What aspects of letters of recommendation predict performance in medical school? Findings from one institution.

ABSTRACT

PURPOSE: To study medical students' letters of recommendation (LORs) from their applications to medical school to determine whether these predicted medical school performance, because many researchers have questioned LORs' predictive validity. METHOD: A retrospective cohort study of three consecutive graduating classes (2007-2009) at the Uniformed Services University of the Health Sciences was performed. In each class, the 27 students who had been elected into the Alpha Omega Alpha (AOA) Honor Medical Society were defined as top graduates, and the 27 students with the lowest cumulative grade point average (GPA) were designated as "bottom of the class" graduates. For each student, the first three LORs (if available) in the application packet were independently coded by two blinded investigators using a comprehensive list of 76 characteristics. Each characteristic was compared with graduation status (top or bottom of the class), and those with statistical significance related to graduation status were inserted into a logistic regression model, with undergraduate GPA and Medical College Admission Test score included as control variables. RESULTS: Four hundred thirty-seven LORs were included. Of 76 LOR characteristics, 7 were associated with graduation status (P ≤ .05), and 3 remained significant in the regression model. Being rated as "the best" among peers and having an employer or supervisor as the LOR author were associated with induction into AOA, whereas having nonpositive comments was associated with bottom of the class students. CONCLUSIONS: LORs have limited value to admission committees, as very few LOR characteristics predict how students perform during medical school.