Prevalence and characteristics of group standardized letters of evaluation in emergency medicine: A cross-sectional observational study.

Abstract

Background: The standardized letter of evaluation (SLOE) for emergency medicine (EM) is a well-established tool for residency selection. While previous work characterizes the utility and outcomes related to SLOE use, less is known about SLOE authorship patterns and trends.

Objective: The objective was to measure the prevalence of group SLOEs in EM over time, characterize the role groups represented in group SLOEs, and compare the rating practices of groups of authors versus single authors.

Methods: SLOE data from 2016 through 2021 were obtained from the CORD database. An algorithm was developed to process SLOE author fields to accomplish three tasks: (1) determine whether the SLOE was written by an individual or a group, (2) determine the number of named letter writers on group SLOEs, and (3) identify roles of individuals listed on group SLOEs. A total of 150 SLOEs were randomly selected for review by the study team to use as a standard to which algorithm performance was compared. Mean ratings were compared for (1) individual versus group SLOEs and (2) individual SLOEs from clerkship directors (CDs) versus others.

Results: A total of 40,218 SLOEs met inclusion criteria. The algorithm performed well in detecting group SLOEs, authors, and titles. Institutions submitting only SLOEs written by a group of authors increased from 31.4% to 54.5%. Authors per group SLOE increased from 3.4 in 2016 to 4.0 in 2021. Mean ratings were slightly higher in individual SLOEs compared to group SLOEs. Individual SLOEs from non-CDs had higher ratings compared to those from CDs.

Conclusions: The proportion of SLOEs authored by groups increased over the study interval. Grading practices are similar between group SLOEs and individual SLOEs authored by CDs. Individual SLOEs from non-CDs had slightly higher ratings compared to the other groups.