What makes a bad SLOE

[throwaway987654321]

Kinda at a loss here as I have received some negative feedback on some of my shifts and am worried this may impact my SLOE. Granted it’s negative in the sense that they are telling me to work on assessment and plan or HPI/physical as I sometimes don’t ask all the right questions. Would these kind of comments make it in the SLOE? All my other evals have been excellent based on what I’ve heard from other faculty and residents.

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[RPedigo]

Everyone has a different approach to SLOEs, so it would be impossible to tell. I can tell you what I did for my five years as clerkship director. I would get all the evaluations, but specifically ask all residents and faculty to include areas of strength and areas for growth. If a single comment was made for a specific domain, it does not go on the final evaluation and does not go on the SLOE. If multiple assessors cited the same domain for growth over multiple shifts, then it goes on the final evaluation and SLOE. How that is worded also depended on the temporal spacing of the comments. If they were early-rotation comments and that domain was stronger by the end, then I would write something like "by the end of the rotation, throwaway987654321 had excellent differential diagnoses and management plans." The "read between the lines" is that they might not have been great at the beginning of the rotation. If that was still cited as an area for growth by the end of the rotation, that might instead read "throwaway987654321 continued to work on their differentials and management plans, and will be an area for growth in subsequent rotations." During our mid-rotation meeting I read all the cards verbatim and then discuss themes that might be emerging to address for subsequent shifts. I also tell the subinterns that if it is not on their final evaluation that they read, it is not on their SLOE - but not everyone does this. That means I am willing to put negative themes on their final evaluation, including feedback related to interpersonal skills, work ethic, etc. which others may not be willing to do. I felt like not putting it on their final evaluation that they can see felt like "torpedoing" them and did not want them blindsided.

 

[throwaway987654321]

Everyone has a different approach to SLOEs, so it would be impossible to tell. I can tell you what I did for my five years as clerkship director. I would get all the evaluations, but specifically ask all residents and faculty to include areas of strength and areas for growth. If a single comment was made for a specific domain, it does not go on the final evaluation and does not go on the SLOE. If multiple assessors cited the same domain for growth over multiple shifts, then it goes on the final evaluation and SLOE. How that is worded also depended on the temporal spacing of the comments. If they were early-rotation comments and that domain was stronger by the end, then I would write something like "by the end of the rotation, throwaway987654321 had excellent differential diagnoses and management plans." The "read between the lines" is that they might not have been great at the beginning of the rotation. If that was still cited as an area for growth by the end of the rotation, that might instead read "throwaway987654321 continued to work on their differentials and management plans, and will be an area for growth in subsequent rotations." During our mid-rotation meeting I read all the cards verbatim and then discuss themes that might be emerging to address for subsequent shifts. I also tell the subinterns that if it is not on their final evaluation that they read, it is not on their SLOE - but not everyone does this. That means I am willing to put negative themes on their final evaluation, including feedback related to interpersonal skills, work ethic, etc. which others may not be willing to do. I felt like not putting it on their final evaluation that they can see felt like "torpedoing" them and did not want them blindsided.

Thank you for the in depth reply. I believe we do see all the final evaluations so I will probably look out for those comments at the end. I am towards the end of the rotation, and my evals have said the opposite up until now, so I also don’t know if I’m going to be seen as a inconsistent performer

 

[Mat the coolcat]

During our mid-rotation meeting I read all the cards verbatim and then discuss themes that might be emerging to address for subsequent shifts. I also tell the subinterns that if it is not on their final evaluation that they read, it is not on their SLOE - but not everyone does this. That means I am willing to put negative themes on their final evaluation, including feedback related to interpersonal skills, work ethic, etc. which others may not be willing to do. I felt like not putting it on their final evaluation that they can see felt like "torpedoing" them and did not want them blindsided.

I wish it was a requirement across all programs to do these things you mentioned.

 

[The Knife & Gun Club]

During our mid-rotation meeting I read all the cards verbatim and then discuss themes that might be emerging to address for subsequent shifts. I also tell the subinterns that if it is not on their final evaluation that they read, it is not on their SLOE - but not everyone does this. That means I am willing to put negative themes on their final evaluation, including feedback related to interpersonal skills, work ethic, etc. which others may not be willing to do. I felt like not putting it on their final evaluation that they can see felt like "torpedoing" them and did not want them blindsided.

It’s really considerate that you do this. One of the things that frustrated me most was at my “more competitive” away, during the mid-rotation meeting the only thing the aPD would say was a very coy “you’re doing well, keep it up” with no specific areas of strength or areas to improve, even when I asked respectfully.

Then the sloe came and BOOM. Blindsided.

I never will understand why people don’t just tell students where they’re struggling so they can improve.

 

[Brigade4Radiant]

It’s really considerate that you do this. One of the things that frustrated me most was at my “more competitive” away, during the mid-rotation meeting the only thing the aPD would say was a very coy “you’re doing well, keep it up” with no specific areas of strength or areas to improve, even when I asked respectfully.

Then the sloe came and BOOM. Blindsided.

I never will understand why people don’t just tell students where they’re struggling so they can improve.

Because telling students that they’re not doing well means complaints and meetings You get tired of doing this year after year so people just say yeah you’re doing good I won’t give you any real Feedback but they will do it on your SLOE

 

[RPedigo]

Thank you for the in depth reply. I believe we do see all the final evaluations so I will probably look out for those comments at the end. I am towards the end of the rotation, and my evals have said the opposite up until now, so I also don’t know if I’m going to be seen as a inconsistent performer

I think having negative comments on your final evaluation is highly specific but poorly sensitive for having bad comments on your SLOE. (e.g., if it's on your final evaluation it's definitely on your SLOE, but if it is not on your final evaluation there might or might not be additional negative comments on your SLOE. Totally depends on the philosophy of the clerkship director.)

I wish it was a requirement across all programs to do these things you mentioned.

Me too! I also wish SLOEs were criterion referenced, because different sites have different "comparison students" so to speak that dictate the global ratings. So if everyone is highly competitive on a rotation or within an institution, it makes it more difficult to get a strong SLOE. An "average" subintern that rotates in my subinternship is usually a very competitive applicant.

It’s really considerate that you do this. One of the things that frustrated me most was at my “more competitive” away, during the mid-rotation meeting the only thing the aPD would say was a very coy “you’re doing well, keep it up” with no specific areas of strength or areas to improve, even when I asked respectfully.

Then the sloe came and BOOM. Blindsided.

I never will understand why people don’t just tell students where they’re struggling so they can improve.

I agree - it only hurts the student to do this. I have given honest feedback to the subinterns that rotate with us, and sometimes that is hard for them to hear, but important as long as it is specific and actionable information.

Because telling students that they’re not doing well means complaints and meetings You get tired of doing this year after year so people just say yeah you’re doing good I won’t give you any real Feedback but they will do it on your SLOE

Yes, I can see why people might do that. I have had to have multiple meetings with some students who were struggling and might not have gotten as favorable of a SLOE because of it... but if it is the right thing to do for the student in the long term, it's the right thing to do for the student in the long term. It does sometimes lead to complaints and meetings - and is certainly harder than just putting secretive comments on a SLOE - but it is the wrong thing to do for the learner to torpedo them and not give them the chance to improve.

I am transitioning into residency program leadership so I have officially written my last SLOE, but hopefully others adopt this practice in the future.

 

[pillowsnice]

Everyone has a different approach to SLOEs, so it would be impossible to tell. I can tell you what I did for my five years as clerkship director. I would get all the evaluations, but specifically ask all residents and faculty to include areas of strength and areas for growth. If a single comment was made for a specific domain, it does not go on the final evaluation and does not go on the SLOE. If multiple assessors cited the same domain for growth over multiple shifts, then it goes on the final evaluation and SLOE. How that is worded also depended on the temporal spacing of the comments. If they were early-rotation comments and that domain was stronger by the end, then I would write something like "by the end of the rotation, throwaway987654321 had excellent differential diagnoses and management plans." The "read between the lines" is that they might not have been great at the beginning of the rotation. If that was still cited as an area for growth by the end of the rotation, that might instead read "throwaway987654321 continued to work on their differentials and management plans, and will be an area for growth in subsequent rotations." During our mid-rotation meeting I read all the cards verbatim and then discuss themes that might be emerging to address for subsequent shifts. I also tell the subinterns that if it is not on their final evaluation that they read, it is not on their SLOE - but not everyone does this. That means I am willing to put negative themes on their final evaluation, including feedback related to interpersonal skills, work ethic, etc. which others may not be willing to do. I felt like not putting it on their final evaluation that they can see felt like "torpedoing" them and did not want them blindsided.

Are those comments the OP received actually that negative though? I'm assuming all students aren't perfectly reciting HPI's and giving a thorough A/P especially since this is prob the first rotation in a while cause of covid. I would guess those wouldn't be a kiss of death for the OP as more negative comments about professional and such would probably be worse, correct?

 

[RPedigo]

Are those comments the OP received actually that negative though? I'm assuming all students aren't perfectly reciting HPI's and giving a thorough A/P especially since this is prob the first rotation in a while cause of covid. I would guess those wouldn't be a kiss of death for the OP as more negative comments about professional and such would probably be worse, correct?

Correct. "Fun" things to fix (knowledge based, procedure based) and things that are expected to need fixing at the level of training they are at are usually viewed favorably. "Not fun" things to fix (work ethic, other professionalism concerns, interpersonal skills, etc.) or fixing of things that should have been learned a long time ago are viewed much more unfavorably. If it was a theme it would still go in a SLOE and it would be something that would be mentioned, but it would not substantially negatively impact an application really. If everyone else was doing great and did not have those themes for improvement, it still might lead to a less favorable overall SLOE though, such as a designation of "below peers" for "ability to develop and justify an appropriate differential and a cohesive treatment plan."