title: The Role of Letters of Recommendation in the Selection Process of Surgical Residents in Canada: A National Survey of Program Directors.
abstract: OBJECTIVE
  Letters of recommendation (LOR) provide valuable information that help in selecting new residents. In this study, we aim to investigate the perceptions of surgical residency program directors (PDs) in Canada on the elements that can affect the strength and value of LOR.
  
  
  METHODS
  Cross-sectional; survey.
  
  
  METHODS
  A national survey was conducted using an online questionnaire consisting of 2 main sections to collect data from PDs from all surgical subspecialties. The first section included basic background questions about the participant, such as the specialty and experience in selecting resident candidates, whereas the second section was about the elements and characteristics of LOR. Participants were asked to rate the importance of 34 different variables using a Likert scale.
  
  
  METHODS
  Surgical PDs in Canada.
  
  
  RESULTS
  Of 122 PDs, 65 (53.3%) participated in the survey. Work ethic (57; 87.7%), interpersonal skills (52; 80.0%), and teamwork (49; 75.4%) were considered very important parts of the LOR by more than three-quarters of the PDs. Thirty-three (50.8%) PDs reported that a familiar author of LOR would always affect their impression regarding the letter. Additionally, 57 (87.7%) and 35 (53.8%) directors thought that LOR are important in evaluating the candidates and can help in predicting the residents' performance during their residency training.
  
  
  CONCLUSIONS
  LOR are important for the selection of new surgical residents in Canada. Information about the candidate's work ethic, interpersonal skills, and teamwork is essential for a good LOR. Familiarity of PDs with authors of LOR could increase the value of the letter.
authors.affiliation: Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait. Electronic address: yousefmarwan@hotmail.com.
authors.forename: Yousef
authors.initials: Y
authors.lastname: Marwan
authors.affiliation: Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Department of Orthopaedic Surgery, University of Tabuk, Tabuk, Saudi Arabia.
authors.forename: Feras
authors.initials: F
authors.lastname: Waly
authors.affiliation: Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Department of Orthopaedic Surgery, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Nizar
authors.initials: N
authors.lastname: Algarni
authors.affiliation: Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Department of Orthopaedic Surgery, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Addar
authors.affiliation: Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada.
authors.forename: Neil
authors.initials: N
authors.lastname: Saran
authors.affiliation: Centre for Medical Education, McGill University, Montreal, Quebec, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Snell
mesh_terms: D000328:Adult; D002170:Canada; D015709:Correspondence as Topic; D003430:Cross-Sectional Studies; D004503:Education, Medical, Graduate; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D010560:Personnel Selection; D011795:Surveys and Questionnaires
keywords: Interpersonal and Communication Skills; admission; recommendation letter; residency; resident; selection; surgery