2021-2022 Non-Residency-Based EM Physicians SLOE

Official CORD Standard Letter Of Evaluation (SLOE) Non-Residency- Based EM Physicians

2021-2022 Application Season
I have read this year's instructions @ www.cordem.org*

YesNo
Applicant's Name*
AAMC ERAS ID No.*
Letter Writers' Institution*
Letter Writer's Email address*
example@example.com
Reference Provided By*
Telephone*
Format: (000) 000-0000.
Present Position*
Options: Chair, Clerkship Director, Faculty, Group SLOE, Group SLOE+CD, Non-faculty, Vice Chair
Background Information
1.How long have you known the applicant?*
Nature of contact with applicant: (Check all that apply)

Know indirectly through others/evaluationsExtended, direct observation in the EDClinical contact outside the EDAdvisorOccasional contactOther
3a. Did this candidate rotate in your ED?*

YesNo
b. If so, what grade was given?

HonorsHigh PassPassLow PassFail
c. How was the rotation affected by COVID-19? (i.e. lower patient volumes. shortened rotation, hybrid experience)
4a. What EM rotation is this for the student?*
1st Rotation, 2nd Rotation, 3rd Rotation, 4th Rotation, Unknown
b. What date(s) did this student rotate at your institution? (mm/yy)*

MonthDayYear
Date
End Date*

MonthDayYear
Date
5. Indicate what % of students rotating in your Emergency Department received the following grades last academic year:
Honors*
High Pass*
Pass*
Low Pass*
Fail*
Total # students last year*
EM is a required rotation for all students at our institution?*

YesNo
B.Qualifications for EM. Compare the applicant to other EM applicants/peers.
1.Commitment to Emergency Medicine. Has carefully thought out this career choice.*

Above Peers (Top 1/3)At level of peers (Middle 1/3)Below peers (Lower 1/3)
2.Work ethic, willingness to assume responsibility.*

Above Peers (Top 1/3)At level of peers (Middle 1/3)Below peers (Lower 1/3)
3.Ability to develop and justify an appropriate differential and a cohesive treatment plan.*

Above Peers (Top 1/3)At level of peers (Middle 1/3)Below peers (Lower 1/3)
4.Ability to work with a team.*

Above Peers (Top 1/3)At level of peers (Middle 1/3)Below peers (Lower 1/3)
5.Ability to communicate a caring nature to patients.*

Above Peers (Top 1/3)At level of peers (Middle 1/3)Below peers (Lower 1/3)
6.How much guidance do you predict this applicant will need during residency?*

Less than peersThe same as peersMore than peers
7.Given the necessary guidance, what is your prediction of success for the applicant?*

OutstandingExcellentGood
Global Assessment
1. Compared to other EM residency candidates you have recommended in the last academic year, this candidate is in the:*

Top 10%Top 1/3Middle 1/3Lower 1/3
Total Number of letters you wrote last year*
# Recommended students last academic year in the Top 10%
# Recommended students last academic year in the Top 1/3
# Recommended students last academic year in the Middle 1/3
# Recommended students last academic year in the lower 1/3
Written Comments
Please concisely summarize this applicant's candidacy including (1) Areas that will require attention, (2) Any low rankings from the SLOE, and (3) Any relevant non-cognitive attributes such as leadership, compassion, positive attitude, professionalism, maturity, self-motivation, likelihood to go above and beyond, altruism, recognition of limits, conscientiousness, etc. (please limit your response to 350 words or less)

0/350
Please concisely summarize any pieces of information regarding your institution/rotation that may help contextualize your evaluation of the student. For example, you may want to include how many patients per year your department sees, whether it is free-standing or hospital-based, how many and what types of learners you typically teach in your clinical learning environment, etc.’ (Please limit your response to 350 words or less)

0/350
STUDENT HAS WAIVED RIGHT TO SEE THIS LETTER*

YesNo
Date*

MonthDayYear
Date
Signature
You must download the completed form then upload it to ERAS
Should be Empty:

Official CORD Standard Letter Of Evaluation (SLOE) Non-Residency- Based EM Physicians