Reading between the lines: exploring the unwritten rules of letters of recommendation in the Canadian resident selection process
DOI:
https://doi.org/10.36834/cmej.78039Abstract
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.
References
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 DOI: 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 DOI: 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 DOI: https://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 DOI: 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 DOI: 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 DOI: 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 DOI: 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 DOI: 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 DOI: https://doi.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 DOI: 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 DOI: 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 DOI: 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 DOI: 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 DOI: 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 DOI: 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 DOI: 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 DOI: https://doi.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 DOI: 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 DOI: https://doi.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 DOI: 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 DOI: 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 DOI: 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 DOI: https://doi.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 DOI: https://doi.org/10.1075/scl.66.04alb
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 DOI: 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 DOI: 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 DOI: 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 DOI: https://doi.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 DOI: 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 DOI: 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 DOI: https://doi.org/10.37514/PER-B.2011.2379.2.02
Burke K. A rhetoric of motives. University of California Press; 1969. https://doi.org/10.1525/9780520353237 DOI: 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 DOI: https://doi.org/10.1177/0957926502013003054
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