Reference letters for subspecialty medicine residency positions: are they valuable for decision-making? Results from a Canadian study

• Published in: BMC medical education 2020-10, Vol.20 (1), p.350-350, Article 350
• Main Authors: Chopra, Deepti, Joneja, Mala, Sandhu, Gurjit, Smith, Christopher A, Spagnuolo, Catherine M, Hookey, Lawrence
• Format: Article
• Language: English
• Subjects: Audits; Canada; Coding; Communicable Diseases; Directors; Educational aspects; Ethics; Evaluation; Graduate medical education; Humans; Internal medicine; Internship and Residency; Letter of recommendation; Letters; Letters (Correspondence); Literature reviews; Medical education; Medicine; Medicine subspecialty match; Rating Scales; Reference letter; Research Assistants; Residents; Residents (Medicine); Retrospective Studies; Statistical Analysis; Supervisors; Training; Writers; Writing
• ISSN: 1472-6920; 1472-6920
• DOI: 10.1186/s12909-020-02270-7

The letter of recommendation is currently an integral part of applicant selection for residency programs. Internal medicine residents will spend much time and expense completing sub-specialty away electives to obtain a letter of recommendation. The purpose of this study was 1) to examine a large sample of reference letters in order to define essential components of a high-quality letter, and 2) to elucidate the relationship between quality of reference letter and the letter writer. We conducted a two-phase study. In phase one, a large sample of letters of recommendation was examined using an audit tool as a coding framework. A 5-point composite endpoint of high-quality letter components was subsequently developed. In phase two, program director letters were compared to non-program director home institution and non-home institution elective letters based on inclusion of components of the 5-point composite endpoint using Chi square testing. 715 letters were examined (398 non-program director home institution letters, 201 program director letters, and 116 non-home institution elective letters). High-quality letter components were: nature of relationship, duration of relationship, In Training Evaluation Report information, research involvement and comments on areas for improvement. Program director letters had a significantly higher proportion (10.4%) of all 5 high-quality components, compared to 0% in both non-program director home institution letters and elective letters (p