Ethnic and Racial Differences in Ratings in the Medical Student Standardized Letters of Evaluation (SLOE)

Abstract

Background The Standardized Letter of Evaluation (SLOE) stratifies the assessment of emergency medicine (EM) bound medical applicants. However, bias in SLOE, particularly regarding race and ethnicity, is an underexplored area. Objective This study aims to assess whether underrepresented in medicine (UIM) and non-UIM applicants are rated differently in SLOE components. Methods This was a cross-section study of EM-bound applicants across 3 geographically distinct US training programs during the 2019-2020 application cycle. Using descriptive and regression analyses, we examine the differences between UIM applicants and non-UIM applicants for each of the SLOE components: 7 qualifications of an EM physician (7QEM), global assessment (GA) rating, and projected rank list (RL) position. Results Out of a combined total of 3759, 2002 (53.3%) unique EM-bound applicants were included. UIM applicants had lower ratings for each of the 7QEM questions, GA, and RL positions. Compared to non-UIM applicants, only some of the 7QEM components: “Work ethic and ability to assume responsibility,” “Ability to work in a team, and “Ability to communicate a caring nature,” were associated with their SLOE. “Commitment to EM” correlated more with GA for UIM than for non-UIM applicants. Conclusions This study shows a difference in SLOE rating, with UIM applicants receiving lower ratings than non-UIM applicants.

SLOE: A step in the right direction

“…The prior SLOE format had racial bias within multiple sections, including the GA: non-URM candidates were ranked statistically significantly higher than URM candidates. 2 Alvarez et al 3 had similar findings regarding the GA and also found disparities amongst the qualifications for EM questions. "Quiet" applicants were more likely to be placed in lower categories.…”

Automated abstraction of information from standard letters of evaluation: A resource for file review and research

“…2 Decades of research and refinement have led to the current SLOE format and process, which includes the electronic SLOE (eSLOE) platform. 2,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Introduced in 2016, the eSLOE platform is where SLOEs are completed on the Council of Residency Directors in Emergency Medicine (CORD) website and all SLOE information is stored in a central database. 12 To protect learner privacy, access to this database is restricted.…”

“…Recruitment committees and researchers are therefore limited to SLOE information in the portable document format (PDF) files they receive through the Electronic Residency Application Service (ERAS), which has required hand-abstraction of information into formats more amenable to analysis, as has been described in prior studies. 8,9,14,15,17,18 These circumstances are ripe for innovation: How can we leverage the eSLOE database to facilitate access to ERAS SLOE information in a format amenable to file review and research? In this manuscript, we describe an innovation to accomplish this task and outline the specific steps involved for ease of replication.…”

“…To protect learner privacy, access to this database is restricted. Recruitment committees and researchers are therefore limited to SLOE information in the portable document format (PDF) files they receive through the Electronic Residency Application Service (ERAS), which has required hand‐abstraction of information into formats more amenable to analysis, as has been described in prior studies 8,9,14,15,17,18 …”

Educator's blueprint: Holistic applicant file review in undergraduate and postgraduate medical education

“…In addition, these decisions may need to be contextualized to specific characteristics of an application year such as variations in application volume, performance metrics, or demographics.Recent trends of increasing pass/fail grading and identification of bias in several metrics used in these processes underscore the importance of a holistic approach to the selection process with careful attention to how ratings are generated and used to minimize bias. [3][4][5] In this article, we discuss 10 strategies for applicant file review focusing on efficiency, equity, and accountability in the applicant review process.…”