tag:blogger.com,1999:blog-4968787219619380438.post8007464991675236275..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: What can be done about letters of recommendation?Skeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger20125tag:blogger.com,1999:blog-4968787219619380438.post-39165346212738023942016-01-05T07:37:54.742-05:002016-01-05T07:37:54.742-05:00I've heard of that happening. There is no way ...I've heard of that happening. There is no way to know because all you see is the end product.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-90455228506866180122016-01-04T21:10:22.785-05:002016-01-04T21:10:22.785-05:00How about those instances when the faculty member ...How about those instances when the faculty member says to the resident, "Write a draft of your own recommendation letter and give it to me."Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-86319566103909542022015-06-04T22:49:41.789-04:002015-06-04T22:49:41.789-04:00that's good post.that's good post. ajkainoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-52565001145520172482014-08-19T16:24:49.513-04:002014-08-19T16:24:49.513-04:00Charlie, thanks. That's a very nice example of...Charlie, thanks. That's a very nice example of all that is wrong with the system of writing recommendation letters,Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-84225857921084502002014-08-18T11:42:56.466-04:002014-08-18T11:42:56.466-04:00Great post on an impossible problem. I've alw...Great post on an impossible problem. I've always tried to be honest in letters of recommendation, which hasnt always been easy. The most interesting instance was a resident who had surgical skills and dedication to surgery below what I expect of residents asked me to write a letter of recommendation for surgical oncology fellowship. I declined, telling her I would have to mention this in the letter. She demanded it, and as Program Director I felt I had no real choice. Imagine my surprise when I was later called to the Chairman's Office (Andy Warshaw) because Murray Brennan told him it was the most bizarre letter he had ever received (hearsay--Brennan didn't actually tell ME this). I told him the position I had been put in, and that the bizarre part is that he had never seen a truthful letter of recommendation before, and pointed out that I suggested a direct telephone communication in the letter, but had never received such. I was instructed to never write such a letter again, to which I stated we would have to agree to disagree. The hospital ethicist agreed with me. Said resident has gone on to a successful career in surgical oncology, alienating most of those she works with (particularly her juniors) and with mediocre surgical results, but an impressive CV and promotions. So it goes. <br /><br />charlieAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-69736319606282438442014-08-17T14:08:44.009-04:002014-08-17T14:08:44.009-04:00When I was writing letters of recommendation, I ke...When I was writing letters of recommendation, I kept a thesaurus handy because I always ran out of adjectives.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-17266287052342282912014-08-17T01:26:25.756-04:002014-08-17T01:26:25.756-04:00I needed two letters of recommendations to get int...I needed two letters of recommendations to get into the two undergrad programs & agree with you about how totally useless they are. Mine were excellent but in order to get into a masters program I need an academic recommendation and like Josh my profs/instructors in my last degree didn't really know me. So I'm not sure what I'm going to do. It's a couple of years off if I do it (I'm 56, so I'm not sure if it'll get done). Like they'd say "she's a slacker, (insert faculty) would be better off without her". Maybe the whole point is to induce stress in those who want someone who actually knows them to battle said stress.<br /><br />I'm not a fan of personal references for jobs either, but that's only because I stress out over who to ask-the political figure, a teacher, lawyer or someone I worked a lot with at church.<br />A good in person interview can give more information than a form letter (like some of those deans don't have form letters created!)Libbyhttps://www.blogger.com/profile/09274573439351833726noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-4471159846686041022014-08-15T12:13:34.621-04:002014-08-15T12:13:34.621-04:00Anon, thank you. I understand that in some fields ...Anon, thank you. I understand that in some fields what you say is true. We in medicine haven't arrived there yet. We still write long detailed letters full of useless information.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-36433668108409815222014-08-14T10:57:19.259-04:002014-08-14T10:57:19.259-04:00I don't work in the health care field, but all...I don't work in the health care field, but all we are allowed to say in a "recommendation" letter is: "Yes, he worked here, and No, he didn't steal anything." Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-86162460168423542642014-08-14T08:01:01.391-04:002014-08-14T08:01:01.391-04:00Josh, I agree that most of the letters can be diff...Josh, I agree that most of the letters can be difficult to read. They all sound the same--like "Fantasy Land" as I mentioned in the post.<br /><br />They really aren't much help in trying to decide whom to interview.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-16522020438205292702014-08-13T12:28:16.438-04:002014-08-13T12:28:16.438-04:00My medical school class was >270 students large...My medical school class was >270 students large. On the surgery rotation we were put on large impersonal teams with limited facetime with faculty members (who were also always rotating on/off service), so when I needed letters for my residency applications I was essentially asking people who had no idea who I was. The letters were terrible (I remember my PD later telling me as much). So I agree that they serve little purpose. Perhaps they should be optional? Rather than saying "Submit 3 or 4 letters" applicants should be told "A letter of recommendation from a teacher/mentor can be added as an addendum to your application" so that if the person worked in a lab or charity organization they can get recognition for that without subjecting everyone to the other requisite useless letters. When I used to interview applicants I couldn't force myself to read through all of them. I think the best you can do interviewing an applicant is trying to have a genuine face-to-face conversation with them, which is why I always tried to steer interviews towards conversing about a topic, basically to see if the lights were on upstairs.Joshnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-82056793939833249562014-08-13T07:07:29.637-04:002014-08-13T07:07:29.637-04:00Some papers have looked at possible factors associ...Some papers have looked at possible factors associated with poorly performing residents. No consensus has been reached. To the best of my knowledge, no trait has been identified as foolproof in predicting failure.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-29447474552236416812014-08-12T22:34:46.418-04:002014-08-12T22:34:46.418-04:00Sir,
It is interesting that the question of physi...Sir,<br /><br />It is interesting that the question of physician (resident) quality is unanswered in this forum, where in governing bodies such as CMS and ABMS/ABIM, the matter has been settled. This is yet again a matter for physician leadership, which has sadly been absent. Physicians can't identify "quality" amongst our own trainees and in our own ranks, yet regulators, administrators, and payors propose to identify it for us. If methods of identifying excellence among medical students are substandard for own purposes, what does that suggest about the broader movement to identify "quality" in medical care in general and physicians in particular? I am quite certain that I could describe a few excellent physicians, and many good ones. Quantifying or measuring that is another matter.<br /><br />I'd be curious to know if you performed a post-mortem on the residency application of poorly performing residents, in order to identify distinguishing characteristics of applications among the poor performers.Geronimo MDnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-70702736555441590742014-08-12T14:40:20.554-04:002014-08-12T14:40:20.554-04:00First anon, I doubt they will ever be banned. I th...First anon, I doubt they will ever be banned. I think second anon is on to something. A more focused set of questions instead of nebulous characterizations might be better. Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-27977873827044458262014-08-12T13:23:42.533-04:002014-08-12T13:23:42.533-04:00Part of the problem is that a letter of recommenda...Part of the problem is that a letter of recommendation is just too general a format. Instead, what about a series of questions that must be answered: Has this applicant mastered all of the basic procedures? What percentage of advanced procedures has he/she mastered? Is he/she routinely on time? Polite and collegial with other members of the care team? Informative and caring with patients? Are his/her patient outcomes -on a par with, -better than, -worse than what you expect? How long have you known him/her? How many surgeries of his/hers have you participated in? Would you hire this person on your own clinical staff?<br /><br />And so forth. You have to define what pieces of information are important in making a recommendation of value. If everyone has to answer the same set of questions, I'm guessing you would get enough data to make comparisons.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-68923894883209968462014-08-12T11:16:30.256-04:002014-08-12T11:16:30.256-04:00Ban their use. They're obviously a low sensiti...Ban their use. They're obviously a low sensitivity, medium low specificity test for applicants ability and they require a lot of resources. <br /><br />What do we usually do with bad and expensive tests? stop ordering them. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-18479032681321285022014-08-11T22:05:31.748-04:002014-08-11T22:05:31.748-04:00Anon, that's a great point and one which I ove...Anon, that's a great point and one which I overlooked. You are absolutely right. A negative letter can come back to bite the writer. <br /><br />It's a double-edged sword. I know of a case where a writer of a neutral letter of recommendation was sued successfully for failing to mention that the applicant had certain difficulties that caused problems at the new job. Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-77429260298803586342014-08-11T21:55:07.318-04:002014-08-11T21:55:07.318-04:00The answer is in your blog's heading, "Me...The answer is in your blog's heading, "Mean is least himself. . ." Unfortunately, we all know the student can "waive their right" to view the letter, but in today's litigious environment, writing a negative letter which may fall into the wrong hands--or be accidentally viewed by the applicant because the file was 'left on the corner of the desk by mistake', brings a new perspective to the problem.<br /><br />I now write a letter that says, "Please call me to discuss the applicant if you are, indeed, interested in him/her." It isn't foolproof. But it is better than the alternative. Give me a TRUE guarantee the applicant won't see the less-than-perfect letter, and I'll tell the truth. But, no such guarantee exists and I believe letters are truly worthless.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-48212287898862097262014-08-11T20:22:24.789-04:002014-08-11T20:22:24.789-04:00Ha. That's the answer I was looking for.Ha. That's the answer I was looking for.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-19407628824828921632014-08-11T18:10:56.974-04:002014-08-11T18:10:56.974-04:00Patient rankings? ROFL LOL I'm sorry I couldn&...Patient rankings? ROFL LOL I'm sorry I couldn't resist that one.Anonymousnoreply@blogger.com