Letters of Recommendation: Association with Interviewers' Perceptions and Preferences

Objective Letters of recommendation (LORs) are an inescapable aspect of the application process. Standardized LORs (SLORs) have been developed and compared with traditional narrative LORs (NLORs). This study investigated whether there was a difference in degree of association between LOR types and face-to-face interviews. Interviewer preference for LOR was anonymously surveyed. Study Design Survey. Setting Single-institution otolaryngology residency program, 1 year before and 4 years after introduction of SLORs. Subjects and Methods Residency interviewers indicated on a visual analog scale how well their impression of an applicant compared between the LOR and the face-to-face interview. Interviewers assessed each applicant, each year, based on LOR type. Results Of 2573 assessments, 964 were collected (37.5% response rate), including 927 responses related to NLORs, 561 to SLORs, and 316 to medical student performance evaluations (ie, dean's letters). The average association of VAS scores between LORs and interviews ranged from 72 to 81 across years and LOR types. Sixty-one percent of interviewers preferred NLORs, and 13% preferred SLORs. Reasons for these preferences included more information provided in NLORs versus faster read time with SLORs. Conclusions Interviewers' perceptions of applicants based on LORs and face-to-face interviews were comparable across LOR types over the last 5 years. For many reasons, the general utility of the LOR remains questionable, and the continued need for it should be critically assessed.