Negative SLOE

[medstudent33]

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[Pons Asinorum]

Was this a 3rd year rotation or a Sub-I?

 

[dotcb]

Do you have an academic EM department at your school. If so, you need an advisor, and I would ask them your question. You may want to also speak to the clerkship director, though there may not be anything you can do about the grade.

 

[medstudent33]

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[Pons Asinorum]

This was a 3rd year rotations as my 4th year schedule only allows me to complete 1 Sub-I until december. I am currently a DO student and was was interested in pursuing an ACGME residency as I did pretty well on my step 1 (240's). I feel like this is going to look extremely bad being my lowest clerkship grade and I will not have a chance to redeem myself because I am only going to be able to get 1 Sub'I.

I don't understand how your program can only allow time for one Sub-I before December. That makes no sense and if actually the case represents a huge disservice to you and your classmates. The third year grade isn't the kiss of death, especially if your 4th year sub-I shows progression. But you need to have a discussion with your school's administration, or better have an EM faculty or PD speak to them about the burden this schedule places upon you.

 

[future_dr_house]

Why didn't you have any shifts with the clerkship director? And why were you working shifts with locums physicians?

Like others said, it's not the end of the world but you probably could have made the effort to change your shift schedule to get more time in with the people who matter. Think of what your sloe will say, "he made a b and worked with all locums who weren't willing to submit any evaluation information since they have no investment in the long term". Not exactly a strong sloe. This may be overcome since you are a 3rd year student and it's the Sub-Is that count. You really need another rotation in EM though. Talk to someone and make it happen. Sometimes you have to be a pain in the a$$ to get what you want.


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[future_dr_house]

Also, if they are adamant on only one EM fourth year rotation you could attempt to do an EM elective like US, resuscitation month, tox, etc. these are frequently rotations with highly respected individuals in the EM community and can carry nearly as much weight as a sloe.


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[DO3]

Was this rotation at a site with a residency program?

 

[Sloow]

I was a stellar applicant in terms of class rank, board scores, but I bit off more than I could chew and rotated at "high end" programs. One program had never allowed DO's to rotate there before.

Long story short, I did not honor those rotations and I got less interview invites than people in my own class with much lower grades and board scores.


My advice to my GF who is currently a 2nd year DO is to do the opposite of what I did. Rotate at DO friendly/"easy" places get stellar SLOE's.


Most MD's kind of cheat the system. They do 1 home rotation where from what I can see pretty much automatically get an Honors/good SLOE and then they only do 1 other Away which might not even matter bc the 1 Honor and their decent board scores will already guarantee them a ton of interviews



In Summary: I found out the hard way that trying to match EM is a completely different world and whereas before applying I thought maybe the SLOE's had like 50% weight in terms of invites/matching I now know it is much much much higher. Your grades/board scores kind of get your foot in the door at some places due to their cut offs but the rest of the way is 100% SLOE's.

 

[medstudent33]

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[emeddo1]

Unfortunately we did not have access to the attendings schedule for the rotation. Over 50% of the doctors working in the ER were locums. Unfortunate my school requires that we do 3 months of family medicine during 4th year. My schedule works out that all 3 of these months are in the 1st half of the year. There is no way around this with my school. I am also required to do a "primary care selective" which EM does not fall under either. Still not sure what I am going to do.

Sounds like you were at Aria----they have over 1/2 their shifts covered by locums. HUGE NEGATIVE IMO.

 

[ScarletKnights]

Also sounds like you go to LECOM another HUGE NEGATIVE IMO

 

[NurWollen]

Unfortunately we did not have access to the attendings schedule for the rotation. Over 50% of the doctors working in the ER were locums. Unfortunate my school requires that we do 3 months of family medicine during 4th year. My schedule works out that all 3 of these months are in the 1st half of the year. There is no way around this with my school. I am also required to do a "primary care selective" which EM does not fall under either. Still not sure what I am going to do.

I would keep making noise until they bend. Point out that EM generally requires you to do something that your school is not letting you do. I would see if you could get your FM months changed to later in the year. Maybe you could trade with someone in your class who is dead set on FM. It's simply absurd that your medical school's policies conflict are incompatible with residencies' policies.

 

[res1cue]

My advice to my GF who is currently a 2nd year DO is to do the opposite of what I did. Rotate at DO friendly/"easy" places get stellar SLOE's.

Sorry, I reject this completely. I have talked to many PD's at aways I have done, and they unanimously warn against this. PD's are looking for departmental SLOE's from respectable academic institutions. Anything else carries substantially less weight

 

[Makati2008]

Sorry, I reject this completely. I have talked to many PD's at aways I have done, and they unanimously warn against this. PD's are looking for departmental SLOE's from respectable academic institutions. Anything else carries substantially less weight

Agreed. A letter from Indy or Vandy that is even a HP will carry more weight than a Honors from a much lessor known ED.

 

[DarkHorse22]

agree with this.

I was also a DO student. Did my aways at strong ACGME programs, one of which had only 1 DO match ever, the other was more "DO friendly." Moral of the story is work super hard wherever you end up. SLOEs carry the majority of the weight of an applicant. PDs can see through "easy" rotations and appreciate hard work for a lesser grade on tough rotations.

 

[Sloow]

Sorry, I reject this completely. I have talked to many PD's at aways I have done, and they unanimously warn against this. PD's are looking for departmental SLOE's from respectable academic institutions. Anything else carries substantially less weight

If a student does 3 Aways and all Honors from "less respectable" programs and they have good grades/scores. A PD can't say "oh this student is **** those SLOEs are from non top tier programs"

On the other hand. A student with great grades/board scores does 3 aways at "high end" programs and gets P or HP. The PD can now say "maybe this guy is just book smart"


I think rotating at tough places is a high risk high reward scenario and may not be the safest route, esp for DOS who don't have a home ED SLOE to fall back on

 

[res1cue]

If a student does 3 Aways and all Honors from "less respectable" programs and they have good grades/scores. A PD can't say "oh this student is **** those SLOEs are from non top tier programs"

On the other hand. A student with great grades/board scores does 3 aways at "high end" programs and gets P or HP. The PD can now say "maybe this guy is just book smart"


I think rotating at tough places is a high risk high reward scenario and may not be the safest route, esp for DOS who don't have a home ED SLOE to fall back on

Thats one way to look at it, sure.

On the other hand, rather than tell people to aim low, I would prefer to tell people to go to those big academic centers and honor them. Sure it is high risk high reward, but if I wanted to play it safe, I wouldnt shoot for a competitive field like allopathic EM. I would have stuck to the DO match.

Im not saying that a P or HP from a prestigious is better than a honors from a small program.

I am saying an honors from a prestigious program is better than a honors from a small program.

Sorry it didnt work out for you that time, but it worked out for me and many others I know. So best advice is go for those big name programs and kick ass there



Also another thing to add is that the PD who writes your SLOE can be a huge asset to your application. I received an interview offer from a program that I had never heard any other DO interviewing there, and can only conclude it was due to one of my letters.

 

[racerwad]

I was a stellar applicant in terms of class rank, board scores, but I bit off more than I could chew and rotated at "high end" programs. One program had never allowed DO's to rotate there before.

Long story short, I did not honor those rotations and I got less interview invites than people in my own class with much lower grades and board scores.


My advice to my GF who is currently a 2nd year DO is to do the opposite of what I did. Rotate at DO friendly/"easy" places get stellar SLOE's.


Most MD's kind of cheat the system. They do 1 home rotation where from what I can see pretty much automatically get an Honors/good SLOE and then they only do 1 other Away which might not even matter bc the 1 Honor and their decent board scores will already guarantee them a ton of interviews



In Summary: I found out the hard way that trying to match EM is a completely different world and whereas before applying I thought maybe the SLOE's had like 50% weight in terms of invites/matching I now know it is much much much higher. Your grades/board scores kind of get your foot in the door at some places due to their cut offs but the rest of the way is 100% SLOE's.

As others have said, I disagree with this advice. One of the questions on the SLOE form is: "Indicate what % of students rotating in your Emergency Department received the following grades last academic year." If they say >50% got Honors, how impressive is an Honors level SLOE there? That isn't to say you couldn't have been amazing and in the top 10%, but if everyone is getting SLOEs there, you can see the problem. Why would you want to lower the ceiling on yourself like this?

I've met a bunch of great MD applicants this season and I don't think any of them got Honors just because they were from that institution. That is just removing the responsibility from your shoulders to "those MDs."

We as applicants are responsible for the success or lack thereof. The very existence of the SLOE in our specialty implies that it is a very valuable commodity. No other specialty does this. Because of its value, I think hedging your bets and playing it safe only serves to work against you.

 

[littlejuan]

Most MD's kind of cheat the system. They do 1 home rotation where from what I can see pretty much automatically get an Honors/good SLOE and then they only do 1 other Away which might not even matter bc the 1 Honor and their decent board scores will already guarantee them a ton of interviews

Not true at all. My home institution certainly did not give out Honors and good SLOEs like candy. My med school also only allowed us to take one other EM rotation and have it count towards any credit. Any other EM rotation could not be a regular EM rotation, i.e. it had to be tox, ultrasound, etc, or it would eat into our vacation/interview months.

 

[Sloow]

As others have said, I disagree with this advice. One of the questions on the SLOE form is: "Indicate what % of students rotating in your Emergency Department received the following grades last academic year." If they say >50% got Honors, how impressive is an Honors level SLOE there? That isn't to say you couldn't have been amazing and in the top 10%, but if everyone is getting SLOEs there, you can see the problem. Why would you want to lower the ceiling on yourself like this?

I've met a bunch of great MD applicants this season and I don't think any of them got Honors just because they were from that institution. That is just removing the responsibility from your shoulders to "those MDs."

We as applicants are responsible for the success or lack thereof. The very existence of the SLOE in our specialty implies that it is a very valuable commodity. No other specialty does this. Because of its value, I think hedging your bets and playing it safe only serves to work against you.

The misconception with the people who claim that doing an away at a less prestigious place equates to "place handing out Honors like candy" is just that, a misconception.


More stellar candidates are attracted to more "prestigious" programs, which means the quality of people at those places is generally higher than a place that is either in a less desirable location or just an inferior program. That doesnt mean that the less prestigious places give out an Honors to 9/10 people who rotate there. It just means that when you go there, they arnt comparing you to the last 10 people that got 270's on their boards and are super strong candidates, hence it is easier to Honor a place that isnt lets say Hennepin or Indiana.


I agree with you, that I am not an MD, and therefore I cannot make a generalization that "if youre an MD and you do an ED rotation at your home program you are guaranteed an Honors".


I will tell you though, that I have 3 friends who are at MD schools who matched EM this year, they kind of run the spectrum of applicant strength, and I also met quite a few people on my 4 aways and from what I could tell the vast majority of them got Honors at their home institution with only 1 person I met who got a HP and he was quite livid of that fact, almost as if he thought he was guaranteed an Honors.



If you think I am arguing that Honoring a less prestigious place is better than Honoring a more prestigious place, haha, I am definitely not.


DO's are at a disadvantage in the MD match, its just a simple fact, and I think doing a more stable approach to the match is better.


If you are an absolute stellar applicant, top of your class, did very well on boards, then of course, go rotate at a prestigious program, why wouldnt you?

But if you are someone who got like a 210-220 or something, middle of your class AND youre a DO, I would NOT, recommend rotating at places that have only had 1-2 DO's in the last couple years and are very desirable programs.



I would say the best strategy of a DO is to rotate at DO friendly programs (which happen to often be 'less prestigious') for your first 2 Aways, and that way you have 2 Stellar SLOE's in your ERAS around September 15, and then go ahead and rotate at 2 DO unfriendly or very prestigious places for your last 2.


That way your 2 stellar SLOE's, albeit potentially at less prestigious places will not shut any doors for you when the flurry of invites go out late Sept/Oct, and you can still get your face in at some "reach" programs.

Edit: I will add that my board scores/med school grades were very competitive. I had a dream of being those DO's you see who match at programs that either have had no DO's or only have 1 DO every few years. I rotated at 2 MD programs that many very strong candidates on this forum often rank in their top 3, one of which never allowed DO's to rotate there before. I ended up getting a P at said program. The other program PD who meets with all rotators at the end of the rotation told me that I was so competitive I should only apply to 30 places.

Long story short, I ended up far fewer interviews than many of my close friends who had far inferior grades/board scores but rotated at much less desirable programs and got very good SLOE's from them.


So while a few of you are merely theorizing what we are talking about, I actually am someone who went through what we are talking about.


If I woke up tomorrow and it was 1 year ago, I would approach my audition rotations the way I outlined above, thats all I can say.

 

[racerwad]

The misconception with the people who claim that doing an away at a less prestigious place equates to "place handing out Honors like candy" is just that, a misconception.


More stellar candidates are attracted to more "prestigious" programs, which means the quality of people at those places is generally higher than a place that is either in a less desirable location or just an inferior program. That doesnt mean that the less prestigious places give out an Honors to 9/10 people who rotate there. It just means that when you go there, they arnt comparing you to the last 10 people that got 270's on their boards and are super strong candidates, hence it is easier to Honor a place that isnt lets say Hennepin or Indiana.


I agree with you, that I am not an MD, and therefore I cannot make a generalization that "if youre an MD and you do an ED rotation at your home program you are guaranteed an Honors".


I will tell you though, that I have 3 friends who are at MD schools who matched EM this year, they kind of run the spectrum of applicant strength, and I also met quite a few people on my 4 aways and from what I could tell the vast majority of them got Honors at their home institution with only 1 person I met who got a HP and he was quite livid of that fact, almost as if he thought he was guaranteed an Honors.



If you think I am arguing that Honoring a less prestigious place is better than Honoring a more prestigious place, haha, I am definitely not.


DO's are at a disadvantage in the MD match, its just a simple fact, and I think doing a more stable approach to the match is better.


If you are an absolute stellar applicant, top of your class, did very well on boards, then of course, go rotate at a prestigious program, why wouldnt you?

But if you are someone who got like a 210-220 or something, middle of your class AND youre a DO, I would NOT, recommend rotating at places that have only had 1-2 DO's in the last couple years and are very desirable programs.



I would say the best strategy of a DO is to rotate at DO friendly programs (which happen to often be 'less prestigious') for your first 2 Aways, and that way you have 2 Stellar SLOE's in your ERAS around September 15, and then go ahead and rotate at 2 DO unfriendly or very prestigious places for your last 2.


That way your 2 stellar SLOE's, albeit potentially at less prestigious places will not shut any doors for you when the flurry of invites go out late Sept/Oct, and you can still get your face in at some "reach" programs.

Edit: I will add that my board scores/med school grades were very competitive. I had a dream of being those DO's you see who match at programs that either have had no DO's or only have 1 DO every few years. I rotated at 2 MD programs that many very strong candidates on this forum often rank in their top 3, one of which never allowed DO's to rotate there before. I ended up getting a P at said program. The other program PD who meets with all rotators at the end of the rotation told me that I was so competitive I should only apply to 30 places.

Long story short, I ended up far fewer interviews than many of my close friends who had far inferior grades/board scores but rotated at much less desirable programs and got very good SLOE's from them.


So while a few of you are merely theorizing what we are talking about, I actually am someone who went through what we are talking about.


If I woke up tomorrow and it was 1 year ago, I would approach my audition rotations the way I outlined above, thats all I can say.

If I am understanding this correctly, you're saying that this cycle, you did what I endorse: rotate at "big name" place(s) and kill the rotation and that, as a result, the match did not go the way you had hoped. Am I understanding correctly? In this anecdote v. anecdote debate, I also did exactly that and had a better outcome than I could've imagined. At the risk of being a colossal douche, I do not think that the problem was with where you rotated.

I think all students, regardless of board scores, rank, or degree should rotate at both reach and a safety programs. In addition, their application and rank list should have a similar distribution.

I get what you're saying about being a bigger fish in a smaller pond when it comes to SLOEs from "less prestigious" places. I just think lowering the bar like that only harms yourself. The connections that a positive letter from a well-known place can't be overstated.

Your grades/board scores kind of get your foot in the door at some places due to their cut offs but the rest of the way is 100% SLOE's.

If SLOEs are this valuable (and they are) then why not get one from the best place you can?

I still stand by my position. Go to a great place and do great work.

 

[Makati2008]

The misconception with the people who claim that doing an away at a less prestigious place equates to "place handing out Honors like candy" is just that, a misconception.


More stellar candidates are attracted to more "prestigious" programs, which means the quality of people at those places is generally higher than a place that is either in a less desirable location or just an inferior program. That doesnt mean that the less prestigious places give out an Honors to 9/10 people who rotate there. It just means that when you go there, they arnt comparing you to the last 10 people that got 270's on their boards and are super strong candidates, hence it is easier to Honor a place that isnt lets say Hennepin or Indiana.


I agree with you, that I am not an MD, and therefore I cannot make a generalization that "if youre an MD and you do an ED rotation at your home program you are guaranteed an Honors".


I will tell you though, that I have 3 friends who are at MD schools who matched EM this year, they kind of run the spectrum of applicant strength, and I also met quite a few people on my 4 aways and from what I could tell the vast majority of them got Honors at their home institution with only 1 person I met who got a HP and he was quite livid of that fact, almost as if he thought he was guaranteed an Honors.



If you think I am arguing that Honoring a less prestigious place is better than Honoring a more prestigious place, haha, I am definitely not.


DO's are at a disadvantage in the MD match, its just a simple fact, and I think doing a more stable approach to the match is better.


If you are an absolute stellar applicant, top of your class, did very well on boards, then of course, go rotate at a prestigious program, why wouldnt you?

But if you are someone who got like a 210-220 or something, middle of your class AND youre a DO, I would NOT, recommend rotating at places that have only had 1-2 DO's in the last couple years and are very desirable programs.



I would say the best strategy of a DO is to rotate at DO friendly programs (which happen to often be 'less prestigious') for your first 2 Aways, and that way you have 2 Stellar SLOE's in your ERAS around September 15, and then go ahead and rotate at 2 DO unfriendly or very prestigious places for your last 2.


That way your 2 stellar SLOE's, albeit potentially at less prestigious places will not shut any doors for you when the flurry of invites go out late Sept/Oct, and you can still get your face in at some "reach" programs.

Edit: I will add that my board scores/med school grades were very competitive. I had a dream of being those DO's you see who match at programs that either have had no DO's or only have 1 DO every few years. I rotated at 2 MD programs that many very strong candidates on this forum often rank in their top 3, one of which never allowed DO's to rotate there before. I ended up getting a P at said program. The other program PD who meets with all rotators at the end of the rotation told me that I was so competitive I should only apply to 30 places.

Long story short, I ended up far fewer interviews than many of my close friends who had far inferior grades/board scores but rotated at much less desirable programs and got very good SLOE's from them.


So while a few of you are merely theorizing what we are talking about, I actually am someone who went through what we are talking about.


If I woke up tomorrow and it was 1 year ago, I would approach my audition rotations the way I outlined above, thats all I can say.

I think the P was your biggest reason why you received less interviews than others. I was advised at the two MD programs I rotated at that a P can be quite damaging and one of those programs said they don't consider applicants with a P on a sloe for interviews.

Also there have been posters here who have honored/HP at programs that don't take DOs so I'm wondering if you had a mishap on your rotation?

 

[Sloow]

I think the P was your biggest reason why you received less interviews than others. I was advised at the two MD programs I rotated at that a P can be quite damaging and one of those programs said they don't consider applicants with a P on a sloe for interviews.

Also there have been posters here who have honored/HP at programs that don't take DOs so I'm wondering if you had a mishap on your rotation?

I dont know, as you can imagine I have replayed that month over and over in my mind since, I do not believe I warranted a P. I even contacted the Clerkship Director after getting my grade and asked him about it so that I could fix anything for my future Auditions. They said that while my medical knowledge and decision making were above average, that I saw more patients than my colleagues on average, my somewhat soft spoken nature may have come off as disinterest to some people. (I should mention that I am far from an awkward or quiet person, my other SLOE's and Evals through 3rd year all talk about how easy I am to work with and have around etc so I just want to make it clear before someone jumps to 'Aha!', I am just a very hard worker in the ED, and especially on that rotation that specific program gives almost free reign to students so I was hustlin and bustlin)

I dont really know. I think it was probably just a combination of the program or maybe a few residents and/or attendings maybe having a bias towards DO's (name dropping was quite a thing there and when people asked me what school I went to and I would tell them they clearly had never heard of it before).

I really dont know, and at this point I dont care. I just know that if I had not done that rotation, and I probably could have done without doing the other "prestigious" audition that I would have had a lot more interviews.

I matched and am more than happy at where I matched, but there are a decent amount of places that I wanted to check out and interview at that I was not able to and had to watch friends/classmates with far inferior stats get interviews at said places.


I matched and am happy, but I would just caution any prospective DO applicant and even MD applicant to kind of approach their Audition rotations in a more cautious and logical fashion.

Its true that if you shoot for the stars you can fall short and end up on the moon, but you can also fall all the way back to earth.


But like one of the other posters is keen to point out, my story is n=1, just as theirs is n=1. I just wanted to put out what happened to me and if it helps anyone down the road then great.


Take care all

 

[Doctopus]

In every specialty that does not implicitly require away rotations, away rotations are discouraged. "More harm can be done than good by doing them," you'll hear from your internal medicine colleagues. And they are right.

Essentially requiring aways/SLOEs is an effort by emergency medicine residency leadership to ensure relatively unbiased appraisal of potential future employees by impartial outside institutions. Good for them -- not so for you.

Because while, yes, of course, a great performance on an away can be great for you, it is all too easy to mess up. When entering a new hospital, with new EMR, new staff, new locations for everything, etc. etc., where you'll only be working perhaps 14 shifts there (basically just enough time to start to figure things out), and where you're expecting to be acting at the "intern level," it's not easy....

Moreover you work side by side by similarly eager rotators, also seeking great SLOEs. But guess what? Half of you will be below average. And this time, rather than equating to a high pass, as it might at your own institution for any other rotation, you will be labeled "middle third," or god forbid, "bottom third" (1 in 3 rotators will receive this rank if SLOE rules are being followed).

My situation was similar to the poster above me. I would have actually gotten more and higher quality interviews by not going on *any* aways. But you must do at least one away (get at least one SLOE outside of your home institution's) to be considered by the best residencies in the country. So I agree with him: be extremely judicious. Know yourself, your personality. If you are super affable and pick up new systems easily, by all means away it up. If not, consider an away at a place where you might know a resident who can help show you the EMR and where things are in the hospital, etc. And yes, I would definitely consider a medium or even lower-tier program in a city you would otherwise really love to be -- because they will be doing everything to attract you, perhaps even including giving you a great SLOE.

I agree with the above poster that the downside risk is much higher than the upside, and that the impact of your SLOE evals is probably greater than any other single piece of your application, outweighing, on an individual basis, STEP1, STEP2, clinicals...DEFINITELY outweighing them if mediocre or poor.

I would only do one away. (Or if you want to get really advanced, 2 or 2+ aways/SLOEs, and then apply to a bunch of programs, each with a different distribution of 2 SLOEs, always home institution + 1 of your away SLOEs. That way if there's a stinker SLOE, not all programs need to see it.)

 

[racerwad]

If you're this risk averse, maybe EM isn't for you.

Even if you struggle on a rotation at a competitive program, don't you want the opportunity to rise to the challenge? The reward is commensurate with the risk.

None of these programs expect us to be experts. They want to see how hard we are willing to work and how open to teaching we are. If we were already experts, then we wouldn't need residency programs to being with.

 

[hoot504]

If I had read this thread a year ago I would have been petrified of doing an away.

I did two, including one at a mega-competitive west coast program. Honored both, and I'm a guy who only honored a couple of his 3rd year clerkships.

The secret? Be nice to everyone, practice your presentation skills, and above all else be enthusiastic. It really ain't that hard. People aren't looking to write a bad SLOE, they generally want you to succeed. I'm sure from time to time people are misjudged (as may be the case with the OP), but I don't think aways are something to fear.

I think the biggest risk in terms of getting a Pass is flubbing the final, especially if you're taking the NBME shelf, which is not easy.

 

[res1cue]

Racerwads post is spot on

In every specialty that does not implicitly require away rotations, away rotations are discouraged. "More harm can be done than good by doing them," you'll hear from your internal medicine colleagues. And they are right.

Essentially requiring aways/SLOEs is an effort by emergency medicine residency leadership to ensure relatively unbiased appraisal of potential future employees by impartial outside institutions. Good for them -- not so for you.

Because while, yes, of course, a great performance on an away can be great for you, it is all too easy to mess up. When entering a new hospital, with new EMR, new staff, new locations for everything, etc. etc., where you'll only be working perhaps 14 shifts there (basically just enough time to start to figure things out), and where you're expecting to be acting at the "intern level," it's not easy....

Moreover you work side by side by similarly eager rotators, also seeking great SLOEs. But guess what? Half of you will be below average. And this time, rather than equating to a high pass, as it might at your own institution for any other rotation, you will be labeled "middle third," or god forbid, "bottom third" (1 in 3 rotators will receive this rank if SLOE rules are being followed).

My situation was similar to the poster above me. I would have actually gotten more and higher quality interviews by not going on *any* aways. But you must do at least one away (get at least one SLOE outside of your home institution's) to be considered by the best residencies in the country. So I agree with him: be extremely judicious. Know yourself, your personality. If you are super affable and pick up new systems easily, by all means away it up. If not, consider an away at a place where you might know a resident who can help show you the EMR and where things are in the hospital, etc. And yes, I would definitely consider a medium or even lower-tier program in a city you would otherwise really love to be -- because they will be doing everything to attract you, perhaps even including giving you a great SLOE.

I agree with the above poster that the downside risk is much higher than the upside, and that the impact of your SLOE evals is probably greater than any other single piece of your application, outweighing, on an individual basis, STEP1, STEP2, clinicals...DEFINITELY outweighing them if mediocre or poor.

I would only do one away. (Or if you want to get really advanced, 2 or 2+ aways/SLOEs, and then apply to a bunch of programs, each with a different distribution of 2 SLOEs, always home institution + 1 of your away SLOEs. That way if there's a stinker SLOE, not all programs need to see it.)

The reason why PDs want to see these SLOEs from away rotations is because they are difficult and objective. This shows that you arent just gaming the system like you are suggesting

Going to a foreign institution where you dont know anybody and dont even know the EMR and still honoring the rotation speaks volumes. That is exactly what we are expected to do in a few months and they want to see that we are capable of it. It is the same idea as DO students taking the USMLE

Esp as a DO student, how else can we prove to these PDs that we are just as good as MD students except by outperforming them at their own home institution?

In general I find it distasteful when people advise others to shoot for mediocrity

 

[racerwad]

If I had read this thread a year ago I would have been petrified of doing an away.

I did two, including one at a mega-competitive west coast program. Honored both, and I'm a guy who only honored a couple of his 3rd year clerkships.

The secret? Be nice to everyone, practice your presentation skills, and above all else be enthusiastic. It really ain't that hard. People aren't looking to write a bad SLOE, they generally want you to succeed. I'm sure from time to time people are misjudged (as may be the case with the OP), but I don't think aways are something to fear.

I think the biggest risk in terms of getting a Pass is flubbing the final, especially if you're taking the NBME shelf, which is not easy.

Racerwads post is spot on

The reason why PDs want to see these SLOEs from away rotations is because they are difficult and objective. This shows that you arent just gaming the system like you are suggesting

Going to a foreign institution where you dont know anybody and dont even know the EMR and still honoring the rotation speaks volumes. That is exactly what we are expected to do in a few months and they want to see that we are capable of it. It is the same idea as DO students taking the USMLE

Esp as a DO student, how else can we prove to these PDs that we are just as good as MD students except by outperforming them at their own home institution?

In general I find it distasteful when people advise others to shoot for mediocrity

I think that these guys have hit the nail on the head. One other point: if you do feel as though you are struggling at the end of week one, talk to someone! It says a lot about your insight and maturity if you can recognize when you aren't working to your potential. Moreover, many of the ED faculty (at least at the places I went) are faculty just for this opportunity to help someone make the most of their rotation. They enjoy teaching and mentoring.

Aways shouldn't be scary - it should be an exciting opportunity to show that you belong. You've worked hard to get to your senior year of medial school. Enjoy it.

Oh, and don't underestimate the shelf as @hoot504 says. Not everyone uses it; some programs use their own. Regardless, you do need to keep reading during the month.