What Are We REALLY Looking for in a Letter of Recommendation?

Rajesh, Aashish; Rivera, Mariela; Asaad, Malke; Chandra, Abhishek; Baloul, Mohamed S.; Backstrom, Courtney; Shaikh, Nizamuddin; deAzevedo, Rafael U.; Farley, David R.

doi:10.1016/j.jsurg.2019.06.008

Cited by 34 publications

(23 citation statements)

References 17 publications

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“…Meanwhile, the absence of superlative descriptors such as no adverb to follow ‘I recommend’, is viewed as a red flag. The importance of keywords is further highlighted in surgery LORs where similar key phrases such as ‘we will plan to recruit this candidate’, and ‘I give my highest recommendation’ were highly valued [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…These keywords and phrases may also be categorized based on an unofficial hierarchy. For instance, in surgery LORs [ 13 ], the phrase ‘One of the best’ is considered superlative to ‘Outstanding’, which in turn trumped the word ‘excellent’. As such, unfamiliarity with this classification system may cause inexperienced letter-writers to convey a message different than intended.…”

Section: Discussionmentioning

confidence: 99%

“…Standardized LORs were introduced to simplify LORs, minimize of the ‘variance between applicants’ attributes’ and reduce superlatives bias often seen in narrative LORs [ 17 ]. This switch has brought on mixed results, with reports of improved inter-rater reliability, more efficient interpretation of LORs time, and reduced gender bias [ 17 ], but also reports of grade inflation, which fails to mitigate the superlative inflation seen in narrative LORs [ 13 , 17 ]…”

Section: Discussionmentioning

confidence: 99%

“…However, the importance of the description of the nature of this relationship is conflicting in prior studies. For instance, a narrative description of the letter writer and applicant relationship was found to be extremely valuable in Dermatology residency candidates[ 4 ], but was found to be less important in general surgery residency candidates[ 13 ].…”

Section: Discussionmentioning

confidence: 99%

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Attitudes towards and impact of letters of recommendation for anesthesiology residency applicants

Pierre

Weber

Abramowicz

2021

Medical Education Online

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Background: This survey aims to identify the relative value and the critical components of anesthesiology letters of recommendation(LORs) from the perspective of Program Directors (PDs) and Associate/Assistant Program Directors (APDs). Knowledge and insights originating from this survey might add to the understanding of the anesthesiology residency selection process and mitigate unintended linguistic biases. Methodology : Anonymous online surveys were sent to anesthesiology PDs/APDs from the Accreditation Council for Graduate Medical Education (ACGME) accredited anesthesiology residency Programs in the USA (US), as listed on the ACGME website and the American Medical Association Fellowship and Residency Electronic Interactive Database (AMA FREIDA) Residency Program Database. The survey authors were blinded to the identity of the respondents. Results : 62 out of 183 (33.8%) invited anesthesiology PDs/APDs completed the survey anonymously. In our survey, LORs are reported as more important in granting an interview than in making the rank list. 64% of respondents prefer narrative LORs. 77.4% of respondents look for specific keywords in LORs. Keywords such as ‘top % of students’ and ‘we are recruiting this candidate’ indicate a strong letter of recommendation while keywords such as ‘I recommend to your program’ or non-superlative descriptions indicate a weak letter of recommendation. Other key components of LORs include the specialty of the letter-writer, according to 84% of respondents, with anesthesiology as the most valuable specialty. Although narrative LORs are preferred, 55.1% of respondents are not satisfied with the content of narrative LORs. Conclusion : LORs containing specific keywords play an important role in the application to anesthesiology residency, particularly when submitted by an anesthesiologist. While narrative LORs are still the preferred format, most of our respondents feel they need improvements. The authors suggest specific LOR improvements including creating formalized LOR training, adding a style guide, and applying comparative scales, with standardized vocabulary in the narrative LOR.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Attitudes towards and impact of letters of recommendation for anesthesiology residency applicants

Pierre

Weber

Abramowicz

2021

Medical Education Online

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“…In response to these noted shortcomings, program directors and medical educators are often asked to comment on what could make LORs more helpful. Researchers have examined, in a limited fashion, the role of the letter writer [10], key elements and phrases in letters and correlations between LORs with objective data [11,12].…”

Section: Introductionmentioning

confidence: 99%

Reference letters for subspecialty medicine residency positions: are they valuable for decision-making? Results from a Canadian study

et al. 2020

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Background The letter of recommendation is currently an integral part of applicant selection for residency programs. Internal medicine residents will spend much time and expense completing sub-specialty away electives to obtain a letter of recommendation. The purpose of this study was 1) to examine a large sample of reference letters in order to define essential components of a high-quality letter, and 2) to elucidate the relationship between quality of reference letter and the letter writer. Methods We conducted a two-phase study. In phase one, a large sample of letters of recommendation was examined using an audit tool as a coding framework. A 5-point composite endpoint of high-quality letter components was subsequently developed. In phase two, program director letters were compared to non-program director home institution and non-home institution elective letters based on inclusion of components of the 5-point composite endpoint using Chi square testing. Results 715 letters were examined (398 non-program director home institution letters, 201 program director letters, and 116 non-home institution elective letters). High-quality letter components were: nature of relationship, duration of relationship, In Training Evaluation Report information, research involvement and comments on areas for improvement. Program director letters had a significantly higher proportion (10.4%) of all 5 high-quality components, compared to 0% in both non-program director home institution letters and elective letters (p < 0.001). A significantly higher proportion of program director letters had 4–5 high-quality components (62.5%) compared to 2% of non-program director home institution letters and 0% of elective letters (p < 0.0001). Conclusions Letters of recommendation from elective rotations are of the poorest quality and such rotations should not be pursued for the sole purpose of obtaining a letter. The low quality of elective letters leads to the recommendation that writers should decline to write them, programs should not require them and trainees should not request them. Program directors write the highest quality letters and should be a resource for faculty development. Clinical supervisors can use the 5-point composite endpoint as a guide when writing letters for applicants.

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A primer on writing a narrative letter of recommendation for medical students applying to residency

Landry

Coates

Gottlieb

2023

AEM Education and Training

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Letters of recommendation (LORs) are a significant component of the residency application process. [1][2][3] Historically, standardized exams, clerkship grades, and honor societies, were prioritized. 4 However, the shift to holistic review, combined with pass/fail scoring for United States Medical Licensing Examination (USMLE) Step 1, has diminished the rigid, metric-driven components of the application. 5,6 LORs increasingly factor into the decision making process for interview invitations and rank lists. 7 Further, studies have shown LORs to be often biased against women and applicants underrepresented in medicine (UiM). 8 While there is guidance on writing standardized LORs, resources for creating a narrative LOR are more limited. 2,[9][10][11][12][13][14][15] This primer will guide authors on writing narrative LORs for medical students who are applying to residency programs.Recommendations are based on published evidence and the combined experience of the authors. All authors have held positions as advisors and mentors to medical students, residents, fellows, and faculty across four separate academic institutions (e.g., core residency faculty, leadership in undergraduate and graduate medical education, service on medical school admissions committees, residency and fellowship selection committees, and authorship of numerous LORs across all levels of training).

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What Are We REALLY Looking for in a Letter of Recommendation?

Cited by 34 publications

References 17 publications

Attitudes towards and impact of letters of recommendation for anesthesiology residency applicants

Attitudes towards and impact of letters of recommendation for anesthesiology residency applicants

Reference letters for subspecialty medicine residency positions: are they valuable for decision-making? Results from a Canadian study

A primer on writing a narrative letter of recommendation for medical students applying to residency

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