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The SLOE Guide 2026-2027
What EM and OB-GYN Applicants Need to Know About Standardized Letters of Evaluation
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For Emergency Medicine applicants, the Standardized Letter of Evaluation (SLOE) is often one of the most closely reviewed parts of the residency application. Obstetrics and Gynecology now uses its own standardized evaluation as well, although the form, authorship, and application strategy differ meaningfully between the two specialties.
This guide explains what a SLOE is, when applicants may need one, who should complete it, what the forms evaluate, and how SLOEs are submitted through ResidencyCAS for the 2026-2027 application cycle.
Before you begin, review our complete ResidencyCAS Application Guide for a section-by-section breakdown of the application. Then return here for a closer look at SLOEs.
Table of Contents
- What Is a SLOE?
- Is a SLOE Required?
- Why SLOEs Carry So Much Weight
- Emergency Medicine SLOEs
- The OB-GYN SLOE
- Who Should Complete Your SLOE?
- When Should a SLOE Be Completed?
- What Is Included in an EM SLOE?
- What Is Included in an OB-GYN SLOE?
- How Many SLOEs Do You Need?
- How SLOEs Reach ResidencyCAS
- SLOEs Versus Narrative Letters
- How to Prepare for a Strong Evaluation
- The FERPA Waiver
- Common SLOE Mistakes
- Final Thoughts
What Is a SLOE?
A Standardized Letter of Evaluation, or SLOE, is a structured evaluation used primarily in Emergency Medicine (EM) and Obstetrics and Gynecology (OB-GYN). Instead of allowing every evaluator to write an entirely different letter, the SLOE asks writers to assess applicants using a common set of criteria.
The word evaluation is important. A SLOE is not simply a traditional recommendation letter placed into a standardized template. Its purpose is to provide a credible, comparative, and competency-based assessment of an applicant’s performance.
Although EM and OB-GYN both use the term SLOE, their forms are not interchangeable. The specialties differ in who typically completes the evaluation, what is assessed, how the form is submitted, and how applicants should incorporate it into their overall letter strategy.
Is a SLOE Required?
Emergency Medicine: Most EM programs expect at least one SLOE, and some may expect more. Applicants should review the instructions for every program on their list rather than assume that all programs have identical requirements.
OB-GYN: One SLOE is strongly recommended for OB-GYN applicants, but it is not universally required by every program. Individual programs may establish their own requirements, so applicants should verify them before assigning evaluations.
A SLOE also does not necessarily come “in addition to” a full set of narrative letters. SLOEs and traditional letters both count toward the maximum number of evaluations that can be assigned to a program.
Why SLOEs Carry So Much Weight
Traditional letters can vary widely. One writer may provide a detailed clinical assessment, while another may offer only broad praise. Because SLOEs use defined questions and comparison groups, they give program directors a more consistent way to interpret an applicant’s performance.
In EM, the residency-based eSLOE is especially valuable because it may incorporate feedback from multiple faculty members, compare the applicant with other students who rotated at the institution, and include the applicant’s anticipated position on the institution’s rank list.
The OB-GYN SLOE serves a related but distinct purpose. It was developed to reduce some of the variability, subjectivity, and potential bias associated with traditional letters while highlighting competency-based performance, distinguishing strengths, and areas for continued development.
Emergency Medicine SLOEs
The Council of Residency Directors in Emergency Medicine (CORD) recognizes four SLOE formats. Applicants should understand the differences because these evaluations are written in different settings and do not all provide the same information.
Residency-Based eSLOE
The residency-based eSLOE is completed by faculty at an institution with an ACGME-accredited EM residency program. It is usually an institutional or group evaluation that incorporates input from individuals such as the clerkship director, program director, associate program directors, and other faculty members.
This is the only EM SLOE format that asks where the applicant is expected to fall on the institution’s anticipated rank-order list. Because the writers have experience evaluating a broad group of rotating students, this SLOE provides meaningful comparative context.
Non-Residency-Based SLOE
This form is completed by EM faculty at a clinical site that does not sponsor its own EM residency program. It allows the evaluator to assess the applicant’s performance in an EM setting but does not include the same institutional rank-list comparison as the residency-based eSLOE.
Subspecialty SLOE
A subspecialty SLOE may be completed after an EM-related rotation such as pediatric emergency medicine, ultrasound, toxicology, emergency medical services, or simulation. It can provide useful information about performance in that setting, but it should not automatically be treated as equivalent to a residency-based eSLOE from a general EM rotation.
Off-Service SLOE
The off-service SLOE, sometimes called the O-SLOE, is completed by faculty from a rotation outside of EM, such as internal medicine, surgery, anesthesia, or critical care. It gives non-EM evaluators a structured way to describe qualities that may predict success in EM residency.
For the 2026-2027 cycle, CORD’s Recovery feature allows reapplicants to retrieve and update previously written non-residency-based, subspecialty, and off-service SLOEs. Applicants and evaluators should confirm current CORD instructions before relying on a prior evaluation.
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The OB-GYN SLOE
OB-GYN does not use the same four-form system as EM. Instead, the OB-GYN SLOE asks the evaluator to identify the capacity in which the assessment was completed.
Chair's Letter
A department chair may complete the SLOE based on personal interaction with the applicant, feedback gathered from other faculty members, or both.
Composite or Group Assessment
A composite SLOE may reflect input from an advising team, a clerkship or sub-internship leadership group, or multiple physicians who worked with the applicant. A well-constructed composite can provide a broader and more representative assessment than a letter based on one brief interaction.
Individual Assessment
An individual faculty member may complete the SLOE based on direct observation of the applicant, such as during a sub-internship, acting internship, or other meaningful clinical experience.
The best format depends on the applicant’s institution and experiences. Applicants should not assume that an individual assessment is automatically stronger than a chair’s letter or composite evaluation. The goal is to identify the person or group able to provide the most informed, specific, and representative assessment.
Who Should Complete Your SLOE?
Emergency Medicine
For a residency-based EM rotation, applicants should follow the site’s established eSLOE process. The ideal author is not necessarily the individual attending with whom the applicant has the closest relationship. A residency-based eSLOE is often strongest when completed by the institutional education team that understands the full rotating cohort and can provide reliable comparative data.
For non-residency, subspecialty, or off-service SLOEs, the evaluator should have sufficient direct observation to comment specifically on the applicant’s clinical performance, professionalism, communication, teamwork, and readiness for residency.
Ask about the process early in the rotation. Some sites automatically collect faculty evaluations and generate a group eSLOE, while others may ask the applicant to identify faculty members who observed them closely.
OB-GYN
The OB-GYN SLOE should be completed by the individual or group that knows the applicant’s clinical work best. Ideally, the evaluation will come from an OB-GYN faculty member or team with meaningful direct or aggregated observation, often connected to a sub-internship.
Depending on the institution, that may be a supervising physician, sub-internship director, department chair, clerkship leadership group, or committee. Seniority alone should not determine the choice.
When Should a SLOE Be Completed?
Emergency Medicine
Applicants commonly request a SLOE after substantive EM rotations, particularly core rotations and away rotations at residency-based sites. Discuss the process on the first day rather than waiting until the final week.
Requesting a SLOE does not obligate an applicant to assign it to every program. Applicants may request more evaluations than they ultimately use, although they will generally not be able to read waived letters before deciding how to assign them.
When planning which evaluations to use, consider the type of rotation, the amount of direct observation, the feedback received, the timing of the rotation, and the requirements of each program. An experienced EM advisor can be especially helpful.
OB-GYN
An OB-GYN SLOE should generally be completed near the end of the experience on which it is based. This gives the evaluator the benefit of the most complete and current performance data. Composite evaluations are often assembled after an OB-GYN sub-internship or another substantial fourth-year experience.
What Is Included in an EM SLOE?
The exact items vary somewhat by SLOE type, but the residency-based EM eSLOE includes several major categories.
Background and Rotation Information
The form identifies the rotation setting, the applicant’s level of training, the grade received, and how that grade compares with the site’s grading distribution.
Qualifications for Emergency Medicine
The evaluator assesses qualities such as commitment to EM, work ethic, development of differential diagnoses and treatment plans, teamwork, care for patients, anticipated need for guidance during residency, and predicted likelihood of success.
Comparative and Global Assessment
The evaluator compares the applicant with other EM candidates and, in the residency-based eSLOE, indicates the applicant’s anticipated position on the institution’s rank list.
Written Comments
The narrative section allows the evaluator to describe distinguishing qualities, professionalism, maturity, motivation, compassion, and other relevant characteristics. Writers may also explain unusually high or low ratings.
Applicants should review the evaluation criteria before the rotation, but they should not approach the experience as a checklist. Programs are looking for consistent performance across clinical reasoning, reliability, communication, teamwork, professionalism, and responsiveness to feedback.
Also, watch our video: How to Fill Out the ResidencyCAS Application for 2027.
What Is Included in an OB-GYN SLOE?
The OB-GYN SLOE includes four major components.
Competency Assessment Rubric
The evaluator rates the applicant across competency domains using developmental reference points such as early clerkship student, immediate end-of-OB-GYN-clerkship student, acting intern or fourth-year student, and early intern.
Most Outstanding Feature
The evaluator identifies the applicant’s most outstanding feature in five words or fewer. This section is designed to capture a concise, distinguishing strength.
Areas for Focus
The evaluator may identify up to three areas that the applicant should continue developing as an incoming intern. Applicants should not interpret the presence of growth areas as inherently negative. Residency programs expect graduating medical students to have skills they still need to develop.
Narrative
The evaluator provides a brief narrative, generally limited to 250 words, describing one or two distinctive characteristics or strengths. This section is not intended to repeat the applicant’s entire CV or mimic a traditional multi-page recommendation letter.
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How Many SLOEs Do You Need?
Emergency Medicine
There is no single combination that is correct for every applicant. Most EM programs expect at least one SLOE, while some may prefer or require additional SLOEs.
Many applicants obtain evaluations from a core EM rotation and one or more away rotations. However, the number requested is not the same as the number assigned to each program. Applicants should build their strategy around the quality and type of their evaluations, their rotation schedule, and program-specific requirements.
Programs may notice when an applicant completes a substantial EM rotation but does not submit an associated SLOE, particularly when that site ordinarily produces residency-based eSLOEs. This is not automatically disqualifying, but applicants with an unusual letter pattern should discuss it with an EM advisor.
OB-GYN
One SLOE is strongly recommended, generally alongside additional narrative evaluations. Applicants may assign up to four total evaluations to each program, but they should check each program’s preferred number and combination.
If you’d like personalized guidance on completing the Publications section of your ResidencyCAS application, our experienced advisors are here to help. Click here.
How SLOEs Reach ResidencyCAS
Applicants begin by creating an evaluation request in the Evaluations area of ResidencyCAS and identifying whether the request is for a SLOE or a narrative letter.
Emergency Medicine
EM SLOEs are completed through CORD’s eSLOE platform. The applicant’s ResidencyCAS Letter ID is entered into the CORD system, and the completed SLOE is then transmitted to ResidencyCAS. Residency-based eSLOEs require the appropriate CORD access, while instructions for the other SLOE formats may differ.
OB-GYN
The OB-GYN SLOE is completed through the Liaison Letters portal connected to ResidencyCAS. After the applicant creates the request, the evaluator receives instructions for completing the SLOE or submitting the appropriate narrative evaluation.
Once an evaluation appears in ResidencyCAS, the applicant assigns it to individual programs. Applicants may request multiple evaluations, but no more than four may be assigned to a single program. Requirements may vary by specialty and program.
After an application has been submitted to a program, an assigned evaluation generally cannot simply be removed or exchanged as though the original assignment never occurred. Review assignments carefully before submission and follow current ResidencyCAS instructions when adding later evaluations.
SLOEs Versus Narrative Letters
A SLOE and a narrative recommendation letter serve overlapping but different purposes.
A SLOE:
- Uses a standardized format
- Includes defined ratings or comparisons
- Is usually tied to a specific clinical experience or evaluation process
- Provides comparative information that may be difficult to interpret from a traditional letter
- Counts toward the program’s evaluation limit
A narrative letter:
- Gives the writer more freedom to select the structure and content
- May describe clinical, research, leadership, service, or other experiences
- Can provide detailed examples and personal context
- Also counts toward the program’s evaluation limit
Applicants should not assume that one format is always better. The right combination depends on the specialty, the program, and the applicant’s experiences.
Also, watch our video: How to Complete the ERAS® Residency Application: Step-by-Step Tutorial
How to Prepare for a Strong Evaluation
Applicants cannot control the ratings or narrative an evaluator ultimately submits. They can control how they approach the rotation and the evaluation process.
Ask about the SLOE process early. Learn who collects evaluations, whether the letter is written individually or by a group, and what information the site needs from you.
Seek specific feedback throughout the rotation. Ask what you are doing well, what you should change, and whether your performance improved after you received feedback.
Be reliable. Arrive prepared and on time, follow through on assigned tasks, communicate changes promptly, and take ownership appropriate to your level of training.
Demonstrate clinical honesty. Never misrepresent a history, examination finding, task completion, or clinical decision. Ask for help when you are uncertain.
Work well with the entire team. Strong performance includes communication with residents, nurses, staff, consultants, patients, and families, not merely impressing one supervising physician.
Provide requested materials promptly. Depending on the site, the evaluator may ask for a CV, personal statement, ResidencyCAS Letter ID, deadlines, or other administrative information.
What Applicants Can and Cannot Control
You cannot control:
- The evaluator’s final ratings
- The comparison group used by the institution
- The site’s grading distribution
- The exact narrative that appears in a waived evaluation
- How an individual program weighs each part of the SLOE
You can control:
- How strategically you select rotations
- Whether you understand the evaluation process
- Your preparation, reliability, and professionalism
- How actively you request and apply feedback
- Whether you request the evaluation early enough
- How carefully you assign evaluations to programs
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The FERPA Waiver
ResidencyCAS asks applicants whether they waive their right to view each evaluation. Applicants are generally advised to waive access because confidential evaluations are more likely to be viewed as candid assessments.
Waiving access does not guarantee a positive evaluation, and it does not mean an applicant will be able to review the letter before deciding where to assign it. Make the decision carefully before submitting the request because it may not be reversible.
Common SLOE Mistakes
Waiting until the end of the rotation to learn how the site handles SLOEs
Assuming the most senior or personally enthusiastic faculty member is automatically the best evaluator
Treating every EM SLOE format as equivalent to a residency-based eSLOE
Focusing only on clinical knowledge while neglecting reliability, communication, teamwork, professionalism, or receptivity to feedback
Selecting an OB-GYN evaluator based on title alone rather than the quality and breadth of observation
Assuming that every program wants the same number or combination of evaluations
Failing to review program-specific requirements before assigning letters
Assigning evaluations too quickly without considering the rotation setting, timing, feedback received, and overall letter strategy
If you’d like personalized guidance on securing strong Standardized Letters of Evaluation (SLOEs) and optimizing your residency application strategy, our experienced advisors are here to help. Click here.
Final Thoughts
The SLOE is one of the few major components of the residency application that applicants do not write themselves. However, it reflects months of decisions that applicants can influence: where they rotate, how they perform, whether they seek and incorporate feedback, and how thoughtfully they manage the evaluation process.
For EM applicants, understanding the differences among the residency-based eSLOE, non-residency-based SLOE, subspecialty SLOE, and off-service SLOE is essential. For OB-GYN applicants, the priority is identifying the individual or group able to provide the most informed and representative assessment.
Review the current instructions from CORD, ResidencyCAS, and each program before finalizing your strategy. Requirements and submission procedures can change between application cycles.
If you would like expert guidance on your ResidencyCAS application and evaluation strategy, contact The Match Guy HERE.
You can also combine personal statement editing, ResidencyCAS application editing, and interview preparation through one of our Match Application Packages HERE.
Good luck with your application,
The Match Guy
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