Emergency medicine standardized letter of recommendation: predictors of guaranteed match

The Council of Emergency Medicine Residency Directors (CORD) standardized letter of recommendation (SLOR) has become a common, reliable, and useful tool in the evaluation of emergency medicine (EM) applicants. A "guaranteed match" (GM) is the SLOR's bottom-line superlative response. It is also the SLOR's least common superlative response. Because candidates receiving a GM are a select group, the authors thought it would be useful to identify SLOR information that predicts a GM recommendation.

This was a secondary analysis of a database of all EM SLORs submitted to a single EM residency during the 1998--1999 application cycle to one EM residency program. Response to GM and 16 data points in the background/qualification sections were analyzed by chi-square, univariate analysis, and logistic regression.

Four hundred eleven SLORs were analyzed. Qualification information was more predictive than background information for applicants receiving a GM. The highest univariate odds ratios for background information were "staff author" (OR = 1.7, 1.0--2.8), "extended contact" (OR = 2.2, 1.0--4.5), "clinical contact outside the ED" (OR = 3.0, 1.5--5.9), and "honors on EM rotation" (OR = 5.4, 3.0--9.8). The highest univariate odds ratios for qualification information were "outstanding differential diagnosis ability" (OR = 10.1, 5.8--17.4), "outstanding work ethic" (OR = 13.1, 5.2--33.3), and "outstanding global assessment" (OR = 58, 24.2--139). Logistic regression analysis demonstrated "outstanding global assessment" (p < 0.000; r = 0.92) and "outstanding work ethic" (p = 0.028; r = 0.71) to be statistically predictive of GM.

There were both background and qualification data points predictive of a "guaranteed match." Qualification information had a greater predictive value than background information. Medical student applicants, letter writers, and letter evaluators may find this information useful when dealing with SLORS.