Ethics Seminars: Beyond Authorship Requirements—Ethical Considerations in Writing Letters of Recommendation

Abstract

Abstract. Letters of recommendation may serve a number of vital functions related to the evaluation, selection, and promotion of candidates. The lure of academic celebrity or the desire of an individual candidate for a flattering letter must not threaten the veracity of the content. Letters of recommendation should be appropriately authored to meet the needs of the institution or individual requesting the letter, while keeping authenticity paramount. Length and content should be complete but not overly verbose. Relevant elements suggested by standardized formats should typically be included, such as nature of contact with the applicant, commitment to emergency medicine, work ethic, ability to develop a differential and treatment plan, personality, interpersonal interactions, and an overall comparative ranking. The seven cardinal elements of an exemplary letter of recommendation are that it should be: 1) authentic (based on adequate first-hand knowledge of the candidate's skills); 2) honest (accurate; avoiding exaggeration or hyperbole); 3) explicit (avoidance of veiled omissions); 4) balanced (taking care to incorporate both strengths and weaknesses); 5) confidential (avoiding unnecessary or unanticipated disclosure); 6) of appropriate detail and length (content relevant to the institutional or individual requests); and 7) technically clear (avoidance of unnecessary abbreviations and jargon). The implied duty to future students, colleagues, researchers, and patients who might come in contact with the applicant should motivate authors to write honest, explicit, appropriate, and complete letters.

Mentoring Medical Students in Academic Emergency Medicine

“…Information has been published about the ethics of authorship for letters of recommendation, including what is appropriate and inappropriate to include in these letters. 42,43 If something might seem inappropriate yet is believed to be an integral part of the letter, legal advice is encouraged. This may protect the author as well as the student and possibly prevent subsequent consequences.…”

Dear Program Director: Deciphering Letters of Recommendation

“…The literature contains advice for letter writers, such as specific language and formatting to use in LORs, reviewing the applicant's academic performance, and meeting with them to learn more about them before writing the letter. 12,14,[16][17][18]20,24,25 While there were similarities among the perceptions of residency and fellowship PDs regarding LOR features, we also found differences. Writers might take these into account when composing LORs for residency or fellowships.…”

“…Letters often are drafted with latent information that requires PDs to decode their meaning. [12][13][14] An article in a previous issue of the Journal of Graduate Medical Education ''Viewpoint From a Program Director: They Can't All Walk on Water'' characterizes the current state of applications to residency programs as one in which applicants all look the same on paper, yet suggests that faculty with experience can ''read between the lines'' of LORs. 15 Given the notion of the use of ''code'' in LORs, novice letter writers may not know the code.…”

Hepatitis C Virus–Infected Resident: End of Residency, End of Career?

“…And the reason for this is the person reviewing the resident’s letter, whether it be a physician or an administrator, is likely to know very little about HCV infection, its treatment, or policies regarding infected health care workers. Indeed the poor knowledge base of surgeons regarding HCV has been welldocumented[32]. It is far easier to deny employment to such an individual than to thoroughly research the subject and understand the national policy regarding infected physicians.…”