Writing a Medical Student LOR
L Noronha, MDHospitalist Best Practices
April 29, 2015
Review residency application timeline
Describe pertinent literature
Provide recommendations for DHM faculty to write effective LORs
Objectives
Phase II: 4/28/14 – 4/24/15 Jan/Feb ’15: meet with assigned match advisor 3/2/15: submit Phase III schedule
Phase III: 4/27/15 – 4/24/16 Required Sub-I, ICU, CAC, Med in NM Step 2 CS/CK, 4 electives, research
SOM Class of 2016 Timeline
Mid-Sept: ERAS due Nov-Jan: Interview season Late Jan: submit rank list March: match day
Timeline cont’d
Schedule Sub-I by September for LOR UNM Sub-I before “Audition rotation”
Solicit 3 LORs 1 from UNM faculty in selected field
Can write strong supportive letter Request LOR 6wks before due date* Submit personal statement/CV to LOR writer
Typical advicefrom OMSA/match advisors
LOR Due date is 10 weeks after Match Day
AAMC LORP
Students Can See When You Have Uploaded Your LOR
Students Can Assign Your Letter to Selected Programs
PubMed/MeSH: EM, med school studies No correlation with performance
Academic Medicine/Green Journal Dept LOR (format, value, inconsistency)
Google IM LOR, EM SLOR, Surgery LOR, ENT LOR, Anesth
LOR
Literature Review
“Fantasy Land”
1
DeZee, K, et al ,“Letters of Recommendation: Rating, Writing, and Reading by Clerkship Directors of Internal
Medicine”, Teaching and Learning in Medicine: An International Journal, 2009, 21:2, 153-158
• 2006 CDIM survey• Questions about residency and
medical school application LOR’s• Features and importance of
LOR’s
• 83 of 110 institutional members responded
LOR: R, W, R
Review of med school/residency LOR lit Describes LOR in other sectors Among authors’ reccs
Remember the responsibility you have to the profession of medicine
Rank among peers Offer for recipient to call you to clarify content
Wright S, “Writing More Informative Letters of Reference”, JGIM. 2004;19:588-593
1. Integrity2. Motivation3. Capacity4. Understanding
5. Knowledge and experience
Dee Hock’s Hiring Criteria*
*adapted from: http://www.fastcompany.com/27454/dee-hock-management
2
https://www.sgim.org/File%20Library/SGIM/Resource%20Library/Meeting%20Handouts/SGIM/2012/WB09KdZhandout.pdf
LOR Checklist from LTC Kent J. DeZee, MD MPH FACP
Grall K, et al “Analysis of the Evaluative Components on the Standard Letter of Recommendation (SLOR) in Emergency Medicine”. Western Journal of Emergency Medicine. Vol XV (4) July 2014.
Reviewed 1457 SLORs to U of A EM programs (26.7% of ERAS applicants)
91-96% of responses in top 2 tiers
Conclusion: does not discourage grade inflation!
EM SLOR
3
2014 PD Match Survey (All)
2014 IM PD Survey
9 faculty surveyed on LOR opinions during 1st 2 weeks of February (just after rank list)
PD/former PD/APDs/Faculty recommended by residency coordinators
Survey of UNM DOIM Faculty
Structured 20 minute indiv/small group interviews Author LOR format/appearance LOR Content
Student characteristics Language
Other comments
DOIM Faculty Survey
Phase II/3rd year clerkship attending Sub-I attending
Mentor Title (i.e. PD, APD, CD)
Notes on Author
Format
Describe extent of relationship, investigation Indicate if spoke to others
Describe ward structure, patient load Observations
Growth over time Incorporation of feedback
Close Prognosis, whether you want them
Format, Part 2
Teamwork/Compatibility Ward team Multidisc
Connection with patients Flexibility Communication
Content
Desirable characteristics to describe
“Gets it” [the big picture] Can communicate detail and summary as
needed “Would want to care for my family member” “Took on the patients no one else wanted to
see” “Functioning like an intern” (include how) “Joy to work with”
Winners
Meets expectations On time Professionally dressed
Solid Satisfactory Good
Language for an average/weak LOR
Keep notes on students for whom you agree to write a LOR (i.e. email folder)
Schedule a brief meeting before you compose LOR Review personal statement/CV prior Discuss career plans, issues in application to counter, where
applying Review Dr. DeZee’s checklist Use DoIM letterhead, date with final version, ink sign/scan Show to others for review before uploading
Suggested LOR Best Practices
Kent J. DeZee , Matthew R. Thomas , Matthew Mintz & Steven J. Durning (2009) Letters of Recommendation: Rating, Writing, and Reading by Clerkship Directors of Internal Medicine, Teaching and Learning in Medicine: An International Journal, 21:2, 153-158, DOI: 10.1080/10401330902791347
Friedman RB. Fantasy land. N Engl J Med. 1983;308(11):651-653.
Rodriguez RG, Dezee KJ, Byars LA, Hemmer PA. Letters of recommendation: how to rate, write, and use them in your evaluationof applicants. Workshop presented at Academic Internal Medicine Week, 2011. Available at: http://www.im.org/Meetings/Past/2011/AIMW11/Presentations/Documents/2011%20CDIM
Wright SM, Ziegelstein RC. Writing more informative letters of reference. J Gen Intern Med. 2004;19:588-593.
Keim SM, et al. A Standardized Letter of Recommendation for Residency Application. Acad Emerg Med 1999;6(11):1141-6. [Detailed explanation of the EM standardized LOR, the only currently used standardized LOR]
Grall K, et al “Analysis of the Evaluative Components on the Standard Letter of Recommendation (SLOR) in Emergency Medicine”. Western Journal of Emergency Medicine. Vol XV (4) July 2014.
AAMC 2014 Annual Report: https://members.aamc.org/eweb/upload/2014%20Annual%20Report%20non-flash.pdf
AAMC LoRP: https://www.aamc.org/services/eras/282520/lor_portal.html
2015 Main Residency Match Advanhttp://www.nrmp.org/wp-content/uploads/2015/03/ADT2015_final.pdfce Data Tables : http://www.nrmp.org/wp-content/uploads/2015/03/ADT2015_final.pdf
References
Questions