similar way into top, middle, and bottom thirds. So, I was able to extrapolate.

 

[jw3600]

Hello. My school assigns an overall percentage and separates people into honor, high pass, and pass. They then state: while I can't tell you what your SLOE says, we break people up in a very similar way into top, middle, and bottom thirds. So, I was able to extrapolate.

I don't wanna respond to you in 2 threads. From what you're saying it's quite possible you received middle third. You may be jumping to conclusions.

 

[Mo_$$_Mo_Debt]

I don't wanna respond to you in 2 threads. From what you're saying it's quite possible you received middle third. You may be jumping to conclusions.

That could very well be true. I think based on my percentage score compared to their cut offs, there is a good chance it might be on the lower side. I'm also new to SDN so sorry if I'm replying in odd places or something haha. Still learning.

 

[jw3600]

That could very well be true. I think based on my percentage score compared to their cut offs, there is a good chance it might be on the lower side. I'm also new to SDN so sorry if I'm replying in odd places or something haha. Still learning.

You're fine. It just happens that the issue came up in 2 different threads.