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The Impact of Standardized Letter of Recommendation Origin on Orthopedic Surgery Residency Match Outcomes
Sarah Bergren1, Julian Wier1, Hannah Shelby1
1Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, California.
Objective:
Orthopedic surgery remains one of the most competitive specialties in the United States residency match processes. Many factors are considered when evaluating applicants, including the Standardized Letters of Recommendation (SLORs). Away rotations play another instrumental role in the match. As both SLORs and away rotation play an important role in the orthopedic surgery match process, it is important to understand how home versus away SLOR writers influence match rates.
Setting:
An individual, academic orthopedic surgery residency program accredited by the Accreditation Council for Graduate Medical Education in the United States.
Participants:
Individual applications submitted to the residency program for the 2023 to 2024 orthopedic surgery residency application cycle were reviewed. After identifying 8.9 as the 50th percentile of SLOR scores, SLORs were divided into "high" scores (>8.9) and "low" scores (≤8.9) (50th percentile) and match rates to orthopedic surgery programs between high and low scoring SLORs were compared using an adjusted odds ratio, while accounting for demographic and academic variables.
Results:
About 350 SLORs were identified from 200 unique applications with an average score of 8.7 ± 1.2, without differences between scores from home versus away institutions. The unadjusted match rate for applicants with a high home SLOR score was 88.5%, while those with a high away SLOR score only demonstrated a 66.0% match rate. After adjusting for confounding variables, applicants with a high scoring home SLOR were 4 times more likely to match than applicants with a high scoring away SLOR (p = 0.017). There was no difference in match success of applicants with low scoring SLORs from home versus away institutions.
Conclusions:
Applicants with high-scoring home SLORs were associated with significantly improved match rates than those received from away rotations only, despite no significant difference in actual SLOR score.