UNC OBGYN Medical Education Symposium
WHAT’S IN A LETTER (OF RECOMMENDATION)? DO GENERALISTS WRITE DIFFERENTLY THAN SPECIALISTS? Nicole Kerner, MD, Duke University, Department of Obstetrics and Gynecology Elayna P. Kirsch, MD, Stoney Brook, Department of Obstetrics and Gynecology Lisa G. Hofler, MD, MPH, MBA; The University of New Mexico, Department of Obstetrics and Gynecology Lori Avery; Geisel School of Medicine at Dartmouth Lorene Temming, MD; Atrium Health Carolinas Medical Center Jill Sutton, MD; East Carolina University, Department of Obstetrics and Gynecology Alexis Clifford, University of Florida College of Medicine, Duke University Fuqua School of Business Sarah K. Dotters-Katz, MD, MMHPE; Duke University, Department of Obstetrics and Gynecology Introduction: Letters of recommendation (LOR) for Obstetrics and Gynecology (OBGYN) residency are commonly written by both generalists and subspecialists in the field. Best practices regarding LOR-writing for OBGYN residency applicants is unclear, however may encompass varied letter formats, lengths, and closing statement structure. Given the importance of LOR to the OBGYN residency application, it is important to study letter-writing practices and how they may differ between OBGYN generalists and subspecialists. We sought to compare common LOR-writing practices between OBGYN generalists and subspecialists. Methods: Established ‘best practices in LOR-writing’ from other specialties were compiled to develop a survey to assess the use of these practices among OBGYN faculty when writing LOR for residency applicants. Content and face validation were performed prior to dissemination. The survey was sent to OBGYN faculty in five departments (Duke University, The University of New Mexico, Dartmouth-Hitchcock, East Carolina University, and Atrium Health Carolinas Medical Center) from 3/2022 – 5/2022, after IRB approval. Respondents were included if they wrote >1 OBGYN residency LOR annually and indicated their field of practice. Primary outcomes included routine use of the following LOR-writing practices: bold/italics, description of students’ role and experience with residents, highlights from student curriculum vitae (CV), length <1 page, and final sentence structure. Common practices used by subspecialists were compared to those used by generalists. Results: Of 189 OBGYN faculty who were sent the survey, 135 (71%) responded and 62 (46% of respondents) met inclusion criteria. Among the study cohort, 21 faculty identified as a generalist and 41 identified as a subspecialist. No differences in gender, duration of practice, or formal education roles (all p=ns) were identified between generalists and subspecialists. There were no differences in use of bold/italics (10%vs29%, p=0.11), description of students’ role and experience with residents (95%vs88%, p=0.65) or inclusion of CV highlights (62%vs73%, p=0.23) between generalist-writers and subspecialist-writers. Nor were there differences in last sentence structure, further defined as the use of superlatives, percentage rank, or desire for the program to ‘keep’ the applicant, (all p=ns). However, generalists were more likely to write letters <1 page (90%vs63%, p=0.03). After controlling for gender, practice duration, and medical education role, generalists were 80% more likely to keep letters to 1 page or less (aOR 0.20, 95%CI:0.04, 0.99). Conclusion: Other than preferred letter length, common practices in LOR-writing for OBGYN residency applicants did not vary between subspecialists and generalists. The letter length discrepancy may reflect different expectations for fellowship LOR and residency LOR. As best practices for residency LOR are further elucidated, dissemination to all LOR-writers, generalists, and specialists, is essential.
