SLOEs

[DrWhozits]

Ive looked at a bunch of different places which discuss SLOEs but never have been able to get a clear answer for this:

How many SLOEs are required? Or is it just a 0<1<2 sort of thing?

The way my school's 3rd and 4th year is set up makes this sort of a complicated process.

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[TheOther]

It's my understanding that in order to be competitive, you need at least 2 (solid) SLOEs.

 

[gamerEMdoc]

Every applicant in EM should have at least two SLOEs. If you were going to pursue matching and EM, I assume a candidate will have done 2 EM rotations at residency sites (usually more). There should be no reason if you do two or more rotations at sites with EM residencies that you cant get two SLOEs.

 

[CliveStaples]

1 isn't enough. 2 is good. 3 might be better. 4 isn't necessary.

 

[Status Sciaticus]

My PD has mentioned that 1 home and 1 away is all you need. 2nd aways should be focused on EM electives such as US, Tox, or EMS, etc..
Not sure how many PD's agree with it but he said thats the norm.
On SDN, i see 1/2 of posts with 3 rotations and the other with 2 though.

 

[CliveStaples]

My PD has mentioned that 1 home and 1 away is all you need. 2nd aways should be focused on EM electives such as US, Tox, or EMS, etc..
Not sure how many PD's agree with it but he said thats the norm.
On SDN, i see 1/2 of posts with 3 rotations and the other with 2 though.

I'd agree that one home and one away is all that you need (as long as they are both at residency programs which can provide meaningful SLOEs).

I would say you should either do a second away rotation for your third SLOE or don't do the away at all. These US/Tox/EMS away rotations provide little value, won't give you a SLOE, and come with all the inconvenience and expenses that come with doing an away rotation. Unless you're absolutely interested in that specific EM elective, I wouldn't do it (and even in that case, I would suggest finding it at your home institution and saving yourself the hassle and cost).

Two or three SLOEs. Both are acceptable. If you have two good SLOEs you really don't need a third. If you have a good SLOE and a mediocre SLOE, a third one that's also good can help cover for the mediocre one. The problem is that you can't know how these letters will be before you schedule your aways and once you go to one, you'll really be expected to get and submit the letter.

 

[DrWhozits]

Thanks, everybody. My school doesn't have a program. So I guess I will be aiming to do two aways and possibly a third.

 

[EMhopeful*]

As one PD I met put it, EM physicians are accustomed to making decisions with limited/incomplete information, so many programs will offer II's with only 1 SLOE uploaded. However, the II's are often offered with the expectation that additional SLOEs will be uploaded. It becomes clear when interviewing that many programs expect a minimum of 2 SLOEs to be competitive for the rank list.

Bottom line: you need at least 2 SLOEs. Ideally, both SLOEs should be uploaded by September 15th, but you can still get II's if only 1 SLOE is uploaded by then.

 

[BoardingDoc]

My PD has mentioned that 1 home and 1 away is all you need. 2nd aways should be focused on EM electives such as US, Tox, or EMS, etc..
Not sure how many PD's agree with it but he said thats the norm.

I agree that one home and 1 away is all you need. There is absolutely no need whatsoever to do an US/Tox/EMS elective.

 

[Status Sciaticus]

I agree that one home and 1 away is all you need. There is absolutely no need whatsoever to do an US/Tox/EMS elective.

Yes. I should clarify. He mentioned that if you absolutely HAD to do a 2nd away to do those electives, especially since doing a 3rd EM rotation, you will be graded to a much higher standard than your 1st or 2nd.
I'm leaning on the 1+1 instead of 2 aways, unless theres an overwhelming need to do it since our school doesnt count more each course more than twice.

 

[RockFlag&Eagle]

This is just my opinion, but I would say if you're going to do a third month do another emergency month. I'm not sure that you will get graded any harder...that might be speculative and I'd be curious to hear what some faculty on here would say about that. I'd only do an EM subspecialties month if you're genuinely interested in it or if it's your only chance to do an away at a program you want to see up close because there are no EM elective slots for you that month. Just a student opinion here tho.

 

[BoardingDoc]

I'm not sure that you will get graded any harder...

I agree. The away coordinators generally have no idea how many EM rotations you've done and even if they did, the idea that they'd grade you harder compared to your fellow rotators makes no sense. I still agree that there is no necessity to doing a 3rd EM rotation, but it is by no means abnormal to do so. Many of the applicants I spoke to this cycle had done 2 aways +1 home, largely to get an idea if they liked specific programs which made sense.

 

[Status Sciaticus]

This is just my opinion, but I would say if you're going to do a third month do another emergency month. I'm not sure that you will get graded any harder...that might be speculative and I'd be curious to hear what some faculty on here would say about that. I'd only do an EM subspecialties month if you're genuinely interested in it or if it's your only chance to do an away at a program you want to see up close because there are no EM elective slots for you that month. Just a student opinion here tho.

I agree. The away coordinators generally have no idea how many EM rotations you've done and even if they did, the idea that they'd grade you harder compared to your fellow rotators makes no sense. I still agree that there is no necessity to doing a 3rd EM rotation, but it is by no means abnormal to do so. Many of the applicants I spoke to this cycle had done 2 aways +1 home, largely to get an idea if they liked specific programs which made sense.

these points are fair too. The reasoning given to us was that if its your 3rd time doing the same rotation, you are expected to know your stuff better than students who are doing their 1st or 2nd rotation so there is a greater expectation.
It was also mentioned that the faculty do know how many rotations you have done since one of the boxes for the SLOE asks how many prior rotations have you done.

 

[Trail Blazer]

I'll throw in my 2cents and advocate for 3 or 4 EM rotations. I was lucky enough to have a home(ish) program where I did my first EM rotation. I decided pretty early on that I wanted to do 3 aways for a number of reasons:
1. Get a flavor of different styles of programs. My home program is more of a county ED, so I wanted to compare it to a community, tertiary, and super academic ED. Further, each ED is run differently (ie pods vs grab a chart and go vs sections). Finally, it is interesting to see how lectures are so different in each program.
2. Diversity for region. I think this helped immensely as I did an away on the west coast, S, and SE regions. If you can show you can work with different types of personalities (both patients and staff), I think this will look "good" to programs that you can fit seamlessly into any team.
3. More SLOEs to choose from. If you have a bad experience on one away, don't upload that SLOE. Most of the time your 4th SLOE won't be uploaded until November or December, and by that point you've had a number of interviews as it is. I felt a lot of programs didn't even realize I had done a 4th away as that 4th SLOE wasn't uploaded yet.
4. Overall experience. You learn a lot about EM by getting a ton of different opinions. Some places use TIMI, others use HEART. Some places have ECMO, others hypothermia. Trauma bays are all different. Do you mind hallway beds, or prefer all private rooms?

I think the big caveat is that you have to be confident that you'll do fine on your aways. Doing this many could backfire, as it may increase your chances of getting that dreaded SLOE that torpedoes your app. On the flip side, it could also give you 3 or 4 bomb SLOEs that boosts a lower step score and average grades.

Getting into a residency is all about playing the game. The crappy part is that you have so many decisions to make. The awesome part is that YOU get to make those decisions, so its in your control.

Good luck future EM docs!

 

[RPedigo]

Thanks, everybody. My school doesn't have a program. So I guess I will be aiming to do two aways and possibly a third.

On the last CORD/CDEM survey (I forget which it was) they found that about 80% of programs will extend interviews with 1 SLOE, the other 20% of programs required two SLOEs, and no programs required >2 SLOEs. So, from an application standpoint, 2 rotations is the way to go. After that, you could do additional rotations but it would not meaningfully change your application strength (e.g., 3 SLOEs that are good don't help more than 2 SLOEs that are good) as long as your first two SLOEs were decent. You could (as Trail Blazer suggested above) do more rotations to get a feel for where you might want to go, and to get "face time" at a specific rotation site, but it would not be necessary. If you bombed one of your first two rotations, having a 3rd SLOE would be helpful, though; hopefully that is not an issue!

 

[gamerEMdoc]

2 SLOEs are all you need, but maybe more than 2 rotations. For several reasons. It depends on the candidate. If you are a US MD with great scores and a good application, then your fine with two rotations and two SLOEs. But if for whatever reason you don't have a top tier application, rotating at more sites gives several benefits. First and foremost, if you do ask for more than 2 SLOEs, you can try and guess based on your rotation grades which SLOEs will be the strongest to submit to programs during interview season. Second, rotations almost always open up an interview spot at a given location. Doing 4 EM months may be the difference between 8 interviews vs 10 interviews for some candidates, and that statistically is very important. Does that apply to everyone? Absolutely not.

 

[TheNewOne]

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[CliveStaples]

Current M1 here, I'm still learning about the EM residency application process and I have a couple questions about SLOE that I would appreciate some help on.

A student doing his or her very first EM rotation will most likely have a tough time impressing the attending simply due to inexperience rotating in the ER. In that case isn't it unlikely that a SLOE from the first EM rotation will not be that great? Doesn't that mean the student almost has to do 2 aways just to get 2 good SLOEs?

Do EM residency programs expect the student to upload a SLOE from each EM rotation? Does not having a SLOE from an EM rotation considered a red flag?

Honestly I doubt students get all that much "better" then more rotations they do. Also, your evaluation on your SLOE (google it; you can see how it's graded) is based on your performance relative to your peers. So your first EM rotation is probably going to be compared to a bunch of people who are also on their first rotation. Two SLOEs is fine for 90% of people.

 

[racerwad]

...
A student doing his or her very first EM rotation will most likely have a tough time impressing the attending simply due to inexperience rotating in the ER. In that case isn't it unlikely that a SLOE from the first EM rotation will not be that great? Doesn't that mean the student almost has to do 2 aways just to get 2 good SLOEs?

Do EM residency programs expect the student to upload a SLOE from each EM rotation? Does not having a SLOE from an EM rotation considered a red flag?

Everyone has to do a first rotation at some point. Your first SLOE can be as good as your last. No one expects you to be amazing at your first rotation or your last - you just have to be hardworking, teachable, and enthusiastic.

Programs do expect you to upload every SLOE, but they also won't know where you had rotated. If you tell a program you rotated at a spot and then tell them you aren't uploading that SLOE, that would be a red flag. Otherwise, what they don't know can't be used against you.

Honestly, people overthink this. Expectations of medical students are really quite low. Just do your best and enjoy your rotations.

 

[TheNewOne]

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[tux4]

Honestly I doubt students get all that much "better" then more rotations they do. Also, your evaluation on your SLOE (google it; you can see how it's graded) is based on your performance relative to your peers. So your first EM rotation is probably going to be compared to a bunch of people who are also on their first rotation. Two SLOEs is fine for 90% of people.

I definitely got better with each one. You can learn to gauge the role of the med student in the ED and where you fit in best in certain situations. You learn the type of questions to ask that you wouldn't think of before unless you had ED experience. I knew after my first rotation how important it is to familiarize yourself early with where everything is and what resources are available. Made a big difference for me.


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[NRAI2001]

I m an FM resident interested in doing EM. My residency does have an EM fellowship for FM grads and that's a part of the reason I ranked it higher (discovered my interest in EM too late). I m at an unopposed FM residency where FM is the only program other than the EM fellowship.

How would I go about getting a SLOE in that situation? I could get one from the fellowship PD?

My goal would be to finish my FM residency and to then reapply to EM programs with or without the possibility of getting some credit from my current program.

 

[racerwad]

I m an FM resident interested in doing EM. My residency does have an EM fellowship for FM grads and that's a part of the reason I ranked it higher (discovered my interest in EM too late). I m at an unopposed FM residency where FM is the only program other than the EM fellowship.

How would I go about getting a SLOE in that situation? I could get one from the fellowship PD?

My goal would be to finish my FM residency and to then reapply to EM programs with or without the possibility of getting some credit from my current program.

Sadly, the most credit you'd get is 6m, depending on the mood of the PD. The fellowship won't be able to give you a SLOE because they aren't an ACGME accredited residency. Your best bet is to do an EM rotation on an elective month at an institution that has a program.

 

[gamerEMdoc]

I m an FM resident interested in doing EM. My residency does have an EM fellowship for FM grads and that's a part of the reason I ranked it higher (discovered my interest in EM too late). I m at an unopposed FM residency where FM is the only program other than the EM fellowship.

How would I go about getting a SLOE in that situation? I could get one from the fellowship PD?

My goal would be to finish my FM residency and to then reapply to EM programs with or without the possibility of getting some credit from my current program.

SLOES are meant to rank 4th year students against other fourth year students. You shouldn't be getting SLOEs several years into residency, nor should anyone expect you too. CORD discourages SLOES to be written for people who arent students.