The LETTER of Recommendation: Showcasing a Student's Strengths

Pearls and pitfalls in letters of recommendation for neurology residency applications

Letters of recommendation are a cornerstone of residency applications. Variability and bias in letters exists across specialties, neurology being no exception. Studies done in other specialty fields assessing nuanced language uncovered key attention points for improvement and mitigation of bias, lessons from which should be applied in the field of neurology. We review common pearls and pitfalls in the letter solicitation, writing and reading process, with suggested best-practices for residency applicants, letter writers, and program faculty reviewers. We advocate for the thoughtful selection of writers, emphasis on highlighting professional skills, and attention to implicit bias. This discussion focuses on recommendations for US advanced or categorical neurology programs, but elements of this guidance may apply more broadly to fellowship and faculty promotion letters as well.

Writing effective letters of recommendation in physiology

A letter of recommendation is a statement of support for a person that has been requested by some individual or organization. In physiology, the purpose of the letter may be to support admission to an academic program, funding of a fellowship grant proposal, consideration for a trainee position in a research laboratory, an award from a professional society, or an application for a job. The goal of the letter should be to provide personalized insight into the suitability of the candidate for the position or award that cannot be easily obtained from other materials in an application or nomination process. Despite the importance of writing effective letters of recommendation, most physiologists receive no formal training in this requisite professional skill. In this Perspective, I first discuss the responsibilities and challenges of writing letters of recommendation, for whom you should consider writing a letter, the pros and cons of asking the candidate to create an initial draft, and the information required for you to write a letter. I then describe a helpful structure to follow when writing a letter of recommendation, including the opening paragraph (introduction), main body, and summary sections. Next, I share 10 insider tips for writing effective letters of recommendation. I complete the commentary by discussing special circumstances, including writing letters for solid but not highly ranking candidates and acting as a "substitute" for a primary mentor. It is hoped that this perspective will provide guidance for early career physiologists in this essential skill of the profession.NEW & NOTEWORTHY This Perspective provides essential background, a step-by-step guide, and key insider tips for writing an effective letter of recommendation aimed at helping early career physiologists with this important professional task.

Confidence of Faculty in Writing Letters of Recommendation for Pediatric Fellowship Applicants

BACKGROUND

The assessment of pediatric residents applying to subspecialty fellowship programs relies on faculty letters of recommendation (LOR). However, it is unclear if pediatric faculty are confident that their LOR are effective.

OBJECTIVE

This study aims to assess the confidence of pediatric faculty in writing an effective LOR for pediatric residents applying to subspecialty fellowship programs.

METHODS

Survey development was conducted using evidence-based best practices. Surveys were distributed via email in 2021 to all full-time pediatric faculty members who taught pediatric residents in a large academic medical center. Categorical values were compared by chi-square test.

RESULTS

Eighty-five out of 150 (57%) faculty members completed the survey. Forty-one percent of participants were very confident that their LOR provided adequate content to assess residents during the application process. Confidence was associated with higher academic rank (p=0.02), frequent contact with residents (p=0.01), and writing >2 LOR in the last five years (p=0.0002). Confident LOR writers were more likely to describe their own background, details about the resident's scholarly activity, and the resident's ability to work as part of a team. Thirty-five percent of respondents reported never considering gender bias when writing LOR, whereas 28% reported always considering gender bias. Eighty-seven percent of respondents reported an interest in receiving LOR writing guidelines.

CONCLUSION

Half of the faculty respondents were not very confident in their ability to write an effective LOR for pediatric residents applying for a fellowship. Faculty development and standardized instructions on writing effective LOR may be helpful both at the institutional and national levels, including the importance of considering gender bias when writing LOR.