for the 2020-2021 application cycle, from CORD’s Advising Students Committee in Emergency Medicine (ASC-EM)

With the unpredictable future of COVID 19, we are aware that institutions have begun altering the clinical experience for students, and instituting bans on travel for both their faculty and students. Several institutions have already decided not to accept any visiting students for clerkship rotations, and it is likely that others will prohibit their own students from traveling to complete away rotations. Further, students may be limited in their ability to evaluate and treat respiratory complaints, potentially limiting a comprehensive assessment of their clinical skills.

The Council of Residency Directors in Emergency Medicine (CORD) Advising Students Committee in Emergency Medicine (ASC-EM) anticipates that the travel restrictions will significantly impact the number of visiting rotations available and the ability of EM bound students to travel to any remaining available rotations.

We anticipate institutional and regional variability in both the spread and response to COVID 19. Many students will likely be unable to complete any away rotations this academic cycle. This will limit students’ collective ability to obtain Standardized Letters of Evaluation (SLOE) outside of their home institutions. For students without a home residency program, these travel limitations may prohibit their ability to obtain any SLOEs.

In this continuously evolving, exceptionally challenging time, we feel that it is important for the educational community to be united and speak with a clear voice. ASC-EM proposes the following recommendations for EM program leadership, medical schools, and EM-bound medical students to consider for the upcoming EM application cycle.

1. Encourage programs to be flexible with their SLOE requirements
   • Programs have traditionally held non-SLOE letters of recommendation (LoR) in lesser regard. Programs have also traditionally had expectations surrounding the number of SLOEs a student would need to have submitted in order to be considered for an interview (typically 1-2) or rank (typically 2).
   • ASC-EM recommends for application cycle 2020-2021 that residency program leadership consider reducing their typical 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. We also recommend programs be willing to accept alternative letters of recommendations to act as surrogates for their typical SLOE requirements as detailed in the paragraphs below.
2. Encourage programs to give weight to alternative (non-SLOE) Letters
   • Examples of alternative LORs include, but are not limited to, orphan SLOEs (a SLOE from a home EM rotation at an institution without an associated residency program), EM sub-specialty SLOEs , or a letter written by an advisor 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.
   • Given the increased emphasis that will be placed on non-SLOE letters, letter writers who are not EM physicians should be made aware of the importance of ensuring their letters address knowledge, skills, and behaviors typically seen in the “qualifications for EM” section of SLOEs. Standard template for this can be found on the CORD website.
3. Use of clear language to reflect loss of opportunities:
   • Medical Student Performance Evaluation (MSPE): We anticipate institutional and regional variability in both the spread and response to COVID 19. ASC-EM recommends that institutions include a clear, explicit statement in their MSPE explaining any institutional policy limiting their students’ ability to complete emergency medicine rotations.
   • SLOE: ASC-EM recommends use of a standard verbiage to be added to SLOEs or letters written by advisors for those schools who have students that could not obtain the recommended number of rotations.
4. Encourage students to go on fewer (if any) away rotations
   • Given the possibility of drastically limited EM rotation spots, ASC-EM would like to revise the number of away rotations we have recommended students complete in previous application cycles. In the event that a student is both able to travel from his/her home institution and to secure an available clerkship position at an institution accepting visitors, that student should not perform more than one visiting rotation (for those with a home program), and not more than two, maximum (for those without a home EM rotation). 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.

We understand that these proposed changes may be uncomfortable for programs, who have relied on SLOEs to be the ultimate representation of a student’s abilities, and for students, who are eager to be able to demonstrate their skills in the audition setting. Ultimately, these recommendations are motivated by preserving the health and safety of our EM community and ensuring that our students who traditionally are at the greatest disadvantage in navigating the application process are not excluded entirely from consideration.