SLOE Questions

[AlwaysOnDivert]

Apologies if this question has already been asked, or if I'm posting in the wrong forum.

I'm a 3rd year DO student, been planning on going EM before even getting into med school. To keep my options open, I'm planning on doing 4th year rotations at both MD and DO programs. Will MD programs accept SLOEs obtained from a DO program? Will they be given less weight if they aren't from an MD program? Will DO programs accept MD SLOEs?

Thanks for taking the time to read/respond!

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[BoardingDoc]

Apologies if this question has already been asked, or if I'm posting in the wrong forum.

I'm a 3rd year DO student, been planning on going EM before even getting into med school. To keep my options open, I'm planning on doing 4th year rotations at both MD and DO programs. Will MD programs accept SLOEs obtained from a DO program? Will they be given less weight if they aren't from an MD program? Will DO programs accept MD SLOEs?

Thanks for taking the time to read/respond!

If you are rotating at an MD EM program, they will write a SLOE for you after your rotation is over. If you rotate at a DO EM program, you can get a regular letter, but they are not allowed to write SLOEs.

 

[AlwaysOnDivert]

Is this also true for DO programs that have accreditation or "Initial Accreditation" status from the ACGME? Still trying to sort out how the merger affects various things.

 

[BoardingDoc]

Is this also true for DO programs that have accreditation or "Initial Accreditation" status from the ACGME? Still trying to sort out how the merger affects various things.

If they're ACGME accredited, they can write SLOEs. I don't know about initial accreditation

 

[gamerEMdoc]

If you are rotating at an MD EM program, they will write a SLOE for you after your rotation is over. If you rotate at a DO EM program, you can get a regular letter, but they are not allowed to write SLOEs.

DO programs have been writing SLOEs for years. Their PDs are members of CORD, who developed, edits, and publishes the SLOE for each year. Some DO programs traditionally choose not to participate in writing SLOEs (I have my suspicions why), but I assure you, they are "allowed" to write SLOEs. The ACGME doesn't regulate SLOE writing, ACGME accredidation has nothing to do with who should or shouldn't write a SLOE.

 

[gamerEMdoc]

"Will MD programs accept SLOEs obtained from a DO program? Will they be given less weight if they aren't from an MD program? Will DO programs accept MD SLOEs?"

I can only speak for myself, but I don't care where the SLOE comes from. I care mostly about the competitiveness breakdown to put the students raking into some kind of context. What percentage of people are rated top 10%, top 1/3, mid 1/3, low 1/3. There are some really big name places that over-inflate their SLOE rankings (ex 30% top 10, 50% top 1/3, 20% mid 1/3, 0% low 1/3), and some community hospitals that are really tough graders and hit a more normal distribution. It doesn't matter to me whether the program is an AOA or ACGME program when I look at the SLOE.

 

[AlwaysOnDivert]

Awesome, thanks! Follow up question: I'm doing an EM rotation through my school at the end of this year. The hospital has residency programs and is owned by a university health system, but this particular hospital doesn't have an EM residency. I take it they cannot write a SLOE for me?

 

[BoardingDoc]

DO programs have been writing SLOEs for years. Their PDs are members of CORD, who developed, edits, and publishes the SLOE for each year. Some DO programs traditionally choose not to participate in writing SLOEs (I have my suspicions why), but I assure you, they are "allowed" to write SLOEs. The ACGME doesn't regulate SLOE writing, ACGME accredidation has nothing to do with who should or shouldn't write a SLOE.

That's interesting if correct. I freely admit that I'm basing my statement off of DO students I've spoken with who have said that their programs required them to rotate at ACGME programs if they needed a SLOE. Apparently this is not a universal DO thing

 

[gamerEMdoc]

That's interesting if correct. I freely admit that I'm basing my statement off of DO students I've spoken with who have said that their programs required them to rotate at ACGME programs if they needed a SLOE. Apparently this is not a universal DO thing

It's possible some ACGME programs want to see SLOEs from other ACGME programs, because it indicates you are likely doing the ACGME match, not the AOA match. I also suspect that the reason some DO programs don't write SLOEs is because in the DO match, its not as necessary at some programs to have a SLOE to match (but it is at the competitive DO programs). So by not writing SLOEs for candidates, it hurts the candidates competitiveness at bigger DO residencies, and it kills their chances in the ACGME match. Obviously, that is 100% PURE SPECULATION and I have no proof of that, but I for the life of me can't understand why a residency program would otherwise tell rotating students they don't write SLOEs because "you don't need them to match AOA". Well, you do at many AOA programs, and not every student wants to match AOA. So to me, it seems self serving to do this as a program. Maybe there's other reasons, but I can't think of any.

 

[gamerEMdoc]

Awesome, thanks! Follow up question: I'm doing an EM rotation through my school at the end of this year. The hospital has residency programs and is owned by a university health system, but this particular hospital doesn't have an EM residency. I take it they cannot write a SLOE for me?

They can, but its discouraged by CORD. Anyone can download the SLOE form and fill it out. Its not like you have to have some secret login to obtain it (although you do if you use the E-SLOE which most use now, because it automatically tracks your stats for you). So technically anyone can download the form and fill it out. What they can't do is, honestly answer the last question, which states where do you anticipate this student being on your rank list, and unfortunately, this is probably the most important question on the form.

If you can get two SLOEs from two places with a residency program, I'd try and do so. Use the one at your home institution as a 3rd one. If you can't, then at least get a 2nd at a place with a residency.

 

[BoardingDoc]

It's possible some ACGME programs want to see SLOEs from other ACGME programs, because it indicates you are likely doing the ACGME match, not the AOA match. I also suspect that the reason some DO programs don't write SLOEs is because in the DO match, its not as necessary at some programs to have a SLOE to match (but it is at the competitive DO programs). So by not writing SLOEs for candidates, it hurts the candidates competitiveness at bigger DO residencies, and it kills their chances in the ACGME match. Obviously, that is 100% PURE SPECULATION and I have no proof of that, but I for the life of me can't understand why a residency program would otherwise tell rotating students they don't write SLOEs because "you don't need them to match AOA". Well, you do at many AOA programs, and not every student wants to match AOA. So to me, it seems self serving to do this as a program. Maybe there's other reasons, but I can't think of any.

Appreciate the info. Thanks for clarifying.

 

[Lexdiamondz]

Apologies if this question has already been asked, or if I'm posting in the wrong forum.

I'm a 3rd year DO student, been planning on going EM before even getting into med school. To keep my options open, I'm planning on doing 4th year rotations at both MD and DO programs. Will MD programs accept SLOEs obtained from a DO program? Will they be given less weight if they aren't from an MD program? Will DO programs accept MD SLOEs?

Thanks for taking the time to read/respond!

I wouldn't roll the dice on a SLOE from an Osteopathic programme if my goal was to match ACGME. ACGME program directors may not be familiar with SLOE writers from DO programmes and that may not work in your favour depending on what region you're planning on applying in or hoping to break into.

 

[gamerEMdoc]

I wouldn't roll the dice on a SLOE from an Osteopathic programme if my goal was to match ACGME. ACGME program directors may not be familiar with SLOE writers from DO programmes and that may not work in your favour depending on what region you're planning on applying in or hoping to break into.

Depends on the ACGME program. I mean, to be honest, there are like 200 programs. If you tell me a random community ED program from the other side of the country, I can't tell you if that's a DO program or an ACGME program. If you are applying to mostly community EM programs, I think a SLOE from an AOA program would be fine. But yeah, if you are 100% going the ACGME route, probably best to get ACGME SLOEs.

Re: SLOEs and where they come from, in my opinion, assuming the rank is the same (top 10, top 1/3, etc), then in my mind I weight the SLOE as follows:
1. Well known place that doesn't inflate their grades
2. Place that doesn't inflate their grades but isn't a big name place.
3. Big name place with grade inflation
4. No name place with grade inflation

That's how, in my mind, I think about the quality of a SLOE, taking into account the prestige of the institution, and how they do or don't over inflate their SLOE scoring. Obviously, this is one persons opinion, take that for what its worth.

 

[AlwaysOnDivert]

Bumping this as there are apparently new SLOE options.

TL;DR: how would the new CORD SLOE versions from Subspecialty Rotation and Non-EM Residency Faculty be weighed?

CORD now has options for a SLOE from an EM subspecialty, as well as one from faculty practicing at institutions with no established EM residency. Any thoughts on how each of these would be weighed? I completed a 3rd year clerkship at a university institution with no EM residency but very busy department, so I could get a letter from the director of that program. I am also scheduled for a 4th year Ultrasound rotation, and I imagine I could easily get the subspecialty letter from that.

 

[racerwad]

Since you now have this option, you should exercise it. I imagine that it is fair to say it won't be a 1:1 comparison if your other SLOE is from big name program X, but I'm sure you knew that. The US rotation is probably less useful than the regular ED rotation since it is a niche focused on one specific thing rather than your performance compared to your peers in the ED (which is, you know, the whole point of the SLOE) but I'd still send it.

 

[AlwaysOnDivert]

That's what I was thinking. I have two regular ED sub-I's scheduled that I should be getting letters from. One is at a DO program (with ACGME Initial Accreditation). The other is at St. Louis University. My SLU rotation ends on 10/15, I'm told that isn't too late to get a SLOE, correct?

 

[futureemdoc91]

Since you now have this option, you should exercise it. I imagine that it is fair to say it won't be a 1:1 comparison if your other SLOE is from big name program X, but I'm sure you knew that. The US rotation is probably less useful than the regular ED rotation since it is a niche focused on one specific thing rather than your performance compared to your peers in the ED (which is, you know, the whole point of the SLOE) but I'd still send it.

I have a different view on this bc I have a friend that did an US rotation and got a regular sloe from it (not the new "subspecialty" sloe) and at interviews it was discussed that it was one of the strongest letters in his file. The reasoning was that they already had a sloe from a regular EM rotation that showed they could function in the department and compared them to others, but during the US rotation which was largely a make your own schedule and show up when you want, it showed that they were self-directed and hard working, but also gave them the exposure to every faculty member and resident that was rotating through the department that month which was a huge advantage in getting to know people and having personality shine. BUT it depends on where you do this rotation because I have heard some less positive stories too.

 

[racerwad]

I have a different view on this bc I have a friend that did an US rotation and got a regular sloe from it (not the new "subspecialty" sloe) and at interviews it was discussed that it was one of the strongest letters in his file. The reasoning was that they already had a sloe from a regular EM rotation that showed they could function in the department and compared them to others, but during the US rotation which was largely a make your own schedule and show up when you want, it showed that they were self-directed and hard working, but also gave them the exposure to every faculty member and resident that was rotating through the department that month which was a huge advantage in getting to know people and having personality shine. BUT it depends on where you do this rotation because I have heard some less positive stories too.

I can only answer from the perspective of a resident who participates in the recruitment and ranking process at one program. I'm glad it worked out for them.

 

[futureemdoc91]

I can only answer from the perspective of a resident who participates in the recruitment and ranking process at one program. I'm glad it worked out for them.

Fair. At most formal ultrasound rotations there are several students each year, allowing comparison to still occur (it's on the sloe-subspecialty form). Additionally, youre able to pick up a few shifts to work in the department as well, allowing comparisons then to occur too.

tl;dr ultrasound is worth it. i think EMS rotations are less valuable because you aren't with the faculty and residents all the time. But maybe I am biased because I have one set up.

 

[westdescartes]

"Will MD programs accept SLOEs obtained from a DO program? Will they be given less weight if they aren't from an MD program? Will DO programs accept MD SLOEs?"

I can only speak for myself, but I don't care where the SLOE comes from. I care mostly about the competitiveness breakdown to put the students raking into some kind of context. What percentage of people are rated top 10%, top 1/3, mid 1/3, low 1/3. There are some really big name places that over-inflate their SLOE rankings (ex 30% top 10, 50% top 1/3, 20% mid 1/3, 0% low 1/3), and some community hospitals that are really tough graders and hit a more normal distribution. It doesn't matter to me whether the program is an AOA or ACGME program when I look at the SLOE.

Could I ask you about this? I'm wondering if there's possibly a bias that the big name places accept competitive EM applicants who do well on rotations, and thus their grades are inflated because more of their rotators are "honors" quality?

 

[gamerEMdoc]

Could I ask you about this? I'm wondering if there's possibly a bias that the big name places accept competitive EM applicants who do well on rotations, and thus their grades are inflated because more of their rotators are "honors" quality?

Very true

 

[AlwaysOnDivert]

Following up since so far I haven't received a definitive response: getting a SLOE in from a rotation that ends on 10/15 won't be too late, correct? I'll hopefully have at least one by mid-September.

 

[doggydog]

Following up since so far I haven't received a definitive response: getting a SLOE in from a rotation that ends on 10/15 won't be too late, correct? I'll hopefully have at least one by mid-September.

It's certainly not ideal, but it doesn't seem like you have a better option.

 

[gamerEMdoc]

Following up since so far I haven't received a definitive response: getting a SLOE in from a rotation that ends on 10/15 won't be too late, correct? I'll hopefully have at least one by mid-September.

Nope, as long as you have one in Sept, getting the second mid interview season should be ok for the majority of programs.

 

[Technorino]

Quick questions for you all!

Is getting 4 SLOE's looked down upon?

Should I just stick with 3 and ask the last program to not give me a SLOE (new program)?

 

[gamerEMdoc]

Quick questions for you all!

Is getting 4 SLOE's looked down upon?

Should I just stick with 3 and ask the last program to not give me a SLOE (new program)?

I dont think its looked down upon, Im just not sure what it adds.

 

[Technorino]

I dont think its looked down upon, Im just not sure what it adds.

Would you say that there any cons to doing three away rotations?

 

[gamerEMdoc]

Would you say that there any cons to doing three away rotations?

Nope, other than the cost of travel and hassle of being away from home. Aways are like auditions, and obviously thats probably more stressful than doing a home radiology rotation. But other than that, I dont see any major negatives.

 

[Birdstrike]

No one really cares that much about these letters, honestly. They're usually so generic, bland and scream "I barely knew this guy. Probably needs a 3 year residency to know what he's doing. He seemed alright though. I think."

Unless, a letter is bad. Then they care.


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[gamerEMdoc]

No one really cares that much about these letters, honestly. They're usually so generic, bland and scream "I barely knew this guy. Probably needs a 3 year residency to know what he's doing. He seemed alright though. I think."

Unless, a letter is bad. Then they care.

Sent from my iPhone using SDN mobile

Are you talking about SLOEs? Because if so, this is not true. I agree the comments section sometime is generic, but the sloe rankings are very important. when surveyed, PDs rank sloes as the most important part of the application in EM, they are much more important than board scores.

 

[Birdstrike]

Are you talking about SLOEs? Because if so, this is not true. I agree the comments section sometime is generic, but the sloe rankings are very important. when surveyed, PDs rank sloes as the most important part of the application in EM, they are much more important than board scores.

I was referring to the subjective written portion, not the numerical or ranking portions, which are just a rehash of academic performance (which is very important).


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[DrMcCoyDO]

From personal experience, make sure that the DO program you’re getting a SLOE has experience writing them; if not, try to get another rotation at a program that does. My second SLOE was from my home EM program, where there was virtually no experience putting together a SLOE, and that significantly hurt me in interview season. I actually didn’t find out how poorly the letter was prepared until the APD at my final interview (where I fortunately ended up matching) pointed out to me the mistakes in its preparation.

 

[surely]

Does U Vermont have experience writing SLOEs for rotating students? I know it's becoming a new EM residency program in 2019 but wasn't sure if they have been writing SLOEs for students before this date. Thanks!

My understanding is that only places with a residency program can write SLOEs. Since they haven't started their program yet, I'm 99% positive they haven't written SLOEs before. If you're a home student at University of Vermont, ask the clerkship director or the graduating students how this was done. If you're not a home student but you're thinking of doing an Away there to get a SLOE... I don't see how that could work.

 

[gamerEMdoc]

My understanding is that only places with a residency program can write SLOEs. Since they haven't started their program yet, I'm 99% positive they haven't written SLOEs before. If you're a home student at University of Vermont, ask the clerkship director or the graduating students how this was done. If you're not a home student but you're thinking of doing an Away there to get a SLOE... I don't see how that could work.

Well the difference between the residency sloe and the modified sloe that is for non residencies that still have med students rotate is the last question (which is probably the most important) regarding where do you anticipate ranking this student in your program. If Vermont is starting in 2019, they will be ranking people in the match so I would imagine they could use the traditional sloe.