Emergency Medicine Residency Applicants Research Articles

Trends in Core Clerkship Grading Among Emergency Medicine Residency Applicants

Trends in Core Clerkship Grading Among Emergency Medicine Residency Applicants

Racial Bias on the Emergency Medicine Standardized Letter of Evaluation.

Studies on components of residency applications have shown evidence of racial bias. The Standardized Letter of Evaluation (SLOE) is an assessment measure for emergency medicine (EM) residency applications and, as more specialties opt to use SLOEs in place of narrative letters of recommendation, understanding bias on standardized assessments is essential. To determine whether there is a difference in rankings on the EM SLOE between underrepresented in medicine (UIM) and non-UIM applicants, White and non-White applicants, and to examine whether differences persist after controlling for other characteristics. The sample was drawn from medical students who applied to EM residency at the study institution in 2019. We compared rankings between UIM and non-UIM students and between students of each individual race/ethnicity and White students, after controlling for United States Medical Licensing Examination Step scores, Alpha Omega Alpha status, type of school (US MD, US DO, internation medical graduate), Medical Student Performance Evaluation class percentile, affiliated program vs visiting clerkship SLOE, gender and the interaction of race/ethnicity and gender, and adjusted for students submitting multiple SLOEs, using ordinal regression. There were 1555 applicants to the study institution in 2019; 1418 (91.2%) had a SLOE and self-identified race/ethnicity. After controlling for applicant characteristics, non-UIM students were significantly more likely to be ranked higher than UIM students on "Rank Against Peers," (OR 1.46, 95% CI 1.03-2.07) and Grade (OR 1.46, 95% CI 1.05-2.04). Analysis of EM SLOEs submitted to our institution demonstrates racial bias on this standardized assessment tool, which persists after controlling for other performance predictors.

Gender Differences in Language of Standardized Letter of Evaluation Narratives in Osteopathic Emergency Medicine Residency Applicants.

BackgroundThe standardized letter of evaluation (SLOE) is used by emergency medicine (EM) faculty during the interview and match process. Data has shown that female allopathic applicants score higher in communal characteristics and have a greater number of ability words in the narrative portion of the SLOE as compared to their male counterparts. ObjectiveTo determine if there is a difference in the language used to describe male and female osteopathic applicants within the SLOE. MethodsAll applicants to a three-year EM residency within a single application cycle were eligible for inclusion. Exclusion criteria included allopathic applicants, applicants without a SLOE, or applicants with a SLOE only from the interviewing program. Data collected included applicant demographics and SLOE narratives. The previously validated Linguistic Inquiry and Word Count (LIWC; Pennebaker Conglomerates, Inc., Austin, TX) product was used to analyze word counts from the narrative portion of each SLOE. Descriptive statistics and t-tests for continuous data were used. ResultsOf the 577 applicants to the residency program, 318 met inclusion criteria and 33% were female. Females had a higher COMLEX-2 (590 vs 559; p=0.05) as compared to males but no difference was found for the remainder of the baseline demographics. No difference was found for the number of words in the narrative portion of the SLOE between males and females (males = 122 words; females = 127 words; p=0.53). Words within the social (p=0.006), achievement (p=0.007), and standout (p<0.001) categories were more frequent in osteopathic female applicants as compared to males. No statistical differences were detected for the other 13 categories analyzed. ConclusionIn this sample of osteopathic applicants, little linguistic difference was noted for the narrative portion of the SLOE. SLOE authors did, however, use more social, achievement, and standout words to describe females as compared to male applicants.

Medical student self-assessment as emergency medicine residency applicants.

Emergency medicine (EM) applicants are encouraged to consider their own "competitiveness" when deciding on the number of applications to submit. Program directors rank the Standardized Letter of Evaluation (SLOE) as the most important factor when reviewing an applicant. Accurate insight into how clinical performance is reflected on the SLOE could improve medical students' ability to gauge their own competitiveness. This study aims to determine the accuracy of students' self-assessment by SLOE evaluation measures when compared to the SLOE completed by faculty after their EM clerkship. Participants of this multicenter study included fourth-year medical students who had completed their EM clerkship and were applying to EM residency. Students completed a modified SLOE to reflect rankings they believed they would receive on their official SLOE. Additionally, students completed a survey assessing their knowledge of the SLOE, their perception of feedback during the clerkship, and their self-perceived competitiveness as an EM applicant. Correlation between the rankings on the student-completed SLOE and the official SLOE was analyzed using the Kendall correlation. Of the 49 eligible students, 42 (85.7%) completed the study. The correlation between scores on the student-completed and official SLOE were significantly low (r<0.68) for each item. The majority of students agreed that they were satisfied by the quantity and quality of feedback they received (31/42, 73.8%). Few students agreed that they knew how many applications to submit to ensure a match in EM (7/42, 16.7%). This study demonstrates that students did not accurately predict their rankings on the official SLOE at the end of an EM rotation and had little insight into their competitiveness as an applicant. These findings highlight opportunities to mitigate the burden on students and programs caused by the increasing number of applications per applicant. Further research is needed as to whether strategies to increase insight into competitiveness are effective.

More Is More: Drivers of the Increase in Emergency Medicine Residency Applications.

IntroductionThe average number of applications per allopathic applicant to emergency medicine (EM) residency programs in the United States (US) has increased significantly since 2014. This increase in applications has caused a significant burden on both programs and applicants. Our goal in this study was to investigate the drivers of this application increase so as to inform strategies to mitigate the surge.MethodsAn expert panel designed an anonymous, web-based survey, which was distributed to US allopathic senior applicants in the 2017–2018 EM match cycle via the Council of Residency Directors in Emergency Medicine and the Emergency Medicine Residents Association listservs for completion between the rank list certification deadline and release of match results. The survey collected descriptive statistics and factors affecting application decisions.ResultsA total of 532 of 1748 (30.4%) US allopathic seniors responded to the survey. Of these respondents, 47.3% felt they had applied to too many programs, 11.8% felt they had applied to too few, and 57.7% felt that their perception of their own competitiveness increased their number of applications. Application behavior of peers going into EM was identified as the largest external factor driving an increase in applications (61.1%), followed by US Medical Licensing Exam scores (46.9%) – the latter was most pronounced in applicants who self-perceived as “less competitive.” The most significant limiter of application numbers was the cost of using the Electronic Residency Application Service (34.3%).ConclusionA substantial group of EM applicants identified that they were over-applying to residencies. The largest driver of this process was individual applicant response to the behavior of their peers who were also going into EM. Understanding these motivations may help inform solutions to overapplication.

Advising special population emergency medicine residency applicants: a survey of emergency medicine advisors and residency program leadership

BackgroundThe objective of this study was to determine the advising and emergency medicine (EM) residency selection practices for special population applicant groups for whom traditional advice may not apply.MethodsA survey was distributed on the Council of Residency Directors in EM and Clerkship Directors in EM Academy listservs. Multiple choice, Likert-type scale, and fill-in-the-blank questions addressed the average EM applicant and special population groups (osteopathic; international medical graduate (IMG); couples; at-risk; re-applicant; dual-accreditation applicant; and military). Percentages and 95% confidence intervals [CI] were calculated.ResultsOne hundred four surveys were completed. Of respondents involved in the interview process, 2 or more standardized letters of evaluation (SLOEs) were recommended for osteopathic (90.1% [95% CI 84–96]), IMG (82.5% [73–92]), dual-accreditation (46% [19–73]), and average applicants (48.5% [39–58]). Recommendations for numbers of residency applications to submit were 21–30 (50.5% [40.7–60.3]) for the average applicant, 31–40 (41.6% [31.3–51.8]) for osteopathic, and > 50 (50.9% [37.5–64.4]) for IMG. For below-average Step 1 performance, 56.0% [46.3–65.7] were more likely to interview with an average Step 2 score. 88.1% [81.8–94.4] will consider matching an EM-EM couple. The majority were more likely to interview a military applicant with similar competitiveness to a traditional applicant. Respondents felt the best option for re-applicants was to pursue the Supplemental Offer and Acceptance Program (SOAP) for a preliminary residency position.ConclusionAdvising and residency selection practices for special population applicants differ from those of traditional EM applicants. These data serve as an important foundation for advising these distinct applicant groups in ways that were previously only speculative. While respondents agree on many advising recommendations, outliers exist.

Factors Affecting Emergency Medicine Residency Applicant Perceptions of Competitiveness and Number of Applications Submitted

Factors Affecting Emergency Medicine Residency Applicant Perceptions of Competitiveness and Number of Applications Submitted

Advising Medical Students During COVID-19: The Case for a Single Emergency Medicine Rotation for All.

The COVID-19 pandemic has disrupted the usual approach to exploring and applying into emergency medicine (EM) for medical students. On March 17th, 2020, the American Association of Medical Colleges issued guidance strongly suggesting that medical students be removed from direct patient care. Many medical schools removed medical students from clerkships and postponed hosting visiting medical students indefinitely. An informal query of EM clerkship directors on the Clerkship Directors in Emergency Medicine (CDEM) list-serve confirmed this trend in EM, with a clear majority of respondents pulling their students from clinical rotations and halting visiting student rotations.

Applicant Attitudes Toward the Association of American Medical Colleges' Standardized Video Interview.

The Standardized Video Interview (SVI) was developed by the American Association of Medical Colleges to allow applicants to include objective data about professional behaviors and interpersonal and communication skills. Although the SVI pilot was administered to individuals applying to emergency medicine (EM) residency programs during the 2018 Electronic Residency Application Service (ERAS) cycle, little data have been published evaluating the applicant's perceptions. This survey aims to assess EM residency applicant attitudes toward the SVI. During the 2018 ERAS application season an anonymous survey was administered to interviewees at one urban Accreditation Council for Graduate Medical Education-approved EM residency. Respondents were asked questions regarding the production of their video interviews, thoughts regarding the additive value of the SVI, and individual demographic data such as ethnicity and sex. Participation was optional. A total of 219 of 238 candidates completed the survey representing a 92% response rate. While the majority of applicants did not feel that their ethnicity impacted their application, 58.1% of those who did self-identified as African American or Asian. A total of 8.7% of respondents felt the SVI added information about their professional behaviors and 11% felt that it added information about interpersonal and communication skills. Only 2.8% of survey respondents felt the SVI should remain a portion of the ERAS application. Most respondents felt that the SVI was not an accurate representation of their interpersonal and communication skills or their professionalism and that it did not add value to their applications. While most cohorts were not concerned about bias regarding sex, ethnicity, sex, or age, a small subset felt that there was a potential for the SVI to bias the party reviewing their applications. Very few applicants felt the SVI should remain a part of the ERAS application. Applicant attitudes toward the SVI are largely negative and require further investigation prior to becoming a standard part of applicants' ERAS files.

Comparison of the Standardized Video Interview and Interview Assessments of Professionalism and Interpersonal Communication Skills in Emergency Medicine.

The Association of American Medical Colleges Standardized Video Interview (SVI) was recently added as a component of emergency medicine (EM) residency applications to provide additional information about interpersonal communication skills (ICS) and knowledge of professionalism (PROF) behaviors. Our objective was to ascertain the correlation between the SVI and residency interviewer assessments of PROF and ICS. Secondary objectives included examination of 1) inter- and intrainstitutional assessments of ICS and PROF, 2) correlation of SVI scores with rank order list (ROL) positions, and 3) the potential influence of gender on interview day assessments. We conducted an observational study using prospectively collected data from seven EM residency programs during 2017 and 2018 using a standardized instrument. Correlations between interview day PROF/ICS scores and the SVI were tested. A one-way analysis of variance was used to analyze the association of SVI and ROL position. Gender differences were assessed with independent-groups t-tests. A total of 1,264 interview-day encounters from 773 unique applicants resulted in 4,854 interviews conducted by 151 interviewers. Both PROF and ICS demonstrated a small positive correlation with the SVI score (r=0.16 and r=0.17, respectively). ROL position was associated with SVI score (p<0.001), with mean SVI scores for top-, middle-, and bottom-third applicants being 20.9, 20.5, and 19.8, respectively. No group differences with gender were identified on assessments of PROF or ICS. Interview assessments of PROF and ICS have a small, positive correlation with SVI scores. These residency selection tools may be measuring related, but not redundant, applicant characteristics. We did not identify gender differences in interview assessments.

15 Does Standardized Video Interview Score Correlate With In-Person Interview Score in Emergency Medicine Residency Applicants?

15 Does Standardized Video Interview Score Correlate With In-Person Interview Score in Emergency Medicine Residency Applicants?

74 Sex Differences in Language of Standardized Letter of Evaluation Narrative for Emergency Medicine Residency Applicants

Sex differences in language for letters of recommendation have been identified in many professional fields. Our prior study evaluated the narrative portion of the emergency medicine Standardized Letter of Evaluation (SLOE) for all applicants invited to interview during a single residency application cycle. In this prior study, we found that letters of recommendation for women applicants had more frequent words related to “affiliation,” and contrary to prior research, “ability” words appeared with greater frequency for women applicants. We now aim to examine the differences in language used to describe men and women applicants within the SLOE narrative for all applicants in one application cycle, rather than only the invited applicants. All applicants to a 4-year urban, academic EM residency program within a single application year were included in the sample. Only SLOEs from the applicants’ first EM rotation were included. Exclusion criteria were: SLOE of applicants from non-Liaison Committee on Medical Education (LCME) schools or first rotation SLOE not available for download. Data was collected on applicant sex, age, Alpha Omega Alpha (AOA) designation, and medical school rank. The previously validated Linguistic Inquiry and Word Count (LIWC) program was used to analyze frequency of words within categories relevant to letters of recommendation. We assessed for differences by sex in 16 word categories (9 defined by the LIWC and 7 defined by word lists created by previous studies in the field). Descriptive statistics, chi-squared and t-tests were used to describe the sample, and Mann-Whitney U tests were used to compare the word counts by sex. Of 1001 applicants in the 2016 application cycle to our institution, 822 (82%) had a first rotation SLOE available for analysis. 64% were men and 36% were women; there were no differences between sex for baseline characteristics including: age (mean 27 years), top 25 schools (22.5%), AOA rates (12.7%), and having earned advanced degrees (10%). The median word count per SLOE narrative for men was 170 and for women was 180, which was not statistically different (p=0.15). Within the 16 word categories, after adjusting for letter length, word frequency differences between sex were only present in 2 categories: social words (women: 23 words/letter; men: 21 words/letter, p=0.05) and ability words (women: 2 words/letter; men: 1 word/letter, p=0.04).The remaining categories, including words representing communal or agentic traits and “standout” adjectives, “grindstone” traits, and teaching and research words were also not statistically different between men and women applicants. Building upon prior research in this expanded study population, our results indicate that there are minimal language differences by sex in SLOEs for EM applicants. The wording differences noted in 2 categories were statistically significant, but of unclear real-world significance with only a 1-2 word difference between sex. Future work could evaluate how the SLOE format may contribute to this relative lack of bias compared to other fields and formats.

Virtual Reality as an Interview Technique in Evaluation of Emergency Medicine Applicants.

Current interviewing strategies and the standardized letter of evaluation may not provide enough insight into preferred resident characteristics. Emergency medicine (EM) residency programs are challenged with identifying trainees who can problem solve, communicate, and work well with fellow health professionals. Structured interviews have previously been used and can help predict success but candidates have reported a negative impression with their use. This structured virtual reality (VR) interviewing method was designed so that interviewers can observe the communication abilities, subtle personality traits, and teamwork skills of applicants interviewed at an EM residency program. A consumer VR headset became available and in combination with an interactive team game was incorporated into a standardized team-based interview session. This session was designed to allow observation of candidates' communication, problem solving, and teamwork skills. Surveys were collected to examine the satisfaction of EM residency applicants who participated in this novel standardized interviewing method using a VR headset. After the submission of rank lists, but prior to Match Day, those who interviewed were e-mailed a voluntary, anonymous, and confidential survey asking about their interview experience, specifically about the VR portion. The survey was sent to 102 applicants with 63 responses for a 62% response rate at the completion of the 2015 to 2016 interview season. Overall study findings suggested that participants had a highly favorable impression of the VR portion of the interview. Specifically, participants reported that this interview technique was appropriate and worthwhile. Additionally, participants attested that the Oculus portion of the interview gave insight to their work ethic, personality, and communication skills and how they work with others. The novel interviewing method used in this study allowed interviewers to gain insight beyond that of the paperwork and brief face-to-face interaction. Study findings suggest that interviewees accepted the use of this novel interview method. It has been incorporated into our interview process for three consecutive years.

Prior Global Health Experience Among Emergency Medicine Residency Applicants to Two Residency Programs

Prior Global Health Experience Among Emergency Medicine Residency Applicants to Two Residency Programs

Emergency Medicine Residency Applicant Characteristics Associated with Measured Adverse Outcomes During Residency.

IntroductionNegative outcomes in emergency medicine (EM) programs use a disproportionate amount of educational resources to the detriment of other residents. We sought to determine if any applicant characteristics identifiable during the selection process are associated with negative outcomes during residency.MethodsPrimary analysis consisted of looking at the association of each of the descriptors including resident characteristics and events during residency with a composite measure of negative outcomes. Components of the negative outcome composite were any formal remediation, failure to complete residency, or extension of residency.ResultsFrom a dataset of 260 residents who completed their residency over a 19-year period, 26 (10%) were osteopaths and 33 (13%) were international medical school graduates A leave of absence during medical school (p <.001), failure to send a thank-you note (p=.008), a failing score on United States Medical Licensing Examination Step I (p=.002), and a prior career in health (p=.034) were factors associated with greater likelihood of a negative outcome. All four residents with a “red flag” during their medicine clerkships experienced a negative outcome (p <.001).Conclusion“Red flags” during EM clerkships, a leave of absence during medical school for any reason and failure to send post-interview thank-you notes may be associated with negative outcomes during an EM residency.

Gender Differences in Language of Standardized Letter of Evaluation Narratives for Emergency Medicine Residency Applicants.

While gender differences in language for letters of recommendation have been identified in other fields, no prior studies have evaluated the narrative portion of the emergency medicine (EM) standardized letter of evaluation (SLOE). We aim to examine the differences in language used to describe male and female applicants within the SLOE narrative. Invited applicants to a 4-year academic EM residency program within a single application year with a SLOE were included in the sample. Exclusion criteria were SLOE of applicants from non-Liaison Committee on Medical Education (LCME) schools or first rotation SLOE not available for download. Data were collected on applicant gender, age, rotation grade, Alpha Omega Alpha designation, and medical school rank. The previously validated Linguistic Inquiry and Word Count (LIWC) program was used to analyze frequency of words within categories relevant to letters of recommendation. Descriptive statistics, t-tests, and chi-square tests were employed in analysis. Of 1,025 applicants within a single application year, 265 were invited to interview; 237 applicants had a first rotation SLOE available for analysis. There were no differences between male and female applicants for baseline characteristics. The median word count per SLOE narrative was 199; within the LIWC dictionary and user-defined categories, words within the categories of affiliation and ability appeared more frequently for female applicants. Our results with respect to the SLOE narrative reinforce prior research that letters of recommendation for female applicants highlight communal characteristics of teamwork, helpfulness, and compassion. Contrary to prior research, ability words highlighting intelligence and skill appeared with greater frequency for female applicants. No pervasive differences were found in other word categories. In this sample, the standardized format of the SLOE resulted in letters that were relatively free of gender bias.

Distribution of Honors Grades Across Fourth-year Emergency Medicine Clerkships.

Medical student grades during emergency medicine (EM) rotations are a key factor in resident selection. The variability in grading among EM clerkships is not well understood. The objective was to describe the current grade distribution of fourth-year EM clerkships. This was an observational study at an EM residency program. We identified grade distributions by reviewing the standard letter of evaluation from individuals applying to our residency program for the 2016 match. Descriptive statistics of proportions, standard deviations (SDs), and p-values were calculated. A total of 1,075 applications from 236 individual clerkships were reviewed. Thirty-four programs did not give an honors grade during the previous year. Four of these programs distributed a highest grade of "high pass" and 30 gave only "pass" and/or "fail." Of the remaining 202 programs, the percentage of grades that were given as honors ranged from 1% to 87% with a mean (±SD) of 25% (±17.2%). Of the 202 programs that granted honors grades, 63 (31.2%) sites gave between 1 and 14.9% honors grades, 69 (34.2%) gave 15% to 29.9% honors grades, 27 (13.4%) gave 30% to 44.9% honors grades, and 24 (11.9%) programs granted honors to greater than 45% of their students. Medical schools required an EM rotation at 82 (40.6%) sites. Among these programs, honors grades were given to 24% (±16.7%) of students with a range of 4% to 85% while programs that did not require clerkships gave a mean (±SD) of 26% (±17.5%) with a range of 1% to 87% and a p-value of 0.54. Honor grade distribution varies markedly across U.S. fourth-year EM clerkship sites. Requiring EM clerkships does not affect honor percentages. A minority of sites only give pass/fail grades. Program directors should consider this marked variation in grades when reviewing EM residency applications.

Financial Implications of the Emergency Medicine Interview Process.

Emergency medicine (EM) residency interviews are an important, yet costly process for programs and applicants. The total economic burden of the EM interviewing process is previously unstudied. Graduate medical education funding and student finances are both fragile shifting sources, which appear to fund most of these economic expenditures. The total economic impact of the EM interview season is unknown. This study sought to calculate total dollars spent by EM residency programs and senior medical students (M4) during interview season. Potential solutions for reducing this burden will be outlined. Institutional review board-approved, piloted e-mail surveys were sent to accredited (Accreditation Council for Graduate Medical Education [ACGME] and American Osteopathic Association [AOA]) EM program directors (PDs) and M4 student members of EMRA. PDs were queried after the 2014-2015 interview season. PDs questions included demographics, estimated faculty, and resident and administrative time used, along with dollars spent during the 2014-2015 interview season. M4 questions included demographics and dollars spent during the 2015-2016 season. Results were reported using descriptive statistics. Financial data for EM programs were calculated with academic EM faculty, resident, and administrative assistant salaries along with reported hours used during the interview season. A total of 82 of 223 EM PDs completed the survey, reporting an mean annual cost of $210,649.04 per program to review, screen, and interview applicants based on time spent by faculty, resident, and administrative assistants. A total of 84.6% of EM program costs were due to faculty hours. A total of 180 of 1,425 EM-bound M4 students completed the survey, reporting a mean annual estimate of US$5,065.44 per student to apply and interview. Seventy-two percent of estimated costs were due to airfare and lodging. Loans and credit cards were the top two methods of payments of these interview costs by students. Extrapolating the cost of EM personnel with hours spent, the economic burden of an interview season for EM programs is approximately US$46,974,735.92. M4 students spent US$19,724,823.40 for application fees and interview-related expenses. Emergency medicine residency programs and applicants appear to spend over US$66 million per cycle on the interview process. EM residency programs may save resources by reducing faculty hours associated with the interview process and leveraging administrative and resident resources. Creation of regional or national fixed interview locations may also be appropriate. Applicants may reduce travel costs by participating in video interviews, reducing program applications, and attending regionalized interview days. A full conversation among all specialties and organized medicine needs to take place to reform the systems in place to reduce the economic burden on students and residency programs.

Correlation Between United States Medical Licensing Examination and Comprehensive Osteopathic Medical Licensing Examination Scores for Applicants to a Dually Approved Emergency Medicine Residency

BackgroundIt is important for emergency medicine (EM) residency programs to be able to correlate the United States (US) Medical Licensing Examination (USMLE) and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) scores of applicants. ObjectiveWe sought to determine the correlation between USMLE and COMLEX scores for EM residency applicants. MethodsRetrospectively, from 2006 through 2013, USMLE and COMLEX examination scores for applicants to our 4-year, 56-member, dually approved EM residency were analyzed. Using the COMLEX score as the outcome variable and USMLE score as the predictor, multiple linear regression models, stratified by test step, were created. ResultsThere were 556 students representing 25 discrete medical schools included. Pair 1 consisted of applicants submitting COMLEX Level-1 and USMLE Step-1 scores (n = 486). Pair 2 were those with COMLEX Level-2 and USMLE Step-2 scores (n = 356). For Pair 1, mean, standard deviation, and median scores on the COMLEX were 551, 69, and 548, respectively; for the USMLE, scores were 216, 16, and 217, respectively. Results for Pair 2 on COMLEX were 566, 80, and 562, respectively; USMLE results were 228, 18, and 229, respectively. A strong correlation was observed for Pair 1 (r = 0.78; p < 0.001). A 1-point increase in USMLE Step-1 is associated with a 3.55-point increase in the COMLEX Level-1 score (β = 3.55; 95% confidence interval [CI] 3.30–3.80; p < 0.001). A similar strong correlation was observed for Pair 2 (r = 0.72; p < 0.001), where a 1-point increase in USMLE Step-2 is associated with a 3.29-point increase in the COMLEX Level-2 score (β = 3.29; 95% CI 2.96–3.62; p < 0.001). ConclusionsA strong positive correlation between Steps 1 and 2 of the USMLE and COMLEX was found.

A Multicenter Study of the Family Educational Rights and Privacy Act and the Standardized Letter of Recommendation: Impact on Emergency Medicine Residency Applicant and Faculty Behaviors

Residency applicants have the right to see letters of recommendation written on their behalf. It is not known whether applicants are affected by waiving this right. Our multicenter study assessed how frequently residency applicants waived their FERPA rights to view their letters of recommendation, and whether this affected the ratings they were given by faculty. We reviewed all ERAS-submitted letters of recommendation to 14 ACGME-accredited programs in 2006-2007. We collected ERAS ID, program name, FERPA declaration, standardized letter of recommendation (SLOR) use, and SLOR Global Assessment ranking. The percentage of applicants who waived their FERPA rights was determined. Chi-square tests of independence assessed whether applicants' decision to waive their FERPA rights was associated with their SLOR Global Assessment. We examined 1776 applications containing 6424 letters of recommendations. Of 2736 letters that specified a Global Assessment, 2550 (93%) applicants waived their FERPA rights, while 186 did not. Of the applicants who chose not to waive their rights, 45.6% received a ranking of Outstanding, 35.5% Excellent, 18.3% Very Good, and 1.6% Good. Of applicants who waived their FERPA rights, 35.1% received a ranking of Outstanding, 49.6% Excellent, 13.7% Very Good, and 1.6% Good. Applicants who did not waive their FERPA rights were more likely to receive an Outstanding Assessment (P = .003). The majority (93%) of residency applicants waived their FERPA rights. Those who did not waive their rights had a statistically higher chance of receiving an Outstanding Assessment than those who did.