# Examining Gender Differences and the Impact of Additional Fourth Year Rotations on Emergency Medicine Standardized Letter of Evaluation (SLOE) Scores

## TL;DR

This study finds that female applicants score higher in some areas of emergency medicine evaluations, and doing more rotations doesn't improve scores.

## Contribution

The study provides new evidence on gender differences and the limited impact of additional rotations on SLOE scores in emergency medicine.

## Key findings

- Female applicants scored significantly higher in four domains of SLOE ratings.
- Additional fourth-year rotations did not significantly improve SLOE scores.
- Scores showed a trend of highest performance during the first rotation.

## Abstract

Introduction: The Emergency Medicine (EM) Standardized Letter of Evaluation (SLOE) is a critical component of the residency application process, yet questions remain regarding potential gender bias and the impact of repeated fourth-year rotations on applicant scores. This study examined gender differences in SLOE ratings and evaluated whether completing additional rotations influenced scores.

Methods: A retrospective review of 243 SLOEs from 101 residents at a large urban academic EM residency program (2015-2021) was conducted, excluding non-EM evaluations and incomplete forms. SLOE items were converted to numerical scores for analysis. Independent-sample t-tests assessed gender differences across 10 quantitative questions, while one-way ANOVA evaluated differences in scores across first, second, and third sub-I rotations.

Results: Female applicants received higher scores than male applicants on all 10 items, with statistically significant differences in four domains: ability to formulate a differential/treatment plan (2.41 vs. 2.20, p=0.008), ability to communicate a caring nature to patients (2.64 vs. 2.48, p=0.029), overall rotation grade (2.41 vs. 2.20, p=0.015), and estimated rank list position (2.78 vs. 2.54, p=0.04). No significant gender differences were observed in commitment to EM, teamwork, work ethic, or predicted success in residency. Comparison of fourth-year medical students' first, second, and third EM rotations (n=159) revealed no statistically significant differences across SLOE scores (p>0.05), although trends suggested the strongest overall performance during the first rotation.

Conclusion: Female applicants received significantly higher ratings in select evaluative domains, consistent with prior research on gender-related variability in SLOEs. Additional rotations did not yield statistically significant improvements in scores, supporting current guidance that applicants should not complete more than two EM fourth-year rotations. These findings underscore the potential influence of home institution dynamics on early SLOE evaluations and support the need for greater standardization and transparency in evaluation practices to promote fairness and equity in the residency selection process.