How to Fill Out the EM SLOE: Rank and Ratings

How to Fill Out the EM SLOE: Rank and Ratings

Place each student on the rank-list question against your program's actual rank list from last year, and keep a tally for the season. In the first two cycles of the eSLOE 2.0, 20.5% of 11,789 letters put the student in the "top 10%" of the rank list. A writer whose own top-10% share runs well above one in ten tells readers that their scale means little.

The rank-list answer is the one SLOE item a reader can check with arithmetic. Clinical skills and professionalism ratings run high in the national data: the same study found 81.7% to 85.7% of applicants rated 4 or 5 on each professionalism and interpersonal item. CORD's instructions for the 2026-27 cycle say: "Please utilize the full grading scale." They add: "Residency programs prefer an honest letter over an inflated one." This page is for the emergency medicine faculty member or clerkship director completing the form. Which specialties use which standardized form is in standardized letters of recommendation by specialty, and every residency letter guide sits in our medical school and residency essays hub.

CORD's SLOE page, which carries the faculty instructions for the 2026-27 cycle, and the ResidencyCAS help page were checked on November 7, 2026. The national data below come from peer-reviewed studies of the 2022-23 and 2023-24 cycles, read through the National Library of Medicine's records that day.

Which SLOE you are writing

CORD lists four SLOE types: the eSLOE, the non-residency-based SLOE, the sub-specialty SLOE and the off-service SLOE; the specialty table quotes each. Only one carries the question this page is about: "only the eSLOE, which is to be written by EM faculty at a site with an EM residency program, asks where a student will fall on the rank list." CORD describes its writers as "faculty at an EM residency program, with knowledge of all students rotating through the program and the projected rank list," and adds: "Group SLOEs authored by some combination of Clerkship Director/Program Director/Vice Chair of Education are standard and expected when writing an eSLOE."

That is the population behind the rank-list question: the students who rotated with you, judged by people who build your list. A rank-list answer from a writer outside that group is a guess.

What the form asked in 2022-24

The eSLOE 2.0 study in the Journal of Graduate Medical Education (2025) describes three parts: "parts A (core EM clinical skills), B (professionalism and interpersonal skills), and C (anticipated guidance during residency and rank list placement)." The rank-list categories were top 10%, top third, middle third and lower third.

How rank-list answers were spread

Two studies report the spread for the eSLOE 2.0:

Sources: the eSLOE 2.0 study (JGME, 2025) and the cross-sectional study of 264 programs (Western Journal of Emergency Medicine, 2025), which concluded that "Both grades and rank list demonstrated evidence of a skewed distribution toward higher grades and rank-list position."

Our arithmetic: 20.5% of letters in a 10% category is about two times the label. Top 10% plus top third comes to 57.7% in the national data, against 33.3% if answers matched the labels.

The problem is older than the current form. A 2010 study of 102 standard letters from five California institutions (2008-09 cycle) found the global assessment tier "accurately predicted the applicant's actual ROL position" in 27 letters (26%) and "overestimated the applicant's position on the ROL in 67 (66%)".

Our view: the rank-list answer should describe where the student would sit on your real list, and nothing else. When your answers drift above your list, every SLOE you sign loses value, including the ones for your best students.

The countercase: some writers see few students, or one unusual cohort. With six rotators, "top 10%" holds less than one student, so the categories are coarse. If this year's group really is stronger than last year's, say so in the comments with numbers: "four of this year's nine rotators are above anyone we ranked in our top third last year".

A procedure for placing each student

1. Before the season, gather what CORD lists before a first eSLOE: "Student grades from the prior year" and "Your rank list distribution from the eSLOES that you wrote in the prior academic year."
2. Pull last year's final rank list and mark where the top 10%, top third and middle third fell on it, by name.
3. For each new student, ask: where would this student have landed on last year's list?
4. Answer the rank-list question with that position.
5. Keep a running count of your answers this season. If your top-10% count passes one in ten of the rotators you have rated, re-read the last three before you submit the next one.
6. When the answer and the ratings point different ways, explain the gap in the comments.

Comments that help a reader

The comments are where your judgment shows. CORD's rules for every SLOE type: "Do explain pre-entrustable designations from Part A and extremes of scale use (1 or 5) from Part B," and "Do NOT reiterate information that can be found in other sections of the ResidencyCAS application." Use the space for the evidence behind an extreme answer, the context behind a gap between ratings and rank, and what the student did that the scales cannot hold.

Describe behavior, not temperament. A 2023 study of 1,582 SLOEs at one program (2016-17 cycle) found students described as "quiet," "shy," and/or "reserved" were placed in the top 10% or top third of the anticipated rank list less often than other students: "33% vs 58%". If a student speaks little on shift, write what they did instead.

Constructed example: a comment that labels and one that shows

Constructed example, written by us, not a real SLOE comment. Context (invented): Dr. J. Halvorsen is clerkship director at an EM residency program. Grace Odum rotated for four weeks.

Grace is a quiet but hardworking student who will make a fine emergency physician. She was a pleasure to work with.

It labels her temperament, gives no evidence and closes with faint praise.

Constructed example, written by us, not a real SLOE comment. Same invented writer and student.

Grace saw 14 to 16 patients a shift by week three, the most of our 22 rotators this year. On a busy night she recognized a posterior MI on an ECG read as normal at triage and presented it to the attending before the repeat. She speaks briefly on shift and her presentations are complete. We placed her in the top third because two rotators were stronger at managing several sick patients at once.

That is 74 words. It gives volume with a comparison group, one incident with her action, a behavior in place of "quiet", and the reason for the rank-list answer.

Submitting through ResidencyCAS

The ResidencyCAS help page gives the route when a student requests a SLOE:

• "You'll receive an email from ResidencyCAS with a link to the CORD eSLOE Portal and a unique ResidencyCAS Letter ID".
• "Enter the ResidencyCAS Letter ID in the field located under the AAMC ID. This ID is required to submit the SLOE."
• "Click Submit to ResidencyCAS at the bottom of the form."

CORD's page adds that a resubmission replaces the earlier version: "If you re-submit a previously transmitted SLOE to ResidencyCAS, it will update on the ResidencyCAS side to replace it with the most recent version." A SLOE you already wrote can be reused: "If it's saved in your CORD eSLOE dashboard, just open it, add the ResidencyCAS Letter ID, and submit." If you have only the PDF, the page says to "use the UUID at the bottom of the PDF to recover the form in the eSLOE Portal". For narrative letters, ResidencyCAS sends "a link to Liaison Letters, the ResidencyCAS evaluator portal." Which EM programs use ResidencyCAS and which use ERAS is in ResidencyCAS vs ERAS by specialty. ERAS upload rules were not verified for this page; AAMC's pages refused our request (HTTP 403).

SLOE writer checklist

1. Confirm the SLOE type the student requested and that you sit on the ranking committee for an eSLOE.
2. Pull last year's rank list and mark the category cut points.
3. Place the student by where they would sit on that list.
4. Check your season tally before you submit.
5. Explain any extreme answer, or any gap between ratings and rank, in the comments.
6. Replace temperament words with what the student did.
7. Enter the ResidencyCAS Letter ID and submit from the eSLOE portal.

Questions about the EM SLOE

How many students should I put in the top 10%?

About one in ten of the students you rated, if your rotators look like last year's. The national eSLOE 2.0 data had 20.5% of letters in that category.

Can a site without an EM residency write a SLOE?

Yes. ResidencyCAS lists a "Non-residency-based SLOE: written by EM faculty after a rotation at a site without an EM residency program."

Should I write a narrative letter as well as the SLOE?

Only if the student asks for one. ResidencyCAS says "Narrative letters are typically used for non-clinical experiences such as research, volunteering, leadership, or mentorship."

Can I reuse a SLOE I wrote before the student requested it in ResidencyCAS?

Yes. Open it from your eSLOE dashboard, add the ResidencyCAS Letter ID and submit. A second eSLOE after your interview is news worth a short EM residency letter of intent or update.

Get a free review of the letter

Get a free Quick Review of the letter you write alongside the SLOE against GradPilot's residency letter of recommendation rubric. The SLOE holds your ratings; the review reads the narrative letter, the part the form cannot hold, for your basis for judgment, the patient-care incidents you saw yourself and how strongly you close. The student's own statement is covered in the emergency medicine ResidencyCAS personal statement guide.

More letter guides for EM and residency writers:

• Standardized letters by specialty: which specialties use a SLOE, SLOR or eSLOR, checked November 7, 2026.
• MSPE vs letter of recommendation: what the dean's letter already tells programs.
• Residency letter of recommendation sample: a constructed narrative letter, annotated.

Sources

Retrieved November 7, 2026, except where noted.

• Liaison, ResidencyCAS: Complete a Recommendation (no year stated): eSLOE writers, non-residency SLOE, narrative letters, Letter ID, reuse, submission.
• Bord S, et al., eSLOE 2.0: Examining Data From the First 2 Application Cycles, Journal of Graduate Medical Education, 2025 (2022-23 and 2023-24 cycles): form parts, rank-list and part B distributions. Read via the National Library of Medicine's record.
• Mannix A, et al., Emergency Medicine Clerkship Grading Scheme, Grade, and Rank-List Distribution, Western Journal of Emergency Medicine, 2025 (2022-23 cycle, 264 programs): mean rank-list distribution.
• Oyama LC, et al., Inaccuracy of the global assessment score in the emergency medicine standard letter of recommendation, Academic Emergency Medicine, 2010 (2008-09 cycle, 102 letters): accuracy of rank-list estimates.
• Quinn JK, et al., The Standardized Letter of Evaluation: How We Perceive the Quiet Student, Western Journal of Emergency Medicine, 2023 (2016-17 cycle, 1,582 SLOEs): quiet-labeled students and rank-list placement.
• Council of Residency Directors in Emergency Medicine, CORD Standardized Letter of Evaluation (SLOE) ("Information for faculty for the 2026-27 application cycle"): SLOE types, which SLOE asks for rank-list placement, group eSLOEs, data to gather, comment rules, resubmission.
• Not retrieved: AAMC ERAS pages (HTTP 403 to our request on November 7, 2026); no ERAS rule is quoted on this page.