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