Thread by @GamerEMDoc

1 / Ok here is my thread to demystify the “SLOE” for med students who are interested in EM. Settle in, this is going to be a long one (24 tweets) as we define the SLOE, its importance, and what all goes into it.

2/ First, let me define it. A “SLOE” stands for a Standardized Letter of Evaluation. It’s the LORs you will get when applying to EM.

3/ Your SLOEs (2-3 in most non-covid years) will define the competitiveness of your app. More than any other aspect of your application, the SLOE is consistently rated as the most important aspect of a candidate's application when applying to EM.

4/ There are several forms of SLOE. The most important is a SLOE from an EM residency program. These are written in an electronic format (esloe) which tracks data trends from year to year. You will typically get 2 SLOEs (home/away or 2 aways if you have no home program).

5 / Some get 3, though the 3rd may also be one of the other types of alternative sloes as noted below.

6 / The other forms of SLOEs include subspecialty SLOEs and non-residency SLOEs. This year, because of COVID an off service SLOE (O-SLOE) was also added. In non-COVID years, these carry less weight than an EM-residency SLOE and you should always have at least 2 regular SLOEs.

7 / How do you request a SLOE? It's like requesting any other LOR via ERAS. You send a LOR request via ERAS to whoever writes the SLOE for the program you are rotating at. They fill it out via the Esloe system, and that spits out a PDF that they then upload to ERAS as a LOR.

8 / So what is in the SLOE… well, there are multiple parts. For reference, you can view an old version of the SLOE before it changed to the esloe here in order to follow along with the different sections if you want.

emed.wisc.edu/sites/default/…

9 / The first part is just demographics, your name, your AAMC #, the institution, name, and position of the author, and their contact info. This is followed by 4 sections (A through D) each of which I will break down.

10 /
Section A: Background Information
This section gets at how you know the applicant. It asks questions about what month they rotated, how often you worked with them (vs indirectly knowing them from others), which # of EM rotation it was for them, and what grade they got.

11/ This section then displays the data of the grades given the previous year (Esloe system tracks this data year to year). It shows how many students rotated the previous year, and what percentage got each grade.

12 / This allows programs to understand your grade better. Honors at a place that gives 90% of their students honors may not be as prestigious as a HP at a place that gives only 10% honors and 30% HP for instance.

13/ With COVID, this years SLOE adds a section for programs to identify if their grading scale became P/F this year because of COVID and to list any other restrictions COVID brought to the rotation.

14 /
Section B: Qualifications for EM
This is a section that asks the author to rate you as upper 1/3, mid 1/3, low 1/3 in 5 key areas identified as making a successful transition to becoming an EM resident. They are:

15/
Commitment to EM; carefully thought out this career choice.
Work ethic, willingness to assume responsibility
Ability to develop and justify an appropriate DDx and a cohesive treatment plan.
Ability to work with a team.
Ability to communicate a caring nature to patients.

16 /
The last 2 questions in section B are:
How much guidance do you predict this applicant will need during residency (less than peers, same as peers, more than peers)
Given the necessary guidance, what is your prediction of success? (outstanding, excellent, good)

17/
Section C: Global Assessment
This is the most important part of the SLOE in my opinion. There are two sections, both of which you are ranked as Top 10%, top 1/3, mid 1/3, Low 1/3.

18 / The first question asks the evaluator to rank you vs all the candidates they wrote a SLOE for in the last year. The esloe automatically imports the data from the previous year, so programs can see how many students the programs put in each category.

19/ The second question asks how highly you estimate the candidate will be on your rank list. Top 10%, top 1/3, mid 1/3, low 1/3, or unlikely to be on our rank list.

20/ These questions are similar but different. You can potentially be a top 1/3 candidate on a rank list, but a middle of the road student at a place that has a competitive group of students rotating for instance.

21/
Section D. Written Comments
This is a summary of the applicant’s evaluation, with the intent to explain any low rankings or areas that need attention. They specifically ask to mention any issues related to leadership, compassion, professionalism, maturity, altruism, etc

22/ There is a second section here for programs to describe their rotation structure, grading, etc to communicate how their rotation is setup.

23/ Ok with all that being said, there is a lot of data captured in the SLOE. The rotation grade, and how it compares to others. The 5 key attributes. The global assessment and where you will likely be on the rank list. And the narrative of why they feel this way about you.

24/ I hope this helps demystify the SLOE a little bit. Feel free to reach out with any questions anytime. DMs are always open.