Abstract. Objective: To compare the Council of Emergency Medicine Residency Directors' (CORDS) standardized letters of recommendation (SLORs) with traditional narrative letters of recommendation (NLORs) with regard to interrater reliability, consistency, and time of interpretation. Methods: In part I of the study, four members of the residency selection committee each evaluated the same 20 SLORs and 20 NLORs from which all identifying characteristics had been deleted. Using Likert-type scales of the global assessment, each letter was assigned a numeric value from 1 to 7. The interrater reliability was calculated for both types of letters using the Kendall coefficient of concordance. Average time to interpretation of the letters was also determined. In part 11, using the same numeric values as in part I, 207 single-author SLOFUNLOR pairs were evaluated to determine whether the global assessment of the SLOR was consistent with that of its partner NLOR. Interpretation of the NLOR was performed blinded to the SLOR. Statistical analysis was calculated using Spearman correlation coefficients. Results: In part I of the study, the interrater reliability of the SLOR was 0.97, as compared with 0.78 for the NLOR. The average time to interpret the global assessment of the SLOR was 16 seconds, vs 90 seconds for the NLOR. In part I1 of the study, of the 207 SLOR/NLOR pairs, 112 (54%) were assigned the same numeric value, 80 (39%) differed by one, 13 (6%) differed by two, and two (1%) differed by three, for an overall correlation of 0.58. Conclusions: Compared with NLORs, the CORD SLOR offers better interrater reliability with less interpretation time. Single-author SLORMLOR pairs submitted for a single applicant do not correlate well. Residency selection committees must decide whether the added work of interpreting NLORs is beneficial. Key words: letter of recommendation; postgraduate education; emergency medicine; residency; selection. ACADEMIC EMERGENCY MEDI-CINE 1998; 5:1101-1104 RADITIONAL narrative letters of recommen-T dation (NLORs) are a factor of the resident selection process considered to be more influential than U.S. Medical Licensing Examination (USMLE) scores.' Along with transcripts and the dean's letter, they are a n important pre-interview source of information about a n applicant's interpersonal and clinical skills.2 Accurate interpretation of NLORs requires time and a significant amount of experience, and even experienced interpreters find the task d i f f i~u l t .~ Frequently, important information is missing or worded in a manner that is subject to a range of i n t e r p r e t a t i~n .~ With the aim of making data extraction more precise and efficient, the Council of Emergency Medicine Residency Directors (CORD) has developed a standardized letter of recommendation (SLOR). A SLOR would be expected to require less time and experience to interpret t h a n a NLOR. It would ensure t h a t information considered important to residency selection committees was not omitted. The experience of the previous appl...

Objectives: In this study, an endovaginal ultrasound (US) task trainer was combined with a high-fidelity US mannequin to create a hybrid simulation model. In a scenario depicting a patient with ectopic pregnancy and hemorrhagic shock, this model was compared with a standard high-fidelity simulation during training sessions with emergency medicine (EM) residents. The authors hypothesized that use of the hybrid model would increase both the residents' self-reported educational experience and the faculty's self-reported ability to evaluate the residents' skills.Methods: A total of 45 EM residents at two institutions were randomized into two groups. Each group was assigned to one of two formats involving an ectopic pregnancy scenario. One format incorporated the new hybrid model, in which residents had to manipulate an endovaginal US probe in a task trainer; the other used the standard high-fidelity simulation mannequin together with static photo images. After finishing the scenario, residents self-rated their overall learning experience and how well the scenario evaluated their ability to interpret endovaginal US images. Faculty members reviewed video recordings of the other institution's residents and rated their own ability to evaluate residents' skills in interpreting endovaginal US images and diagnosing and managing the case scenario. Visual analog scales (VAS) were used for the self-ratings.Results: Compared to the residents assigned to the standard simulation scenario, residents assigned to the hybrid model reported an increase in their overall educational experience (D VAS = 10, 95% confidence interval [CI] = 4 to 18) and felt the hybrid model was a better measure of their ability to interpret endovaginal US images (D VAS = 17, 95% CI = 7 to 28). Faculty members found the hybrid model to be better than the standard simulation for evaluating residents' skills in interpreting endovaginal US images (D VAS = 13, 95% CI = 6 to 20) and diagnosing and managing the case (D VAS = 10, 95% CI = 2 to 18). Time to reach a diagnosis was similar in both groups (p = 0.053).Conclusions: Use of a hybrid simulation model combining a high-fidelity simulation with an endovaginal US task trainer improved residents' educational experience and improved faculty's ability to evaluate residents' endovaginal US and clinical skills. This novel hybrid tool should be considered for future education and evaluation of EM residents. The use of endovaginal US by emergency physicians (EPs) has demonstrated potential to decrease emergency department (ED) length of stay and to facilitate rapid assessment of patients with ruptured ectopic pregnancy.2,3 During the past 10 years, acquiring and interpreting US images has become an accepted part of the training of emergency medicine (EM) residents. The

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HF simulation-based assessment using objective measures, particularly time to action, discerned our novice from our experienced residents.

Abstract. Objective: The Council of Emergency Medicine Residency Directors (CORD) standardized letter of recommendation (SLOR) has become a common, reliable, and useful tool in the evaluation of emergency medicine (EM) applicants. A ''guaranteed match'' (GM) is the SLOR's bottom-line superlative response. It is also the SLOR's least common superlative response. Because candidates receiving a GM are a select group, the authors thought it would be useful to identify SLOR information that predicts a GM recommendation. Methods: This was a secondary analysis of a database of all EM SLORs submitted to a single EM residency during the 1998-1999 application cycle to one EM residency program. Response to GM and 16 data points in the background/qualification sections were analyzed by chi-square, univariate analysis, and logistic regression. Results: Four hundred eleven SLORs were analyzed. Qualification information was more predictive than background information for applicants receiving a GM. The highest univariate odds ratios for background information were