Applying - Letters of Recommendation

Updated August 2016

Emergency Medicine uses a unique letter writing form, the Standardized Letter of Evaluation (SLOE). This is very different from your standard narrative letter of recommendation. Instead of having three glowing letters extolling your virtues and ignoring your deficiencies, the SLOE compares your performance and candidacy against your peers also applying to EM. As you can imagine, this results in the SLOE being a very informative document to Program Directors considering your application. This makes your letters one of the most important parts of your application, and one of the best ways to enhance your application.  The source and quality of an applicants letters will often make the difference between an interview offer or a rejection.

How many letters do I need?

You will need at least three letters.  Some programs allow the submission of a fourth letter.  The first three should be from someone with whom you have worked clinically.  The fourth is more variable depending on the program.  This can be a good place to include a letter from a research mentor or an advisor.  This can even be from a friend or family member, depending on the programs requirements.  



How many letters should be from EM?
Unlike some other specialties, EM programs are not looking for broad diversity in these letters.  Program Directors would be perfectly happy with all three letters coming from EM faculty.  You can get letters from other specialties, but the more EM the better.


Who should I ask to write letters?
The best letters you can get are SLOE's from Emergency Physicians who write lots of SLOE's and who have worked with you clinically.  Take a look at the SLOE form and it will become clear why it provides better information.  The writer needs to establish their credentials, how they know you, how well you did on their rotation, and then contrast you with other students applying to EM.  The writer also needs to specify how many letters they write.  A SLOE written by someone with a larger sample size of students to compare (more letters written) will have greater credibility.  This letter format, unique to EM, makes our letters more powerful and impactful on your application. The weight other specialties place on third year rotations and board scores, in making interview decisions, is instead placed on your performance in EM.

Your best bet for useful SLOE's is going to be the Clerkship Director of your EM rotations.  Many programs now write a Departmental Letter where the Clerkship Director and Program Director's co-write your letter.  Many feel that these are the most useful letters: the letter writer's know what the letter reader's are going to want.  Other EM faculty can write SLOE's but if they only write a few letters a year they may be better off writing you a more traditional letter.  Any letter from EM faculty, whether a SLOE or a traditional letter, is going to be more useful than letters from other specialties.

Your goal should be to get a letter from each of your EM rotations.  If you do two EM rotations by September (any later than that and the letter may delay your application being complete), you will have two EM SLOE's from Residency Program leadership, and you can add one more letter from wherever.  This is the ideal, but many applicants successfully match with a lesser collection of letters, so don't panic.


Can the SLOE hurt my application?

A common fear many students have once they look at the SLOE form is that the honest assessment asked for in the letter might hurt them: somebody has to be in the "bottom 1/3".  Letter writers are acutely aware of this and have all developed strategies to effectively address this very concern. They often go out of their way to make it clear that they use the entire scale and that students in the "bottom 1/3" are viable candidates for EM training. They will usually provide an explanation of what the student needs to do to succeed.  Work hard, show respect for the staff and compassion for your patients, and listen to the feedback your supervisors give you: your letters will be fine.  


What more can I do to ensure I get a good SLOE?

Maximize Your SLOR is an article I wrote for SAEM on how to get a great letter. Even though the name has changed to the SLOE, the advice still holds.


For more on the SLOE:

76 comments:

  1. Hello, I'm applying to AOA programs this year. My first two letters are regular letters from my EM rotation. No one has done SLOEs there, so they are just regular letters. My first Audition is 8/25 to 9/19. Should I submit and additional non SLOE letter now? Or wait until I get 2 SLOEs?

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    1. First, the usual caveat: I would ask an AOA advisor (my knowledge is much greater on osteopaths making the jump to allopathic programs). The need for SLOE's may be much less than on the allopathic side. You can certainly hold a letter slot for your 8/25 - 9/19 SLOE, as it will be in by October. If you use the two EM letters you have as well, that is a great collection of letters. Don't wait for another SLOE after that. The one will be fine.

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  2. Going off the first Anon comment: I just sent three letters to programs: Two audition SLOEs and a non-EM letter. I am waiting for a final SLOE from my third and recently-ended elective that should be in before October. Since I already submitted the three required letters on ERAS and am comfortable with where I stand - is submitting the fourth one optional?

    (And thanks for the extremely helpful blog.)

    ReplyDelete
    Replies
    1. Some programs will take a fourth letter but it will not be necessary to get your application reviewed. It is still worth getting that letter in as it could make the difference in coming off the wait list.

      Glad you find it useful. Questions and suggestions are welcome. Good luck!

      Delete
  3. Hello, third year here. I was wondering if SLOE's can come from the same program? I go to an osteopathic school and will be attempting both matches. My school allows only 3 maximum rotations in EM, to which I will probably choose 2 MD and 1 DO programs. Could I get an SLOE from a two week peds EM elective at an MD program? Am I correct to assume 3 SLOE's are ideal? I know these are a bombardment of questions, I appreciate the blog.

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  4. 3 SLOE's are great but absolutely NOT required. You will have to ask if they will do a SLOE from your 2 week elective. Many departments will allow more than one letter writer, though it can be hard to find a second writer if they do a departmental letter (a composite by the Clerkship and Program Director's). All you really need is one SLOE from someone who writes a lot of letters. Everything beyond that is a bonus.

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  5. Can a SLOE be written by an EM doctor with whom you rotated in a hospital without an EM residency and/or is not part of a university institution?

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  6. Short answer: yes!

    Longer answer: The SLOE was designed to be used by letter writers who write a lot of letters. It even asks for the number of letters written as one of the questions. Practically speaking this means that a SLOE from a member of a Residency Program carries more weight as that person writes (and reads) more letters than most EM doc's. The letter you describe, by an EM doc not at a residency, is still the second best letter you can get, whether it is a SLOE or written in traditional letter form.

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  7. I am a non-allopathic senior--I went to USUHS and after a transitional internship I have spent the past 7 yrs paying off my military commitment as a general medical officer. I currently work in the urgent care section of an Emergency Department and am sure to have a great LOR from the Department Chief, but it is certainly not a residency program, and, as I'm not currently affiliated with a medical school, rotating at EM programs seems to be a non-starter. Any suggestions on LORs for my application process this year? Would you recommend contacting EM programs asking for mini-rotations to get a good SLOE?

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    1. Folks paying off a military commitment and now seeking EM residency are in a unique set of circumstances, particularly when it comes to letters. You will have a hard time getting a SLOE from a Residency Program for all the reasons you mention, HOWEVER you will not be expected to have them. Your GMO experience will be looked at favorably by many Program Directors. Your letter from your Department Chief will be important and I would also seek LOR's from other emergency physicians who know your clinical work well. Those letters should not be SLOE's as they are probably not frequent letter writers AND that is just fine.

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  8. Hi, I am an IMG, I am currently working as a ED scribe and I have done two 6 month hands-on observerships here in the US, both doctors that I have observed are a part of the faculty, but the ED I rotated in is not a part of the official EM residency program. Can they write me a SLOE or only LOR? Thank you!

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  9. Anyone CAN write a SLOE, however it is intended to be written by faculty in EM training programs. If someone writes many letters each year that SLOE can still be helpful. When a writer only does a few a year the reader will not find the information and assessment as reliable. Letters from EM physicians, even non-SLOE's are still better than letters from other specialties.

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  10. DO student here. My adviser, like you, told me that all EM letters would be great. I have two SLOEs from MD programs assigned to ERAS right now. I read in one of your other articles some programs will not review an application unless there are 3 letters in. Do I assign on ERAS a non-EM LOR now for the sake of completeness? I ask because I am finishing up an AOA away (SLOE expected mid October) and will be wrapping up audition season with an ACGME away in October (SLOE ETA mid November).

    My second question is: if I do use a non EM LOR for application completeness, should I use my AOA SLOE complete mid October or ACGME SLOE complete mid November? The November ACGME SLOE is something I am leaning towards since I received high pass on both my ACGME aways and am hoping for an honors for that rotation (AOA rotation does not grade honors/high pass). However, your input is greatly appreciated.

    Long post, but thank you for the excellent blog Dr. Kellogg.

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  11. Your situation is tricky, and the best option depends on the rest of your application. If you feel there are deficiencies that will prevent you from getting interviews without another EM letter than it could be worthwhile to wait for one of those later SLOE's.
    The problem is that all of the interview spots will be offered by mid-October and you will end up on Wait Lists once your application gets reviewed. This is why I generally advise to go for "complete" (3 LOR's) by October 1st over "perfect" but late.
    The only way stalling your application makes sense is if you won't get interviews based on what is in there already. That is usually not the case.
    Those later rotations can be used as a 4th letter for programs on the fence who allow a 4th. And you can also send that SLOE directly to undecided programs where it may help.

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  12. Hello Dr. Kellog,

    Im an MD IMG. I have an SLOE from a rotation I did at at a EM DO residency program from the program director and an MD EM physician LoR from the same rotation. Should I get another SLOE from the same program written by another DO EM physician who I've worked with a lot or ask for an LoR instead. Im finding it very difficult to secure another EM rotation.
    Your input would be much appreciated and thank you for this very helpful blog.

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  13. A SLOE is almost always better than a regular LOR because it asks for comparison to other applicants. Usually the comparison is more valid from someone who writes a lot of letters which is usually Program and Clerkship Directors.
    As for more EM rotations, it has gotten late (october) to complete a rotation and get a letter in that will impact interview offers. Most important right now is to get your letters in so your application gets reviewed.

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  14. Hi Dr. Kellogg,

    Thank you for your blog. I am in a unique situation and am wondering your thoughts. I am in a 3 year accelerated osteopathic program for prior physician assistants. I have several years experience as an EM PA prior to med school. Unfortunately, the schedule for this program is such that I will not be to complete an EM rotation before I apply for the match (earliest would be mid Sept) therefore I likely will not be able to obtain a SLOE. I know that these letters are preferred, however given the circumstances, would regular LORs from my previous attendings be helpful? Is it understandable that I won't have SLOEs? Additionally, do you know of any particular programs that may look favorably upon my previous EM experience as a PA?
    Thank you

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  15. To make sure your application is complete you need to go with letters you have in hand by early October when programs are doing most of their application review and interview offering. You can use a late-arriving SLOE as your fourth letter at the programs that allow four. You can also have it sent directly to the programs you are most interested in but who may be on fence about bringing you in for a late interview.

    It is not uncommon for applicants to have no SLOE's, but it puts you at a disadvantage by making your application difficult to compare to others.

    If you can get that SLOE in by early october, that will make a big difference.

    As for the question of previous experience: most programs will look favorably at having been a PA in EM already.

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    1. Hey man Quick question.

      I'm a 3rd year DO student. I was wondering is it okay to get 2 SLOE's from DO programs, One allopathic SLOE and be able to apply to both ER osteopathic and allopathic match?

      TLDR; DO I need to get two MD SLOE's?

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    2. That would be a perfectly acceptable combination of letters. So long as you have an allopathic letter the allopathic programs will look at you.

      Delete
  16. Hi Dr. Kellogg,

    Thank you so much for all your advice from this blog. I was wondering if you could help me with my current situation. Currently, I am scheduled to finish my first EM rotation at my home institution by September 15th. Does this letter have to be in by September 15th for my application to be complete?

    Also, I am unsure as to what I should do with my other letters. Would it be ok to get my 2nd letter from the same EM rotation from one physician? In addition, can my third letter be from family medicine or internal medicine? I also plan on doing an EM externship at the end of September, which could give me another EM letter; however, it probably would not be submitted by mid October. Thanks again for all your help.

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    1. A rotation finishing in mid-september will get your letter in early enough. A second letter from that rotation is also okay, and better than waiting too long for a letter from a later rotation. Your third letter can be from another specialty. The rotation ending in october won't get a letter in before early november so you would not want to hold up your application under most circumstances. Some residencies let you submit four letters and you could use this for that fourth spot without delaying review of your application.

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  17. Hello Dr. Kellog,

    Can you please clarify a few things for me. How many SLOE's are required out of my 3 LOR's for my application? Also, it looks like I'll have 2 SLOE's and 1 traditional letter from a family medicine physician. I'll finish up my 3rd EM elective September 16th so should I pull the trigger and submit my application early with 2 SLOE's and one traditional or wait for a 3rd SLOE and apply later on in September? I am trying to maximize my chances for interviews given the fact that I am a US IMG. Thank you for your help ahead of time.

    Respectfully,

    Mark

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  18. Mark - Each program has a different number of "required" SLOE's. Some are fine with just 1. If you have 2 SLOE's from 2 different ED's then almost all programs will seriously consider your application.

    Mid-september is NOT too late for a SLOE that is part of your application. There is plenty of time before serious application review starts (after October 1st) to get the letter in. Any later than September and that should be considered an extra (fourth) letter for those programs that take one.

    As a "non-traditional applicant" (ie anybody who is not a US allopathic senior med student), you are right to do everything you can to have your application complete in early October - that gets the maximum number of eyes on it for review.

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  19. Hi
    I am IMG with 4 years of working experience in EM. I am also a member of Royal College of EM (UK). I have 2 questions:

    Can my Instructors (EM Physicians) from India or UK write the SLOE for me?
    How do Program Director/s look at previous experience in EM?

    Thanks
    Appreciate all your time and efforts

    ReplyDelete
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    1. The SLOE is intended to be written for students, evaluating them and comparing them to their peers. Many reviewers would NOT think it appropriate for your circumstances and would prefer you had more traditional letters from your instructors. For more information about the SLOE: http://www.cordem.org/i4a/pages/index.cfm?pageid=3743

      Previous EM experience is usually seen as a strength. That may be helpful, though it is becoming increasingly difficult to get an EM position for IMG's. Rotations at Academic ED's in the U.S. give you the best possible chance to get both SLOE and interviews.

      Delete
  20. Hi Dr. Kellog. I am an IMG and will be applying for ED residency this year. I completed my first ED rotation in Canada which was affiliated with a residency program and has lots of students rotating there. I completed my second ED rotation in the states which was not affiliated with a residency. I am planning on getting two SLOE from the Canadian site and one standard LOR from the american site. Would it be okay for me to get 2 SLOEs from the rotation I did in Canada? Currently, I have the clerkship advisor writing me one and I am planning on getting another one from another faculty member...would that be fine or does having two SLOEs from the same site decrease my chances? Also, does getting SLOE from Canada decrease my chances? Do you advise that I try to find a residency affiliated rotation for sept or oct and try to get a SLOE from there or will these 3 letters plus another letter from one of my other rotations be good enough? Thank you for your help.

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    1. Hi Kristy,
      Having 2 SLOE's from the same site will not hurt your chances, it just does not help as much as having SLOE's from 2 different EM programs.
      The issue with a SLOE from Canada is that few of the U.S. reviewers will know the letter writers. They should trust in their ability to evaluate candidates BUT the personal connection of reading a letter by someone you really know is going to be lost (in most cases). It is likely too late to get a rotation in the US that will provide a SLOE in time for your application to be complete. You do not want to delay your application being reviewable. If a 4th letter could come from an October rotation, that could help. The most important thing to do is to focus your applications on programs with a recent history of taking IMG's and having a back-up plan that is acceptable to you in case you are not able to get enough EM interviews.

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  21. Hi Dr. Kellogg,

    Great blog and quick question. Currently, I am on my last EM elective scheduled to finish at the end of Sept. I have two other SLOE's, one uploaded and assigned from my June rotation, another from August rotation that I expect to be uploaded in a few days. I also have a traditional letter from a family med physician. Given that my rotation finishes at the end of Sept, I don't expect the SLOE till mid Oct, at the earliest. Should I submit my two other SLOE's and the family med letter for a complete letter at the beginning of Oct, or wait till my third SLOE comes out and assign it? It was my understanding that middle of October might be too late, but wanted to clarify. Thanks for your time.

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    1. Given that you already have 2 SLOE's the most beneficial plan is to submit the 3 letters you have. You can designate the 3rd SLOE from this month as your 4th letter for the programs that allow 4. If you only had 1 SLOE than it would be worth holding a spot for that mid-october letter.

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  22. Hey, had a similar question to the one above. Im a DO student that completed 4 ER rotations (1 3rd year, 3 4th year). Of those 4 rotations, 3 have been from DO residencies, and 1 from an ACGME residency. I have already submitted my applications with 3 SLOEs but just recently had another SLOE uploaded from my latest ER rotation. I was wondering if I should upload this latest SLOE? I've heard not uploading a SLOE from an ER rotation has been considered a "red flag" but given I already have 3 with my application, would a 4th even be necessary?

    ReplyDelete
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    1. In almost any circumstance more SLOE's are better. If one is weak, which you may not know, the weight of all the others will drown it out.
      If you only do 2 rotations then not having a letter from one, especially a home rotation, is a red flag.
      With as many letters as you have it does not really matter if one rotation is not represented. It is unlikely that a reviewer is going to pick up on that as your transcript usually does not include your most recent rotations.

      Delete
  23. Hi Dr. Kellogg,

    I want to start off by thanking you for putting up so much valuable information for EM applicants and continuing to be so responsive!

    I am a 4th year DO applicant that has completed 4 audition rotations (2 AOA & 2 ACGME) and my last SLOE was uploaded to ERAS earlier today. So far I have assigned 3/4 because my gut feeling is that the SLOE I received from an AOA rotation in July is not as strong as the others. Although I have not received any red flags from that writer/program, this feeling is based off my perception of the performance from that rotation vs others (e.g. poorer differentials, didn't click as well with attendings/residents). So far I have uploaded the other 3 SLOEs but not the 4th. I understand your philosophy is 'the more EM letters, the better' but I wanted to gauge your thoughts on this unique situation before uploading the last letter.

    Thanks in advance!

    ReplyDelete
    Replies
    1. With 3 other SLOE's you certainly don't need another. Most reviewers will judge a first rotation SLOE differently than one from a later rotation. Most students take a while to adapt to the EM approach and environment. Unless it says something truly negative it is unlikely to hurt you.

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  24. Hi Dr. Kellogg,

    Thank you for so much valuable information for students as well as your reply to every questions!

    I am an IMG and will submit my application next year. I have a short question about the letters: is it true that all the LORs from Emergency faculty should be written in SLOE format? or the traditional letter still works? The reason why I ask this is that I checked the website of CORD (see below) and it reads that "2016-2017: The biggest change for this year is transitioning all of the letters to be completed via the eSLOE website." So, I am a bit confused now...
    BTW, I already have one SLOE from the CD and am going to ask another faculty for another letter during the same ER rotation. The thing is that I am not sure if I should ask a traditional letter or a SLOE?

    Thank you very much!

    http://www.cordem.org/i4a/pages/index.cfm?pageID=3743

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    1. I am going to have to update this page with the eSLOE changes. The way it is going to work is that eSLOE's will be created by each residency program. Each will have an account and it will keep track of all their data for them. The programs will have the option of letting their individual attendings write eSLOE's as well. But the program may also choose to only have the official "departmental letter" as an eSLOE and have individual faculty write separate letters. There is nothing to stop that faculty member from writing their letter in the SLOE format (the old templates are still around). A SLOE is always going to be better than a narative letter HOWEVER a SLOE that is written like a narrative letter (all positive, nothing constructive, highest ratings in every category) is not going to be trusted UNLESS that person writes a good number of letters each year, with a reasonable distribution, and clearly has some frame of reference for comparison.

      Ask your CD how they are going to handle this in their department - it will be different in each place.

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  25. Hello! MS3 here, with a sort of tight timeline seeing as I attended medical school in the Caribbean. Is it possible to get a SLOE from a Peds ER rotation? I have EM in July and Peds EM in August, hoping to get the SLOEs done before application time. I just wasn't sure if a Peds EM would hold as much weight. Thank you!

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    1. SLOE's from pedi EM rotations is fairly common. The biggest challenge is if those faculty are not frequent letter writers and thus not experienced with contrasting a student with the rest of their applicant peers. The best way to figure out how this is handled is to ask in advance. In general, you would not want your only EM SLOE to be from a pedi EM rotation, but as a 2nd or 3rd, that can be perfectly acceptable.

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  26. Dr. K.

    Regarding SLOEs and application submission timeframe...I have 2 core EM rotations in June and July at a small non-residency hospital (planning on obtaining normal LORs). Then 2 more months EM electives at really solid residency programs - Mid September through mid November (SLOEs).
    I am worried my these SLOEs will come in too late but I was told by a coordinator to apply ASAP in September and then upload SLOEs later when they are in (from the two residency electives) and I should be ok. I was told that it's good to at least have my application submitted and then I can contact the residencies I apply to and let them know I have new SLOEs uploaded. Any advice regarding this situation?

    Thank you for your input!

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    1. Waiting until late November to have your SLOE's in is going to hurt your application.
      You are limited to 3 or 4 letters per program in ERAS and once they go to the programs you cannot replace them. This means you would need to leave 1 or 2 open spots for letters coming from these later rotations, so your application will not be complete until well into the interview cycle. Programs will be unlikely to offer you an interview and will push your application to the "back of the pile" until it is more complete. Most of the interview spots will be gone by the time your application gets reviewed and you will be trying to get wait list spots for January interviews. It would be really difficult to get enough interviews to comfortably match.
      If there is any way you can move one of your rotation up so that it ends in September or turn one of those community months into an elective at a residency, you will have a SLOE with your application, an EM LOR from the community, and a spot saved for the second EM rotation. That would be okay and would only hurt you at programs that insist on 2 SLOE's from separate rotations (there are very few of those).

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  27. Hi! Thanks for posting such useful information. I'm a UK educated doctor with intern experience in EM hoping to apply for EM residency but I haven't done a clinical placement in the US. So my question is can a UK EM attending complete a SLOE? Or does it have to be a US physician? Thanks so much in advance!

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    1. The SLOE is intended to be completed by EM attendings who are familiar with the applicant pool. The key portion is comparing the applicant to the rest of the applicant class. Folks who do not fit that description sometimes still use the SLOE form but the information is not taken seriously. A more standard letter of recommendation would be better. Some programs will consider your application with no SLOE's given your specific circumstances but you face a difficult path to matching in EM without first getting clinical experience in the US.

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    2. Thanks for the response! If I were to apply to Paeds/EM or IM/EM residencies would I have to fulfill the same eSLOE criterion? And given the statistics from previous Match data, would it be wise to apply to 3 "different" specialties? My ideal pathway would be to do EM and then get a fellowship in critical care but failing that I would be content with a different route into critical care (although preferably EM related). I have my degree from Cambridge and have done a research placement in the US but without US EM clinical experience and an eSLOE would you advise against me applying for EM? Any guidance would be much appreciated!

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    3. Combined EM residencies will also want SLOE's but for candidates who don't have access they may make an exception. But they need to be open to non-traditional applicants in the first place Each of those combined programs will have specifics on their website about what combination of letters they want.

      Applying to those "different" specialties will not hurt your application to EM. With your experience there may be residency programs interested in you as an applicant. You can use EMRA Match to help you find programs that currently have IMG residents.

      Given the difficulty you are likely to have getting into an EM residency, an Internal Medicine training route to Critical Care will be the most straightforward path. You can apply to both EM and IM in the same cycle.

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  28. Thanks for the article! You mentioned that if the letter writers are only writing a few SLOEs a year they may be better off writing us a regular LOR. My letter writers fit that description! I'm totally fine with getting a regular LOR but I talked to a few PDs and they said they mark applications with less than 2 SLOEs as incomplete and my application may get filtered out! What do you think? Should I ask my letter writers to write a SLOE even though they are not familiar with it?

    Thanks

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  29. Your question brings up a couple significant controversies among program directors right now, that we are still working on getting consensus on:
    1. Who should write SLOE's?
    2. How many SLOe's does an applicant need to have?

    The first question is being addressed right now by CORD as it has become significantly more difficult to submit a SLOE if you are not a designated SLOE writer by an EM program. This is because of the roll out of the electronic SLOE (eSLOE) form that will only allow designated users to upload to the system. Many residencies write group or departmental letters for all students. Some, like yours, have individual faculty write letters. This is fine, and allowed for with the new eSLOE system. The eSLOE will automatically track how many letters someone has written and show the distribution of their evaluations (top 10, top 1/3, middle 1/3, etc). The suggestion that faculty who don't write many letters should consider writing a more traditional LOR is because it is crystal clear that they don't write many letters which could lead to their opinion being devalued. They may have a lot to contribute in their letter, and that may be easier done when not forced into the specific questions and limited space of the SLOE.

    The second question is actually where the real controversy is. There is currently work being done by CORD and EMRA to make transparent the number of SLOE's needed with an application. This data will be available in EMRA Match (https://webapps.emra.org/utils/spa/match#/search/map) by September. Based on preliminary discussions, but lacking the official data: most programs only require 1 SLOE to consider an application for interview. Some do require 2. We think they are in the minority, but will know soon. 2 SLOE's will always be better for the evaluator than just 1, of course. But delaying your application waiting for a second SLOE is often a bad idea.

    There is not complete agreement between all programs on what they require for an application. There is also disagreement on how letters should be handled. We think that most programs are not going to filter you out with just 1 SLOE, but 2 is safer.

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  30. Does that mean most programs will filter out 0 SLOEs? And if so do you think it's better to get at least one SLOE even if the letter writer is unfamiliar with it than to get 3 great LORs but 0 SLOEs?

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    1. ERAS allows programs to truly filter out applications so that they are never reviewed by the program, such as by step 1 score. Type of letter cannot be filtered in this way. So the letters will be looked at. However, many programs won't consider someone for interview without at least 1 SLOE. But a SLOE written by someone who should probably be writing a regular LOR won't help get an interview. The decision is based on the content of the SLOE not the presence of it. Not every program requires SLOE's from all applicants. Those that are open-minded about their applicant pool are going to be more willing to look at applicants without. Many programs do not feel the need to consider applicants who cannot get SLOE's.

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  31. Greetings,

    I'm having an away beginning Aug 1st and hope to get my first SLOE after that rotation. In September I have another away and am debating between an EM Peds (they said they can give a sloe but not a group sloe) or a regular EM rotation. Halfway through October-November, I have another away that can probably give another SLOE. I'm limited to two months of rotations for EM however if I take the Ped EM I could do that additionally as my pediatrics rotation. My question is, is it more
    Valuable to do the Peds EM and get a sloe that not a group sloe (what does this even mean) and be able to do an additional rotation in late October-November and get my second group sloe then (for a total of 1 early group sloe, 1 late (end of September Peds EM sloe, and a very late group sloe) or just do my first two months of always at EM and get 1 early and one mod late group Sloes?

    Hope that wasn't too confusing. Thanks!

    ReplyDelete
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    1. A group SLOE is one written by the Clerkship Director and the Residency Directors's. Most consider this to be the most trustworthy SLOE you can get (and therefore the most helpful). So having 2 clinical EM months and 2 SLOE's is going to help your application a lot more than a SLOE from a single Pedi EM doc who may not write many SLOE's. I have to recommend that you do the second regular EM rotation. Once you see how your first rotation goes you can decide if you should hold a spot in your letters for the late arriving 2nd group SLOE (if it goes really well you may be better off having an application that is complete on 9/15 with one great SLOE, than one that is complete later but with 2).

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  32. Once the CD's/PD's/APD's get the shift evaluation forms, is there any way to understand how the grading is done? Meaning how Honors, High pass, Pass are derived? If I had to guess, I believe that I got off to an average start, but my recent presentations to residents/attendings have been much better. Quite frankly my hope is to reach the HP threshold.My question is do you know if they recognize improvement in the SLOE's?

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    1. See below for a more full answer on grades vs. SLOE's. Each program grades differently.

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  33. Good morning, I was wondering if improvement is reflected within a SLOE. Say you got off to an average start and you really improved... do I have a chance to get a HP? Also can you get screeened out for just getting a P? I know I'm not going to make it to the fanciest to EM institutions, but with Average Step 1 and Step 2, I'm a bit concerned about only getting a P on this rotation.

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    1. Each institution has such different grading policies that the grade you get is not nearly as important as the ranking compared to your peers that is part of the SLOE. Some programs try to calibrate their grade distribution so that Honors = top 1/3, HP = middle 1/3, and Pass = Bottom 1/3, but that rarely works out so cleanly.
      More importantly, improvement counts a lot in a SLOE. Most reviewers don't mind seeing a letter with a lower grade for the rotation (pulled down by a slow start or a poor shelf exam performance), that mentions improvement, growth, incorporation of feedback, etc. What the reviewer would then look for is how the second rotation went. Did you get the same feedback as the first rotation? Had there been signs of improvement?
      Showing growth across 2 rotations is why programs prefer to have 2 SLOE's to review. They get a much clearer picture of the candidate.

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  34. Hi Dr. Kellogg,
    I am a 4th year medical student who is applying to EM this Fall. My medical school ends 3rd year later than most, so I am just beginning my EM rotation at my home institution. I will get a SLOE from them and I will get another SLOE from an EM attending at a nearby hospital who I have worked with closely. I will also be uploading a LOR from an attending I worked with a lot last year (who is not EM). I have two EM away rotations scheduled, but my first one will not be done until mid-October. I will get a SLOE from them once I finish. Will it hurt my application to not have a SLOE from an away rotation uploaded until near the end of October? I will for sure have three LOR uploaded into ERAS by September 15th, but none will be from an away rotation. Thanks.

    ReplyDelete
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    1. The decision you are going to face is whether to leave one of your letter spots open for that late-arriving SLOE when applying to programs that only allow 3 letters. Your plan is perfect for programs that allow 4 letters. Late-arriving letters often lead to later application review and not having a shot at the first wave of interviews. This is not as big a deal as it sounds because wait list interviews mean just as much as the ones done early in the year.
      To actually answer your question (sort of): having a letter arrive late is going to hurt you a little in the short term but that letter may make the difference for other programs deciding to interview you.
      EMRA Match is trying to add the number of SLOE's required for interview to each programs data. This should be available by 9/15 and can help make the decision for individual programs on whether to leave a spot open for that late letter.

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  35. If I have two SLOEs from the same institution (my home institution) written by two different faculty members for two separate rotations, will it hurt me since it's only from one institution?

    ReplyDelete
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    1. Two letters from one institution won't HURT you (most programs only require 1 SLOE) but having letters from more than one program is more HELPFUL to your application. Think of it this way. If two candidates are otherwise very similar and you only have one interview spot to offer, the program would feel more certain about the candidate with letters from 2 different programs that say similar things. Corroborating evidence is a little more trustworthy.

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  36. Hi Dr. Kellog,

    I will have 2 SLOEs and 1 research (non-clinical interaction) letter by submission of application in early September. I will finish a third EM visiting rotation on 10/1 and plan on submitting a third SLOE when that one is ready. My only worry is that by the time my application is submitted, I won't have 3 completely clinical letters. Do you think this plan is ok?

    Thanks!

    ReplyDelete
    Replies
    1. This plan is great and puts you in an enviable position relative to many applicants. Almost all programs will consider your application with the 2 SLOE's. Your late-arriving SLOE will be a prompt for reconsideration by programs still on the fence.

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  37. I missed a meeting with a clerkship director during a rotation due to a personal emergency. I explained the nature of it and haven't heard anything back. Should I ask point blank if it is going to affect my SLOE negatively? Otherwise the rotation has been great with no problems.

    ReplyDelete
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    1. You can certainly ask - that would give you a chance to remind them of the nature of your missed meeting (emergency, not irresponsibility).

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  38. Hi,
    I currently have two SLOEs uploaded, one from an away institution that was completed by the ED medical director (at a non-residency trauma 1 program with little exposure to SLOEs) and a second SLOE from my home institution at a trauma 1 center that has a large residency program and constant flow of medical students (so large sample size) but my third SLOE will not be uploaded till probably late September/early October after I complete the current EM internship I am doing. Should I try to get a 4th letter? I have been an ER nurse for years and both of my previous SLOE writers gave me great evals and the impression that they would write me strong SLOEs. I have been told it would not necessarily add to my application to get a 4th letter and thus it was not needed? I am mostly worried what will happen if my 3rd SLOE does not get uploaded till beginning of October will my application look weak?
    Thank you so much for your advice.

    ReplyDelete
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    1. A late (though only slightly) arriving letter won't make your application look weak. It may delay review of your application by programs that require 2 SLOE's for review AND who won't count the medical directors letter as one of them. The concern should be that a few programs will consider your application "incomplete" and not review it - they could then give away all their interview spots before ever seeing your application. That will not happen at most programs and the interviews you receive later in the process (off a wait-list or by rolling admission) count just as much as the first wave of interviews that happen in late October or early Nov. It sounds like you are in good shape in terms of letters. Many applicants don't have the "ideal" package of letters (2 SLOE's by PD/CD at 2 different institutions) - while that is the ideal combination, it is by no means necessary.

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  39. Hi Dr. Kellog, thanks for posting all this great advice. I am currently waiting for my first SLOE from my August rotation to be uploaded in which the PD said it won't be available until October when my next EM rotation begins. Should I send out my applications to programs now just having a personal community EM physician letter with the intention of uploading the SLOE when it becomes available, or should I wait until the SLOE is ready to submit applications. I don't want to delay my applications but I also do not want to get screened out early for not having a SLOE/complete application.

    ReplyDelete
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    1. You NEED to submit your application now. Programs will not screen you out for being incomplete, they will delay review until they have enough information. You may miss out on the first wave of interviews from many programs, but that will happen anyway if you delay submission.

      This is really important. If you wait until your application is "perfect" to submit in mid/late-october, reviewers are going to think you applied to them as an afterthought.

      Any program you are serious about applying to should receive your application before MSPE's come out (and really should be getting it 9/15).

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  40. Can a non-US Professor in EM write me a SLOE?

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    1. They shouldn't. It defeats the purpose of comparing you to the applicant pool. You are better off with a non-SLOE (traditional LOR) from someone who does not write many SLOE's each year. There is not much room for written comments on the SLOE. Whereas as a narrative letter gives lots of room to talk about your strengths and experiences.

      The benefit of the SLOE is to give some semi-objective information on an applicant besides their board scores (and allows many EM programs to put less weight into boards). If the information in the SLOE does not appear reliable/objective it won't carry any weight.

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  41. Hi Dr. Kellogg, I was hoping you could help me with some advice regarding LORs and SLOEs. I currently have 2 standard LOR from non-EM physicians, and expect my first SLOE the last week of September and my 2nd SLOE at the end of October. I submitted my applications on 9/15, should I e-mail the programs and inform them on the time frame of my SLOEs? I am just concerned that I'll be considered incomplete at all the programs subsequently won't be taken seriously.

    Thank you for your advice, much appreciated!

    ReplyDelete
    Replies
    1. When your first SLOE arrives at the end of September most programs will review your application. When the second arrives in October those that were waiting for 2 and those who had been on the fence will make a decision. Early November, after your second SLOE arrives, will be good timing for polite contact with the program to let them know there is new information they may find helpful.

      What would put your application at risk of not being taken seriously is if you apply to programs later in October or early November AFTER the first big wave of interviews comes out. This will create the accurate perception that you weren't really interested and only applied out of panic.

      You are in a common situation that will not hurt your chances of matching, though you may need to do some of your interviews later in the season at programs that waited for the second SLOE to make a decision.

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  42. Hi Dr. Kellogg,

    I applied with 3 LORs, with one being a SLOE, on the day the application opened. I uploaded and assigned my second SLOE on 10/9/2017. Do you think I need to let programs know my second SLOE is up or that it will be fine? Thank you in advance!

    ReplyDelete
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    1. It would be reasonable to let programs know that you now have a second SLOE. At least the programs that specify that they want 2 SLOE's to review an applicant.

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    2. Thank you Dr. Kellogg. As a follow up should I email the coordinators with the two letter update or the program coordinators? Thank you

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    3. I would email the program coordinators.

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  43. Hi Dr. Kellogg,

    I have applied with three SLOEs, one from my home institution, and the other two from away rotations, all of which were written by their respective clerkship directors. All of them were present prior to Oct. 1. I was under the impression that this is fine, and that an additional traditional letter doesn't add much. Is it okay to leave my application as is with my three SLOEs being my final and complete package?

    ReplyDelete
    Replies
    1. Yes. 3 SLOE's is an ideal collection of letters (more than good enough), and adding another won't make a difference.

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