ArticleJournal of graduate medical education2026
Engaging Choice Architecture: Interventions in the Emergency Medicine Standardized Letter (eSLOE 2.0) to Adjust Rater Behaviors.
Article in Journal of graduate medical education, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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12 authors.
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Abstract
Background: Residency programs are utilizing standardized letters of evaluation with increasing frequency to obtain concise and discerning information about applicants. However, letters show a narrow distribution of ratings, leading to difficulties differentiating between applicants. Objective: To determine if choice architecture, through 2 interventions on the electronic emergency medicine Standardized Letter of Evaluation 2.0 (eSLOE 2.0), can increase the spread of ratings on letters written for emergency medicine applicants. Methods: On the eSLOE 2.0 Part B for the 2024-2025 application cycle, radio buttons were prepopulated to a "3" on a Likert scale of 1 to 5 (rather than blank), and a pop-up message prompted letter writers to provide narrative justification for ratings of "1" (lowest) or "5" (highest). Ratings of applicants after this intervention were compared with ratings from 2 prior application cycles. Results: A total of 17 727 letters (5938 from 2024-2025; 11 789 from 2022-2024) were analyzed. Post-intervention, there was a decrease in ratings of "5" across all domains in Part B, with the absolute difference in the percentage of students rated "5" ranging from -12.3% to -19.7%. There was a post-intervention increase in percentage of "3" and "4" utilization across all domains ranging from +3.9 to +11.0 and +7.2 to +11.0 respectively. Ratings of "1" and "2" remained stable post-intervention. Conclusions: Prepopulating SLOE Part B ratings to 3 out of 5 and pop-up messages prompting letter writers to justify top or bottom ratings led to a shift in the distribution of scores and a reduction in the percentage of top ratings in the 2024-2025 cycle, as compared to the prior 2 cycles.
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