Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec 26;3(2):543-548.
doi: 10.1016/j.atssr.2024.12.006. eCollection 2025 Jun.

Reading Between the Lines: Determinants of a High-Quality Letter of Recommendation in Cardiothoracic Surgery

Pauline H Go  1   2 , Emma R Zulch  2 , Monica Zukowski  3 , Matthew D Taylor  1   2 , Michael F Reed  1   2
Affiliations

Reading Between the Lines: Determinants of a High-Quality Letter of Recommendation in Cardiothoracic Surgery

Pauline H Go et al. Ann Thorac Surg Short Rep. .

Abstract

Background: The letter of recommendation is an important component of a residency application and is useful for identifying stellar cardiothoracic surgery (CTS) candidates. We identify letter attributes and phrases that CTS program directors (PDs) find to be the most valuable in selecting candidates.

Methods: An online survey was distributed to CTS PDs in the United States and Canada, querying the importance of various letter characteristics. Reponses were ranked on the basis of a weighted average.

Results: Twenty-six (26.5%) CTS PDs completed the survey. Personal acquaintanceship with the writer was the most important characteristic (weighted average, 4.77). Interpersonal skills, teamwork, and professionalism were the most important applicant attributes (4.00, 3.88, 3.76). Inclusion of personal interactions or experiences with the applicant (4.65) and the phrases "I give my highest recommendation" (4.56) and "we plan to recruit this candidate" (4.52) were rated the highest.

Conclusions: Describing personal interactions and experiences with the applicant, their work ethic, interpersonal skills, and teamwork is essential for a strong letter. Personal acquaintanceship with the letter writer has the greatest positive impact overall.

PubMed Disclaimer

Figures

None
Graphical abstract
Figure 1
Figure 1
Applicant themes based on the Accreditation Council for Graduate Medical Education Surgery Milestones framework ranked in order of importance by respondents.
Figure 2
Figure 2
Letter of recommendation (LOR) characteristics ranked in descending order of importance/impression by respondents.
Figure 3
Figure 3
Descriptive and summative phrases rated highest to lowest by respondents.
See this image and copyright information in PMC

References

    1. National Resident Matching Program . National Resident Matching Program; Washington, DC: 2021. Data Release and Research Committee: Results of the 2021 NRMP Program Director Survey.https://www.nrmp.org/wp-content/uploads/2021/11/2021-PD-Survey-Report-fo... Accessed September 7, 2022.
    1. Rajesh A., Rivera M., Asaad M., et al. What are we really looking for in a letter of recommendation? J Surg Educ. 2019;76:e118–e124. - PubMed
    1. 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;74:762–767. - PubMed
    1. Fortune J.B. The content and value of letters of recommendation in the resident candidate evaluative process. Curr Surg. 2002;59:79–83. - PubMed
    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:S64–S68. 94(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 58th Annual Research in Medical Education Sessions):S64-S68. - PubMed

LinkOut - more resources