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Engaging Choice Architecture: Interventions in the Emergency Medicine Standardized Letter (eSLOE 2.0) to Adjust Rater
Sharon Bord1, Doug Franzen2, Erin Karl3
1is an Assistant Professor, Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Journal of Graduate Medical Education
|August 15, 2026
Summary
Choice architecture interventions on the electronic Standardized Letter of Evaluation (eSLOE) shifted rating distributions. Prepopulating ratings and requiring justification reduced top scores, aiding applicant differentiation.
Area of Science:
- Medical Education
- Health Professions Education
- Applicant Evaluation
Background:
- Standardized letters of evaluation are increasingly used in residency admissions.
- Current letters have a narrow rating distribution, hindering applicant differentiation.
Purpose of the Study:
- To assess if choice architecture interventions on the eSLOE 2.0 can broaden rating distributions.
- To improve the ability to differentiate between emergency medicine applicants.
Main Methods:
- Two interventions were applied to the eSLOE 2.0 Part B for the 2024-2025 cycle.
- Interventions included prepopulating radio buttons to '3' and prompting justification for '1' or '5' ratings.
- Applicant ratings were compared to two prior application cycles.
Main Results:
- Analysis of 17,727 letters showed a post-intervention decrease in '5' ratings (-12.3% to -19.7%).
- There was an increase in '3' and '4' ratings (+3.9% to +11.0% and +7.2% to +11.0%, respectively).
- '1' and '2' ratings remained stable.
Conclusions:
- Choice architecture, specifically rating prepopulation and justification prompts, altered score distribution.
- These interventions reduced the percentage of top ratings, enhancing score variability for emergency medicine applicants.
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