I Highly Recommend This Candidate: Survey of PGY1 Program Directors Regarding Residency Letter Recommendation Levels

The impressions of Postgraduate Year 1 (PGY1) residency program directors (RPDs) on the utility of the recommendation concerning admission portion of the Pharmacy Online Residency Centralized Application Service (PhORCAS) letter of recommendation (LOR) for residency candidate applications was evaluated.

This was a cross-sectional, survey-based study addressed to RPDs of American Society of Health-System Pharmacists (ASHP)-accredited residency programs. A 10-item survey assessing program demographics, current rating scales, and alternative rating scales was administered electronically. The primary outcome was to determine the perceived utility of the level of recommendation scale (PhORCAS recommendation concerning admission) for residency applicants. The secondary outcomes assessed the perceived usability and objectivity of alternative scales.

The majority of respondents (309/551) indicated the current level of recommendation scale format was only somewhat effective (56%) and that the recommendation level selected by letter writers impacted their ability to assess applications to at least some degree. This included statistically significant distributions of responses regarding the impact of evaluation options (p < .001) and inflation (p < .001). An alternative 5-point scale with associated percentile guidance was chosen by the majority of RPDs as the most useful (65%) and most objective (68%) rating scale. Varying respondent demographics did not significantly affect the perceived usefulness and objectivity of the various rating scales.

A significant proportion of RPDs find the utility of the current level of recommendation scale limited and may prefer a rating scale with additional points and percentile guidance for both usefulness and objectivity.