Internal medicine fellowship directors’ perspectives on the quality and utility of letters conforming to residency program director letter of recommendation guidelines

O’Connor, Alec B.; Williams, Christopher M.; Dalal, Bhavinkumar; Sulistio, Melanie S.; Roth, Teresa; Milne, Caroline; Collichio, Frances A.; Muchmore, Elaine A.; Alweis, Richard

doi:10.1080/20009666.2018.1500424

Cited by 8 publications

(5 citation statements)

References 15 publications

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“…Our findings are consistent with results from a previous study of LOR-AAIM, where fellowship PDs felt that structured LOR were clearer in communicating residents' performance across 6 core competency domains than LOR-NonAAIM. 5 Bias persisted within LOR-AAIM despite the AAIM guidelines. This finding aligns with previous literature for otolaryngology residency where standardized LOR reduced but did not eliminate bias, especially between men and women.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the well-documented bias in program director (PD) letters of recommendation (LOR) against people who are underrepresented in medicine, [1][2][3][4] these letters persist as an important factor in fellowship selection. [5][6][7] The Alliance for Academic Internal Medicine (AAIM) put forth guidelines in 2017 to standardize the PD LOR to decrease bias and increase quality, but it remains unclear whether these standardizations reduce bias (provided as online supplementary data). 8 In-depth analyses could determine how and where the language of bias appears in LOR and whether standardization mitigates this bias.…”

Section: Introductionmentioning

confidence: 99%

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Race and Gender Bias in Internal Medicine Program Director Letters of Recommendation

Zhang

Blissett

Anderson

et al. 2021

Journal of Graduate Medical Education

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Background While program director (PD) letters of recommendation (LOR) are subject to bias, especially against those underrepresented in medicine, these letters are one of the most important factors in fellowship selection. Bias manifests in LOR in a number of ways, including biased use of agentic and communal terms, doubt raising language, and description of career trajectory. To reduce bias, specialty organizations have recommended standardized PD LOR. Objective This study examined PD LOR for applicants to a cardiology fellowship program to determine the mechanism of how bias is expressed and whether the 2017 Alliance for Academic Internal Medicine (AAIM) guidelines reduce bias. Methods Fifty-six LOR from applicants selected to interview at a cardiology fellowship during the 2019 and 2020 application cycles were selected using convenience sampling. LOR for underrepresented (Black, Latinx, women) and non-underrepresented applicants were analyzed using directed qualitative content analysis. Two coders used an iteratively refined codebook to code the transcripts. Data were analyzed using outputs from these codes, analytical memos were maintained, and themes summarized. Results With AAIM guidelines, there appeared to be reduced use of communal language for underrepresented applicants, which may represent less bias. However, in both LOR adherent and not adherent to the guidelines, underrepresented applicants were still more likely to be described using communal language, doubt raising language, and career trajectory bias. Conclusions PDs used language in a biased way to describe underrepresented applicants in LOR. The AAIM guidelines reduced but did not eliminate this bias. We provide recommendations to PDs and the AAIM on how to continue to work to reduce this bias.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Race and Gender Bias in Internal Medicine Program Director Letters of Recommendation

Zhang

Blissett

Anderson

et al. 2021

Journal of Graduate Medical Education

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“…The orthopedic SLOR contains percentile ranges for team-based skills, professionalism, initiative and drive, and commitment to specialty (The American Orthopaedic Association, 2019). Although research has shown positive effects because of standardization, challenges related to another component of the application - United States Medical Licensing Examination (USMLE) scores - impede major progress toward holistic review ( O’Connor et al, 2018 ; Kaffenberger et al, 2016 ).…”

Section: Perspectivementioning

confidence: 99%

A Call to Improve Conditions for Conducting Holistic Review in Graduate Medical Education Recruitment

Williams¹,

Kwan²,

Pereira³

et al. 2019

MedEdPublish

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The authors identify several components of the application for residency and fellowship recruitment that impede progress toward conducting holistic review in graduate medical education (GME). As well, important differences between undergraduate (UME) and graduate medical education (GME) recruitment are discussed. The authors call for inclusion of questions about family background and disadvantaged status in the GME application, which is a standard practice within applications for health professions. The second recommendation encourages a question about non-cognitive strengths. Many specialties have adopted standardized letters of recommendation (SLORs) or standardized letters of evaluation (SLOEs) that collect this information from letters writers. Programs and applicants would benefit from uniformity across specialties. The authors also call for a centralized, searchable database that provides applicants with each program's mission, educational goals, and alumni outcomes. To support this paradigm shift in GME recruitment, reinforced with new Accreditation Council for Graduate Medical Education standards in July 2019, a task force should provide theoretical, evidence-based reasoning, along with development of new tools.

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“…More recently, guidelines from the Alliance for Academic Internal Medicine (AAIM) have advocated for internal medicine residency PDs to transition to a sLOR for fellowship applicants [9]. These AAIM guidelines have resulted in improved trust in the LOR written by residency PDs for trainees applying for internal medicine fellowships [10]. Pediatric otorhinolaryngology has implemented similar strategies for the PD LOR [11].…”

Section: Introductionmentioning

confidence: 99%

Confidence of Faculty in Writing Letters of Recommendation for Pediatric Fellowship Applicants

Moran,

Dzara,

Frey-Vogel

et al. 2023

Cureus

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Background: The assessment of pediatric residents applying to subspecialty fellowship programs relies on faculty letters of recommendation (LOR). However, it is unclear if pediatric faculty are confident that their LOR are effective.Objective: This study aims to assess the confidence of pediatric faculty in writing an effective LOR for pediatric residents applying to subspecialty fellowship programs. Methods: Survey development was conducted using evidence-based best practices. Surveys were distributed via email in 2021 to all full-time pediatric faculty members who taught pediatric residents in a large academic medical center. Categorical values were compared by chi-square test.Results: Eighty-five out of 150 (57%) faculty members completed the survey. Forty-one percent of participants were very confident that their LOR provided adequate content to assess residents during the application process. Confidence was associated with higher academic rank (p=0.02), frequent contact with residents (p=0.01), and writing >2 LOR in the last five years (p=0.0002). Confident LOR writers were more likely to describe their own background, details about the resident's scholarly activity, and the resident's ability to work as part of a team. Thirty-five percent of respondents reported never considering gender bias when writing LOR, whereas 28% reported always considering gender bias. Eighty-seven percent of respondents reported an interest in receiving LOR writing guidelines.Conclusion: Half of the faculty respondents were not very confident in their ability to write an effective LOR for pediatric residents applying for a fellowship. Faculty development and standardized instructions on writing effective LOR may be helpful both at the institutional and national levels, including the importance of considering gender bias when writing LOR.

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Internal medicine fellowship directors’ perspectives on the quality and utility of letters conforming to residency program director letter of recommendation guidelines

Cited by 8 publications

References 15 publications

Race and Gender Bias in Internal Medicine Program Director Letters of Recommendation

Race and Gender Bias in Internal Medicine Program Director Letters of Recommendation

A Call to Improve Conditions for Conducting Holistic Review in Graduate Medical Education Recruitment

Confidence of Faculty in Writing Letters of Recommendation for Pediatric Fellowship Applicants

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