Abstracts
Abstract
Background: Efforts to better understand and improve letters of recommendation (LORs) in the resident selection process have identified unwritten rules and hidden practices that may limit their effectiveness. The objective of our study is to explore these unwritten rules and hidden practices more fully in one Canadian academic medical community.
Methods: We conducted semi-structured, discourse-based interviews with 18 faculty members from the departments of Internal Medicine and Psychiatry at the University of Manitoba, Canada. Interviews were guided by sample LORs and were focused on experiences with either writing or reading LORs. We analyzed interviews using key concepts from genre theory and Aristotle’s appeals to ethos, logos, and pathos.
Results: Participants described how the practices surrounding LORs are guided by unwritten rules. These practices contributed to writers’ use of visible strategies and textual silence to establish credibility, build a strong case, and appeal to readers. Readers rely on similar strategies, but not always as intended by the writers.
Conclusions: The unwritten rules of one academic community can impede a nationally-facilitated resident selection process. Our findings highlight how critiques and potential improvements to LORs could benefit from considering the use of visible and invisible rhetorical strategies in specific contexts.
Résumé
Contexte : Les efforts visant à mieux comprendre et à améliorer les lettres de recommandation dans le processus de sélection des résidents ont permis d'identifier des règles non écrites et des pratiques cachées qui peuvent limiter leur efficacité. L'objectif de notre étude est d'explorer de façon approfondie ces règles non écrites et ces pratiques cachées dans une communauté médicale universitaire canadienne.
Méthodes : Nous avons mené des entrevues semi-structurées, basées sur le discours, avec 18 membres du corps professoral des départements de médecine interne et de psychiatrie de l'Université du Manitoba, au Canada. Les entrevues ont été guidées par des exemples de lettres de recommandation et ont porté sur les expériences de rédaction ou de lecture des lettres de recommandation. Nous avons analysé les entrevues à l'aide de concepts clés de la Théorie du genre et des appels réthoriques d'Aristote à l'ethos, au logos et au pathos.
Résultats : Les participants ont décrit comment les pratiques entourant les lettres de recommandation sont guidées par des règles non écrites. Ces pratiques ont contribué à l'utilisation par les rédacteurs de stratégies visibles et de silence textuel pour établir leur crédibilité, construire un dossier solide et séduire les lecteurs. Les lecteurs s'appuient sur des stratégies similaires, mais pas toujours dans le sens voulu par les auteurs.
Conclusions : Les règles non écrites d'une communauté universitaire peuvent entraver un processus de sélection des résidents facilité au niveau national. Nos résultats soulignent comment les critiques et les améliorations potentielles des lettres de recommandation pourraient bénéficier de l'utilisation de stratégies rhétoriques visibles et invisibles dans des contextes précis.
Download the article in PDF to read it.
Download
Appendices
Bibliography
- Caretta-Weyer HA, Eva KW, Schumacher DJ, Yarris LM, Teunissen PW. Postgraduate selection in medical education: a scoping review of current priorities and values. Acad Med. 2023;98(11S):S98-107. https://doi.org/10.1097/ACM.0000000000005365
- Patterson F, Cleland J, Cousans F. Selection methods in healthcare professions: where are we now and where next?. Advan Health Sci Educ. 2017;22(2):229-42. https://doi.org/10.1007/s10459-017-9752-7
- Roberts C, Khanna P, Rigby L, et al. Utility of selection methods for specialist medical training: BEME guide no. 45. Med Teach. 2018;40(1):3-19. http://dx.doi.org/10.1080/0142159X.2017.1367375
- Marwan Y, Waly F, Algarni N, Addar A, Saran N, Snell L. The role of letters of recommendation in the selection process of surgical residents in Canada: a national survey of program directors. J Surg Educ. 2017;74(4):762-7. https://doi.org/10.1016/j.jsurg.2017.01.006
- Saudek K, Saudek D, Treat R, Bartz P, Weigert R, Weisgerber M. Dear program director: deciphering letters of recommendation. J Grad Med Educ. 2018;10(3):261-6. https://doi.org/10.4300/JGME-D-17-00712.1
- Saudek K, Treat R, Goldblatt M, Saudek D, Toth H, Weisgerber M. Pediatric, surgery, and internal medicine program director interpretations of letters of recommendation. Acad Med. 2019;94(11S): S64-8. https://doi.org/10.1097/acm.0000000000002919
- Shapiro SB, Kallies KJ, Borgert AJ, O'Heron CT, Jarman BT. Evolution of characteristics from letters of recommendation in general surgery residency applications. J Surg Educ. 2018;75(6):e23-30. https://doi.org/10.1016/j.jsurg.2018.06.005
- Khan S, Kirubarajan A, Shamsheri T, Clayton A, Mehta G. Gender bias in reference letters for residency and academic medicine: a systematic review. Postgrad Med J. 2021;0:1-6. https://doi.org/10.1136/postgradmedj-2021-140045
- Aunins B, Badhey A, Conroy Z, et al. Descriptors in letters of recommendation for otolaryngology residency across gender, race, and time. J Surg Educ. 2022;79(4):935-42. https://doi-org.uml.idm.oclc.org/10.1016/j.jsurg.2022.02.009
- Puscas, L. Viewpoint from a program director: they can’t all walk on water. J Grad Med Educ. 2016;8(3):314-6. https://doi.org/10.4300/JGME-D-16-00237.1
- Towaij C, Raîche I, Younan J, Gawad N. Everyone is awesome: analyzing letters of reference in a general surgery residency selection process. J Grad Med Educ. 2020 Oct 1;12(5):566-70. https://doi.org/10.4300/JGME-D-20-00034.1
- Moran CJ, Dzara K, Frey-Vogel AS, et al. Confidence of faculty in writing letters of recommendation for pediatric fellowship applicants. Cureus. 2023 Nov 30;15(11). https://doi.org/10.7759/cureus.49750
- Saudek K, Treat R, Rogers A, et al. A novel faculty development tool for writing a letter of recommendation. PLOS One, 2020;15(12):e0244016. https://doi.org/10.1371/journal.pone.0244016
- Laskin DM, Bhatti A, Carrico CK. How important are letters of recommendation? A survey of oral and maxillofacial surgery residency program directors. J Oral Maxil Surg. 2019;77(2):247-53. https://doi.org/10.1016/j.joms.2018.09.004
- Rajesh A, Rivera M, Asaad M, et al. What are we really looking for in a letter of recommendation? J Surg Educ. 2019;76(6):e118-24. https://doi.org/10.1016/j.jsurg.2019.06.008
- Stohl HE, Hueppchen NA, Bienstock JL. The utility of letters of recommendation in predicting resident success: Can the ACGME competencies help? J Grad Med Educ. 2011;3(3):387-90. https://doi.org/10.4300/JGME-D-11-00010.1
- Bajwa NM, Yudkowsky R, Belli D, Vu NV, Park YS. Validity evidence for a residency admissions standardized assessment letter for pediatrics. Teach Learn Med. 2018;30(2):173-83. https://doi-org.uml.idm.oclc.org/10.1080/10401334.2017.1367297
- Field NC, Gullick MM, German JW. Selection of neurological surgery applicants and the value of standardized letters of evaluation: A survey of United States program directors. World Neurosurg. 2020;136:e342-6. https://doi.org/10.1016/j.wneu.2019.12.176
- Wang RF, Zhang M, Alloo A, Stasko T, Miller JE, Kaffenberger JA. Characterization of the 2016–2017 dermatology standardized letter of recommendation. J Clin Aesthet Dermatol. 2018;11(3):26-9. https://pubmed.ncbi.nlm.nih.gov/29606997
- Li S, Fant AL, McCarthy DM, Miller D, Craig J, Kontrick A. Gender differences in language of standardized letter of evaluation narratives for emergency medicine residency applicants. AEM Educ Train. 2017;1(4):334–9. https://doi-org.uml.idm.oclc.org/10.1002/aet2.10057
- Tavarez MM, Baghdassarian A, Bailey J, et al. A call to action for standardizing letters of recommendation. J Grad Med Educ. 2022;14(6):642-6. https://doi.org/10.4300/JGME-D-22-00131.1
- Naples R, French JC, Lipman JM. Best practices in letters of recommendation for general surgery residency: results of expert stakeholder focus groups. J Surg Educ. 2020;77(6):e121-31. https://doi.org/10.1016/j.jsurg.2020.06.036
- DeZee KJ, Thomas MR, Mintz M, Durning SJ. Letters of recommendation: rating, writing, and reading by clerkship directors of internal medicine. Teach Learn Med. 2009 Apr 15;21(2):153-8. https://doi.org/10.1080/10401330902791347
- Vidali A. Rhetorical hiccups: Disability disclosure in letters of recommendation. Rhetoric Rev. 2009;28(2):185-204. https://doi-org.uml.idm.oclc.org/10.1080/07350190902740042
- Albakry M. Telling by omission: Hedging and negative evaluation in academic recommendation letters. In: Biber D, Csomay E, Cortes V, editors. Corpus-based Research in Applied Linguistics: Studies in Honor of Doug Biber. Amsterdam: John Benjamins; 2015. p. 79-98. https://doi.org/10.1075/scl.66
- Rothstein J. Qualitative information in undergraduate admissions: A pilot study of letters of recommendation. Economics of Education Review. 2022;89:102285. https://doi.org/10.1016/j.econedurev.2022.102285
- Bawarshi A, Reiff MJ. Genre: An Introduction to History, Theory, Research, and Pedagogy. West Lafayette, IN: Parlor Press and WAC Clearinghouse; 2010.
- Swales J. Genre Analysis: English in Academic and Research Settings. Cambridge, UK: Cambridge University Press; 1990.
- Swales J. Research genres: explorations and applications. Cambridge, UK: Cambridge University Press; 2004. https://doi.org/10.1017/CBO9781139524827
- Kennedy GA. (trans./ed.). On Rhetoric: a theory of civic discourse. Oxford: Oxford University Press; 1992.
- Swales J. Occluded genres in the academy: the case of the submission letter. In: Ventola E, Mauranen A, editors. Academic writing: intercultural and textual issues. Philadelphia: John Benjamins Publishing Company; 1996. p.45-58. https://doi.org/10.1075/pbns.41.06swa
- Thieme K. A play on occlusion: uptake of letters to the university president. Rhetoric Rev. 2022;41(3):226-39. https://doi-org.uml.idm.oclc.org/10.1080/07350198.2022.2038510
- Lingard L, Schryer C, Garwood K, Spafford M. ‘Talking the talk’: school and workplace genre tension in clerkship case presentations. Med Ed. 2003;37(7):612-20. https://doi.org/10.1046/j.1365-2923.2003.01553.x
- van Enk A, Nimmon L, Buckley H, et al. Presenting cases in front of patients: implications for a key medical education genre. Adv Health Sci Educ. 2022;27(3):621-43. https://doi.org/10.1007/s10459-022-10105-x
- Schryer CF. Investigating texts in their social contexts: The promise and peril of rhetorical genre studies. Writing in knowledge societies. 2011 Sep 3:31-52. https://doi.org/10.37514/PER-B.2011.2379
- Burke K. A rhetoric of motives. University of California Press; 1969. https://doi.org/10.1525/9780520353237
- Freadman A. Anyone for tennis? In: Freedman A, Medway P, editors. Genre and the new rhetoric. New York: Taylor & Francis; 1994. p. 43-66.
- Bawarshi A. Accounting for genre performances: why uptake matters. In: Artemeva N, Freedman A, editors. genre studies around the globe: beyond the three traditions. Edmonton, AB: Inkshed Publications; 2015. p. 186-206.
- Perelman C, Olbrechts-Tyteca L. The new rhetoric: a treatise on argumentation. (J. Wilkinson & P. Weaver, Trans.). Notre Dame, IN: University of Notre Dame Press; 1969.
- Bhatia VK. Worlds of written discourse. New York: Continuum; 2004.
- CaRMS. Application process and documents. Available from https://www.carms.ca/match/r-1-main-residency-match/applicant/application-process-documents-r1/documents-r1/. [Accessed on Aug 24, 2023].
- Odell L, Goswami D, Herrington A. The discourse-based interview: A procedure for exploring the tacit knowledge of writers in nonacademic settings. In: Mosenthal P, Tamor L, Walmsley L, editors. Research on writing: principles and methods. London: Longman; 1983. p. 221-236.
- Saldaña J. The coding manual for qualitative researchers. 2nd ed. Los Angeles: Sage; 2013.
- Huckin T. Textual silence and the discourse of homelessness. Discourse Soc. 2002;13(3):347-72. https://doi.org/10.1177/0957926502013003054