Lower-Third SLOE Rankings Impede, But Do Not Prevent, A Match in Emergency Medicine Residency Training

Abstract

Objective: Emergency medicine program directors (PD) value the standardized letter of evaluation (SLOE) as the most important aspect of a residency application when making both invitation and ranking decisions. This study aims to determine whether the presence of any lower-third in either SLOE global assessment (GA) question impacted the ability of an applicant to match into EM. We hypothesized that any lower-third ranking would be associated with increased odds of not matching into EM. Methods: We conducted a retrospective cohort study evaluating allopathic applicants from medical schools in the United States (US allopathic applicants) to a single EM residency program during the 2018/2019 match cycles. GA SLOE rankings from all applications were tabulated and compared to the applicant’s National Resident Matching Program (NRMP) match outcome. Comparative analyses were conducted between SLOE groupings and odds ratios (OR) were calculated. Results: A total of 2,017 SLOEs from 781 US allopathic applicants were analyzed during the study period. Of the total, 277 (35%) applicants in our sample had any lower-third GA ranking, which significantly decreased an applicant’s odds of matching in EM by 79% (OR 0.21, 95% CI, 0.12-0.34). Having more than one lower-third GA ranking did not further statistically decrease the odds of a successful EM match (OR 0.60, 95% CI 0.31-1.17). As a secondary finding of the study, results demonstrate that those applicants having no lower-third GA rankings had a nearly 5 times increased odds of an EM match (OR 4.84, 95% CI, 2.91-8.03). Conclusion: Having any lower-third GA ranking significantly reduced an applicant’s chances of matching into an EM program. Faculty advisors should be aware of the increased risk of not matching for any applicant with any lower-third GA ranking and advise students appropriately, while maintaining the integrity of the SLOE and not divulging the confidential information contained within.

Lower-Third Standardized Letters of Evaluation in Emergency Medicine: Does Gender Make a Difference in Match Outcome?

“…Our study findings suggest that a smaller proportion of female applicants received a lower-third GA ranking compared to male counterparts pursuing the same specialty. Given the findings from our primary study’s larger data set [ 5 ], we know that an applicant, regardless of gender, with any lower-third GA ranking is at a significantly increased odds of not matching into EM. Therefore, the decreased frequency with which females receive a lower-third GA ranking on the SLOE seems to suggest that females are actually not discriminated against and are perhaps actually even better positioned for a successful match in EM when compared to their male counterparts.…”

“…This study is a follow-up study to analyze the impact of lower-third SLOE GA rankings on applicant match outcome status, with respect to gender. It utilizes the same data set as a previously conducted retrospective cohort study assessing the impact of any lower-third GA rankings on match status of all EM applicants, regardless of gender [ 5 ]. This follow-up, retrospective cohort study includes analysis of all U.S. allopathic applicants to a single EM residency program during the 2018 and 2019 match cycles.…”

“…As such, and despite the guidance to distribute applicants evenly across the thirds, only 10-12% of applicants receive a lower-third ranking on any GA question [ 4 ]. Although a large percentage of applicants with a lower-third ranking will ultimately match into the specialty, prior work has confirmed the inferred concern that applicants with any lower-third GA ranking are indeed at an increased risk of not successfully matching in EM [ 5 ].…”

“…Given that the SLOE is the most important part of an EM application and some preliminary work has demonstrated potential variance in SLOE content based on gender, there is an opportunity and need to describe the real-world outcomes of female applicants receiving a lower-third SLOE GA ranking [ 5 ]. The primary objective of this study was to determine whether or not female applicants receiving a lower-third GA ranking were more likely to not match than their male counterparts receiving a lower-third GA ranking.…”

“…This table was originally published as part of an article published by this author group exploring the impact of lower-third GA ranking on all applicants, regardless of gender[5]. Regions in this figure and in the remainder of the paper are derived from the Society for Academic Emergency Medicine residency directory: https://member.saem.org/SAEMIMIS/SAEM_Directories/ResidencyMap/SAEM_Directories/P/ResidencyMap.aspx?hkey=1e134970-ec57-4862-87fb-6971bad7a77bCK, clinical knowledge; GA, global assessment; LCME, Liaison Committee on Medical Education; SD, standard deviation; SLOE, standardized letter of evaluation; USMLE, United States Medical Licensing Examination…”