Dear Program Director,

Lenny Noronha, MD

Division of Hospital Medicine

University of New Mexico School of Medicine

Hospitalist Best Practices

August 15, 2018

After attending this session, participants will be prepared to:

Explain the current purpose and weight of letters of recommendation (LORs) for residency selection

Write LORs for students in less than 1 hour

Objectives

Describe LOR significance, operations – 5 minutes

Small group exercise #1 (Review selected LORs) –15minutes

Review LOR literature – 5 minutes

Discuss solutions to LOR challenges – 10 minutes

Interview ice-breaker – 20 minutes Tell us about a memorable letter you’ve written or about

a pen pal experience!

Session Agenda

Early June: MyERAS opened

Early Sept: applications can be sent to programs

Early Oct: MSPEs released to programs

Nov-Jan: Interview season

Late Jan: submit rank list

March 15: Match Day

SOM Class of 2019 Timeline

Schedule Sub-I by September for LOR

UNM Sub-I before “Audition rotation”

Solicit 3-4 LORs

At least 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 advice from UNM OMSA/match advisors

AAMC LORP

Students Can See When You Have Uploaded Your LOR

Students Can Assign Your Letter to Selected Programs

Purpose: Refamiliarize attendees with typical letter format, content and personal preferences

Instructions:

Assign recorder

Read LORs

Record notes as table, please write on LORs

Small Group Exercise – 15 min

PubMed/MeSH: EM, med school studies No correlation with future performance

Academic Medicine/Green Journal Dept LOR (format, value, inconsistency)

Google IM LOR, EM SLOR, Surgery LOR, ENT LOR, Anesth LOR

Twitter Dr. Barrett

Literature Review

“Fantasy Land”

1

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

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

Survey of Peds PDs

Rated LOR features & common phrases

Compared language of LOR for resident vs fellow app

Saudek, K, et al, “Dear Program Director: Deciphering Letters of Recommendation”, J of Grad Med Ed, June 2018, 261-266.

1. Integrity

2. Motivation

3. Capacity

4. Understanding

5. Knowledge and experience

Dee Hock’s Hiring Criteria*

*adapted from: http://www.fastcompany.com/27454/dee-hock-management

2

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

2015 Survey of UNM DOIM Faculty

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/Content Recommendations

Teamwork/Compatibility Ward team

Multidisc

Connection with patients

Flexibility

Communication

Grammatical errors annoying

Single space, don’t indent

Additional Comments

Desirable characteristics to describe

“Gets it” [the big picture]

Can communicate detail and summary as needed

“Would want [him/her] 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

07/21/15 UNM OMED Lunch & Learn "Writing a Medical Student LOR"

Meets expectations

On time

Professionally dressed

Solid

Satisfactory

Good

Language for an average LOR

Challenging situations

Close to deadline, you’re already behind on other high priority tasks

Student that you weren’t impressed with or don’t remember

Since you’ve worked with student, you’ve learned something unfavorable about them

What do you do as the letter writer?

Questions and Comments

Meet with student before writing LOR (15 minutes)

Do it right away!

Use template format

Spell/grammar check

Please send to me for a 2nd set of eyes!

Template and tips are on wiki!

Suggested Best Practices

Thank you!

Wright S, “Writing More Informative Letters of Reference”, JGIM, 2004;19:588-593

04/15/16 WGEA Conference "Training Your Faculty to Write Meaningful Letters of Recommendation for Medical Students“, Leonard Noronha, MD & Ming-Li Wang, MD; University of New Mexico

Additional References: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

Keim SM, et al. A Standardized Letter of Recommendation for Residency Application. AcadEmerg Med 1999;6(11):1141-6. [Detailed explanation of the EM standardized LOR, the only currently used standardized LOR]

Irby D, Milam S, The Legal Context for Evaluating and Dismissing Medical Students and Residents. Acad Med. 64(1898):639-643

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