title: Variability of Ratings in the Otolaryngology Standardized Letter of Recommendation.
abstract: OBJECTIVE
  To determine the variability of ratings given to students on the otolaryngology standardized letter of recommendation (SLOR).
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Academic otolaryngology training program.
  
  
  METHODS
  496 SLORs to the Cleveland Clinic Otolaryngology Training Program were reviewed. The SLORs were extracted from the applications and analyzed. The distributions of ratings across the 10 categories were statistically analyzed including distribution and standard deviation. Rankings were grouped into deciles for this analysis.
  
  
  RESULTS
  Ratings across the 10 domains revealed clustering of results across the top 2 deciles. The distribution of the bell-shaped curve was shifted significantly to the left, representing the upper deciles. No evidence of gender or geographic bias was found. Longer length of time of association between the applicant and the letter writer correlated to a higher ranking.
  
  
  CONCLUSIONS
  The explosion of applications being sent out by candidates for otolaryngology residency programs has prompted the implementation of the SLOR. The lack of variation in the ratings across the 10 domains does not allow for differentiation among student applicants. Reliance on the narrative letter of recommendation attached to the SLOR still remains the most significant way to differentiate among applicants. Refinements will need to be made in either the structure or use of the SLOR for it to be a more useful tool.
authors.affiliation: Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA kominsa@ccf.org.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Kominsky
authors.affiliation: Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Bryson
authors.affiliation: Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Benninger
authors.affiliation: Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Tierney
mesh_terms: D015709:Correspondence as Topic; D004501:Education, Medical; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D033262:Narration; D010036:Otolaryngology / Q000193:education*; D012189:Retrospective Studies; D013334:Students / Q000523:psychology*
keywords: gender bias; letter of recommendation; residency application