SLOE Lower Third Ranking: Is it the Kiss of Death? Alexis Pelletier-Bui, MD1, Diane Rimple, MD2, Michael Pasirstein, MD, MPH3, Michael Van Meter, MD, MPH4 1Cooper Medical School of Rowan University, Dept of Emergency Medicine, Camden, NJ; 2University of New Mexico, Dept of Emergency Medicine, Albuquerque, NM; 3Drexel University College of Medicine, Dept of Emergency Medicine, Philadelphia, PA; 4The University of Texas Health Science Center at Houston, Dept of Emergency Medicine, Houston, TX

SLOE Lower Third Ranking: Is it the Kiss of Death? Alexis Pelletier-Bui, MD, Diane Rimple, MD, Michael Pasirstein, MD, MPH, Michael Van Meter, MD, MPH INTRODUCTION METHODS In 2015, an IRB approved survey was sent to the Council of Residency Directors’ listserv regarding medical student advisement. Respondents were aware of the plan to publish anonymous responses and their answering of the survey constituted as consent for their responses to be anonymously pooled and published. Respondents were asked eighteen questions in total. One of the questions asked if their program adhered strictly, loosely, or not at all to the recommendation to equally distribute students within the thirds on their global assessments. Respondents were asked about their interview practices and match characteristics for students who were ranked in the top, middle and lower third on their global assessments. They were also asked if they wrote a SLOE for a student ranked in the lower one third who was well suited to become a respectable resident/Emergency Medicine physician. The Standardized Letter of Evaluation (SLOE) was implemented to help better understand an applicant’s strengths and weaknesses, and better compare them with their peers. One of the SLOE questions asks evaluators to stratify students into the top 10%, top third, middle third and lower third compared to other EM residency candidates that the evaluator has recommended in the past year. Many authors of SLOEs are concerned that a global assessment of an applicant in the lower third is the “kiss of death.” One of the objectives of our survey was to capture adherence to SLOE ranking guidelines and assess whether a ranking in the lower third adversely impacts a student’s ability to match in Emergency Medicine.

SLOE Lower Third Ranking: Is it the Kiss of Death? Alexis Pelletier-Bui, MD, Diane Rimple, MD, Michael Pasirstein, MD, MPH, Michael Van Meter, MD, MPH RESULTS Sixty nine percent of respondents felt that applicants that they rated in the lower third were well suited to become respectable EM physicians. # % *No Interviews *<5% of Interviews *5-15% of Interviews *15-30% of Interviews Skipped Question Matched Low 1/3 Did Not Match Low 1/3 Not Sure All Respondents 96 5% 36% 42% 11% 28% 40% 30% 21% Strict Adherence 39 41% 23% 51% 13% 8% 26% Loose Adherence 51 53% 6% 43% 37% 10% 4% 31% 0% No Adherence 6 67% 17% 50% 33% *Estimated percentage of applicants interviewed with a lower third ranking (outside of the institution’s home students)

SLOE Lower Third Ranking: Is it the Kiss of Death? Alexis Pelletier-Bui, MD, Diane Rimple, MD, Michael Pasirstein, MD, MPH, Michael Van Meter, MD, MPH CONCLUSIONS Less than half of EM programs reportedly adhere to SLOE ranking guidelines strictly but most programs reportedly adhere at least loosely. Most programs interview students ranked in the lower third. Programs adhering strictly to ranking guidelines were more likely to interview students in the lower third than those adhering loosely or not at all. Given one third of respondents did not know if they matched an applicant ranked in the lower third, it is difficult to assess how many of these students actually matched. At least 28% of programs did match applicants ranked in the lower third, and programs adhering loosely to guidelines were slightly more likely to match students from the lower third than programs adhering strictly and much more likely than programs without adherence. Lastly, the majority of respondents who rated students in the lower third still felt these applicants would become respectable EM physicians. REFERENCES Official CORD Standardized Letter of Evaluation (SLOE). Retrieved from http://www.cordem.org/files/DOCUMENTLIBRARY/SLOR/SLOE%20Standard%20Letter%20of%20Evaluation%202015.pdf

2015 Student Advisement Survey Questions In which region is your program located? Great Plains, Mid Atlantic, Midwest, New England, Southeastern, Western, Not Sure What style of training primarily categorizes your program? County, Academic, Community How well did your program adhere to the SLOE guidelines by placing 1/3 of your students in each section (Top 1/3, Middle 1/3, Lower 1/3)? Adhered Strictly, Adhered Loosely, Did Not Adhere Do you plan on adhering to the guidelines next year? Yes, No Approximately how many applicants (NOT from your institution) did you interview with a LOWER 1/3 ranking in the Global Assessment of the SLOE? None, <5% of your interviews, 5-15% of your interviews, 15-30% of your interviews, >30% of your interviews Approximately how many applicants (NOT from your institution) did you interview with a MIDDLE 1/3 ranking in the Global Assessment of the SLOE? Assuming that you know only your home institution SLOE when advising: For the “Average” EM Applicant (HP/H, 230, 1-2 projects, no red flags) with TOP 1/3 on Global Assessment, how many programs would you advise applying to? 10-20, 20-30, 30-40, >40 Assuming that you know only your home institution SLOE when advising: For the “Average” EM Applicant (HP/H, 230, 1-2 projects, no red flags) with a MIDDLE 1/3 on Global Assessment, how many programs would you advise applying to? Assuming that you know only your home institution SLOE when advising: For the “Average” EM Applicant (HP/H, 230, 1-2 projects, no red flags) with a LOWER 1/3 on Global Assessment, how many programs would you advise applying to? Did you write a SLOE for some students rated in the LOWER 1/3 in the Global Assessment who are well suited to become respectable residents/EM Physicians? Yes, No If you advised medical students, APPROXIMATELY how many students did not match into Emergency Medicine? Last Year – 2013-14? (Free Text Answer) This Year – 2014-15? (Free Text Answer) What was the main reason for student(s) going unmatched? Free Text Answer Compared to the last few years, how would you describe the number of interview cancellations during the 2014-15 season? (NOT including those that declined an initial interview offer) A lot more, A few more, About the same, A few less, A lot less If available, what was the total number of cancellations (not those initially declined) for your program during the 2014-15 season? Have you contacted a student’s home institution regarding a late cancellation? We would like a look at the trend of ranks per position filled for the 2015 Match. Please perform the following calculation – the number of the lowest matched applicant on your rank list in 2015 divided by the number of residents in your upcoming intern class. Example: Program X went to 130/180 positions on their rank list to fill their intern class of 12; calculation = 130/12 = 10.83 Is this better or worse than your match the year before (2014)? Better, Worse, Don’t Know Did you match anyone with a SLOE in the LOWER 1/3? Yes, No, Don’t Know