Design and implementation of a radiation oncology standardized letter of evaluation (RO-SLOE) for the evaluation of medical students and radiation oncology residency applicants

Abstract

<h3>Background</h3> Prior research has shown that clerkship grades and letters of recommendation for radiation oncology residency applicants are susceptible to grade inflation and bias, both of which diminish the utility of these criteria when evaluating prospective candidates. This is especially pertinent in light of the shift of USMLE Step 1 to Pass/Fail and recent initiatives in our field to better promote diversity, equity, and inclusion. Other fields such as emergency medicine have implemented a standardized letter of evaluation (SLOE) to address these and other concerns. This project will seek to design and adopt a new radiation oncology SLOE (RO-SLOE). <h3>Methods</h3> Members of the Radiation Oncology Education Collaborative Study Group (ROECSG) Undergraduate Medical Education (UGME) working group designed a survey to assess attitudes regarding the efficacy and design of a RO-SLOE. This is conditionally approved under an educational IRB waiver and pending full IRB approval. The survey population will be members of the Association of Directors of Radiation Oncology Programs (ADROP), current residency program directors, and medical school clerkship directors. <h3>Results</h3> Our data will provide a contemporary snapshot of residency admissions practices, willingness of residency programs to consider the RO-SLOE in the admissions process and provide a framework to design novel questions for inclusion on a final RO-SLOE. We anticipate that a RO-SLOE would transparently reflect applicant's level of preparedness for residency compared to their peers, reflect institutional and evaluator grading practices, and allow for narrative feedback to qualify these objective metrics. <h3>Discussion</h3> We expect that the RO-SLOE will offer a novel, easily adaptable means to provide both actionable feedback to medical students and a standardized admissions criterion to residency programs to better discriminate between applicants. A RO-SLOE may promote greater diversity in the residency admissions process by minimizing sources of bias in clerkship evaluations and encouraging a shift to more holistic candidate review. By working with stakeholders, we hope to facilitate the RO-SLOE's incorporation into medical school clerkship evaluations and the residency application process.