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Dear Program Director: Deciphering Letters of Recommendation.

Kris Saudek, David Saudek, Robert Treat

    Journal of Graduate Medical Education
    |June 28, 2018
    PubMed
    Summary
    This summary is machine-generated.

    Program directors consistently interpret phrases in letters of recommendation (LORs), with "highest recommendation" being most positive and "showed improvement" most negative. This impacts candidate impressions in residency applications.

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    Area of Science:

    • Medical Education
    • Graduate Medical Education

    Background:

    • Letters of recommendation (LORs) are crucial for residency and fellowship applications.
    • Research on program director (PD) interpretation of LORs, particularly coded language, is limited.

    Purpose of the Study:

    • To analyze how PDs interpret various components of LORs.
    • To differentiate perceived recommendation levels based on LOR content.

    Main Methods:

    • A cross-sectional survey was administered to pediatrics residency and fellowship PDs.
    • PDs rated letter features, applicant abilities, and common phrases on a 5-point Likert scale.
    • Principal component analysis grouped phrases, and statistical tests analyzed mean score differences.

    Main Results:

    • The phrase "I give my highest recommendation" was perceived most positively, while "showed improvement" was most negative.
    • Three distinct groups of phrases emerged: positive (mean 4.4), neutral (3.4), and negative (2.6), with significant differences between all groups (P < .001).
    • A 43% response rate was achieved from 468 PDs.

    Conclusions:

    • PDs demonstrate consistent interpretation of common phrases within LORs.
    • Specific phrases significantly influence PDs' perceptions of applicants.
    • Understanding these phrase interpretations is key for effective LORs in graduate medical education.