Evaluation of the Current Perspectives on Letters of Recommendation for Residency Applicants among Plastic Surgery Program Directors

Background. The goals of this project were to evaluate the current perspective on letters of recommendation and to assess the need for, and acceptance of, a more standardized letter of recommendation (LOR). Methods. An eight-question survey was distributed to plastic surgery program directors. A five-point Likert scale was selected as a means of quantifying the participants’ responses to the survey. Results. Twenty-eight of 71 program directors (39.4%) completed the survey. The majority of participants felt that current LOR did not offer a realistic way to compare applicants ( , ). While most agreed that increasing the objectivity of LOR would be valuable in comparing applicants ( , ), the overall average response to whether a more standardized letter format would improve the resident selection process remained only slightly better than neutral ( , ). Most of the chairmen supported the notion that familiarity with the author of the LOR strengthened the recommendation ( , ). Conclusion. The majority of plastic surgery program directors would like more objectivity in comparing applicants but are ambivalent about a standardized letter of recommendation. 1. Introduction Plastic surgery residency candidates are increasingly competitive which, in turn, raises the complexity of selecting the most qualified applicants. Rating applicants is a multifactorial process involving the assessment of many variables including grades, class rank, performances at subinternship rotations, USMLE scores, AOA and other honors, research accomplishments, and letters of recommendation. In a recent study by Janis and Hatef, a survey was conducted to assess the current method of plastic surgery resident selection and program directors’ satisfaction with the process. The study demonstrated that although many directors were displeased with the current system, few changes have been made towards improvement. Interestingly, letters of recommendation were found to be a valuable criterion for selection, yet letters of recommendation remain primarily a subjective measure of a candidate’s character and quality. Attrition rates from residency programs were deemed unacceptably high, which may reflect a problem with applicant selection. It was concluded that increasing objectivity might raise overall satisfaction [1]. Recently, letters of recommendation have been under scrutiny across many specialties. While some feel that letters of recommendation are an invaluable component in the overall evaluation of each applicant, others argue that, as the number and quality of applicants rise, current