title: Letters of recommendation: rating, writing, and reading by clerkship directors of internal medicine.
abstract: BACKGROUND
  Letters of Recommendations (LORs) are used for applications to medical school and graduate medical education, but how they are used by current internal medicine educators is unknown.
  
  
  METHODS
  In 2006, the Clerkship Directors of Internal Medicine conducted its annual, voluntary survey, and one section pertained to LORs. Survey items were categorized into questions regarding rating, writing, and reading LORs with answers on 3- to 5-point scales.
  
  
  RESULTS
  The response rate for the 110 institution members was 75%. When rating LORs, the most important factor was depth of understanding of the trainee (98% essential or important), followed by a numerical comparison to other students (94%), grade distribution (92%), and summary statement (91%). Although most (78%) agreed that reading LORs in general were important for trainee selection, few agreed that this was because of the ability to discern marginal performance (31%) or predict future performance (25%).
  
  
  CONCLUSIONS
  LORs remain an important part of the application process for medical school and internal medicine residency. Letter writers should convey a great depth of understanding of the applicant, provide a numerical comparison with other students (including a denominator), and give a specific summary statement.
authors.affiliation: Department of Internal Medicine, William Beaumont Army Medical Center, 5005 N. Piedras Street, El Paso, TX 79920-5001, USA. kent.dezee@us.army.mil
authors.forename: Kent J
authors.initials: KJ
authors.lastname: DeZee
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Thomas
authors.forename: Matthew
authors.initials: M
authors.lastname: Mintz
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Durning