AAIM Guidelines for Internal Medicine Structured Evaluative Letter

AAIM Guidelines for Internal Medicine Structured Evaluative Letter (IM SEL)

The Main Residency Match is a pivotal and challenging transition period, requiring both transparency and a commitment to equity. The Coalition for Physician Accountability (CoPA) identified challenges in the shift from medical school to residency which are negatively impacting the UME – GME transition. CoPA recommended sweeping changes to address the UME – GME transitions enigma, one of which encourages the development of structured evaluative letters (SELs) “as a universal tool in the residency program application process.”

In 2020, AAIM released guidelines for summary letters of evaluation (DOM SLOE) to accompany its residency application guidelines. In keeping with CoPA recommendations and through engagement with key stakeholders, the DOM SLOE was revised, expanded, and renamed to IM SEL, incorporating competency-based language reflective of the ACGME IM Milestones 2.0. By presenting specific data in a standardized and structured format, the IM SEL enables a standardized and structured review of an applicant. The IM SEL provides an opportunity to highlight clinical competencies and professional skills not assessed on standardized exams, providing a more holistic view of an applicant’s possible strengths and areas for improvement. Since a structured evaluative letter contains standardized national assessment data, local data, and information on the cognitive and non-cognitive skills that are important to professional development, it could be the most useful tool to both advocate for the skillsets of an applicant and prepare program directors for resources an applicant might need when they match to a program. 

The IM SEL FAQs highlight adjustments made, how to properly navigate the IM SEL, and advise on how to respond to individual components. The IM SEL template and IM SEL mock-up incorporate those core competencies and representations that not only contribute to a uniformed language and consistent information on clerkship and sub-internship experiences but will also decrease preparation time and variability.  

Given that the timing of these guidelines and its supporting documents take place well into the 2021-2022 advising season, AAIM acknowledges that the ability to fully adopt these recommendations will be limited this application cycle. It is acceptable and understandable if certain components of the IM SEL cannot be provided. As with any new form devised to create structure and homogeneity, the IM SEL has its limitations, and would, therefore, undergo additional review and improvement. Widespread adoption will take time. 

SEL Template SEL Mock-Up

Frequently Asked Questions


Learn more about the development of the structured evaluative letter in this webinar from July 2021, conducted by the co-chairs of the Alliance writing group that developed the guidance.

View Webinar