Just wondering. Other specialties with a similar competitiveness do not require aways; for example, I have been a DR hopeful the whole time, and doing an away for DR is absolutely not necessary. On the other hand, even some of my friends with >250s on both Steps are advised to do at least one away rotation (and my home institution is a top 10 med school with a strong EM department, so it's not like they can't get adequate experiences in EM). Is this because you have to get a certain number of SLOEs or something? Has anyone been successful in match without doing an away (assuming they did well at their home program)?
Why is an away rotation virtually a must in EM?
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If the whole point is to get a second SLOE, then does this mean you don't really have to do the away in another region? I thought doing aways only in a certain region (especially if it's the same region as your home school) would hurt the application for programs in other parts of the country.
emthrowaway13579
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I got all 3 SLOEs from the same city and got interviews in every part of the country. If you do well enough you'll be fine, no need to spend a lot of money subletting
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You can do your aways wherever you want (if accepted). Theoretically, you should hit target regions if you don't have ties/school isn't there, etc. But for me, my SLOEs didn't correlate with the geography of my invites anyway, but everyones mileage may vary. I believe geographical ties, at least for EM, are overblown. I got invites from all over.
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Because SLOEs determine competitiveness of the app and generally, you only get one sloe from a given institution.
EM is different from just about any other field in terms of the application process, what you need to do, what programs value, etc.
EM is different from just about any other field in terms of the application process, what you need to do, what programs value, etc.
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Couple of different answers to your question.
1) EM PDs care about different things than PDs in other fields
2) EM is more competitive than you think
EM PDs care way more about indicators of clinical success (SLOEs most importantly, but also home and away rotation grades) and way less about step 1 than other fields. Around 90% of PDs in EM cited SLOE as one of the main factors in considering an applicant and only about 10% said the same of the USMLE. So estimating competitiveness of the field by average step scores would mislead you into thinking EM is less competitive that it actually is. Actually, ranking specialties by competitiveness is hard, but one metric is what percentage is filled by US students vs FMGs. Looking at the NRMP match report is misleading in this way, because it breaks down US MD seniors vs everyone else, which gives EM a fill rate of around 65%, comparable to, for example, diagnostic radiology at 59%. However, if you look at who makes up the remainder in EM (attaching table), it's primarily US MD graduates (people who have graduated at least one year prior and not 4th year MD students) and DO students. US IMGs, non US IMGs, and unmatched spots put together make up around 5% of residency spots. This gives EM a US MD/DO match rate of around 95%, which brings it into the surgical subspecialty match range (if you are considering US MD and DO students to be roughly equivalent). I don't have analogous data for radiology though, and would be interested in looking at it.
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You got any more of that sweet sweet data? Particularly the success/match rate in EM for previous US grads? 😀
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I thought I had the data but I don't think it exists regarding reapplicants. The match data will show you how many reapplicant MD's matched in each specialty, but they lump all DO's (new grads and reapplicants) together. And while they provide numbers for how many DO's applied to EM, and how many matched, nowhere can I find the data showing how many reapplicants applied to any individual specialty.
Sorry!
Sorry!
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The SLOE, which I’m sure was created with noble intentions, has turned the process of applying to EM into a complete circus. It has turned into a monster that I don’t think anyone saw coming. At some point, something has to change to rein this process in. It’s crazy that people are literally spending thousands of dollars that they don’t have and crisscrossing the country to “play the game” as was alluded to in a post above. It’s craziness, and, quite honestly, will end up staining our specialty. Other specialties do just fine at matching competitive applicants without putting them through what applicants to EM programs have to worry about. What it’s going to take is a group of programs coming together and ditching the current way of thinking. Guess what? There are people who rotate at an institution, the institution thinks they’re great, they match, and they turn out to be terrible residents. On the flip side, programs match outstanding residents who excel that didn’t rotate at their programs. This whole process needs to be toned way down.
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At its root, because you spend a vast majority of your residency months in the ED with a good deal of autonomy on potentially ill patients. This means a bad resident can cause a lot of pain. Many of the surgical specialties seem to have the same emphasis on away rotations. People want an unbiased evaluation, preferably from someone whose judgement they trust. Other specialties that have more oversight and involves less time on any one service tend to care more about boards scores and other metrics.
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deleted547339
Or it means you decided on EM late.
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Sure. Then we'll do what Ortho does. Everyone needs to score 260 or more on their boards and have at least three publications. Because that's clearly what makes you a good EM resident.
I get the concerns about the confidentiality of SLOEs, that's a whole separate topic, but to say this is some type of circus is just not the reality. No one is forcing anyone to criss-cross the country. CORD specifically recommends 2 SLOEs. Students scheduling tons of rotations has more to do with their own anxiety rather than the reality of these recommendations. You need two SLOEs, one from your home program, one from an away (or two aways if you have no home). Many people can get away with matching with only one. There's no recommendation that one has to be on the west coast and one on the east coast. I don't think two EM rotations to apply to EM is too much to ask. I doubt any specialty of any matter of competitiveness would routinely match students who do only one rotation in their specialty.
Also, this system isn't going away. If anything, its going to get more powerful. CORD is already looking at standardized student end of shift grading for rotations, who knows when that will happen. Programs aren't going to band together and ditch the SLOE. Is it perfect in predicting great residents? Nope. Nothing is. But it is far more accurate in predicting them than any other aspect of the application, which is why every year PD surveys continue to show it being ranked the most important part of the application by far.
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I am curious: where in your education/training/career are you? Because I don't think I've heard anything like what you describe from any EM PDs, APDs, or faculty.
SLOEs aren't perfect. There are definitely some pitfalls that folks experienced with them know to watch out for. But they are way better than what's happening in other specialties. Mostly because the SLOE asks blunt, to the point questions. LORs are all glowing, SLOEs (mostly) tell us what people really think.
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Unfortunately no. Most of the data I have come either from CORD, EMRA, or NRMP reports. Occasionally there is a research article that comes out that's relevant.
This has some relevant info that may be interesting, though not exactly what you are looking for:
Diagnosing the Match: Trends in the Applicant Selection Process
-about 10-15% of programs screen out applicants with previous training (figure 5)
-there seem to be about 50-100 US grad matches per year (figure 6). Unfortunately as @gamerEMdoc we don't have the denominator. It's actually somewhat surprising that the data isn't out there. I wonder if it would be worth emailing the NRMP to find out.
Also if you haven't already, CORD has a guide for re-applicants you might want to read:
https://www.cordem.org/globalassets/files/student-resources/applying-guide---re-applicant.pdf
Though it's probably all information you know already.
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DO3 is an attending at a community shop.
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For anecdotal data, check out this years application spreadsheet if you haven’t already, there’s a couple of spots where we tagged ourselves as reapplicants, you’d have to extrapolate the data from there.
NRMP also has an interactive version of the charting outcomes that will display subsets of data, IIRC reapplicants might be one of them
Interactive Charting Outcomes in the Match - The Match, National Resident Matching Program
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Do you have data from your residency supporting SLOE being that useful? Would be interesting if you graded your residents then went back and tried to tease out what metrics in the application data best correlated with the highest rated residents.
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I don't have data, so this is anecdotal. I have definitely seen residents with one top tier SLOE turn out not to be great, although this is not at all common. I'm not sure that I have seen yet a student with two high SLOEs that agree the student is great turn out to be bad. I can't think of one example. When you see multiple places all agreeing someone is a really good student, it's as close as you are going to get to being accurate in this process IMO.
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So I chased this down a little further. A few emails between the NRMP, ERAS, and the AAMC data steward later I found out that this report would cost $500. I don't think I can convince my department to pay that for just a few data points so this will probably have to remain a mystery for now.
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I think also that the data set is so small that it could violate privacy laws. When only 1-2 US grads per state match in a specialty each year, their anonymity is lost.
So you can pay for them to give you that data, but what information will it give you? How much of the reapplication pool is self-selection or from SOAP? Meaning, they realized that they’re not competitive enough for EM or they SOAPed into a categorical position and they’re happy with the outcome.
I know I’m lucky to have the outcome I did. I am VERY thankful.
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In 2018 the match data says there were 66 US MD grads who were reapplicants who matched in EM. No idea how many of the DOs that matched were reapplicants. And no idea how many reapplicants applied.
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If I'm using the NRMP interactive data tool right, for 2018 the success rate of matching into EM for USMD reapplicants/previous grads was about 55% (41/74), maybe give or take a few % for the people who opted not to have their data used for research purposes. Would you say 55% is about right for reapplicants, in your experience as a PD?
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I never ever realized that tool existed. Lets you search only previous grads by MD, DO, or combined as well. Wish the data was more clearly presented instead of big circles you have to hover over, but that's a pretty useful tool nonetheless.
I mean, you can even create a filter of people who took the COMLEX and didn't take Step 1 and see their match rates. This is amazing! I have no idea how I never knew this existed! Thanks @wh2k13
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I am not in any way trying to argue with you here, but I think there are some issues "you" (the global you in the EM residency admin world, not you @gamerEMdoc specifically) may not be taking into account, or may be minimizing.
I agree with DO3 that the SLOE was created with noble intentions but the process has gotten out of control, at least from the outsider's perspective (non-EM attending a long way out from having to deal with any of this crap).
Not sure if you're following this thread, but it seems like EM is actually going the ortho route, they're just doing so at the away rotation stage, rather than the residency app/interview stage.
Also - again, as an outsider - it seems as if students have much less, if any at all, control over how their SLOE comes out, compared to applicants to every other specialty. Have a crap shift with the faculty member in charge of writing the SLOE? Watch out for a "will not rank" SLOE in your future, regardless of how well the rest of the rotation went. At least with "regular" LORs, you can control who writes a LOR for you, if not what gets written.
I absolutely recognize that, in a specialty like EM where, even if you work 20 shifts over a 4 week period, you may only work with the same attending 2 or 3 times at most, making LOR writing, at the very least complicated. But it's unclear that the SLOE is the solution to that problem.
It's also possible that I've got a little SDN Stockholm Syndrome going on and I'm just feeling bad for all these folks who didn't match because of a SLOE that nuked their app, or the ones that can't even get an away to get that SLOE in the first place.
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EM is not going the way of ortho. Yes aways are getting harder to get because of the amount of interest in EM combined with people over-applying. However, EM is not anywhere close to being exclusive like Ortho. For instance, for DOs in 2018, EM had a 60% match rate for COMLEX under 500. Ortho didn't cross the 60% match line until a score of over 700. COMLEX < 600 had a ZERO percent chance of matching in Ortho. That means that not only were DO students with lower COMLEX scores (less than 500) getting rotations, they were matching in EM 60% of the time. These are people that would have had to score 250 points higher to even be considered to apply for Ortho, yet they were getting rotations and matching in EM. So no, EM is definitely not excluding people like Ortho does. Lower level candidates are still able to secure rotations. It just takes time, but they get them. Most programs aren't even approving rotations until after the match. I approved ours last week. It can take a month or two before you get all the rotations set up, then people cancel and you have to set up more. It takes awhile. Most candidates will get rotations, its just nerve racking early on because everyone thinks they wont. Its not the reality of the data.
People worrying about not having their aways set up right now is the exact same thing as people worrying about their number of interviews at the beginning of October. I understand the fear. But I also know its irrational, because I know when interviews come out and those same people message me 4 weeks later to tell me they now have 15 interviews. You just have to have patience and let the process play out.
True that students have no control over the letters, other than doing their best on their rotation. I mean, students also have no control over their board scores, other than doing well on the test. You don't get to take the test 20 times and pick the best score to submit. Same with your letters, cherry picking the one person that liked you the most doesn't give an accurate view of how good you are as a student. I do agree, the SLOE is subjective, to a point, but most people don't write stuff on a SLOE based on one bad opinion. Its a composite of all the faculties opinions of a student so "one bad shift" sinking a student isn't common. I look at hundreds of apps a year, read 2-3 SLOEs on all these people deciding who to interview and I can tell you, almost universally, SLOEs almost always agree across multiple institutions. The same negative comments get repeated. People called "untrainable" at one place get called the same at another. People with bad differentials get it noted multiple times. The final SLOE rank is almost ALWAYS within one category of eachother across all SLOEs. Someone might be a top 10 at one place an a top 1/3 at another, but I'm not sure I've ever seen someone be a top 10 somewhere and a bottom 1/3 elsewhere. You just have to take my word on this, there is significant inter-rater reliability with these things, its almost impressive how closely people SLOEs align.
That being said, I understand the frustration when a SLOE sinks a candidate, and it strikes fear into every applicant. I can tell you, when this happens, usually the other sloes were mediocre, or worse and there was more than one low 1/3 or dnr. It's pretty rare when someone goes unmatched and I look at their app for me to see a low 1/3 or DNR SLOE sink their app with all their other sloes being top 1/3 or above. I don't think I've ever seen that to be honest. But I get the fear, no matter how unrealistic it is. People don't like the unknown or to give up control. It makes us anxious.
But that's why I post here. To try to take a little bit of the anxiety out of this crazy process!
BoardEligibleEventually
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Have medical school grades? Because thats what the SLOE basically is, a standardized grading system.
There have been studies on the SLOE, although its adapted and changed over time. Im not sure it could ever be prospectively validated though. There were studies initially that looked at the different sections and which ones predicted the highest match rate. There have been PD surveys where 150 PDs responded and 149 of 150 (99.3%) said it was important and should continue. 93% said it was the most important part of the application in deciding who to interview. The SLOE website has links to past studies, but I doubt you’ll ever see a great study with something like this.
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How would you go about creating a variable that captures, in a quantitative fashion, a "great resident". Not gonna happen.
BoardEligibleEventually
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Then I don't think the SLOE should be exalted as the wonderful metric that it is.
Personally I never understood why the academic EM community considered itself so distinct and special from the other medical specialties that letters of recommendation simply weren't adequate. I've heard arguments made that "students may only work with each attending one time in a given month long rotation" - I got an anesthesiology recommendation letter for a backup after working with the attending for only one day. I've heard "the ED is a high stress environment unlike no other" - I would argue that the OR is not exactly a cakewalk either and students pursuing surgery need to demonstrate they have their **** together. The academic emergency medicine community has brainwashed itself into believing the SLOE is something much greater than it really is.
I know nothing I say here changes anything, I just personally think a disservice is done to students and a lot of needly worry and anxiety is created that kind of ruins the experience. I know my student EM rotations would have been way more fun if I knew the one attending that wasn't on team BoardEligibleEventually couldn't demolish my SLOE with one bad shift eval. Hope the kids can have fun while diving into our specialty.
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I've not heard the "high stress environment" line before. That doesn't really hold weight for me either. The SLOE is not perfect, but it overcomes a few issues that arise with personal letters of rec. It diversifies the sources of evaluation, and thus theoretically creates a more balanced opinion. Students can't cherry pick their best experiences. It also assigns objective metrics to each student -- percentile and rank, which allow programs to differentiate between students using more than board scores.
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It's not a metric. Neither are grades (without a distribution) or LORs. The metrics are within the SLOEs themselves, showing how the individual programs grade their students and how overly inflated their grades are. It allows you to see how much you can trust the opinion of the institutions recommendations. Every institution is going to have a different level of grade inflation. That was the whole point of the SLOE. The SLOE isn't a metric, but it does allow the readers to know what the grading metrics at places are so you know how to interpret how the student performed versus others.
I get that some people are uncomfortable with the blinding of the process, however I always come back to "what is a better solution"? It's easy to complain about something, but what is a better way of evaluating and ranking candidates? If 95% of people that do this for a living say there isn't a better way, I'd venture to say that there probably isn't at least at the moment. No one wants to judge people by board scores alone, and that is the only piece of data that is standardized. Medical school grades are a joke at many schoolsto the point that some are as high as 90% or more of their classes getting "Honors" on some rotations. Some schools not only don't rank, but won't give quartiles. So school and rotation grades based on the MPSE certainly can't be utilized to stratify students. So what are you left with? You either go with board scores or EM performance by some type of standardized assessment that nearly all programs use. If choosing between those, I'll take a clinical assessment any day of the week in evaluating who is a better student in the ED. If something better comes along, then maybe the SLOE will lose its importance. But as of now, what is a better way of predicting how good of a resident someone will become?
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It sounds like you're saying that's an argument against the SLOE, but I'd actually think your experience getting that letter would be an argument FOR the SLOE, at least from the residency's perspective - if I were trying to make sure I get the best residents, I would want to make sure that the letter singing their praises was based on more than a few hours' or even a few days' worth of experience with them. It's really easy for even a so-so student to be on their A-game for a day and get a letter out of that, it's a lot harder to fake it for a whole month of interactions with different attendings who will ask different questions, see you with different types of patients, and see you under a variety of circumstances (day shift, night shift, slower shift, patients-all-trying-to-die-at-one-time shift, etc).
BoardEligibleEventually
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What I am saying is that, one day with a single anesthesiologist in a department of many attending anesthesiologists with multiple teaching styles and personalities, was perceived as adequate for a letter to apply to the specialty. I fail to see where our specialty is so special, different, and unique that a completely separate set of rules and criteria must be met in order to be considered for residency. Plain jane single author LOR work for and are accepted in literally every other specialty. I did not and still have not sipped the SLOE kool aid.
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Just because a letter from one person you worked with once is good enough for another specialty doesn't mean the SLOE isn't a good idea. A plain LOR that provides no good accurate information isn't good enough to determine how good people are. So just because other specialties are ok with a bad system doesn't mean we should accept a bad system. EM recognized 20 years ago that LORs were virtually garbage in terms of programs trying to determine which students will be ok and which ones will need significant remediation. That's why the SLOE was formed. The fact that other specialties don't use a better system doesn't mean EM shouldn't use the better system.
I'd bet on more specialties adopting a SLOE geared towards their specialty before I'd believe EM reverting back to regular LORs. Ortho now has a standardized LOR. So does Radiology.
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I wonder if there would be utility in letting students see what third they belong in without being able to read the comments. Similar to how you get a grade for a rotation.
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I'm pretty sure it would affect the content significantly. There was a study that looked at blinded sloes vs sloes where the student didn't waive the right to see the letter. The ones where the students didnt waive the right were consistently rated much higher. I wish there was some way that students could know their competitiveness (other than applying and seeing if they get interveiws), but in reality the second students know what their SLOEs say, the grades will get significantly over inflated just like medical school grades are.
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As a clerkship director my experience has been that among students receiving poor evaluations in clinical rotations, many (if not most) will attribute it to that one bad shift with that one faculty member. In reality that is often the one bad interaction they have some insight on, and there were plenty of other interactions that went poorly that the students don't realize have gone poorly. Dunning-Kruger effect if you will.
Also, sometimes that one bad shift is bad precisely because the letter writing attending has received complaints from the other faculty about this student's performance. Now, forward feeding is it's own problem and should be avoided, but I think that's another explanation for the common trope of 'everything was perfect until that one shift with the SLOE writing attending'.
I am not saying the scenario you describe has never happened. Though looking back I can only think of one case where I think it may have affected a student's match. Not a systematic rebuttal by any means, but should be enough to say that this is at most very rare.
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Seeing where you fall in aggregate in relation to your peers (like an MSPE) and seeing the whole SLOE with personal comments are not the same thing and not comparable. You can let a student know where the SLOE ranks them at a particular program. I do not think that is an equivalent comparison to seeing the whole SLOE and therefore is not a good reason to not let students know where they fall as a percentage. Many reputable programs will let students know which letters to use, so there is already a preference for good letters if you went to a better school. I think it is a problem when PDs collectively complain that applicants over apply, but do not want to give applicants info on the most critical aspect of their application. That is what drives up interviews/costs and aways leading to more faculty time and energy spent on medical student recruitment. Programs can’t have their cake of getting applicants that are competitive for them and eat it too by not telling applicants how competitive they are.
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I meant along the lines of 4-6 weeks after the rotation seeing which third you fall into. This shouldn't be any different than how grades are assigned for clerkships. Heck, I got grades from my away rotations that are in my transcript. The whole fact that these don't correspond to each other (grade and SLOE rank) is kind of the whole problem. If I honor my aways according to my grades, I'm going to think I nailed the SLOE. But what happens if it is a school that Honors 80% of students and they don't share their grading schema?
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The question I replied to was about knowing the rank on the individual SLOE, not an aggregate. I agree, having some aggregatated idea of your SLOE competitiveness would be nice. I'm not sure how it would work. But I think it would be beneficial to the students without really affecting the blinding of the SLOEs.
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Yeah, I agree the grades should match the SLOEs. They don't because the grades aren't blinded, not because the SLOEs are. People are uncomfortable giving average or below average grades. Medical school grades are oftentimes crazy top heavy.
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So the alternative is to give average or below average grades secretly so that the student can't appropriately evaluate their application.
Give me the hurt feelings and a better application cycle.
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Yet somehow students manage to do it every year with a pretty high match rate for EM.
I mean, I agree with you, I wish there would be more transparency. My point is transparency on an individual SLOE level leads to over-inflated scores, just like medical school grades have become over-inflated. I don't think knowing the exact rank of each SLOE is a good idea. An overall idea of the cumulative strength of the SLOEs in total, I'm fine with.
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Just going to re-post something I said here two years ago that I think is really applicable today with all the frustration I see about the SLOE system online. Every once in awhile, despite all the frustration, sometimes you just need to accept the truth, no matter how hard it is.
From Aug 2017:
Like it or not, you are applying for a job still and the market dictates that you are not in the drivers seat. The market is in the employers favor. You may not like the rules, but you have to play the game. Dont like it? Tough. There's a thousand people behind you willing to play the game to compete. Im not saying this to be mean or harsh, Im saying it because its good advice. This is a competition. You are competing with thousands of students. You cant go into the super bowl and demand the nfl change the penalty rules because you dont like them. I say this because I honestly think its good life advice that many wont tell you. Everything you want will not be given to you. You will not like certain rules, certain processes, etc. But in the end of the day, systems are built by the people in the driver seat. The market dictates who can be choosy and who cant. In three years, when you graduate from residency and you enter a market where are physicians are a shortage, you are in the driver seat. Hospitals have to compete for you. The situation is completely flipped. Do you think hospitals enjoy the fact that they have to continue to pay people more money, give bigger bonuses, develop recruitment strategies, etc. Nope. However, that's what the market dictates, and you have to do what you have to do to survive.
I wholeheartedly believe there are two types of people in this world. The people that read this and get upset/angry/defensive and feel like the system is unfair and who will continue to complain. And the people that say "game on", who don't let the annoyances and hassles stop them, and who will run through a brick wall if its between them and their goal. The world isn't built around you and its not always fair. Tough. Run through the wall.
From Aug 2017:
Like it or not, you are applying for a job still and the market dictates that you are not in the drivers seat. The market is in the employers favor. You may not like the rules, but you have to play the game. Dont like it? Tough. There's a thousand people behind you willing to play the game to compete. Im not saying this to be mean or harsh, Im saying it because its good advice. This is a competition. You are competing with thousands of students. You cant go into the super bowl and demand the nfl change the penalty rules because you dont like them. I say this because I honestly think its good life advice that many wont tell you. Everything you want will not be given to you. You will not like certain rules, certain processes, etc. But in the end of the day, systems are built by the people in the driver seat. The market dictates who can be choosy and who cant. In three years, when you graduate from residency and you enter a market where are physicians are a shortage, you are in the driver seat. Hospitals have to compete for you. The situation is completely flipped. Do you think hospitals enjoy the fact that they have to continue to pay people more money, give bigger bonuses, develop recruitment strategies, etc. Nope. However, that's what the market dictates, and you have to do what you have to do to survive.
I wholeheartedly believe there are two types of people in this world. The people that read this and get upset/angry/defensive and feel like the system is unfair and who will continue to complain. And the people that say "game on", who don't let the annoyances and hassles stop them, and who will run through a brick wall if its between them and their goal. The world isn't built around you and its not always fair. Tough. Run through the wall.
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A LOR system would probably be worse. Rotate for one day or a short period of time with someone and then rely on that letter? How can anyone really recommend a person based on 1 day? First, I would be concerned about the people that would abuse this- I know so and so is a doctor at hospital X, i'll just get a good letter from them since they know my family etc etc. Also, you're waiting on someone to write a letter as opposed to a committee or program that's responsible for the letter (which I would assume grants a more timely turnaround). Lastly, I would rather have a collective input from the entire team about how I work and what kind of person I am vs one person who may be having a bad day when im with them or some other uncontrollable variable. I think it's a good way to weed out the people that aren't meant for the field, or just aren't good people- you can't hide who you are when people see you for a month, under stress .
As an applicant going into the next cycle, believe me, the faults of the SLOE system terrify me. I honestly feel like those negative aspects are amplified here because, well, it's SDN and that's what tends to happen. On the flip side, there are 1000's of applicants that go through this process and do just fine.
I really appreciate being assessed on how I work and what kind of person I am, vs my scores and what numbers I have accomplished. If I'm going to spend 3-4 years with a program I would rather they give me an assessment based on who I am and what I contribute vs what I scored on a test last summer. For every 250 step 1 and step 2 there's a slew of people lined up with similar scores. You have to have some way to differentiate them. I'm not surprised to hear that other programs are starting to trend towards a sloe-type of letter or system because it just makes more sense.
As an applicant going into the next cycle, believe me, the faults of the SLOE system terrify me. I honestly feel like those negative aspects are amplified here because, well, it's SDN and that's what tends to happen. On the flip side, there are 1000's of applicants that go through this process and do just fine.
I really appreciate being assessed on how I work and what kind of person I am, vs my scores and what numbers I have accomplished. If I'm going to spend 3-4 years with a program I would rather they give me an assessment based on who I am and what I contribute vs what I scored on a test last summer. For every 250 step 1 and step 2 there's a slew of people lined up with similar scores. You have to have some way to differentiate them. I'm not surprised to hear that other programs are starting to trend towards a sloe-type of letter or system because it just makes more sense.
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WhatsGoodie
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As a recently matched MS4, I have to advocate for the SLOEs. EM is a unique field that requires you to work with a different team each shift in many different clinical situations and times of the day/week. Therefore, obtaining a LOR from that chill attending who you think will write you a glowing recommendation after a few shifts does not reflect your potential as a future EP because you do not have to demonstrate your adaptability, teamwork skills and clinical capabilities in uncomfortable or changing circumstances. Also, senior residents will have more meaningful input toward a SLOE than med school evaluations that are sent directly to the student, which are likely to be biased for that reason. These student qualities and encounters on shifts are much more representative of a medical student's clinical potential and cohesion within a future residency class than filling out multiple choice answers for hours on end.
I have my biases as I will be graduating from a middle tier MD program and would not have dreamed of getting the interview invites and subsequent match at an SDN "top program" if it were not the opportunity to shine on aways and in SLOEs. The whole VSAS and SLOE process is grueling and seems unfair when you compare yourself to peers going into other specialties that are on cruise control after a high step 1. It is extremely difficult to get accepted for away rotations, there is a lot of anxiety, and it can be demoralizing at times. I personally applied for 3 different months at 20 different programs and received only 2 acceptances in May and June. The other 18 programs that I did not get selected for an away all invited me for an interview. I think that this shows how difficult it is to differentiate between applicants without this important tool, but also how it can be used to the student's advantage for standing out on a residency application. It is not a secret how important it is, so treat it like the EM USMLE.
Many people who did not receive positive SLOEs are going to complain the loudest, and several of the students on my aways and med school fall into this group. In my observations, these were the people who A) acted entitled and did not take the rotation for what it is: a job interview as an acting resident, or B) did not work hard enough to improve, were not receptive to feedback, or assumed everyone would get good feedback like other clerkship evaluations. Ultimately, don't be afraid to pick up difficult patients or be wrong in your management/plans. There is not an expectation to be at the level of an attending. As long as you provide reliable H&Ps with a reasonable differential, assessment, and plan that you can provide justification for, you will excel and impress. When you get something wrong or cannot answer a question, I think that attendings were more impressed when I acknowledged that I did not know something and told them that I would research it and come back with a quick presentation about the topic. And of course, prove yourself as an employee and learner by doing the obvious: do your work, be proactive when caring for your patients, stay engaged, be early to shifts and stay late if there are loose ends to tie up in charting/your patient's care, don't overstep your role, make the residents you are working with look good, be supportive of your fellow rotators, be humble, show initiative by reading up on gaps in your knowledge, and ask questions when appropriate/when you actually are interested about the answer. If I were a faculty member reviewing applications, I would be impressed by a top tier med school and a stellar step 1, but I would much rather have the person who has demonstrated being a hard worker, a great co-worker, and a student that is eager to learn from what I have to teach them.
I have my biases as I will be graduating from a middle tier MD program and would not have dreamed of getting the interview invites and subsequent match at an SDN "top program" if it were not the opportunity to shine on aways and in SLOEs. The whole VSAS and SLOE process is grueling and seems unfair when you compare yourself to peers going into other specialties that are on cruise control after a high step 1. It is extremely difficult to get accepted for away rotations, there is a lot of anxiety, and it can be demoralizing at times. I personally applied for 3 different months at 20 different programs and received only 2 acceptances in May and June. The other 18 programs that I did not get selected for an away all invited me for an interview. I think that this shows how difficult it is to differentiate between applicants without this important tool, but also how it can be used to the student's advantage for standing out on a residency application. It is not a secret how important it is, so treat it like the EM USMLE.
Many people who did not receive positive SLOEs are going to complain the loudest, and several of the students on my aways and med school fall into this group. In my observations, these were the people who A) acted entitled and did not take the rotation for what it is: a job interview as an acting resident, or B) did not work hard enough to improve, were not receptive to feedback, or assumed everyone would get good feedback like other clerkship evaluations. Ultimately, don't be afraid to pick up difficult patients or be wrong in your management/plans. There is not an expectation to be at the level of an attending. As long as you provide reliable H&Ps with a reasonable differential, assessment, and plan that you can provide justification for, you will excel and impress. When you get something wrong or cannot answer a question, I think that attendings were more impressed when I acknowledged that I did not know something and told them that I would research it and come back with a quick presentation about the topic. And of course, prove yourself as an employee and learner by doing the obvious: do your work, be proactive when caring for your patients, stay engaged, be early to shifts and stay late if there are loose ends to tie up in charting/your patient's care, don't overstep your role, make the residents you are working with look good, be supportive of your fellow rotators, be humble, show initiative by reading up on gaps in your knowledge, and ask questions when appropriate/when you actually are interested about the answer. If I were a faculty member reviewing applications, I would be impressed by a top tier med school and a stellar step 1, but I would much rather have the person who has demonstrated being a hard worker, a great co-worker, and a student that is eager to learn from what I have to teach them.
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The ability to communicate amiably and effectively with other people is an important trait, just as things like clinical acumen and work ethic are. Being judged on your "soft skills" as well as your clinical skills is not unfair, it is an incentive to become a more well rounded applicant. Moreover, these skills are not only required to land a residency position, but will come into play in every job search you enter.
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Totally disagree. Sure everyone likes people that fit in or are fun to be around, but I can tell you, but when students are just trying to fit in but aren't clinically good, its SOOOOOO obvious they are trying to use their social skills to look better than they are. I would take a quiet person who does their job effectively any day over someone who is constantly trying to be social and likable but can't present a case coherently.
