CORD eSLOE | Evaluation - Non-residency based

Did you read the instructions found here?

Yes

Demographic Data

Applicant First Name

Last Name

AAMC ID

ResidencyCAS Letter ID

Letter Authors (Name, Title) Please list all:

Evaluator Institution

Preferred Author Contact Individual and Method

What is your present position?

Background Information

Nature of contact with applicant (check all that apply):

Know indirectly through others/evaluations

Extended, direct observation in the ED

Advisor

Occasional Contact

Clinical Contact outside ED

N/A

Other (explain)

How long have you known the applicant?

Did this candidate rotate in your ED?

Yes

What is your grading scheme for the rotation that this student completed?

Grade received on the rotation

Number of students

Indicate what % of students on this rotation received the following grades last academic year (grades from each category should add up to 100%):

Honors %

High Pass %

Pass %

Fail %

Honors %

Pass %

Fail %

Pass %

Fail %

A %

B %

C %

D %

F %

Current sum

Dates of rotation (Start and End):

EM is a required rotation for all students at our institution?

Yes

Evaluation of Student: Part A

The following questions are a criterion-referenced assessment, meaning it pertains to the student’s overall competency compared to a set metric, which in this case is the readiness to begin an emergency medicine residency program. Please note this is NOT a comparison to peers. Indicate where this student stands in terms of readiness to be an incoming EM intern.

1. Ability to perform a focused history and physical exam:

Fully entrustable

Mostly entrustable

Pre-entrustable

2. Ability to generate a differential diagnosis:

Fully entrustable

Mostly entrustable

Pre-entrustable

3. Ability to formulate a plan:

Fully entrustable

Mostly entrustable

Pre-entrustable

4. Ability to perform common ED procedures:

Fully entrustable

Mostly entrustable

Pre-entrustable

Unable to assess or we do not assess

5. Ability to recognize and manage basic emergent situations:

Fully entrustable

Mostly entrustable

Pre-entrustable

Evaluation of Student:

Please rate the student in the following areas using a rating scale (LEFT side = best candidate I’ve seen, RIGHT side = minimally acceptable for an EM resident)-Note: Your average ratings for the year should typically look like a bell shaped curve distribution. If you select the far left or far right of the scale, please discuss this in your narrative feedback in section D.

1. Compassion, sensitivity, and respect towards patients and team members

Exceptional EM candidate