key: cord-0879217-v2nnu155
authors: Katirji, Linda; Smith, Liza; Pelletier-Bui, Alexis; Hillman, Emily; Zhang, Xiao Chi; Pasirstein, Michael; Olaf, Mark; Shaw, Jazmyn; Franzen, Douglas; Ren, Ronnie
title: Addressing Challenges in Obtaining Emergency Medicine Away Rotations and Standardized Letters of Evaluation Due to COVID-19 Pandemic
date: 2020-04-02
journal: West J Emerg Med
DOI: 10.5811/westjem.2020.3.47444
sha: a32ee2f6e8756561aa9aa4a5b5ffb110367b0fd7
doc_id: 879217
cord_uid: v2nnu155

nan

department settings and to receive real-time assessment of their clinical skills.

The Council of Residency Directors in Emergency Medicine (CORD) Advising Students Committee in Emergency Medicine (ASC-EM) anticipates institutional and regional variability in both the spread and response to COVID-19. Travel restrictions and host institution rotation closures will impact the number of emergency medicine (EM) rotations EM-bound medical students can complete in an unprecedented manner. They may prevent students from completing any away rotations this academic cycle, challenging the students' collective ability to obtain EM Standardized Letters of Evaluation (SLOE) outside of their home institution. For students without a home EM program to rotate in, they may not have the ability to obtain any SLOE at all, which could be devastating to their EM residency application. 6, 7 Historically, SLOEs obtained from home and away EM rotations have served as important tools to determine which candidates to invite for residency interviews. [6] [7] [8] [9] Approximately 80% of EM programs will not consider an applicant for an interview unless they have at least one SLOE. 10, 11 In the most recent review of the Emergency Medicine Residents' Association (EMRA) Match website, of the 175 out of 258 programs self-reporting a SLOE requirement, only 13 programs (7%) stated they would review an applicant without a SLOE while 79 programs (45%) stated they required two SLOEs before

Addressing Challenges in Obtaining EM Away Rotations and SLOE due to COVID-19

considering an applicant for interview. 12 Over the past decade, the group SLOE, written by the EM clerkship and residency education team at a residency program, has become the preferred SLOE for residency EM applications. 6, 8, 13, 14 Program directors have since held single-author SLOEs, SLOEs from EM faculty not affiliated with a residency program, and non-SLOE format letters of recommendation (LoR) in lesser regard. 6, 15 In the present COVID-19 pandemic, students without a residency-based home EM rotation will face markedly greater barriers to obtaining these coveted group SLOEs. EM's emphasis on residency group SLOEs over other letter types creates an undue burden on these vulnerable students and makes the application process intrinsically inequitable. This inequity warrants a reevaluation of the current application practice.

In this continuously evolving, exceptionally challenging time, it is important for the educational community to face these challenges in a united front. ASC-EM proposes the following recommendations for all stakeholders, including EM program leadership, medical schools, and EM-bound medical students, to consider for the upcoming EM application cycle.

1. Programs should be flexible with their SLOE requirements.

a. ASC-EM recommends for application cycle 2020-2021 that residency program leadership consider reducing the number of SLOEs needed to review an application to one SLOE (or fewer) to account for students who cannot obtain a SLOE at their home institution or from away rotations. We also recommend programs to accept alternative letters of recommendations to act as surrogates for their typical group SLOE requirements as detailed in the paragraphs below.

2. Programs should give weight to alternative LoRs that include the traditional SLOE content. a. Examples of alternative LoRs include, but are not limited to, a SLOE from a home EM rotation at an institution without an associated EM residency program ("orphan" SLOEs), EM sub-specialty SLOEs (ultrasound, toxicology, pediatric EM, emergency medical services, or other sub-specialties), and LoRs written by advisors for the instance that a student has been entirely unsuccessful in obtaining an EM rotation. The CORD website contains instructions and a template for writing such SLOEs. 16 a. We anticipate EM rotations that accept visiting students will become a scarce opportunity that must be shared to maintain a healthy application environment. We ask all stakeholders in the EM application process, including but not limited to faculty advisers, clerkships, and students, to be cognizant of the number of EM rotations each student chooses to complete. Given the possibility of drastically limited EM rotation positions, ASC-EM would like to revise the number of away rotations we have recommended students complete in previous application cycles. b. Students who can rotate at their home EM program:

In the event that a student is able to both travel to institutions accepting visiting students and secure available clerkship positions, that student should not complete more than one away rotation. c. Students without a home EM program: Students should not complete more than two away rotations. We understand that these proposed changes may be uncomfortable for programs that have relied on SLOEs to be the most important representation of a student's abilities, and for students who are eager to be able to demonstrate their competencies in the audition setting. [6] [7] [8] Ultimately, these recommendations are motivated by the need to preserve the health and safety of our EM community and to ensure that students who traditionally are at the greatest disadvantage in navigating the application process are not excluded entirely from consideration.

Although the COVID-19 pandemic was the impetus for these unique recommendations, our response may be applicable to future, unforeseen circumstances that alter the usual application process. Emergency physicians are known to be adaptable to their ever-changing clinical environment, and we are confident that our flexibility will extend to the academic realm as well.

Available at

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Guidelines for safety of trainees rotating abroad: consensus recommendations from the Global Emergency Medicine Academy of the Society for Academic Emergency Medicine, Council of Emergency Medicine Residency Directors, and the Emergency Medicine Residents' Association

Council of Emergency Medicine Residency Directors' standardized letter of recommendation: the program director's perspective

National Residency Matching Program. Results of the 2018 Program Director Survey

The Standardized Letter of Evaluation for postgraduate training: a concept whose time has come

Time to reevaluate the away rotation: improving return on investment for students and schools

Emergency medicine residency selection criteria: an update and comparison

What do they want from us? A survey of EM program directors on EM application criteria

Analysis of the evaluative components on the Standard Letter of Recommendation (SLOR) in emergency redicine

A comparison of standardized and narrative letters of recommendation

EMRA and CORD Student Advising Guide

The Standardized Letter of Evaluation (SLOE) for Non-EM Residency Faculty