Standardized Letters of Recommendation and Match Success Among Orthopaedic Surgery Residency Applicants

Standardized letters of recommendation (SLORs) aim to make applicant letters more comparable, but score inflation raises concerns about their usefulness. In orthopaedic surgery, the 2023 SLOR was similarly affected.

To evaluate the 2023 SLOR's association with orthopaedic surgery residency Match success and the association between below-average scores and Match outcomes.

We reviewed all applications to our orthopaedic surgery residency program during the 2023-2024 cycle, including demographics, objective applicant metrics, and 2023 SLOR scores (7 criteria, 10-point scale). SLORs are optional, and applicants may submit 0 to 4 at our program. Match success was defined as matching into an orthopaedic surgery residency program by the start of the next academic year, confirmed via internet search. Univariate testing and multivariable logistic regression evaluated associations between objective metrics, SLOR scores, and Match success. Effect estimates are reported with 95% confidence intervals (CIs).

Of 492 applications, 367 (75%) contained 2023 SLORs; of these, 234 applicants (64%) matched into orthopaedic surgery. Matched applicants had higher mean cumulative SLOR scores than unmatched applicants (8.9±0.8 vs 8.3±1.2; difference, 0.6; 95% CI, 0.3-0.8; P<.001), and mean score was independently associated with Match success (OR, 1.80; 95% CI, 1.36-2.38). Across all SLORs, a single score of 6 or below (n=37) was not associated with reduced Match success, whereas multiple such scores (n=44) were associated with a 42 percentage point lower Match rate (36% vs 78%; 95% CI, -58 to -21; P<.001).

Higher 2023 SLOR scores were positively associated with Match success. A single score of 5 or 6 was not associated with decreased Match success, whereas multiple such ratings were.