The Role of Letters of Recommendation in the Selection Process of Surgical Residents in Canada: A National Survey of Program Directors

Marwan, Yousef; Waly, Feras; Algarni, Nizar; Addar, Abdullah; Saran, Neil; Snell, Linda

doi:10.1016/j.jsurg.2017.01.006

Cited by 20 publications

(11 citation statements)

References 20 publications

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“…Orthopaedic surgery residency selection committees and applicants consider the narrative letter of recommendation an important subjective component of the residency application [5,25]. However, the opportunity for confidential communication regarding intangible components of an applicant (such as work ethic, interpersonal skills, teamwork, and other such traits) often is vague [14,16,24,27], which leaves the reader feeling as if he or she is trying to crack a code to grasp the letter writer's intention. One prior study attempted to evaluate inter-reader agreement of narrative letters of recommendation using an overall impression of the.…”

Section: Discussionmentioning

confidence: 99%

Are Narrative Letters of Recommendation for Medical Students Interpreted as Intended by Orthopaedic Surgery Residency Programs?

Egan

Dashe

Hussein

et al. 2021

Clin Orthop Relat Res

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Background Narrative letters of recommendation are an important component of the residency application process. However, because narrative letters of recommendation are almost always positive, it is unclear whether those reviewing the letters understand the writer’s intended strength of support for a given applicant. Questions/purposes (1) Is the perception of letter readers for narrative letters of recommendation consistent with the intention of the letter’s author? (2) Is there inter-reviewer consistency in selection committee members’ perceptions of the narrative letters of recommendation? Methods Letter writers who wrote two or more narrative letters of recommendation for applicants to one university-based orthopaedic residency program for the 2014 to 2015 application cycle were sent a survey linked to a specific letter of recommendation they authored to assess the intended meaning regarding the strength of an applicant. A total of 247 unstructured letters of recommendation and accompanying surveys were sent to their authors, and 157 surveys were returned and form the basis of this study (response percentage 64%). The seven core members of the admissions committee (of 22 total reviewers) at a university-based residency program were sent a similar survey regarding their perception of the letter. To answer our research question about whether letter readers’ perceptions about a candidate were consistent with the letter writer’s intention, we used kappa values to determine agreement for survey questions involving discrete variables and Spearman correlation coefficients (SCCs) to determine agreement for survey questions involving continuous variables. To answer our research question regarding inter-reviewer consistency among the seven faculty members, we compared the letter readers’ responses to each survey question using intraclass correlation coefficients (ICCs). Results There was a negligible to moderate correlation between the intended and perceived strength of the letters (SCC 0.26 to 0.57), with only one of seven letter readers scoring in the moderate correlation category. When stratifying the applicants into thirds, there was only slight agreement (kappa 0.07 to 0.19) between the writers and reviewers. There were similarly low kappa values for agreement about how the writers and readers felt regarding the candidate matching into their program (kappa 0.14 to 0.30). The ICC for each question among the seven faculty reviewers ranged from poor to moderate (ICC 0.42 to 0.52). Conclusion Our results demonstrate that the reader’s perception of narrative letters of recommendation did not correlate well with the letter writer’s intended meaning and was not consistent between letter readers at a single university-based urban orthopaedic surgery residency program. Clinical Relevance Given the low correlation between the intended strength of the letter writers and the perceived strength of those letters, we believe that other options such as a slider bar or agreed-upon wording as is used in many dean’s letters may be helpful.

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Section: Discussionmentioning

confidence: 99%

Are Narrative Letters of Recommendation for Medical Students Interpreted as Intended by Orthopaedic Surgery Residency Programs?

Egan

Dashe

Hussein

et al. 2021

Clin Orthop Relat Res

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“…51 While professionalism, medical knowledge, and technical skills have historically been a part of these letters, recently concepts of teamwork, systems-based practice, and volunteerism have been emphasized 52 but familiarity with the letter writer is still considered an important factor. 53 Determining the academic reputation of a medical school may also be difficult as many medical universities have multiple medical schools. For example, the All India Institute of Medical Sciences has 15 different medical schools.…”

Section: The Fair Evaluation Of the Indian Residency Applicantmentioning

confidence: 99%

A Primer on General Surgery Applicants Who Have Graduated From Indian Medical Schools

Schenarts

Panwar

Krishnamurty

et al. 2023

The American Surgeon™

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Background: Graduates of Indian medical schools account for the greatest proportion of non-US born international medical graduates applying to general surgery residency programs. Purpose: Provide information to facilitate fair and holistic review of applicants from Indian medical schools. Research Design: Comprehensive review of the Indian medical education system, including history, regulatory agencies, medical school admission, curriculum, cultural differences, immigration issues, and outcomes after residency. Results: The Indian medical education system is one of the world’s oldest. The number of medical schools and graduates continues to increase. Medical school admission criteria are variable. Recent regulatory changes have improved the quality of applicants entering the US. Emphasis on academic performance over volunteerism as well as communication styles differ from US graduates. The success of graduates during and after residency is well documented. Conclusions: Understanding the differences in the US and Indian medical education systems will provide a basis for the fair evaluation of applicants.

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“…While SRLs have not been implemented for Canadian surgical programs, a study published in 2017 found that about half of Canadian surgical program directors would recommend the use of SRLs and think that this would improve the selection process. 5 Evidence supporting SRLs There is evidence supporting the use of SRLs (also known as standardized letter of recommendation or standardized letter of evaluation) for residency applications, primarily from the United States (US) EM match where over half of programs require at least one EM-specific SRL. The US EM SRL was first introduced in 1999 by the Council of EM Residency Directors to provide a more objective evaluation of actual performance that can be used to compare applicants for optimal program fit.…”

Section: Contextmentioning

confidence: 99%

Should Canadian urology adopt structured reference letters for residency matching?

Nguyen

Chan²,

Andonian³

et al. 2022

CUAJ

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ConclusionsIt is increasingly relevant to innovate the CaRMS match considering the ever-increasing pressure on residency programs to rank potential residents with fixed resources, visiting electives, and switch to virtual interviews in the context of the COVID-19 pandemic and possibly moving forward as well. While there are many advantages to a urology-specific SRL for the Canadian match, there are potential pitfalls and limitations. If the SRL is adopted, its development and adoption should engage all relevant stakeholders, including trainees, and proceed in a stepwise fashion. CUAJ -Residents' RoomNguyen et al Structured reference letters for residency matching 5

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The Role of Letters of Recommendation in the Selection Process of Surgical Residents in Canada: A National Survey of Program Directors

Cited by 20 publications

References 20 publications

Are Narrative Letters of Recommendation for Medical Students Interpreted as Intended by Orthopaedic Surgery Residency Programs?

Are Narrative Letters of Recommendation for Medical Students Interpreted as Intended by Orthopaedic Surgery Residency Programs?

A Primer on General Surgery Applicants Who Have Graduated From Indian Medical Schools

Should Canadian urology adopt structured reference letters for residency matching?

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