The standardized letter of evaluation (SLOE) in emergency medicine: The internal validity of the SLOE 2.0

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.