dear program director,
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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
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
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?
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
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
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