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Having a hard time with this..explain SLOE for me please

Discussion in 'Emergency Medicine' started by thatoneguysvt, Mar 15, 2017.

  1. thatoneguysvt


    Jan 25, 2017
    I was a scribe for a year before medical school. I loved it. Came into medical school wanting to do EM. I find it sort of frustrating/borderline repulsive that aways are required for, excuse my language, a non-competitive specialty. It's almost pushed me to the point of not wanting to do aways to get these stupid things. EM average step is 233 and they're trying to make themselves pseudo-competitive I guess?? Diagnostic rads has a 99% match rate and their average step score last year was 240. Guess what? Don't require aways. I guess I'm missing something but EM better stop pissing in good applicant's cheerios just so they can seem more competitive than they actually are. I just find it so blatantly stupid that an EM program would reject people that are competitive for the likes of ortho, derm, etc just because they don't have two "standardized" letters. Is standardization not what the USMLE is for? Very sorry for the rant. Approaching the end of 3rd year and my obgyn rotation has sucked the life out of me.
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  3. app1

    app1 5+ Year Member

    Jun 5, 2011
    witzelsucht and kmb1908 like this.
  4. brabbit2222

    brabbit2222 2+ Year Member

    May 26, 2013
    In case you haven't noticed, EM salaries have been steadily rising the last few years. Functioning well in the ED as a student is arguably the most important thing you could do from the PDs perspective, hence the strong suggestion to do an away rotation to prove it. I'm sorry the field you are interested in is becoming more competitive. In case you decide on a different specialty, trust me, there will be plenty of your classmates ready to take your spot.
    witzelsucht likes this.
  5. CliveStaples

    CliveStaples 5+ Year Member

    May 5, 2012
    Yeah I think that it's really less about the aways and more about trying to have evaluation methods that go beyond standardized board exams, which test a particular skill set - your ability to take the standardized exam. While this skill is important to your ability to pass your future board exams, I think all residencies have experienced and understand that this does not make for the best evaluation of future residents. What do they decide? Well, if you spend a month with us and kind of pretend like you're a resident, and we standardize the way that you're evaluated across different programs, then maybe that will be more representative of what EM programs want than board exam scores.

    So here's the problem - if these letters are really helpful, then why not get more of them to build up the sample size and quality of the data? Competitive specialties like Ortho, Derm, Plastics, ENT, etc. generally require away rotations and letters from their specialty so this really isn't all that different. We just happen to not care about board exam scores quite as much as those other specialties do.
  6. RockFlag&Eagle


    Jan 30, 2017
    If it's that big of a deal to you, and I'm not sure why it is, just move onto the next specialty. And fwiw, aways are crazy beneficial for you as an applicant as you try to decipher what you are looking for in a program. Also, they're just fun...and this is coming from someone who drug his family across the country for 2 months last summer. And take it easy, you sound stressed (and like a bummer).
  7. hoot504

    hoot504 PGY-III 7+ Year Member

    Jan 17, 2009
    Exactly. Aways should be looked at as a chance to get away, meet people, experience life in a different part of the country. I know they can be expensive, but god they are the best part of medical school (or have the potential to be, anyway). I would not look at aways as an obstacle at all.

    Now I understand that the stress of obtaining an away might be a little grating, but who cares, keep your ducks in a row and you're sure to get one (or several).
    racerwad likes this.
  8. EMapplicant2017


    Oct 1, 2016
    The fallacy here is the assumption that standardized boards are the only legitimate metric. That's exactly the point of the SLOE. It's intended to be an objective measure of medical student competency. It's not your regular "atta-boy" LOR, but a form letter that addresses specific EM-related questions. The thought is that your home institution will go easy on their own students; therefore outside input is necessary. This is unique to our field, but I suspect there will be more broad application of SLOEs as the years go on, (in "more competitive" fields).

    I don't think anyone here champions the competitiveness of EM. That being said, your assessment is at best misunderstood.

    EM is increasingly competitive. Board scores are only one of the required assessment tools.

    USMLE is for 50,000 foot broad applicant screening. SLOEs are tools to determine adequacy for interviews.
    Last edited: Mar 15, 2017
    DokterMom and racerwad like this.
  9. Angry Birds

    Angry Birds Angry Troll 5+ Year Member

    Dec 4, 2011
    I don't think you should worry yourself too much about this, since EM is clearly not the specialty for you. If you can't respect the specialty, then how would you respect yourself once you become a practitioner of said specialty? Such an attitude is better suited to surgery..
  10. Cinematographer

    Cinematographer More chill in real life Gold Donor Classifieds Approved 7+ Year Member

    Jun 20, 2010
    Denver, CO
    A noncompetitive specialty? Homie were you a scribe in the 90s?
  11. HooliganSnail

    HooliganSnail 5+ Year Member

    Mar 13, 2012

    In the DO world, the away or "audition" rotation has been standard practice for decades. We are just now getting into the swing of the ACGME where so many students match to places that they only interviewed at, and never actually rotated.

    Away rotation is the most important factor when choosing students. We care the most about seeing the students who have rotated in OUR department. We want to see you work with the team, we want to hear the way that you think. We want to know if you are lazy. This rotation is the single largest factor in choosing our rank order list BY A MILE......

    We pass on people with amazing board scores every year. We pass on students from great schools every year. We pass on lots of "people who are competitive for the likes of ortho or derm" (as if that means jack ****) EVERY YEAR.

    We take students based on how the work and interact with us during rotation, because through the years we have learned that it is the best determinate if they will have a positive influence on our program. We have learned that you just can't rely on any other factor, because those things can lead you astray......not perfect, but it's the best we've got.

    You could say "well, if you only match students who have rotated with you, then you are limiting yourself, and could miss good applicants", and you probably are right.....We always fill our match list though, and we have not "scrambled" a spot in anyone's living memory.....I guess that means we are pretty darn competative......
    CajunMedic, EMedGrrl and DokterMom like this.
  12. Epinephreus

    Epinephreus 2+ Year Member

    Jun 6, 2013
    What?! EM is a very attractive specialty. For the right person, it has great work-life balance, utilizes many specialties, is hands on, allows for great career development in other areas like education/admin/etc. There is a reason it is as competitive as it is and becoming even more so.

    Furthermore, I applied to 3 places to do an away and secured spots at 2 of them. It really isn't that hard, sounds like you are just lazy. And god forbid a specialty values something other than one test you take.
    Aonyx likes this.
  13. gro2001

    gro2001 SOCMOB Physician Faculty 10+ Year Member

    Jul 4, 2006
    the desert
    My first impulse was to assume you are trolling. Then I decided to give you the benefit of the doubt and respond, so here is my perspective that may help you understand the situation better:

    1) EM is competitive. Step scores in this case are misleading, since surveys of EM residency program directors reveal that they assign less value to those than some other specialties do. Instead, consider the match. There were no (or almost no) unfilled spots in the match for the last few years. This means the specialty is competitive and PDs certainly have the luxury to be somewhat picky in what hoops they choose to make applicants jump through.

    2) USMLE scores aren't as useful in EM as they are in other specialties. Yes, they serve a useful purpose and they correlate with chances of passing the boards. However, while they may be good at telling who will be a great pathologist, and are probably only marginally useful at telling who will be a great almost anything else, they seem to be very bad at telling us who will be a great ED doc.

    3) EM needs a tool like the SLOE more than other specialties do. EM very different from other things you have experienced in medical school in terms of knowledge, approach, lifestyle (not always in a good way), workload per unit of time, etc that there really is no substitute for trying it out and having someone objectively assess that experience. A standardized letter (thats why it has to be an SLOE like tool) from an objective observer (that's why it has to be an away) seems to be more predictive of someone being a great EM resident to work with than anything else. Making sure applicants have tried EM in a couple of different settings also decreases the chance that they don't know what they are getting into and will drop out, burn out, or will be a pain to work with.
  14. witzelsucht

    witzelsucht 5+ Year Member

    Jun 20, 2012
    Hey guys, D1 college football player here. Getting inundated with requests from NFL coaches who want to see "video" of me "playing football." I really don't get it, my bench press, vertical jump, and 40-yd dash numbers are incredible. The college team I play for has a ridiculous record while I was on the team. It is really bothering me that all these guys are interested in is what it "looks like" when I play football, even though they have ALL my stats for weightlifting and running. What a bunch of obnoxious jerks. Just look at my stats, they are very competitive!
  15. SamtheWise


    Mar 1, 2017
    Your question seems more inflammatory than genuinely curious, but I will answer because I will operate under the assumption that you are not trying to agitate.

    I'm not necessarily sure what makes something a 'competitive' specialty. If it's purely based on board scores, then no, EM is not comparable to plastics or derm. However, EM this year had fewer unfilled spots than Derm, so take that for what it's worth.

    Aways are important for both programs and applicants. In addition to medical knowledge and ability to take standardized exams, EM requires a unique skill set that is not really assessed anywhere else in medical school. Similarly, as an applicant, it's great to get a sense of the different types of programs that exist (community vs academic vs county). For example, doing your residency at Maricopa is a wildly different experience than Vanderbilt, both are wonderful places, but a different kind of person will thrive at each place. Aways can help you determine this.

    Yes, the SLOEs are stressful, I know people who look great on paper but perform in a mediocre manner on a rotation and struggle to get interviews. Conversely I know people who were extremely average on the USMLE and grades but are interviewing at LAC and Denver thanks to great SLOEs. EM is an extremely egalitarian specialty, and I think that judging applicants on their interpersonal skills, work ethic and teachability fits with these values.

    And man, to rule out the greatest specialty in the world because of the application process quirks, you're really doing yourself a disservice.
    Aonyx likes this.
  16. thatoneguysvt


    Jan 25, 2017
    Sorry, I am stressed. I guess I just don't understand the point of a high step score and all A's during third year to prove how strong of an applicant you are when I can go do an away and somehow rub the wrong person the wrong way and all of a sudden the aforementioned stuff is out the window and a guy with substantially lower stats than me is all of a sudden a better applicant.

    I'm just more frustrated with obtaining aways at the moment. I'm on obgyn and literally spending more time at the hospital than I have on any other rotation by far. Meanwhile, all my friends are on psych or some other chill rotation getting their **** taken care of.
  17. thatoneguysvt


    Jan 25, 2017
    Lmao as a die hard football fan and former football player I find this hilarious, even though I am the butt of the joke!
    jessk2015 likes this.
  18. SamtheWise


    Mar 1, 2017
    I get it, but if you speak to an advisor they'll help you select quality aways that can enhance your application and help you understand the specialty better. There is definitely an element of 'not pissing off the wrong person' but it's like that in every specialty. If you're killing third year, you clearly understand how to succeed on tests and clinically, so you likely have no reason to worry. At least in my experience, surgeons and OB-GYNs were much pettier and more likely to knock you down on your evals for something dumb than anyone at any of my away rotations. People understand that this is the career you've chosen, so unless you do something really egregious (which again I wouldn't worry about because it sounds like you know how to succeed around residents and patients) nobody wants to tank your application.
  19. thatoneguysvt


    Jan 25, 2017
    Well thanks for the encouragement, really needed it. Didn't come here to be abrasive or inflammatory, certainly not looking for pats on the back or anything either. Really just wanted to vent and maybe see if others felt the same towards the SLOEs as I do.
  20. DrWhozits


    Jan 15, 2017
    I find it hilarious that Radiology is the example used in the OP, for 1) Radiology is the perfect example of misinterpreting "competitive" for "OMG 240 USMLE", and 2) Its one of those specialities that an away would be worthless in, since you aren't expected to learn most of that skill set until residency begins.

    Ps not hating on rads, actually seems like something I would like to do.
  21. DokterMom

    DokterMom 2+ Year Member

    Mar 1, 2013
    Have you read the 2017 SOAP thread and seen all of the posts from unmatched EM applicants. Sorry, but EM has ALREADY become very competitive, and SLOEs are probably the best assessment of an applicant's ability -- more reliable than the measures most other specialties use anyway. It is in each school's best interests to 'puff up' the qualifications of their graduates. Evaluations from other schools (SLOEs) level the playing field.
    britney1027 likes this.
  22. racerwad

    racerwad Physician 7+ Year Member

    Sep 8, 2009
    Don't underestimate the value of great boards and grades. At our program, those factors influence interview invites and, more importantly, where you start on the rank list. For us, your position moves from there based on interview and SLOEs, but your grades have a huge effect on where you start (at least for us). Also, people place too much emphasis on the effect of "one bad comment." For many people, it is either truly an outlier and therefore not a big deal, or part of a pattern that they are just too obtuse to recognize. As long it is the former for you, you will be fine. Aways were the most fun clinical work of medical school for me. It was a nice change to travel, see different places, meet cool people, and see programs I was interested in.
  23. KinesiologyNerd

    KinesiologyNerd 5+ Year Member

    Aug 16, 2012
    Anytown, USA
    I like that you cited two specialties that applicants very commonly do aways for in your argument that aways are stupid. Bravo!
  24. thatoneguysvt


    Jan 25, 2017
    Yeah, the specialties that have the highest grades and step scores. It would make sense that they require aways.
  25. DarkHorse22

    DarkHorse22 7+ Year Member

    Nov 18, 2009
    i do not understand this logic
  26. thatoneguysvt


    Jan 25, 2017
    . You mean you don't understand how the few positions offered to the creme of the crop would require further differentitating the best fit for the most desired specialties? Makes prettt good sense to me.
  27. DeadCactus

    DeadCactus SDN Lifetime Donor Lifetime Donor Classifieds Approved 10+ Year Member

    Oct 28, 2006
    You'll notice many of the competitive surgical sub-specialties also expect applicants to do away rotations. EM is in the group of specialties that has you working with a relatively small cohort of people for the vast majority of the time you are in residency, similar to the surgical subspecialties. In many other fields, there are a ton of residents rotating through a ton of services and the actual contact between any one resident and the majority of the other residents and faculty is fairly diluted. That's very different from most EM programs where you're spending 18+ months in the ED in a setting where your work directly affects multiple other residents and attending who are on with you. I couldn't care less about your board scores beyond it being an easy way to stratify people and estimate if you'll have academic issues. I care very much what you're like to work with at 2AM on your 5th overnight in a row. If there is an away applicant who is at least OK to work with, that's a better bet than rolling the dice on someone who I met for a few hours on an interview. From talking with peers in other specialties, I'm far more cognizant of what everyone in my program is like to work with than those in many other specialties. (And far more concerned with what I'm like to work with.)
    AntoninusPius likes this.
  28. Angry Birds

    Angry Birds Angry Troll 5+ Year Member

    Dec 4, 2011
    you apologize and then continue with your stupidity and arrogance. Get outta here.
    racerwad and EMapplicant2017 like this.
  29. gamerEMdoc

    gamerEMdoc Associate PD; EM Clerkship Director Physician Faculty Gold Donor Classifieds Approved 2+ Year Member

    Feb 10, 2016
    Your board scores and your other third year rotations are great, but none of those predict if you're going to be a great EM resident. SLOEs are the closest thing to an objective measure of what residents fit well in the specialty. I'll give you the benefit of the doubt that you are having a bad day, but you have to understand that acting like you are better than everyone will possibly kill your chances at many places. EM doesnt act like its more competitive than it is. It is competitive. It is what it is. And if you go on rotation and start complaining about the whole process you are going to be red flagged quickly. So much of our field is our ability to socially interact with other team members and patients from all walks of life. Coming on here and bashing the specialty is not exactly the way to go, especially when its your only post on the EM board. Oddly enough for someone who always wanted to do EM, your only other post was two months ago in the what are my chances for derm thread, which I find odd because those are two of the most opposite fields of medicine.
  30. HooliganSnail

    HooliganSnail 5+ Year Member

    Mar 13, 2012

    This I understand.....

    I did 3 away rotations for EM. Two I was very successful at, one they really did not like me (I also didn't love them, so it was mutual) Some programs just have a different idea in what they want in their visiting medical students.....sometimes it is not a good fit.....O well.

    I have a great friend who is a co-resident with me currently. I remember him having a really hard time at a rotation that I was doing very well with. He is an amazing doctor...for whatever reason they just didn't like him. That's just the way it is.

    I matched my number 1 and have been (mostly) happy every since. My friend matched his number one, and he seems (mostly) happy too.
  31. surely

    surely MD Class of 2018 7+ Year Member

    May 9, 2010
    I was skeptical of the predictive value of SLOEs myself, so I went looking for published data. Was sort of hoping that none existed so I could continue grumbling quietly about jumping through hoops. But apparently SLOE global ratings and Away rotation grades correlated strongly with resident performance in this multicenter study: This makes their use in discriminating between residency applicants pretty valid (assuming this was a well-designed study).

    Would be interested in reading more on the subject of correlating applicant data to resident performance, if anyone's got related articles to share. With a 90% match rate among US allopathic seniors per Charting Outcomes, clearly most of the people with bottom-third SLOEs and lower Step scores are still matching somewhere. I'd hazard a guess that most of them eventually go on to become perfectly adequate EM attendings. So I have to wonder, at the end of the day, how much does all of this vetting and ranking of applicants really matter?
    EMedGrrl likes this.
  32. DarkHorse22

    DarkHorse22 7+ Year Member

    Nov 18, 2009
    Right. so you understand that away rotations help in differentiating applicants. So why reserve it for specialties that require high board scores? I also refuse to accept the idea that high board scores and grades = creme of the crop. Just ask an orthopod to explain diastolic heart failure without using the word ancef. Believe me, ortho/derm/optho might all be good at taking tests. But they are not all the best doctors.
    EMapplicant2017 likes this.
  33. EMedGrrl

    EMedGrrl 10+ Year Member

    Feb 8, 2007
    Stick with derm and YouTube...
  34. The White Coat Investor

    The White Coat Investor AKA ActiveDutyMD Physician Partner Organization 10+ Year Member

    Nov 18, 2002
    SDN Partner
    This too shall pass. Get some sleep soon. You're grumpy. And for goodness sake don't go into OB/GYN or General Surgery. You'll be miserable.

    I don't think you have to do an away, do you? At any rate, it's a smart thing to do. I did 3 EM rotations-one as my elective late in my third year at a local community hospital that routinely has students (and where I had done other rotations), one at my home school that didn't have an EM rotation at the time, and one to fulfill a military requirement. My SLOEs or whatever they were called back then came from my home school for the civilian match and the military away I did for the military match. It worked out okay. I got my # 1 choice in both matches. High USMLE scores helped. Reasonably good grades helped. But getting honors in all three EM rotations was clearly important. I had classmates with similar stats and grades who didn't get anywhere near the interview invites I had. And I knew plenty of military docs I rotated with that seemed smart to me who didn't match at all in the specialty.

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