Council of Emergency Medicine Residency Directors' Standardized Letter of Recommendation: The Program Director's Perspective

Abstract

Objectives: The standardized letter of evaluation (SLOE) was created in 1997 to provide residency program directors (PDs) with a summative evaluation that incorporates normative grading (i.e., comparisons to peers applying to emergency medicine [EM] training). Although the standard letter of recommendation (SLOR) has become increasingly popular and important in decision-making, it has not been studied in the past 12 years. To assess the SLOR's effectiveness and limitations, the perspective of EM PDs was surveyed in this study.Methods: After validation of the questionnaire by 10 retired PDs, the survey was sent to the PD of each of the 159 EM residencies that existed at that time. The survey was circulated via the Council of Emergency Medicine Residency Directors' (CORD) listserv from January 24, 2013, to February 13, 2013. Weekly e-mail reminders to all PDs served to increase participation.Results: A total of 150 of 159 PDs (94.3%) completed the questionnaire. Nearly all respondents (149 of 150; 99.3%) agreed that the SLOR is an important evaluative tool and should continue to be used. In the application process, 91 of 150 (60.7%) programs require one or more SLORs, and an additional 55 (36.7%) recommend but do not require a SLOR to be considered for interview. When asked to identify the top three factors in deciding who should be interviewed, the SLOR was ranked first (139 of 150; 92.7%), with EM rotation grades ranked second (73 of 150; 48.7%). The factors that were most often identified as the top three that diminish the value of the SLOR in order were 1) "inflated evaluations" (121 of 146; 82.9%), 2) "inconsistency between comments and grades" (106 of 146; 72.6%), and 3) "inadequate perspective on candidate attributes in the written comments" and "inexperienced authors" (60 of 146; 41.1% each). Conclusions:The SLOR appears to be the most important tool in the EM PD's armamentarium for determining which candidates should be interviewed for residency training. Although valuable, the SLOR's potential utility is hampered by a number of factors, the most important of which is inflated evaluations. Focused changes in the SLOR template should be mindful that it appears, in general, to be successful in its intended purpose.ACADEMIC EMERGENCY MEDICINE 2014;21:680-687 © 2014 by the Society for Academic Emergency Medicine P rior studies have shown that traditional narrative letters of recommendation (NLOR) suffer from a number of significant limitations. Such letters do not predict future performance.1,2 They often repeat cognitive merits of the applicant and do not specifically address noncognitive domains that may be more predictive of performance as a resident. 2,3 The information that is provided is not comparative and is often

Use of standardized letters of recommendation for otolaryngology head and neck surgery residency and the impact of gender

“…The SLOR has also been purported to reduce the grandiosity often seen in narrative letters; nevertheless, subjective and objective analyses have indicated that letter writers continue to consistently select the highest ranks when reviewing student performance. The SLOR thus fails to achieve one of its goals and yields a seemingly homogenous pool of applicants . Multiple studies have shown that when choosing responses in a Likert‐type scale, as is utilized in the SLOR (Fig.…”

What Do They Want from Us? A Survey of EM Program Directors on EM Application Criteria

“…?” 5 This referred to the incremental increase in number of away rotations students were pursuing. Despite knowledge that strong EM rotation grades and the standardized letter of evaluation (SLOE) carry significant weight6 in an EM residency application, students often buffer their applications with multiple away rotations and apply to dozens of residency programs, irrespective of the overall quality of their candidacy 5. While the clerkship directors declared that more is not necessarily better in respect to rotations and SLOEs, we felt that the addition of EM residency PD attitudes would reinforce the message of the CDEM guide.…”

An Analysis of the Top-cited Articles in Emergency Medicine Education Literature

“…Many articles have been widely disseminated despite not being highly cited. For instance, all EM residencies use the “Standardized Letter of Evaluation” (SLOE), as one way of reviewing potential applicants; however, the paper describing its predecessor, the “Standardized Letter of Recommendation (SLOR) and subsequent SLOE papers would not appear on the top 25 cited list in this article 53, 54. This suggests that citation numbers alone do not provide all information regarding the reach of research being performed.…”