To SLOE or not to SLOE

This summer as you rock your rotations, get your information uploaded to ERAS, and get your application for EM residency buffed and ready for prime time, one question comes up, are all EM letters better than a combination of SLOE and non-SLOE/EM letters.

SLOE are the Standard Letter of Evaluations, used by EM faculty to compare students to their fellow applicants, and predict their future potential success within an EM residency. These letters were designed by an EM task force, to minimize grade inflation, and focus on the student's characteristics and potential, when compared to their peers. Program faculty like to see two or more SLOE to consider an application complete, and consider for an interview.

Non SLOE letters of recommendation, within EM are usually used  by non-residency EM faculty. They can be useful for community EM faculty to endorse a students attributes toward EM. While not ideal they are still within EM and are read and considered. Non EM letters, tend to be considered less useful, because they frequently do not reflect on the applicants attributes that apply to EM. Many students are intelligent, hard working, and enthusiastic, but not all can translate these attributes into the fast paced, chaotic EM environment.

Council of Residency Directors list serve recently had an active discussion on this topic and program leadership consistently expressed they want to see 2 EM SLOE from program faculty.  All EM letters is generally preferable to non-EM letters. The one instance non EM/SLOE can be helpful is when it comes from a supervisor who has worked with the student closely over time. If a student did  a longitudinal research, public health project, or graduate degree, the mentor of this project's endorsement  is supportive for the application, adds another perspective of the student, and it's absence could be suspicious.

In the end the desire of program leadership is what matters, this is the audience you want to impress. Get SLOEs, as many as you can from different programs, and if you have been involved in a long term project, get your mentor's recommendation as well. Generally non-EM letters are unlikely to aid your application in EM.

So You Got a High Pass

So You Got a High Pass....

This time each year, I hear from many students that they are devastated by their grade on their first EM rotation. There appears to be a common misconception that a High Pass is a death knell. This is far from the case, we are frequently swayed to interview students who receive High Pass on their first EM endeavor. 

So why you ask, do we get excited for those who weren’t rock stars from day one? The answer is simple: If you could choice to train one of two runners, they both run the 100 in 12 seconds one with perfect form, and the other with horrible form, who do you choose? We choose the second, if you teach her good form she will beat the first.  The student who gets a High Pass on their first rotation, and Honors on the second will outdistance the rock star every time. Our great search in residency is for the teachable student. 

So what can you do to become this sought after teachable candidate? You need to improve in each aspect of EM. This is the time to be proactive; call or write the clerkship director at your first rotation, and get the specifics you need to address. 

For most this falls into two categories: 

1. Approach
2. Application

The approach for EM that is successful is proactive, energetic, and enthused. You want to go in, and light the place on fire. Be forceful, everywhere, and ahead. Run to action, put gloves on, and think what they will need next, and supply it. Never pass up an opportunity to get involved, or do even a menial task. You will be noticed and given more. Being reserved, quiet, or contemplative is likely to result in evaluations below your ability. Be willing to put your thoughts out there, and show how you can apply yourself. 

The application is realizing there are discrete skills in EM, you need to have them. The first is the EM presentation, read The Three Minute EM Presentation learn it, and do it. The second is the weighted differential, keep it wide, focused on the worst possible diagnoses, that could present like your patient, the probable reasons for this presentation, and the interesting (Zebra) that could present like this. Have this ready before your presentation, so you can amend your presentation to include the pertinent positive, and negatives for this differential. Review common EM core content, by reading texts, review books, or listen to EM basic or FOAMcast. The Plan is the last step, come up with how you will address your differential. Less is often more, don’t forget to start with your interventions for the patient, and then go to ancillary testing, that helps discriminate your differential. Now make it happen, be the first to recheck the patient, check test results, and think what you will do with the positive or negative result. 

Turn your disappointment into determination. Show us you can and will learn the form, and beat the natural.