Racial Bias in Medical Student Standardized Letters of Evaluation (SLOE
Abstract
Learning Objectives: Weigh the value of Standardized Letters of Evaluation (SLOE) in emergency medicine residency selection given the bias that may negatively impact students who are underrepresented in medicine (URM).
Objective: Emergency Medicine (EM) residency leaders designed the Standardized Letter of Evaluation (SLOE) to minimize variations in letters of recommendation for EM-bound medical students. Despite standardization, evidence is lacking regarding the effectiveness of the SLOE to minimize bias, especially relevant to race and ethnicity. This study aims to determine the presence of implicit racial bias in SLOEs.
Methods: This was a cross-section study of EM-bound applicants across three geographically distinct US training programs during the 2019-2020 application cycle. Using descriptive and regression analyses, we evaluated whether one’s underrepresented in medicine (URM) status impacted each of the 7 qualifications of EM physician (7QEM) questions, global assessment (GA) score, and projected rank list (RL) position.
Results: A total of 2,002 unique applications were included. Overall, we found that URM students had lower grades in each of the 7QEM questions, with male URM students more significantly impacted than female URM students. Similar trends were seen in GA scores and RL positions for URM students (p < 0.001). We also found that, compared to non-URM candidates, URM students were less likely to benefit from the following components: Work Ethic and ability to assume responsibility, Ability to work in a team, and Ability to communicate a caring nature.
Conclusions: This study suggests that bias exists in the SLOE which may negatively impact URM students. URM students are disproportionately evaluated on 3 of the 7QEM, suggesting opportunities for training for SLOE writers and further analysis of the contribution of the SLOE in systemic barriers the prevent diversity in medicine.