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Learning Objectives: To design an educational experience for senior medical students that addresses coping with medical errors.Introduction: Navigating and coping with medical errors, which are inevitable realities of clinical practice, is an important physician competency. While medical students and residents recognize the importance of this topic, medical training programs vary substantially in their approach to teaching about medical error, and many offer no formal instruction in this topic.Educational Objective: To design an educational experience for senior medical students that addresses coping with medical errors.Curricular Design: We designed and implemented an educational experience within the established fourth-year capstone course at our institution, which is a required 2-week curriculum that prepares 4th year students for the transition to internship. After a brief lecture on medical errors, students participated in a standardized patient encounter in which they were required to disclose a medical error to the spouse of a critically ill patient. The error in the scenario was administration of an incorrect antibiotic leading to anaphylaxis requiring intubation. The standardized patients were instructed to portray strong emotions appropriate to the situation, including anger, shock, and grief, requiring students to navigate the error disclosure process in a realistic way. Afterwards, students participated in group debriefing focused on the challenges of disclosing medical errors and the impact of error on professional identity. Student feedback on the curriculum was obtained using a post-course survey.Impact: This novel experience addresses an under-recognized but important topic in medical education. Among participating students, 94% agreed that medical error is an important topic, and 92% felt more comfortable discussing medical errors. Formal instruction in coping with medical errors may help mitigate the adverse psychological impact of making medical errors in clinical practice, and better prepare students for the transition to residency and beyond.

Purpose: The National Academy of Medicine has called for "identifying opportunities to improve the diagnostic process". We studied the association between problem representation and diagnostic accuracy during an objective structured clinical exam (OSCE). Materials and methods: We conducted a non-randomized controlled trial during a ten-case OSCE. We measured whether a summary statement prompt increased the likelihood that the student listed the correct diagnosis and whether better summary statements were correlated with diagnostic accuracy. Results: 114 students provided 1135 responses. The non-prompted control group yielded 631 responses, listing the correct diagnosis first 73% of the time and within the top three slots 85% of the time. The intervention group exposed to the prompt yielded 453 responses listing the correct diagnosis first 72% of the time (P = 0.617) and within the top three slots 84% of the time (P = 0.760). Summary statements were scored on a 0, 0.5, or 1 rubric. When grouped according to summary statement score, students listed the correct diagnosis first 74%, 70%, and 72% of the time respectively (P = 0.666). The correct diagnosis was included within the top three slots 88%, 82%, and 83% of the time (P = 0.238). Conclusions: Prompting students to form a summary statement did not improve diagnostic accuracy. Better summary statements were not correlated with diagnostic accuracy.

Background: Standardized letters of evaluation (SLOEs) are an important part of residency recruitment, particularly given the limited availability of other discerning factors in residency applications. While consensus regarding SLOE competitiveness has been studied within a small group of academic faculty, it remains unexplored how a more diverse group of letter readers interpret SLOEs in terms of competitiveness. Methods: A sample of 50 real SLOEs in the new SLOE format (2022 eSLOE 2.0) were selected to match the national rating distribution and anonymized. These SLOEs were ranked in order of competitiveness by 25 faculty members representing diverse demographics, geographic regions, and practice settings. Consensus levels were assessed using previously defined criteria and compared to prior results using a cutoff of ±10% to define a significant difference in consensus levels. Two models were tested to determine their ability to predict consensus rankings: a point‐based system and a linear regression model. Results: Faculty consensus in this diverse cohort was slightly below the level measured among academic emergency medicine faculty in the prior study, though no differences were greater than the ±10% cutoff. Prediction models also performed similarly to a previous study except at the tight level of agreement, where consensus was stronger in this study compared to previous results. There is greater consensus among faculty at academic institutions than at community institutions, and years of experience was not correlated with higher consensus. Conclusions: The degree of consensus regarding competitiveness using real SLOEs was similar in this diverse national sample compared to a prior study in a smaller and more homogenous group ranking mock SLOEs. Consensus ranks were predicted with good accuracy using both the point system and the regression model. [ABSTRACT FROM AUTHOR]

Background: While faculty have previously been shown to have high levels of agreement about the competitiveness of emergency medicine (EM) standardized letters of evaluation (SLOEs), reviewing SLOEs remains a highly time‐intensive process for faculty. Artificial intelligence large language models (LLMs) have shown promise for effectively analyzing large volumes of data across a variety of contexts, but their ability to interpret SLOEs is unknown. Objective: The objective was to evaluate the ability of LLMs to rate EM SLOEs on competitiveness compared to faculty consensus and previously developed algorithms. Methods: Fifty mock SLOE letters were drafted and analyzed seven times by a data‐focused LLM with instructions to rank them based on desirability for residency. The LLM was also asked to use its own criteria to decide which characteristics are most important for residency and revise its ranking of the SLOEs. LLM‐generated rank lists were compared with faculty consensus rankings. Results: There was a high degree of correlation (r = 0.96) between the rank list initially generated by LLM consensus and the rank list generated by trained faculty. The correlation between the revised list generated by the LLM and the faculty consensus was lower (r = 0.86). Conclusions: The LLM generated rankings showed strong correlation with expert faculty consensus rankings with minimal input of faculty time and effort. [ABSTRACT FROM AUTHOR]

Background: Emergency medicine (EM) has introduced a new, competency‐based standardized letter of evaluation (SLOE) template. While a previous version of the SLOE has been shown to promote a high degree of faculty consensus regarding competitiveness, this has not been shown for the new SLOE template. Objective: The objective was to evaluate faculty consensus on competitiveness for the new EM SLOE 2.0. Methods: Fifty mock SLOE 2.0 letters using the new template were drafted and sent to a group of experienced EM educators. The 50 letters were ranked by the experienced faculty as well as a point‐based prediction model and a regression model and the results were compared. Results: Faculty consensus on competitiveness remained strong when using the new SLOE 2.0 format. The points‐based prediction model and regression model both demonstrated a high level of agreement with faculty consensus rankings for the SLOE 2.0. Conclusions: Introduction of the new, competency‐based SLOE 2.0 format did not have a deleterious effect on faculty consensus rankings of competitiveness. [ABSTRACT FROM AUTHOR]

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Background: Given the importance of the standardized letter of evaluation (SLOE) for application to emergency medicine (EM) residency, it is important that SLOE developers and authors understand how reviewers determine SLOE competitiveness. To inform SLOE design and authorship, the authors set out to build a novel theory to explain how faculty holistically interpret SLOE competitiveness. Methods: The authors used constructivist grounded theory to explore how EM faculty determine SLOE competitiveness. They used purposive sampling to recruit EM faculty participants with at least 1 year of experience in scoring SLOEs. One author conducted hour‐long, semistructured interviews over Zoom between August 2023 and March 2024. Two authors iteratively coded the data to develop the initial codebook, organize codes into categories, and build connections to construct the resulting theory. Results: The authors interviewed 11 EM faculty from throughout the United States. Participants described a complex process to determine SLOE competitiveness. They began by contextualizing the SLOE to determine its trustworthiness and value before using various components of the SLOE to stratify and refine their understanding of competitiveness. Finally, when participants noted the inconsistency between different aspects of the SLOE, they used various methods to reconcile discordances and determine competitiveness. Conclusions: This study illuminates the framework used by EM faculty to determine applicant competitiveness based on the SLOE and highlights several factors that SLOE authors should consider to ensure the accurate and efficient transfer of information. [ABSTRACT FROM AUTHOR]

Background Standardized Letters of Evaluation (SLOEs) are an important part of resident selection in many specialties. Often written by a group, such letters may ask writers to rate applicants in different domains. Prior studies have noted inflated ratings; however, the degree to which individual institutions are "doves" (higher rating) or "hawks" (lower rating) is unclear. Objective To characterize institutional SLOE rating distributions to inform readers and developers regarding potential threats to validity from disparate rating practices. Methods Data from emergency medicine (EM) SLOEs between 2016 and 2021 were obtained from a national database. SLOEs from institutions with at least 10 letters per year in all years were included. Ratings on one element of the SLOE—the "global assessment of performance" item (Top 10%, Top Third, Middle Third, and Lower Third)—were analyzed numerically and stratified by predefined criteria for grading patterns (Extreme Dove, Dove, Neutral, Hawk, Extreme Hawk) and adherence to established guidelines (Very High, High, Neutral, Low, Very Low). Results Of 40 286 SLOEs, 20 407 met inclusion criteria. Thirty-five to 50% of institutions displayed Neutral grading patterns across study years, with most other institutional patterns rated as Dove or Extreme Dove. Adherence to guidelines was mixed and fewer than half of institutions had Very High or High adherence each year. Most institutions underutilize the Lower Third rating. Conclusions Despite explicit guidelines for the distribution of global assessment ratings in the EM SLOE, there is high variability in institutional rating practices. [ABSTRACT FROM AUTHOR]

Background Standardized letters of evaluation (SLOE) are becoming more widely incorporated into the residency application process to make the letter of recommendation, an already critical component in a residency application packet, more objective. However, it is not currently known if the reviewers of these letters share consensus regarding the strength of an applicant determined by their SLOE. Objective We measured the level of faculty agreement regarding applicant competitiveness as determined by SLOEs and the ability of 2 algorithms to predict faculty consensus rankings. Methods Using data from the 2021-2022 Match cycle from the Council of Residency Directors in Emergency Medicine SLOE Database as a blueprint, authors created 50 fictional SLOEs representative of the national data. Seven faculty then rated these SLOEs in order of applicant competitiveness, defined as suggested rank position. Consensus was evaluated using cutoffs established a priori, and 2 prediction models, a point-based system and a linear regression model, were tested to determine their ability to predict consensus rankings. Results There was strong faculty consensus regarding the interpretation of SLOEs. Within narrow windows of agreement, faculty demonstrated similar ranking patterns with 83% and 93% agreement for "close" and "loose" agreement, respectively. Predictive models yielded a strong correlation with the consensus ranking (point-based system r=0.97, linear regression r=0.97). Conclusions Faculty displayed strong consensus regarding the competitiveness of applicants via SLOEs, adding further support to the use of SLOEs for selection and advising. Two models predicted consensus competitiveness rankings with a high degree of accuracy. [ABSTRACT FROM AUTHOR]

This article discusses the need for innovation in accessing data from the emergency medicine (EM) standard letter of evaluation (SLOE) for recruitment, research, and quality assurance purposes. The authors propose an automated abstraction system to decrease the burden of manually processing SLOE data. They describe the development process, implementation phase, and outcomes of the system, which successfully abstracted information from 1129 SLOEs. The authors also discuss the limitations and potential future improvements of the system. Overall, this innovation shows promise for efficient and effective abstraction of SLOE data. [Extracted from the article]

Alice, an underrepresented-in-medicine (URM) student and considered "quiet" by some, rotated at a program where students only present to and are evaluated by attendings, the final exam is 25% of the grade, and the SLOE categories are strictly followed. In reply: The SLOR was initially developed as a solution to the problem of inflated clerkship grades and a lack of evaluative data in narrative LORs.[1] The new SLOE 2.0 was similarly developed to remedy problems with the previous SLOE format. With the prior SLOE, program directors (PDs) were not provided all of those details - they saw the "top one-third" GA and could only assume that Alice and Bob had equivalent clerkship performances and were equally "good.". [Extracted from the article]

Background: The standardized letter of evaluation (SLOE) is a crucial component of emergency medicine (EM) residency applications. Initially developed in 1995 and revised to electronic SLOE (eSLOE) 2.0, this tool aims to provide a standardized evaluation of medical students., Objective: This study aimed to conduct internal validation by analyzing the distribution and correlation of scores in eSLOE 2.0 and identify any ranking skew., Methods: A multi-institutional cross-sectional study conducted using eSLOE 2.0 data from applicants to five geographically diverse U.S. EM residency programs during the 2022-2023 application cycle. Data from 2891 eSLOE 2.0 s across 1633 applicants were analyzed using descriptive statistics, chi-square, and Spearman's rho., Results: Scores for all questions were moderately left-skewed. The mean scores for all part B questions were above 4.0. Strong correlations were found between part A and B scores with anticipated guidance (AG) and rank list (RL) positions. The AG had a higher correlation with RL positions than grades. The mean RL score indicated that the average student fell between the middle and top thirds., Conclusions: The study demonstrates left skew in eSLOE 2.0 scoring, including a higher prevalence of scores in the fully and mostly entrustable ranges for part A and the consistently high scores in part B., Competing Interests: The authors declare no conflicts of interest., (© 2025 Society for Academic Emergency Medicine.)

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., Competing Interests: The authors declare no conflicts of interest., (© 2025 Society for Academic Emergency Medicine.)

Background The COVID-19 pandemic has led to substantial changes in the delivery of healthcare and medical education. Little is known about how the pandemic has altered medical students' perceptions in regard to career choice. Methods The authors developed and implemented a multi-center survey that evaluated medical students' preferred career choice before and during the coronavirus pandemic, as well as the influence of pandemic-related factors on that choice. The survey was distributed to all levels of medical students (MS) at nine medical schools across the country from November 2020 to January 2021 and represented a convenience sample. Preferred career choice was assessed through the use of a Likert scale and additional factors affecting career choice were solicited. The degree of interest before and during the pandemic, as well as factors influencing the shift, were treated as ordinal variables and compared using chi-squared testing. Cohen's Kappa statistic was calculated to assess the degree of shifts of interest in Emergency Medicine among students. The study was deemed exempt by the Institutional Review Board at the host institution, Sidney Kimmel Medical College at Thomas Jefferson University, and all participating sites. Results A total of 1431 of 6710 (21.3%) eligible students completed the survey. The COVID pandemic was cited as a reason for a changed interest in specialty by 193 (13.5%) students. The most common reason for specialty change was the students' clinical experience, followed by a desire to be on the front lines, and personal/family health concerns. There was a significant association between career change and degree of interest among students interested in emergency medicine (EM) as their future specialty before the COVID pandemic as well as during the COVID pandemic. Living with an immunocompromised individual had a significant association with a reduced interest in EM. There was a significant association between EM rotation completion and how interested students were in EM as their future specialty before the COVID pandemic and during the COVID pandemic. Among EM-interested students whose specialty interest was changed by the COVID pandemic, 34 (41.5%) became less favorable to EM, 28 (34.2%) stayed the same, and 20 (24.4%) students became more favorable to EM. Conclusions The impact of COVID-19 on medical students' career choice is a complicated matter that involves both personal and professional factors. It appears that there is a trend towards less interest in the field of EM with multifactorial influences, some of which are related to the COVID-19 pandemic., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Chandra et al.)

Chest pain is the second most common complaint in emergency departments, with 6.4 million visits annually in the United States. A quarter of these patients will be diagnosed with acute coronary syndromes, but among those, nearly half will have nondiagnostic electrocardiograms. Non–ST-segment elevation myocardial infarction (NSTEMI) is twice as common as ST-segment elevation myocardial infarction (STEMI), and lack of clarity surrounding the best management of this condition can contribute to adverse outcomes. In this review, current national management guidelines for NSTEMI are summarized as they pertain to the ED, and the evidence base supporting them is considered. Issues surrounding special patient populations are addressed, and new diagnostic and therapeutic modalities are discussed.